REPORT OF CASES AND COMMENT By Dr. Straus Cardiac irregularities in cases of gallbladder disease are not infrequent; many are functional. During the last few months I have operated in four cases (three cases of gallbladder disease and one of duodenal ulcer) in which the pulse before operation showed a permanent irregularity consisting of premature contractions. In only one of the cases was there any enlargement of the heart; none of the others showed any other evidence of organic disease. In these four cases the extrasystoles may have been due to a vagus reflex phenomenon. While it is generally agreed that extrasystoles are abnormal systoles of a portion of the heart due to impulses which originate, independent of the pacemaker and the Purkinje system, in certain heterogenic zones in the heart itself, and are due to conditions of abnormal irritability, in the cases I report this increased local irritability may