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The development of Bad Nauheim, a German spa that over 2 centuries became dominant in the attraction of patients with heart disease is described. Here, patients experienced a regimen of saline baths and mostly static exercises developed by the Schotts, 2 physician brothers. Concomitant with the bathing and exercises, there was a social atmosphere conducive to relaxation. Many visiting physicians were impressed that there were improvements in the patients' cardiac status. One skeptical exception was Sir James Mackenzie, whose views are synopsized. The reported improvements may have had a modicum of a physiologic base, from recent investigations on the nature of heart failure, and may have anticipated the current use of exercise in cardiac rehabilitation.

In 94 patients with prominent left axis deviation, there was a marked disparity in the mean angles determined by the maximum magnitude of the deflections and that determined by areas. There was also considerable variation in the angle of the maximum vector in the frontal plane (frontal plane angle) and the angle of 50 msec vector in the frontal plane. Similar results were observed in 17 cases of ostium primum atrial septal defect. These differences contrasted with the findings in a normal group of 50 subjects where a close correlation was found. The initial vector was directed to the right in approximately 80% of normals and 60% of the patients with LAD indicative of conduction defects in the left anterior fascicular or its distal ramifications. We conclude that a rightward orientation of the 5--10 msec vector (i.e. causing a Q wave in lead 1) should not be required for diagnosis of left anterior fascicular block. The spatial orientation of the initial vector was always anterior in the control subjects. In these 'normals', as well as in the patients with left axis deviation, the initial vector varied markedly in its azimuth direction (right or left) when superiorly directed; but when inferiorly directed in the normal subjects it was virtually always directed rightward. From these data we were unable to construct rigid criteria which would reliably distinguish aberrant excitation patterns manifested by gross left axis deviation in the electrocardiograms of patients with established heart disease from subjects without defined heart disease. Old infarction patterns, anterior, inferior, and lateral were not obscured by the associated anterior fascicular block.

The bactericidal capacities of neutrophilic polymorphonuclear neukocytes (PMN) from five untreated adults with bacterial endocarditis (BE), eight untreated patients with other forms of acute bacterial infection (ABI), and fourteen drug-free uniinfected normal subjects (NS) were compared with a new technique that uses five increasing bacteria-to-neutrophil ratios ranging from 1.25 to 100 Staphylococcus aureus per neutrophil. PMN from uninfected NS or untreated patients with ABI demonstrated a similar and reproducible ability to kill increasing numbers of S. aureus in 8 per cent normal serum. In contrast, the bactericidal activities of the PMN from untreated patients with BE were significantly depressed and the defect was more apparent at high ratios. Neutrophils from some of these individuals had decreased bactericidal action only at high ratios, indicating a quantitative type of neutrophil defect. There was no morphologic deficiency in the uptake of bacteria by BE neutrophils and comparable rates of glucose [-1-14C] oxidation were found in BE and control neutrophils stimulated with various ratios of heat-killed bacteria. Therefore, the observed abnormality appeared to be that of intracellular killing rather than of ingestion. The proportions of bacteria killed by the MN of untreated patients with BE improved after antibiotic treatment and became equal to those of NS or untreated ABI patients. This rapid return to normal bactericidal function by the PMN during treatment indicates that the prior deficiency was an acquired consequence of the infectious process of BE.

Vectorcardiographic studies on ventricular premature beats (VPB'S), occurring in records wherein the sinus beats were associated with an intraventricular conduction defect attributed to anterior fascicular delay or block, did not identify the exact site of a presumed reentry mechanism. The hypothesis that the orientation of the initial vectors of the VPB might reveal either anterograde or retrograde emergence from the anterior fasciulus iwth a reentry PVB was not strongly supported, although one or the other mechanism was compatible with the early vectors of certain VPBs. The VPBs revealed greater angular change on the spatial orientation of sequential early vectors (5--10--15 milliseconds) than occurred in sinus beats. Recurring VPBs, which appeared to casual visual inspection steriotyped in form, showed considerable variation in the orientation of the early vectors, indicating, in the cases studied, that VPBs, in the strictest sense, may be associated with differing initial entrance pathways to the myocardium and thus may be 'multiform'.

Hospitals have become safer from electric shock accidents, but physicians who delegate to the electronics experts full responsibility in this regard will be shirking an obligation. Every physician should be involved both in programs to prevent these accidents in medical settings and in efforts to educate the public concerning the risk of electrocution in and around the home.

The growth of knowledge of the QT interval of the ECG is reviewed. 1980 was the centennial of the first careful measurements of Burdon-Sanderson and Page, and also the 60th anniversary of Bazett's contribution that established a predictable relation of the QT to heart rate in normal subjects. The waxing and waning of interest in the QT among clinical cardiologists appear to have been related to a low sensitivity and specificity of abnormal QT/rate ratios in many clinical diseases. The QT duration has been established as a valuable measurement, and sometimes the patterns may be nearly pathognomonic of electrolyte disturbances. Alterations from a predicted normal mean may give a clue to disease. The importance of transient dissociation of the predicted QT from the measured QT with rapid changes in heart rate deserves further emphasis. In the publication of data on the duration of QT, the reporting only of the corrected QT (QTc), the index of Bazett, conveys an incomplete picture of the nature of the changes. The prolonged QT pattern in adults should be suspected of being related to drugs first, except when a neurogenic cause is apparent. The idiopathic hereditary syndrome still defies a completely adequate explanation, though neurogenic influences are overtly important. No universal management has been established.

Since the introduction of digitalis into therapy approximately 200 years ago, there have been continuing admonitions concerning its toxicity. Over 400 years ago, herbalists listed the plant as being poisonous. In fiction, the homicidal use of digitalis has appeared in the writings of Mary Webb, Dorothy Sayers and Agatha Christie. Ten instances in real life of alleged homicide by digitalis and trials of the accused are listed. The drug has been used with suicidal intent rather infrequently, compared with other medications. Possibly, it is more commonly used for such a purpose in France than in England or the United States. The fraudulent use of digitalis in the support of claims for disability because of heart disease has occurred, and one large conspiracy of physicians and lawyers in the swindle of insurance companies during the 1930s is a shameful episode in the record of these professions. Although innocent, one professor of medicine who was involved committed suicide. Two pharmaceutical (manufacturing) blunders that occurred in Belgium and Holland with mislabeling are mentioned. These resulted in numerous deaths and the profession seemed rather slow to recognize the nature of these small epidemics of poisoning. Instances of psychiatric illness with digitalis seem well documented. The story of digitalis toxicity continues into the present and physicians should be vigilant regarding the drug's potential for poisoning that can result from prescribing digitalis with ignorance of proper dosage, pharmacodynamics or drug interactions, as well as from accidental overdose as in children and use with self-destructive or homicidal intent.

Five hundred ECG's, machine processed by the commercially available IBM Bonner-Mt. Sinai System, have been reviewed. The diagnostic printouts were of value as an adjunct to the physician's interpretations, but were not sufficiently reliable--in regard to either sensitivity (identification of the abnormal or borderline) or specificity (accuracy in predicting typical abnormalities)--to allow us to condone any claim for it being an independent reliable diagnostic service to noncardiologist clinicians. Despite this desclaimer for current diagnostic reliability of ECG computer analyses, specifically the IBM-Bonner system, we continue to be of the firm conviction that progress through this method of ECG analysis will have much to contribute in future years.