Archives of internal medicine . icle, the irritability of which was, possibly,in itself diminished, or tlmt the same vagus influence served to depressthe ventricular irritability. The lesion in this heart is prol)al)ly a fibrous myocarditis seriouslyinvolving the His bundle Avithout totally destroying it. The clinicalphenomena are remarkably similar to those in the case reported byGriffith and Cohn.^ In this instance there was also an exceedingly pro-longed a-c interval, amounting once to second. The tracings showintermissions, owing to the dropping of occasional beats, or a 2 to 1rhythm d
Archives of internal medicine . icle, the irritability of which was, possibly,in itself diminished, or tlmt the same vagus influence served to depressthe ventricular irritability. The lesion in this heart is prol)al)ly a fibrous myocarditis seriouslyinvolving the His bundle Avithout totally destroying it. The clinicalphenomena are remarkably similar to those in the case reported byGriffith and Cohn.^ In this instance there was also an exceedingly pro-longed a-c interval, amounting once to second. The tracings showintermissions, owing to the dropping of occasional beats, or a 2 to 1rhythm due to tlie dropping regularly of alternate beats from failure ofconduction. On another tracing, the dropping of every third beat causesan alternation of short and long pauses, a 3 to 2 rhythm. Occasional 8. Remarks on the Study of a Case Sliowing a Greatly Lengthened a-c Intervalwith Attacks of Partial and Complete Heart-Block, with an Investigation of theUnderlying Pathological Conditions, Quart. Jour. vii, 12( ^ W. S. THAYER—F. W. PEABODY 345 ventriculai extrasystoles were noted, and finally, the establishment of anearly regular ventricular rhythm of about 43, which the authorsregarded as a 3 to 2 rhythm; this might, however, and we are inclined tobelieve, should be interpreted as we have interpreted Tracings 21 to 26in Case 2; that is, as an automatic ventricular rhythm in which an occa-sional beat is hastened by an impulse which has passed through the a-cbundle. At other times there were periods of apparently total block witha rate of 26 per minute and once there was a characteristic alternatingpulse. The lesion in this case proved to be an aneurysm of the rightposterior sinus of Valsalva which had depressed the aortic cusp to suchan extent that the septum membranosum was included in the aneurysmal]30ueh. severely compressing the main stem of the auriculoventricularbundle and cutting off the left branch. GENERAL SUMMARY Case 1.—A nian of 53 with rather
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