The Circus Movement (Entrapped Circuit Wave) Hypothesis and Atrial Flutter
Authors: DAVID A. RYTAND
Journal: Annals of Internal Medicine (1966)

Review1 July 1966The Circus Movement (Entrapped Circuit Wave) Hypothesis and Atrial FlutterDAVID A. RYTAND, M.D., F.A.C.P.DAVID A. RYTAND, M.D., F.A.C.P.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-65-1-125 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn the half century of its existence, the circus movement hypothesis has been accepted and rejected, ignored and misunderstood. There seems to be some revival of interest in it now, but even should this mechanism eventually be discredited completely as that underlying atrial flutter, fibrillation, or other arrhythmias, the hypothesis yet is worthy of review for its own sake. Moreover, many of the studies were published in journals relatively inaccessible to medical readers; unfortunately, these have been more often cited than correctly quoted, and evidence of their having been studied carefully in recent years is sparse. I hope that this...References1. MAYER AG: Rhythmical pulsation in scyphomedusae. Carnegie Institution Publication No. 47, 1, 1906. CrossrefGoogle Scholar2. MAYER AG: Rhythmical pulsation in scyphomedusae.—II. Papers from the Tortugas Laboratory of the Carnegie Institution of Washington. Publication No. 102, Vol. I, 115, 1908. Google Scholar3. MAYER AG: The cause of pulsation. Popular Sci. 73: 481, 1908. Google Scholar4. MAYER AG: Nerve conduction and other reactions in Cassiopea. Amer. J. Physiol. 39: 375, 1916. CrossrefGoogle Scholar5. MAYER AG: Nerve-conduction in Cassiopea xamachana. Papers from the Department of Marine Biology of the Carnegie Institution of Washington. Vol. XI, 1, 1917. Google Scholar6. MAYOR AG: Effect of diminished oxygen upon rate of nerve conduction in Cassiopea. Amer. J. Physiol. 51: 543, 1920. CrossrefGoogle Scholar7. KINOSITA H: Initiation of entrapped circuit wave in a scyphomedusa, Mastigias papua. Jap. J. Zool. 9: 209, 1941. Google Scholar8. ROMANES GJ: Jelly-Fish, Star-Fish and Sea-Urchins. The International Scientific Series, Vol. 49. D. Appleton and Co., New York, 1898. Google Scholar9. GARREY WE: The nature of fibrillary contraction of the heart.—Its relation to tissue mass and form. Amer. J. Physiol. 33: 397, 1914. CrossrefGoogle Scholar10. MINES GR: On circulating excitations in heart muscles and their possible relation to tachycardia and fibrillation. Trans. Roy. Soc. Canada [Biol.] 8: 43, 1914. Google Scholar11. LILLIE RS: Circuit transmission and interference of activation waves in living tissues and in passive iron. Science 69: 305, 1929. CrossrefMedlineGoogle Scholar12. MINES GR: On dynamic equilibrium in the heart. J. Physiol. (London) 46: 349, 1913. CrossrefGoogle Scholar13. FASTIERSMIRK FNFH: Some properties of amarin, with special reference to its use in conjunction with adrenaline for the production of idio-ventricular rhythms. J. Physiol. (London) 107: 318, 1948. CrossrefGoogle Scholar14. WESTLANDA TCJF: Minimal mass required for induction of a sustained arrhythmia in isolated atrial segments. Amer. J. Physiol. 202: 232, 1962. CrossrefMedlineGoogle Scholar15. COVINOD'AMATO BGHE: Mechanism of ventricular fibrillation in hypothermia. Circ. Res. 10: 148, 1962. CrossrefMedlineGoogle Scholar16. WEDDTENNEY AMSM: Action of aconitine on the cold-blooded heart. Proc. Soc. Exp. Biol. Med. 84: 199, 1953. CrossrefMedlineGoogle Scholar17. TENNEYWEDD SMAM: Disturbances of rhythm in the cold-blooded heart under aconitine. Circ. Res. 2: 28, 1954. CrossrefMedlineGoogle Scholar18. SCHMITTERLANGER FOJ: Directional differences in the conduction of the impulse through heart muscle and their possible relation to extrasystolic and fibrillary contractions. Amer. J. Physiol. 