kenzie, The Study of the Pulse, 1902; anche Hirschfelder, American Journal of the Medical Sciences, settembre 1906, e Morrow, Brit-ish Med. Senza dubbio, la contrazione della auricola, ma per localizzare questa onda o, effettivamente, per interpretare a tutto l'impulso venoso complicatedè necessario avere un tracciato simultaneo dell'impulso arterioso, preferibilmente della carotide, o del battito apicale del cuore. Uno di questi ultimi tracciati consente di rilevare l'impulso venoso
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A text-book of physiology, for medical students and physicians . kenzie, The Study of the Pulse, 1902; also Hirschfelder, American Journal of the Medical Sciences, Sept., 1906, and Morrow, Brit-ish Med. Journal, 1906 and 1907.33 514 CIRCULATION OF BLOOD AND LYMPH. undoubtedly, the contraction of the auricle, but in order tolocate this wave or, indeed, to interpret at all the complicatedvenous pulse, it is necessary to have a simultaneous tracing ofthe arterial pulse, preferably the carotid, or of the apex beat ofthe heart. Either of these latter tracings enables one to markupon the venous pulse the point at which the ventricular systolebegins, and the wave immediately preceding this point mustbe due to the auricular contraction, the a wave (Figs. 214 and215). Following the rise of the a wave there is a fall, the firstnegative wave, which is due to the auricular relaxation. Theinterpretation of the other two positive and negative waveshas been the subject of much discussion. Mackenzie, one ofwhose tracings is reproduced in Fig. 215, believed that the. Fiy. 214.—Simultaneous tracings of the carotid and venous pulses. In the venoustracing (internal jugular) a indicates the auricular wave due to the contraction of the auri-cle; r is the carotid wave due (Mackenzie) to an impulse from the neighboring carotidartery; v is the ventricular wave due to the checking or stagnation of the flow into theauricle as this chamber fills during the period of closure of the auriculoventricular valves;x, dilatation due to auricular relaxation; y, the period of ventricular diastole. (Mackenzie.) c wave is due simply to the pulse in the neighboring carotidartery, and that, therefore, it has no significance in regard tochanges within the heart itself. Careful records made by otherobservers show, however, that this explanation is insufficient.The c wave begins in the jugular before the arterial pulse wavereaches the carotid, hence this wave cannot be due wholly tothe carotid pulse. As is sh
