James Mackenzie

Remarks on the Meaning and Mechanism of Visceral Pain as Shown by the Study of Visceral and other Sympathetic (Autonomic) Reflexes.

.-SYMkPATIIETic REFLEXES. IN the following study an attempt is made to demonstrate the-principles on which pain and other symptoms of visceral disease are produced. A great many phenomena of which we are cognisant lave never been carefully analysed, but have beexi heedlessly attributed to some seemingly self-apparent cause. On critical examination it will be found that the phenomena are of a nature totally. different from that usually accepted, and involve a complex mechanism hitherto unsuspected. Many of the observations quoted here may seem trivial and unimportant, but as straws show the direction in which the wind blows, so an appreciation of the true alature of these simple reflexes reveals the meaning of many important clinical symptoms at present overlooked

Observations on the Inception of the Rhythm of the Heart by the Ventricle: As the cause of Continuous Irregularity of the Heart.

THIS paper seeks to explain that most puzzling of all the forms of irregularity of the heart, where the heart is never regular in its action, where seldom or never two beats of the same character follow one another. Many names have been applied to this condition, such as delirium cordis, the mitral pulse, pulsus irregularis perpetuus, a heart irregular through loss of vagus control, etc. As the result of a study of a large number of cases where a jugular pulse was present I have been able to establish the fact that the cause of the irregularity is due to the rhythm of the heart proceeding from the ventricles, and not, as normally, from the great veins as they debouch into the auricles. I am also convinced that in all other cases of continued irregularity where there is no jugular pulse to explain matters (as in old people and others who suffer from attacks of palpitation with irregular action of the heart) the same cause is at work, not only because of similarity in type, but because in such people there is a great tendency to extra-systole of the ventricles-a condition which, as will be seen, often precedes the continuous irregularity.

Observations ON THE PROCESS WHICH RESULTS IN AURICULAR FIBRILLATION

a great number of heart problems. It was found, for instance, tllat this abnormal state resulted in the greatly increased susceptibility of the hiart to stimulationnot onij by agents which increase the rate of the ventricle but also by agents whiclh diminish the rate. It was found also that the heart reacted to drugs of the digitalis group with a greater readiness than does the normal acting lheart. Heart failure is more readily induced, and the character ofthe SA

A NEW OUTLOOK IN CARDIOLOGY

aiid the parts concerned in startinig heartheat a great extent, accumulated in a well definied cells the sino-auricular node, wlhich imiouth of the superior venacava. There ini the auricle capable of initiating the auricle continues to beat regularly Nlien the specialized tissue of thle sino-auricular destroyed. Although not clearly definied, there reason for assuming that all the parts concerned starting of the heart beat act harmoniously, probably

A Lecture ON THE SOLDIER'S HEART AND WAR NEUROSIS: A STUDY IN SYMPTOMATOLOGY: Delivered at the Clinical Institute, St. Andrews

INTRODUCTION. IN the investigation of disease the necessity for the study of symptoms has been recognized since the days of Hippocrates. Yet, notwithstanding the vast amount of labour spent on the subject, our knowledge to-day is far from complete. In an attempt to improve this knowledge I have been guided by certain principles the application of wlhich has been attended with a measure of success. I desire to-day to illustrate the application of these principles in one field of research in which I have been labouring for over thirty years. During that research I have learnt many things, one of the chief being the fact tllat to investigate symptoms in any branch of medicine requires

The First George Alexander Gibson Memorial Lecture. AN APPRECIATION OF THE MAN AND HIS WORK: Delivered before the Royal College of Physicians of Edinburgh.

future years, when the work that lhe has done becomes part of the general knowledge in medicine, and all his individuality has gone-as happens to all workers-the question may be asked, What manner of man was this whom his fellows honoured by raising to hiim tllis memorial? It seemed to me, and it met with the approval of your President, that the first lecture might, with propriety, be devoted to an appreciation of Dr. Gibson himself and of some part of hiis work. There are many phases of his life of which I have but little knowledge. I cannot speak, except from hearsay, of his great gifts as a teacher in the lecture room and in the hospital wards. But of the fruit of his work as a physician I can speak, for I have been a devoted student of his work almost from. the day he began to write. I will restrict myself to dealing with his work and character as they presented tlhemselves to me, choosing those portions of his work of which I may claim to 1have some knowledge, and whose value, therefore, I am able to determine. Naturally sulch a procedure will give but an imperfect picture of the whole subject, but still the fact that it is a sincere and knowledgeable criticism will carry with it some idea of the greatness of the man. Dr. Gibson was never content to be merely the mouthpiece of tradition. Few men have ever had his grasp of the subjects with which he dealt, in the sense that he approached them from such varied points. He had a fine historical sense, so that he was always interested in the origin of an idea, and it was to him a delight to trace tlhrough the centuries the progress and growth of somne conception that had influenced medical thought. It was this trait in hiis writings that made them so valuable to all students of a subject, particularly when, as often happened, he made a running commentary of the value of each contribution. The interest he took in his subject naturally led hiim to explore fields outside the region of clinical medicine, to detect the sources of knowledge that influenced medicine. Thus it is we find so many auxiliary sciences called upon to contribute their quiota of knowledge. Especially did he keep himself acquainted with what was going on in the physiological laboratory, and h-e was always eager to seize upon the latest observations, and apply them to the interpretation of the manifestations of disease in the huiman stubject. As a teacher of medicine, and as a physician called upon to study all forms of disease, it was incumbent oni him to

The Oliver-Sharpey Lectures ON HEART FAILURE: Delivered before the Royal College of Physicians of London.

LBCTURIE I.-AN ANALYSIS OF THE PRBSENT-DAY CONCBPTION OF HEART FAILURE. MR. PRESIDBNT AND GENTLEMEN,-I thank you for the honour you have conferred upon me in inviting me to give these lectures. In seeking for a suitable subject, I considered the type of lecture usually given before you, and I found that most of your lectures deal with observations made in laboratories, or drawn from hospital experiences, and rarely, if ever, deal with practical observations derived from general practice. It is now many years since it was foroed upon me that the study of disease and its treatment would never be satisfactorily accomplished until the general practitioner took his share in the work of research. Hitherto his position in the rank of investigators has not been appreciated, and if he has had no actual discouragement, his attempts have been too often received with a chilling indifference. The need for his help will be realized if we but reflect upon our imperfect knowledge of the coutse of many chronic diseases, where neither the inception nor the different phases of the progress are understood. Usual exponents of medicalscience are not brought into intimate contact with the varying manifestations of disease. The trivial ailments by which the beginning of the diseases are often made manifest are lost to them. Thesubtle changes that go on as the disease advances are usually missed, and the links between the stages are too often based on inference alone. When such a process takes the place of

A Preliminary Inquiry into the Tonicity of the Muscle Fibres of the Heart

THIS paper is intended to direct attention to the explanation of a common cause of heart failure. Even in the present day heart failure, and particularly dilatation of the heart, is looked upon too much from a mechanical standpoint. The question of tonicity is one that still needs a great amount of study from physiological, pharmacological, and clinical aspects, and here I touch only on a few points that I have already worked out.