87: 326, 1928. CrossrefGoogle Scholar19. GARREY WE: Auricular fibrillation. Physiol. Rev. 4: 215, 1924. CrossrefGoogle Scholar20. MOE GK: On the multiple wavelet hypothesis of atrial fibrillation. Arch. Int. Pharmacodyn. 140: 183, 1962. Google Scholar21. SCHERFCOHEN DJ: The Atrioventricular Node and Selected Cardiac Arrhythmias. Grune & Stratton, New York, 1964. Google Scholar22. ROSENBLUETHGARCÍA RAMOS AJ: Estudios sobre el flutter y la fibrilación. II. La influencia de los obstáculos artificiales en el flutter auricular experimental. Arch. Inst. Cardiol. Méx. 17: 1, 1947. Studies on flutter and fibrillation. II. The influence of artificial obstacles on experimental auricular flutter. Amer. Heart J. 33: 677, 1947. MedlineGoogle Scholar23. LEWISFEILSTROUD THSWD: Observations upon flutter and fibrillation. Part II.—The nature of auricular flutter. Heart 7: 191, 1920. Google Scholar24. LEWIS T: Observations upon flutter and fibrillation. Part IX.—The nature of auricular fibrillation as it occurs in patients. Heart 8: 193, 1921. Google Scholar25. JOLLYRITCHIE WAWT: Auricular flutter and fibrillation. Heart 2: 177, 1911. Google Scholar26a. RITCHIE WT: Further observations on auricular flutter. Quart. J. Med. 7: 1, 1913. Google Scholar26b. RITCHIE WT: Auricular Flutter. W. Green & Son, Ltd., Edinburgh, 1914. Google Scholar27. MACWILLIAM JA: Fibrillar contraction of the heart. J. Physiol. (London) 8: 296, 1887. CrossrefGoogle Scholar28. MACWILLIAM JA: On electrical stimulation of the mammalian heart, in Transactions of the International Medical Congress, vol. III. Ninth Session. Washington, D. C., 1887, p. 253. Google Scholar29. HERTZGOODHART AG: The speed-limit of the human heart. Quart. J. Med. 2: 213, 1909. Google Scholar30. ROSNER SW: Atrial tachysystole with block. Circulation 29: 614, 1964. CrossrefGoogle Scholar31. WENCKEBACH KF: Die unregelmässige Herztätigkeit und ihre klinische Bedeutung. Wilhelm Engelmann, Leipzig and Berlin, 1914. Google Scholar32. MACKENZIE J: Diseases of the Heart, 3rd ed. Henry Frowde and Hodder & Stoughton, London, 1918, p. 237. Google Scholar33. LEWIS T: The Mechanism and Graphic Registration of the Heart Beat, 3rd ed. Shaw & Sons Ltd., London, 1925, p. 260. Google Scholar34. PRINZMETALCORDAYOBLATHKRUGERBRILLFIELDSKENNAMEROSBORNESMITHSELLERSFLIEGFINSTON MERWHEICJSRJALAALWE: Auricular flutter. Amer. J. Med. 11: 410, 1951. CrossrefMedlineGoogle Scholar35. HECHT HH: The mechanism of auricular fibrillation and flutter. Circulation 7: 594, 1953. CrossrefGoogle Scholar36. LEWISDRURYILIESCU TANCC: A demonstration of circus movement in clinical flutter of the auricles. Heart 8: 341, 1921. Google Scholar37. PARKINSONBEDFORD JDE: The course and treatment of auricular flutter. Quart. J. Med. 21: 21, 1927. CrossrefGoogle Scholar38. SIMONSONBERMAN ER: Differentiation between paroxysmal auricular tachycardia with partial A-V block and auricular flutter. Amer. Heart J. 42: 387, 1951. CrossrefMedlineGoogle Scholar39. ENSELBERG CD: The esophageal electrocardiogram in the study of atrial activity and cardiac arrhythmias. Amer. Heart J. 41: 382, 1951. CrossrefMedlineGoogle Scholar40. LILLIE RS: Resemblances between the electromotor variations of rhythmically reacting living and non-living systems. J. Gen. Physiol. 