20 



Signs of marked cardiac insufficiency; 

 rate 82 per minute, with frequent extrasys- 

 toles. Tmx=llO. Large goiter. Thyroid much 

 increased in size. 



This woman is the mother of the pa- 

 tient Geraldo, who was in the hospital with 

 diplegia. 



Record no. 8 



The only remarkable thing about this 

 tracing is the extrasystoles of ventricular 

 origin. 



Observation no. 10. 



Ventricular extrasysfole. No signs oj 

 cardiac insufficiency. Atropine test. 



B. C. , white, male, 44 years, married, 

 farm laborer, resident at Trahyras. 



Examined March 23, 1913. 



Previous history as in the preceding 

 case; only intermittent fever. This patient 

 came to consult us on account of a strong 

 facial neuralgia which had lasted for 5 days. 

 He is moderately tall and well built. No 

 subjective symptoms. Heart not enlarged. 

 Heart sounds without noticeable alterations, 

 with the exception of tympanism of the 

 second sound in the aortic area. Pulse with 

 numerous extrasystoles. Pulse 64 when lying 

 down, standing 75. The atropine test accel- 

 erates the pulse and makes it more regular. 

 Liver and spleen not noticeably enlarged. 

 Thyroid enlarged, with a cystic nodule. 



Records 9 and 9-A. 



I) The radial tracing shows frequent 

 extrasystolic beats, which interrupt the 

 rhythm. The extrasystoles are ventricular, 

 as may be seen in the venous tracing. 



II) An hour after injection of Ü,g001 of 

 atropine the pulse is perfectly regular and 

 slightly accelerated. 



Observation no. 11. 



Ventricular extrasystole. Dilatation of 

 the heart. Atropine not modifying the extra- 

 systoles. 



C, white, male, 13 years, resident at 

 Muquem. 



Examined October 24, 1913. 



Previous history. Malaria with recent 

 attacks qf fever. This patient complains of 

 gastric pains, a feeling of gaPtric fulness and 

 sometimes has attacks of giddiness. He does 

 not complain of dyspnea, palpitation or any 

 other symptom. Heart enlarged, apex be- 

 neath the fifth rib in the mammillary line, 

 8,5 cm. from the midsternal line. First sound 

 muffled. Second reduplicated. Mesosystolic 

 murmurs in pulmonary area. Pulse 84 per 

 minute, with frequent extrasystoles. Tnix.r= 

 110. The atropine test accelerates t!ie heart 

 beats (105 per minute). Liver not enlarged. 

 Spleen enlarged and painful on pressure. 

 Thyroid increased in volume. Inguinal glands 

 enlarged. 



November 24, 1913. Pulse rate 85. No 

 change in the physical signs of the heart. 

 Nuiiierous extrasystoles. 



January 15, 1913. No modifications in 

 the physical signs of the heart. Numerous 

 exfrasystoles. Number of beats 90 when 

 lying down and 104 standing ; the extra- 

 systoles are as numerous in one position as 

 in the other. 



Record no. 10. 



The rhythm of the pulse is interrupted 

 by extrasystolic beats of ventricular origin. 

 There is also a slight sinus arrhythmia. 



Observation no. 12. 



Ventricular extrasystole ; the atropine test 

 makes the rhythm regular. 



V. D., mulatto, 35 years, widow, resi- 

 dent at Lassance. 



Examined April 18, 1913. 



Previous history, only attacks of inter- 

 mittent fever. 



Complains of occasional attacks of pal- 

 pitation. No other subjective symptoms. 



Heart increased in volume, apex beat 

 in the fourth intercostal space, in the mam- 

 millary line, 8, 5 cm. from the midsternal 

 line. 



