21 



No noticeable change in the heart 

 sounds. Pulse 76, with frequent exirasysto- 

 les. 



before— 76 ps. ? Tmx. 130. 



Katzenstein I during-82 » 120. 



I after -80 « 125. 



Pulse 92 standing. Liver not enlarged. 

 Spleen enlarged, with a thin, hard margin. 

 Glands not hypertrophied. Thyroid with 

 moderate goiter. Her husband died sud- 

 denly. 



Records no. 11 and 11 -A. 



I) Radial pulse full, rather slow, rhythmic, 

 the dominant rhythm interrupted by extra- 

 systoles with ample compensating period- 

 Rate little less than average, 68 per minute. 

 Extrasytoles frequent, and scattered irregu- 

 larly in the tracing. The venous pulse with 

 strongly accentuated carotid waves; a waves 

 well marked, v waves slightly marked. 



Corresponding to the extrasystoles of 

 the radial pulse there are exaggerated rises 

 of the jugular pulse due to the simultaneous 

 contraction of auricle and ventricle. The 

 auricles contract rhythmically ; the contrac- 

 tion of the ventricles is anticipated. Ventri- 

 cular extrasystoles. 



II) Taken after injection of Og.OOl of 

 sulphate of atropine. Rate increased; from 

 6& to 92. Disappearance of the extrasystole. 

 Radial pulse rhythmic and regular. Venous 

 pulse with carotid appearance. Ventricular 

 extrasystoles in the heart, rather slow; disap- 

 pearance of the same half an hour after 

 atropine, with moderate acceleration, 68; 92. 



Observation no. 13. 



Ventricular and nodal exstrasystoles^ 

 Palpitation. 



A. C, mulatto, 40 years old, male, sin- 

 gle, laborer, resident at Beltrão. 



Examined March 3, 1913. In his history 

 there is only a reference to intermittent 

 fever that he had some months previously, 

 from which there remains pain in the right 

 hypochrondrium. At present, aside from this 



pain, he complains of attacks of palpitation 

 which are transient and infrequent. No other 

 subjective symptoms elicited. Heart not en- 

 larged. Heart-beats interrupted in their 

 rhythm by extrasystoles in bigeminal series. 

 Sounds normal. Pulse 78, one beat being 

 strong and one extrasystolic. Tmx. 110. 

 After the injection of 0,001 g. atropine the 

 pulse becomes regular, 92 lying down and 

 115 standing. Liver and spleen are a little 

 enlarged. Thyroid enlarged with a volum- 

 inous ¿oiter. 



Records no. 12, 12-A and 12-B. 



(I This tracing shows a type of bigem- 

 inal pulse caused by ventricular extrasys- 

 toles which succeed each other in aUerna- 

 ting cycles. The legend explains itself. 



II) Tracing taken fifteen nJnutes after 

 injection of Og,001 of atropine. The succession 

 of bigeminal beats if= ''nferrupted by a tri- 

 geminal group. This group seems to be 

 formed by the addition of an auriculo-ven- 

 tricular extrasystole to the ventricular extra- 

 systole. The a wave which is fused with the 

 c'wave of the first extrasystole belongs to the 

 dominant rhythm; the second a c is due to 

 the fusion of two synchronous extrasystolic 

 waves. The auricular rhythm regains its rate 

 from the extrasystolic auricular wave. 



III) Taken one houi and twenty minutes 

 after atropine. The puise has become regu- 

 lar and the rate somewhat increased. 



Observation no. 14. 



Ventricular extrasystoles. Cardiac insuf- 

 ficiency. Palpitation. 



J. L. , mulatto, 34 years, male, married, 

 farm laborer, resident at Bagre. 



Examined April 14, 1913. 



The patient had convulsive attacks up 

 to the age of 18 when they ceased. He also 

 had intermittent fever about twelve years 

 ago. There is nothing worth mentioning in 

 the previous history of this man who was 

 strong and hardworking until the beginning 

 of his present illness, about a year ago. 

 After an attack of "Dysentery" has suffered 