13: 1, 1929. CrossrefMedlineGoogle Scholar41. GROSGURIN J: Remarque théoretique sur le mouvement circulaire de Lewis dans le flutter. Cardiologia (Basel) 25: 243, 1954. CrossrefMedlineGoogle Scholar42. SWAINYANAGITA HHT: A model circus. Univ. Mich. Med. Bull. 29: 338, 1963. Google Scholar43. MOERHEINBOLDTABILDSKOV GKWCJA: A computer model of atrial fibrillation. Amer. Heart J. 67: 200, 1964. CrossrefMedlineGoogle Scholar44. WIENERROSENBLUETH NA: The mathematical formulation of the problem of conduction of impulses in a network of connected excitable elements, specifically in cardiac muscle. Arch. Inst. Cardiol. Méx. 16: 205, 1946. MedlineGoogle Scholar45. SELFRIDGE O: Studies on flutter and fibrillation. V. Some notes on the theory of flutter. Arch. Inst. Cardiol. Méx. 18: 177, 1948. MedlineGoogle Scholar46. ROSENBLUETHGARCÍA RAMOS AJ: Estudios sobre el flutter y la fibrilación. IV. La naturaleza del flutter auricular y de la actividad lenta autosostenida del musculo auricular aislado. Arch. Inst. Cardiol. Méx. 17: 441, 1947. MedlineGoogle Scholar47. SCHERF D: Versuche zur Theorie des Vorhofflatterns und Vorhofflimmerns. Z. Ges. Exp. Med. 61: 30, 1928. CrossrefGoogle Scholar48. BRAMSKATZ WALN: The nature of experimental flutter and fibrillation of the heart. Amer. Heart J. 7: 249, 1931. CrossrefGoogle Scholar49. SCHERFBLUMENFELD DS: Mechanism of auricular flutter caused by crushing and electrical stimulation. Cardiologia (Basel) 24: 193, 1954. CrossrefMedlineGoogle Scholar50. KIMURAKATOMURAOAJISAKAKOYAMAOMIYA EKSHSZ: Experimental studies on the mechanism of the auricular flutter. Tohoku J. Exp. Med. 60: 197, 1954. CrossrefMedlineGoogle Scholar51. KATOSATOHARUMISAKAMOTOKOYAMAMURAO KMKTSS: Studies on auricular flutter. Observations upon F wave. Resp. Circ. 5: 837, 1957. Google Scholar52. LANARILAMBERTINIRAVIN AAA: Mechanism of experimental atrial flutter. Circ. Res. 4: 282, 1956. CrossrefMedlineGoogle Scholar53. SANOYAMAGISHI TS: Spread of excitation from the sinus node. Circ. Res. 16: 423, 1965. CrossrefMedlineGoogle Scholar54. SHARMA PL: Mechanism of post-stimulatory atrial flutter in the dog. Brit. Heart J. 25: 630, 1963. CrossrefMedlineGoogle Scholar55. LEWIS T: Observations upon flutter and fibrillation. Part IV.—Impure flutter, theory of circus movement. Heart 7: 293, 1920. Google Scholar56. FARAHLOOMIS ATA: The action of cardiac glycosides on experimental auricular flutter. Circulation 2: 742, 1950. CrossrefMedlineGoogle Scholar57. BIRNBAUMWIENERFARAH LAA: Mechanisms in the production of atrial fibrillation during asphyxia. Amer. Heart J. 63: 676, 1962. CrossrefMedlineGoogle Scholar58. BROWN BB: A study of factors related to effects of quinidine in experimental auricular flutter. Circulation 5: 864, 1952. CrossrefMedlineGoogle Scholar59. BROWNACHESON BBGH: Aconitine-induced auricular arrhythmias and their relation to circus-movement flutter. Circulation 6: 529, 1952. CrossrefMedlineGoogle Scholar60. KENNAMERMILESPRINZMETAL REM: Studies on Lewis' auricular flutter of post-electrical stimulatory origin. Clin. Sci. 16: 451, 1957. MedlineGoogle Scholar61. MARQUESMOTANOGUEIRA MGJCRA: The mechanism of atrial flutter. Cardiologia (Basel) 40: 269, 1962. CrossrefMedlineGoogle Scholar62. SCHERF D: Studies on auricular tachycardia caused by aconitine administration. Proc. Soc. Exp. Biol. Med. 64: 233, 1947. CrossrefMedlineGoogle Scholar63. SCHERF D: Experiments on the origin of auricular flutter and fibrillation. Arq. Brasil. Cardiol. 