17 



tient retains his appetite, but feels burning 

 in the stomach, which is allayed by draughts 

 of cold water. For about a year now, he 

 gets easily tired and has palpitation after 

 making any effort. The patient also men- 

 tions a feeling of weakness and pains in 

 the legs, and slight vague pains in the 

 body. At times, when obliged to drink 

 much water so as to swallow, he vomits his 

 food. 



The only former ailments the patient 

 mentions are attacks of fever, the first of 

 which appeared six years ago and the last 

 about two months ago. 



The patient is well built and strong 

 looking. On both sides of the parotid region, 

 there are soft masses about the size of al- 

 monds, which seem to be due to a hyper- 

 trophy of the parotid glands. The patient 

 states that their size varies, increasing at 

 times and diminishing at others. Heart not 

 enlarged; apex beat 7.5 cm. from the mid- 

 sternal line, the right margin 3 cm. from 

 the same line. Heart sounds clear. The 

 second sound increased and reduplicated at 

 the pulmonary area. Pulse slow, 44 lying 

 down and 52 standing, accompanying the 

 heart beats. After slight exercise, 70. Katz- 

 ensteintest positive; Tmn. =75. Tmx.=rll5. 



Liver not enlarged, not painful on pres- 

 sure. Thyroid gland enlarged, with a cyst 

 about the size of a walnut in the middle, 

 and smaller local ones. Inguinal glands 

 slightly enlarged. Nervous system negative. 

 Intelligence of a low order. 



An X — ray examination of the process 

 of swallowing was made. A bismuth emu!, 

 sion was easily swallowed, but corn mush 

 containing bismuth was swallowed very 

 slowly and stopped several times owing to 

 a spasm of the esophagus, provoking a 

 feel ng of discomfort and pain. The spasm 

 was stronger at the cardia; as the patient 

 put it "the stomach does not want to let 

 food in". 



Record no. 2 and 2-A 



1) Pulse as in total bradycardia, as may 

 be seen by the jugular and venous tracings. 



The a c interval not lengthened; the dom- 

 inant rhythm regulated by the auricular 

 waves. The venous tracing shows the b 

 waves of Hirschfelder well. Sudden pres- 

 sure on the eye-balls produces a stoppage of 

 the pulse for 4:5 seconds. 



II) It is also a total bradycardia trac- 

 ing like the former one and shows the 

 effect of slow ocular pressure. The pulse 

 has become much s'ower and the retarding 

 influence seems to make itself felt after the 

 pressure has stopped. It is interesting to 

 note that after the compression has ceased 

 the ventricle goes on beating with its own 

 idio-ventricular rhythm, independently of 

 the auricular rhythm, which is slower and 

 the waves of which make themselves felt at 

 the systolic ventricular phase by very acute 

 rises. 



The auricular beats gain in speed grad- 

 ually until they dominate the rhythm. The 

 last beat in the tracing belongs to the auric- 

 ular rhythm. The last but one shows a 

 fusion of the a and c waves. 



This shows that though the diminution 

 of excitability produced by ocular compress- 

 ion acts on all the points of origin of the 

 cardiac contractions, it has a much stronger 

 influence on the sino-auricular ones than on 

 the starting-points of the idio-ventricular 

 rhythm. 



Observation no. 3. 



Simple tachycardia. 



G. do N., negress, 30 years resident at 

 Lassance. 



Examined at 



Previous history of no special impor- 

 tance; the patient states that she has always 

 been well, and has had no disturbances 

 other than those which go with gestation. 

 She has three children one of which was 

 born prematurely at seven months. She 

 has been ill for three months with loss of 

 appetite and a feeling of fulness in the 

 stomach after even modejate eating; poor 

 digestion. Is easily fatigued and has "ave- 

 xame", agony in the heart and a feeling of 



