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Paroxysmal tachycardia is not as a rule caused by intervention of the will. Only very few cases have been described where the subject was able t o accelerate the action of the heart a t a given command by concentrated will power without visible muscular efforts or emotional influences from without.The first such case was described by Tuke (1872). Both in this and subsequent cases reported in the literature by Tarchanoff (1885), Pease (1889) and van der Velde (1897) the increase in the frequency of the heart beat due t o will power was only moderate. Koehler (1914) produced tachycardia in himself and this was associated with an increase of the blood pressure and the respiration rate. He considered that it was due t o increased tone of the sympathetic and decreased tone of the vagus. Pavill and White (1917), West and Savage (1917), and Taylor and Cameron (1922) came to the same conclusion in their various cases, in which the acceleration of the heart beat was combined with mydriasis and a rise in blood pressure. After the injection of atropine ( 2 mg-1/30 grain,) the heart rate increased even during rest but a reduced faculty to increase it still further voluntarily persisted. I n Favill and White's case an electrocardiogram showed, that during the attacks of tachycardia, the R, S and T-waves altered. Carter and TVedd (1918) mentioned a patient who was unable to produce any voluntary increase in the action of the heart under the influence of atropine. The electrocardiogram indicated an ectopic rhythm with a focus in the upper part of the right atrium under the control of subjective inhibiting reflexes but not influenced by vagal stimulation. Carpenter, Hoskins and Hitchcock (1934) described a person who could increase his basal metabolism without visible muscular efforts. There was also a rise in blood pressure and a moderate increase in the pulse rate. Electrocardiograms 29-493631. Acfa med. Scandinav. Vol. CXXXVZ.

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