1: 147, 1948. Google Scholar64. SCHERFROMANOTERRANOVA DFJR: Experimental studies on auricular flutter and auricular fibrillation. Amer. Heart J. 36: 241, 1948. CrossrefMedlineGoogle Scholar65. SCHERF D: The effect of sympathetic stimulation on auricular flutter. Amer. Heart J. 37: 1069, 1949. CrossrefMedlineGoogle Scholar66. SCHERFCHICK DFB: Abnormal cardiac rhythms caused by acetylcholine. Circulation 3: 764, 1951. CrossrefMedlineGoogle Scholar67. SCHERFSCHOTT DA: Extrasystoles and Allied Arrhythmias. Grune & Stratton, New York, 1953. Google Scholar68. SCHERFSCHAFFERBLUMENFELD DAIS: Mechanism of flutter and fibrillation. Arch. Intern. Med. (Chicago) 91: 333, 1953. CrossrefGoogle Scholar69. SCHERFBLUMENFELDTANERYILDIZ DSDM: Cardiac arrhythmias provoked by local applications of delphinine. Arch. Kreisslaufforsch. 33: 4, 1960. CrossrefGoogle Scholar70. SCHERFBLUMENFELDTANERYILDIZ DSDM: The effect of diphenylhydantoin (Dilantin) sodium on atrial flutter and fibrillation provoked by focal application of aconitine or delphinine. Amer. Heart J. 60: 936, 1960. CrossrefMedlineGoogle Scholar71. SCHERFBLUMENFELDYILDIZ DSM: Experimental study of ectopic impulse formation in the left atrium. Cardiologia (Basel) 43: 133, 1963. CrossrefMedlineGoogle Scholar72. GOTOTAMAIYANAGA MTT: Studies on the appearance and termination of aconitine-induced atrial fibrillation with microelectrodes. Jap. J. Physiol. 13: 196, 1963. CrossrefMedlineGoogle Scholar73. PRINZMETALCORDAYBRILLOBLATHKRUGER MEICRWHE: The Auricular Arrhythmias. Charles C Thomas, Publisher, Springfield, Ill., 1952. Google Scholar74. KATZPICK LNA: Current status of theories of mechanisms of atrial tachycardias, flutter and fibrillation. Progr. Cardiov. Dis. 2: 650, 1959. CrossrefGoogle Scholar75. KATOSATOHARUMIMURAOKANAZAWAHANZAWAKIMURA KMKSTSE: Clinical studies on the nature of the auricular flutter. Tohoku J. Exp. Med. 64: 377, 1956. CrossrefMedlineGoogle Scholar76. DECHERDRUSKINHERRMANN GMAG: Momentary atrial electrical axes. II. Atrial flutter, atrial fibrillation, and paroxysmal tachycardia. Amer. Heart J. 29: 20, 1945. CrossrefGoogle Scholar77. CABRERASODI-PALLARES CED: Discusión del movimiento circular y prueba directa de su existencia en el flutter auricular clinico. Arch. Inst. Cardiol. Méx. 17: 850, 1947. MedlineGoogle Scholar78. DUCHOSALSULZER PWR: La Vectorcardiographie. Bibliotheca Cardiologica (Supplementa ad Cardiologia) Fasc. 3: pp. 172, 1949 (Fig. 86, p. 162). Google Scholar79. GRISHMANKROOPJAFFESTEINBERG AIGHLFF: Application of intracardiac, esophageal (electrocardiography) and vectorcardiography to the problem of the circus movement in man. Amer. J. Med. 8: 395, 1950. CrossrefGoogle Scholar80. BROWN WH: A study of the esophageal lead in clinical electrocardiography. Part II. An electrocardiographic study of auricular disorders in the human subject by means of the esophageal lead. Amer. Heart J. 12: 306, 1936. Google Scholar81. KOSSMANBERGER CEAR: Auricular flutter of eleven years' duration with observations on esophageal electrocardiograms. Ann. Intern. Med. 15: 128, 1941. LinkGoogle Scholar82. COPELANDTULLISBRODY GDIFDA: Clinical evaluation of a new esophageal electrode, with particular reference to the bipolar esophageal electrocardiogram. Part II. Observations in cardiac arrhythmias. Amer. Heart J. 57: 874, 1959. CrossrefMedlineGoogle Scholar83. KOSSMANRADERBERGERBRUMLIKBRILLER CEBAJSA: Electrograms in atrial flutter, atrial tachycardia, and atrial fibrillation, in 1 er Congrès Mondial de Cardiologie. Paris. 