1& 



logy and pathogenesis of the numerous clin- 

 ical cases of the cardiac form that we 

 possess. Furthermore, the localization of 

 the parasite in the heart muscle is a con- 

 stant occurrence in the infections by tie 

 Trypanosoma cruzi not only in man but 

 also in laboratory animals as well. 



On the other hand the more recent 

 histopathologic studies of Dr. Crowell show 

 lesions that are considered by him as char- 

 acteristic of the action of the parasite on 

 the myocardum in the chronic process. 



It may also be stated that the studies 

 of Dr. Crowell have shown weil localized 

 lesions in the primitive cardiac bundle, 

 which explains the anomalies of rhythm 

 shown by the physical examination. 



Observation no. 1. 



Cardiac insufficiency. Total bradycardia. 

 Sinus arrhythmia. 



J. P. -White, 21 years, male, laborer, 

 single, resident at Santo Antonio da Lagoa. 



The patient has always been strong and 

 mentions no former ailments. For the last 

 few months he has a feeling of fatigue and 

 gets tired after exertion. He came however 

 to consult us on account of nocturnal delir- 

 ium. In appearance the patient is strong, 

 muscular and well built. There are no sub- 

 jective signs to be noticed. Cardiac area 

 enlarged, apex beat in the 5th intercostal 

 space, outside the mamillary line. Heart 

 sounds quite audible, no murmurs. Pulse 

 arrhythmic, the beats now slow, now fast, at 

 times simulating extrasystolic beats. Number 

 of beats per minute: lying down 50; stan- 

 ding 82. Tmx.=140. Liver slightly enlarged. 

 Spleen not enlarged. Cervical and inguinal 

 glands slightly enlarged. Thyroid gland 

 hypertrophied. 



Record no. 1. 



The radial and cardiac tracings show 

 that between the first and fourth cycle the 

 interval diminishes; the diastolic pause length- 

 ens suddenly from the fourth to the fifth 



cycle and diminishes again gradually until 

 the seventh. At the seventh the same success- 

 ion of sudden lengthening of the diastolic 

 phase with gradual shortening every four 

 beats begins anew. The long diastoles are 

 however not strictly equal nor are the short 

 ones so that the pulse is very arrhythmic. 

 The amplitude of the pulse wave is in pro- 

 portion to the length of the preceding inter- 

 val. On analysis, the venous tracing shows 

 the same irregularity in the succession of 

 the auricular waves; it is the auricular rhy- 

 thm which is altered in the first instance. 

 The a c interval remains normal and there 

 is no change in the conductibility. The regu- 

 lar succession of long and short diastolic 

 phases every four beats shows that the 

 arrhythmia is of respiratory origin, although 

 the curve does not register the oscillations 

 of the respiratory rhythm. The pulse is that 

 found in total bradycardia, 50 beats per mi- 

 nute. 



Observation no. 2. 



Total bradycardia. Spasm of the esopha- 



gus. 



A. S. , negro, 23 years, male, single, 

 resident at Santo Hipolyto, near Lassance. 

 Examined June 23, 1916. The patient came to 

 the hospital on account of an entalo (spasm 

 of the esophagus) which he has had for 

 four years and which started after a fever 

 which lasted about fifteen days. The patient 

 has difficulty in swallowing both liquid and 

 solid food ; it "goes down with difficulty 

 and stops in the throat"; the patient finds 

 deglutition painful and often has spasms of 

 pain after it. Sometimes while swallowing 

 the food is regurgitated. The difficulty is 

 not continuous, but rather periodic and irreg- 

 ular. At times the patient swallows both 

 liquid and solid food easily, at others, he 

 has to take a draught of water after each 

 particle so as to be able to swallow it, and, 

 at others he cannot swallow even water. 

 Certain foodstuffs, such as beans and pep- 

 pered food, seem to bring on the spasm 

 whilst farinaceous ones do not. The pa- 



