An Address ON IRREGULAR ACTION OF THE HEART: Delivered at the Annual Meeting of the Kent Branch of the British Medical Association
Authors: C. Wilson
Journal: BMJ (1915)

f-selectincg this subject for my address to the Brancl I lhave been influenced by tlle followinig considerations:1. Irregula'-ity of tlhe pulse and of tlle cardiac rllythm is a l)leinolnolln wliclh, tlhouglh it confronts us every day and, whlen noticed, invariably arrests attention, lhas very generally puzzled the tllouglhtful observer.It lhas long beeni knownim that it nmy convey grave warning, or tlat miay be almiiost negligible.But, until quiite lately, it lhas not been possible to differentiate the serious from tlle iarimless varieties-of arrlhytlhinia.Thle clhief reason for this innorance lay in the fdt that ou-uis.ualm-etlhods of clinical investigation (tlio pulse, the apeki beat, an-d almost all heart sounds) refer us to tlle ventricles alomie.Tlhe in-iportance of tlle auricles was unsuspected, anid no means were atlhand wlhereby to examinle tlleir action.2. Witlhin recent years a flood of liglht has been thrown uiponi tllis question, prinimarily by Jamues Mackenzie, wlho, wovorking with the polygraplh, -was enabled, clhiefly by a careful analvsis of thje undulations of the jugiuilar vbin, (litferentiate the auricuilar from the ventrictular contrac- tions.This paved the way for Tllomas Lewis, whio, withi the electrocardiograpl, first demionstrated the condition klnown as fibrillatioln, and thius cleared up and explained certain points wlliclh Mackenzie's -work had left obscure.Other niames miglht.bementioned, but it is mainly due tlle wvork of tlhese, two clinicialns, stuppleml-enting the researches of certaini anatomists and plhysiologists, tlhat ouirlknowledge of the cardiac meclhanism, bothl in lhealtlh and disease,lhas been greatly extended, and that we are Biow for tlle first timle in a position to understand and classify thle various irregtularities of tlle heart and the pulse.3. The prognosis oflheart cases, and tlleir managemient, mlore especially as regards permission-or limitationi of effort, is anmatter of primiie iiioment to outr patients.We can lhardlv do a m-iani a worse turni tlhan tocut hiim off ,needlessly fromn hiis worlk or hlis recreation-yet to allow hiim freedom to hiis iunidoing is a still ilmore seriouss miistake.1Few 7more difficult decisionis confront us in our.daily works annd a careful survey of all the aspects of a case slhould be mnade before a conclusion is reaclhed.'Mistakes are often m41ade, and anytliing wliich helps us towards a right decision is of value.Th-le ability to-differentiate the variety of a putlse irregularity puts an iminportant weapon inotur liands, and one wllichl will not ilnffequently turn the scale.4. My last reason for selecting this suibject is tlat, in addition to being new, it is far from easy, and its im- portance -is not univ6rsally recognizeid.Medicine is widd anid widening, and we can none of us keepp up with it a1ll round.The interest of some lhas not yet been awakened to these matters, and othlers lhave yet to realize thlat suchl terms as "sinus arryytllhmia" and "extra- systole, " eart-block and "aurinlar' fibrillation " refer, not to naew anid rare conditions, but to thh e ordinary cases of irreaularhleart actioni, withl or without valve lesion, wN,hich we meleet withl on our daily rounds.FuLrthler, the sconclusion is easily drawn that the recogniition of suchl ionditions is too complicated for thle routinie of general practice.Tile papers whlich appear in 'tle journals are ,genrally illustrated by numiierous tracinngs of the .sy3nehlronousundulationis of various blood vessels, oh- tained byinlgenious appliances, withl whlichl we are most ,of us unfam-iiliar; anid thle mneaning of these tracings is not only by nao meanas self-evident, but is somiietimes revealed soly after close scruitiniy even to thle experts, whlo are, in LewNis's words.' fully conscious of the burdeni whlichi awaits the student or practitioner whio hias yet to bring