3-9 Septembre 1950, Communication 387. J.-B Baillière et Fils, Paris, 1950, p. 318. Google Scholar84. TOROSDAGCASHINCORYLLOSBRYANT SPJEJM: Further intracardiac electrocardiographic observations on the mechanism of auricular flutter in human subjects. Clin. Res. Proc. 7: 221, 1959. Google Scholar85. SODI-PALLARESVIZCAINOSOBERONCABRERA DMJE: Comparative study of the intracavity potential in man and in dog. Amer. Heart J. 33: 819, 1947. CrossrefMedlineGoogle Scholar86. GROEDELMILLER FMM: Auricular flutter studied in direct leads from the human heart. J. Appl. Physiol. 3: 183, 1950. CrossrefMedlineGoogle Scholar87. PRINZMETALGOLDMANGERLACHKENNAMER MAER: Nature of spontaneous auricular flutter in man. Report of a case observed directly during cardiac surgery. JAMA 153: 553, 1953. CrossrefMedlineGoogle Scholar88. WENGERHOFFMANN-CREDNER RD: Observations on the atria of the human heart by direct and semidirect electrocardiography. Circulation 5: 870, 1952. CrossrefMedlineGoogle Scholar89. GIRAUDLATOURPUECH GHP: Le flutter humain. Étude de l'activation auriculaire par les dérivations oesophagiennes et endocavitaires. Arch. Mal. Coeur 48: 817, 1955. MedlineGoogle Scholar90. PUECH P: L'activité Électrique Auriculaire. Normale et Pathologique. Masson & Cie, Paris, 1956. Google Scholar91. RYTANDONESTIBRUNS DASJDL: The atrial rate in patients with flutter. A relationship between atrial enlargement and slow rate. Stanford Med. Bull. 16: 169, 1958. MedlineGoogle Scholar92. JAMES TN: The connecting pathways between the sinus node and A-V node and between the right and the left atrium in th human heart. Amer. Heart J. 66: 498, 1963. CrossrefMedlineGoogle Scholar93. MILLERKASAHARA MRM: Studies on the nerve endings in the heart. Amer. J. Anat. 115: 217, 1964. CrossrefMedlineGoogle Scholar94. PUECHESCLAVISSATSODI-PALLARESCISNEROS PMDF: Normal auricular activation in the dog's heart. Amer. Heart J. 47: 174, 1954. CrossrefMedlineGoogle Scholar95. PAES DE CARVALHO A: Cellular electrophysiology of the atrial specialized tissues, in The Specialized Tissues of the Heart, edited by PAES DE CARVALHO, A., DE MELLO, W. C., HOFFMAN, B. F. Elsevier Publishing Co., Amsterdam, 1961, p. 115. Google Scholar96. LAGERLÖFWERKÖ HL: Studies on the circulation in man. III. The auricular pressure pulse. Cardiologia (Basel) 13: 241, 1948. CrossrefGoogle Scholar97. COBLENTZHARVEYFERRERCOURNANDRICHARDS BRMMIADW: The relationship between electrical and mechanical events in the cardiac cycle of man. Brit. Heart J. 11: 1, 1949. CrossrefMedlineGoogle Scholar98. MCCORDBLOUNT MCSG: Auricular flutter. A hemodynamic basis of clinical features. Amer. Heart J. 50: 731, 1955. CrossrefMedlineGoogle Scholar99. HECHTMYERS HHGB: Auricular heart sounds in auricular flutter. Amer. Heart J. 29: 610, 1945. CrossrefGoogle Scholar100. DESBAILLETSBAUDRAZWESTRIVIER PBRJ: La morphologie de la courbe de pression "capillaire pulmonaire." Cardiologia (Basel) 25: 164, 1954. CrossrefMedlineGoogle Scholar101. ROTH O: Ueber isolierte linksseitige Vorhofstachysystolie (linksseitige Vorhofsflattern). Z. Klin. Med. 80: 351, 1914. Google Scholar102. POPPERKNOTTSELZERGERBODE RWJMAF: Arrhythmias after cardiac surgery. I. Uncomplicated atrial septal defect. Amer. Heart J. 64: 455, 1962. CrossrefMedlineGoogle Scholar103. BRISCOE S: Cholinesterase activity of left and right atria of the rabbit's heart. J. Physiol. (London) 126: 623, 1954. CrossrefGoogle Scholar104. ANGELAKOS ET: Regional distribution of catecholamines in the dog heart. Circ. Res. 16: 39, 1965. CrossrefMedlineGoogle Scholar105. PAINTAL AS: Effects of drugs on vertebrate mechanoreceptors. Pharmacol. Rev. 16: 341, 1964. MedlineGoogle Scholar106. STEINMAGINKLEINFELD EJM: Effect of mersalyl on isolated perfused guinea pig atria. Amer. J. Physiol. 