18 



anguish. Palpitation with rapid beats, which 

 condition sometimes lasts an hour and is 

 accompanied by a feeling of agony ("ave- 

 xame"). 



Record no. 3 and 3-A. 



Taken at a crisis of palpitation. The 

 tracing is perfectly regular only the rhythm 

 is accelerated, 120 beats per minute. We 

 were unable to follow the transition between 

 this and the slower thythm of 3 which 

 accompanied the disappearance of the 

 subjective sensation of palpitation and agony. 

 Nor can we affirm whether the greater rate 

 was brought on by auricular extrasystoles 

 or by the simple acceleration of the normaj 

 rhythm. 



Observation no. 4. 



y achycardia. Palpitation. 



F. P., negro, male, 25 years, resident at 

 Lassance. 



The patient came to be treated on ac- 

 count of strong and uncomfortable heart 

 beats and agony ("avexame"), and states that 

 he often gets frightened without any reason. 

 This condition is accompanied by pal- 

 pitation and agony ("avexame") and causes 

 him much discomfort; it has lasted for over 

 a year. 



Signs of slight cardiac insufficiency, 

 The heart is not enlarged. Heart sounds 

 clear, without murmurs, Thyroid enlarged, 

 with moderate sized goiter. During palpi- 

 tation the heart beats are frequent and 

 violent so as to shake the thoracic wall; the 

 respiratory movements are more frequent 

 and the breathing anguished. There are no 

 lapses of the pulse either at the time of 

 the palpitation or in the intervals. 



The tracing shows an extrasystole at 

 the end of an attack of palpitation. 



Record no. 4. 



Taken at the final phase of an attack of 

 palpitation. A ventricular extrasystole is 

 shown, but it was not possible to take trac- 



ings showing the real nature of the acme 

 beats during palpitation. 



Observation no. 5. 



Asystole. 



R. M. , white, male, 17 years, resident 

 near Lassance. 



The patient suffers from palpitation, is 

 easily fatigued and has attacks of dizziness 

 almost always followed bv fainting. He has 

 become thin. No edema. Signs of cardiac 

 insufficiency. Pulse arrhythmic, at times 

 with heart beats in bigeminal and trigem- 

 inal groups. Heart beats 84, which is more 

 than that of the radial pulse, 73, because 

 not all the extrasystoles are shown in the 

 pulse. Tmx.=l05. Thyroid gland hyper- 

 trophied, specially the middle lobe. Many 

 cervical glands. 



This patient was put in hospital during 

 a crisis of cardiac asystole. At the time 

 there was generalised edema with intense 

 dyspnea and visceral congestion. The pa- 

 tient died of cardiac collapse. The histo- 

 pathologic examination made by Prof. 

 CROWELL showed parasitic foci and in- 

 tense lesions of the myocardium. 



Observation no. 6. 



Ventricular extrasystole. Cardiac insuf- 

 ficiency. Palpitation. Agony. 



M. A., mulatto, 23 years, female, mar- 

 ried, resident at Pirapora. 



Previous history of attacks of inter- 

 mittent fever, and a little while ago arthritis 

 of the wrist after a gonococcic infection 

 which was cured. For sometime the patient 

 has been feeling nervous excitability, pal- 

 pitation and fatigue on exertion. Nocturnal 

 dyspnea with palpitations. These symptoms 

 have become more pronounced in the last 

 fifteen days; she has also gastric pains, a 

 feeling of sickness and abundant saliva- 

 tion. Palpitation with agony ("avexame^') 

 almost constant. 



Precordial beats very violent, with very 

 marked apex shock. Cardiac erectism. Apex 



