27 



an autopsy of this case was performed and 

 showed for the first time the presence of 

 parasites in the chronic form of the disease. 



Record no. 23. 



In the radial tracing were seen extra- 

 systoles with complete compensating repose, 

 possibly ventricular, and marked alternat- 

 ion. 



Observation no. 25. 



Extrasystole. Palpitation. Post-extrasystol- 

 ic alternation. 



C. L. A., mulatto, female, 30 years, re- 

 sident at Contendas. 



Examined January 1, 1913. 



Has been ill for a year until which 

 time she was strong; there is no history 

 of previous disease. For about a year she 

 has had frequent headaches, lack of appetite, 

 difficult digestion, gastric pains, to which 

 were added later on limpness, pain in the 

 legs, weariness and heart palpitation, pro- 

 voked by the slightest effort At present it 

 is the palpitation that disturbs most, as it 

 comes on the least exertion or even while 

 at rest. Neither nocturnal dyspnea, nor ede- 

 ma. Heart not enlarged. First sound un- 

 changed, second with a puhîionary accen- 

 tuation. Mesosystolic murmur at the pulmo- 

 nary area. Cardiac erectism, with very visi- 

 ble pulsation of the veins of the neck. Pulse 

 unstable, the number of beats varying from 

 98 to 112. Tmx. =^125. Very numerous extra- 

 systoles at the beginning of the examination 

 afterwards diminishing. Liver and spleen 

 not enlarged. Thyroid enlarged- 

 Record no. 24. 



Radial pulse with dominant rhythm in- 

 terrupted by ventricular extrasystolic beats; 

 in the venous tracing the a wave of the 

 auricular rhythm and the c' wave of the 

 premature ventricular beat are fused. The 

 interval a c unchanged. In the radial tracing 

 a post-extrasystolic alternation is indicated. 



Observation no. 26. 



Ventricular extrasystole, Post-extrasys- 

 tolic alternation. No subjective symptoms. 



F. R. A., white, male, 26 years, widower, 

 farm laborer, resident at Bebedouro. 



Examined December 7, 1912. 



Previous history: about 10 years ago 

 was jaundiced, edematous, with easily 

 brought on fatigue and palpitation; he was 

 cured. The patient has also had several attacks 

 of ill defined fever. 



At the present date he is strong, inclin- 

 ed to work, without dyspnea on exertion. No 

 edema. He came to consult us on account 

 of a traumatism of the thorax which left a 

 local pain, about 20 days ago. No enlarge- 

 ment of the cardiac area, apex 7, 5 cm. 

 from midsternal line, below and within the 

 nipple; the' right margin 3,5 cm. outside the 

 midsternal line. Tachycardia: Pulse 102, 

 with numerous extrasystoles. During the 

 examination he complained of uncomfort- 

 able heart-beats (emotion). Liver not enlarg- 

 ed. Thyroid much enlarged. 



Record no. 25. 



The radial tracing shows very marked 

 alternation of the pulse principally after the 

 extrasystoles, which are ventricular as shown 

 by the venous pulse. The cardiac tracing 

 shows, besides the respiratory oscillations, 

 very marked auricular waves besides the 

 ventricular waves. 



The jugular tracing is not disturbed; 

 the a waves succeed each other in even 

 rhythm. The high points which are seen 

 on the tracing arise from the fusion of a 

 and c'. Ventricular extrasystoles coinciding 

 with the auricular systole. 



Summary: Ventricular extrasystole with 

 marked alternation. 



Observation no. 27. 



Ventricular extrasystole. Post-extrasysto- 

 lic alternation. 



F. X., white, male, 55 years old, resident 

 at Beltrão. 