199: 460, 1960. CrossrefGoogle Scholar107. GILLMANNPREISS HH: Vergleichsuntersuchungen an 104 Patienten mit Vorhofflattern. Z. Kreisslaufforsch. 52: 139, 1963. MedlineGoogle Scholar108. SPIVACKSACKNERSCHNABEL APMATG: Atrial flutter with 1:1 A-V conduction associated with pulmonary embolism in the aged. Amer. Heart J. 59: 53, 1960. CrossrefMedlineGoogle Scholar109. LEWIS T: Auricular flutter continuing for twenty-four years. Brit. Med. J. 1: 1248, 1937. CrossrefMedlineGoogle Scholar110. RYTANDFRANKPROFANT DAAGR: Simple optical methods for the recognition of atrial flutter, especially at slow atrial rates. Circulation. In press. Google Scholar111. CALO A: Deux cas de flutter auriculaire chez des nourrissons porteurs d'une cardiopathie congénitale. Arch. Mal. Coeur 32: 978, 1939. Google Scholar112. BUSSANREIDSCHERF RERD: Conversion of atrial flutter into atrial fibrillation by carotid pressure. Ann. Intern. Med. 46: 814, 1957. LinkGoogle Scholar113. LOWNLEVINE BSA: The carotid sinus. Clinical value of its stimulation. Circulation 23: 766, 1961. CrossrefMedlineGoogle Scholar114. HARRISONGRIFFINFIENE DCJRTJ: The effects of beta adrenergic blockade with propranolol in patients with atrial arrhythmias. New Eng. J. Med. 273: 410, 1965. CrossrefMedlineGoogle Scholar115. LOWNLEVINE BHD: Atrial Arrhythmias, Digitalis and Potassium. Landsberger Medical Books, Inc., New York, 1958, p. 127, Fig. 34. Google Scholar116. WILTSHIRE H: A case of heart block illustrating the behavior of the auricle during periods of prolonged ventricular silence. Heart 10: 201, 1923. Google Scholar117. LOWNAMARASINGHAMNEUMAN BRJ: New method for terminating cardiac arrhythmias. Use of synchronized capacitor discharge. JAMA 182: 548, 1962. MedlineGoogle Scholar118. CASTELLANOSLEMBERGGOSSELINFONSECA ALAEJ: Evaluation of counter-shock treatment of atrial flutter. Arch. Intern. Med. (Chicago) 115: 426, 1965. CrossrefMedlineGoogle Scholar119. DAVENPORT CB: Alfred Goldsborough Mayor 1868-1922. Mem. Nat. Acad. Sci. 21: 1, 1926. Google Scholar120. Mines GR Anonymous obituary, . Brit. Med. J. 1: 142, 1915. Google Scholar121. Garrey WE Anonymous obituary, . Nashville Banner, June 16, 1951. Also JAMA 147: 334, 1951. Google Scholar122. WHITE PD: Thomas Lewis 1881-1945. Amer. Heart J. 29: 419, 1945. CrossrefGoogle Scholar123. DRURYGRANTPARKINSON ANRTJ: Thomas Lewis. Brit. Heart J. 8: 1, 1946. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: DAVID A. RYTAND, M.D., F.A.C.P.Affiliations: Palo Alto, California, and Hanover, New HampshireFrom the Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif., and the Department of Physiology, Dartmouth Medical School, Hanover, N. H.This paper was presented in part at the Golden Anniversary Session of the American College of Physicians, Chicago, March 24, 1965.Requests for reprints should be addressed to David A. Rytand, M.D., Department of Medicine, Stanford Medical Center, Palo Alto, Calif. 94304. 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