2â 



Examined May 4, IQll. 



The patient complains of vague pains 

 in the extremities and palpitation. Very 

 marked bronze coloring. General emacia- 

 tion. Pulsation; 76, with occasional extra- 

 systoles. Tmx.=100. Pulse standing, 108. 



Record no. 26. 



The appearance of the radial tracing is 

 that of a series of rhythmic beats, inter- 

 rupted by lapses and slight extrasystolic 

 beats. The lapses and the extrasystolic 

 accidents take in the space of 2 or 3 nor- 

 mal beats, according as to whether there are 

 1 or 2 extrasystolic beats; full compensating 

 period of rest. The post-extrasystolic alter- 

 nation is well marked and lasts during many 

 beats after the extrasystole. It is well mark- 

 ed on the whole of the right side of the 

 tracing; 20 beats after the extrasystolic 

 one. 

 Observation no. 28. 



Ventricular extrosysioles. 



M. L., de M. mulatto, male, 28 years 

 resident at Santa Maria. 



Examined April 29, 1911. 



He complains of giddiness, palpitation 

 and precordial pains. Pulse arrhythmic, with 

 frequent extrasystoles, sometimes in bigem- 

 inal series. Pulse 62:Tmx.=110. The extra- 

 systoles are of ventricular origin; the a — c 

 intervals lengthened, as may be seen in the 

 tracing. Thyroid ver/ much enlarged, with 

 goiter. 



Record no. 27. 



The radial pulse is interrupted in its 

 rhythm by premature beats of ventricular 

 origin, shown in the venous tracing by high 

 waves; fusion of ci' and c'. A slight lengthen- 

 ing of a c interval is also noticed; this is 

 a sign of a slight alteration of conductibility- 



Observation no. 29. 



Extrasystoles. Lengthening of a-c. Sud- 

 den death. 



L. J. v., mulatto, male, 35 years, laborer, 

 single, resident at Urucuia. 



Previous history: patient only mentions 

 having had intermittent fever several times. 

 Denies venereal disease. Robust constitution, 

 apparently strong. Skin pale, slight general- 

 ised edema, more marked in the face. Has 

 been feeling ill for about eight years. His 

 legs are weak and he has cramp at night. 

 Palpitation, coming on sometimes when at 

 rest, at other tinics on exertion; precordial 

 pulsation, also in the veins of the neck; 

 these beats are strong and uncomfortable; 

 dyspnea on exertion and nocturnal dyspnea. 

 Frequent cough. Constant sensation of gas- 

 tric fulness, with great discomfort and res- 

 piratory difficulties, increased by taking food, 

 however small the quantity. These symptoms 

 have gradually increased so that patient can 

 no longer work. Heart considerably enlarg- 

 ed. Apex beat in the sixth space, 15 cm. 

 from the midsternal line, reaching to the 

 axillary line; right margin 5 cm. from the 

 midsternal line. Precordial shock diffuse, 

 apex shock ample and intense. Heart sounds 

 muffled, especially at the base. No murmur. 

 Bigeminal beats; the second beat has at 

 times two tones, at others only one, simulating 

 the auricular systolic beats which are not trans- 

 mitted, being very muffled. Pulse slow; some- 

 times the extrasystolic beats of the bigeminal 

 group are felt in the pulse, at other times 

 this is not the case. Pulse 46; Tmx.z=l35. 

 The number of beats varies but slightly with 

 the difference of position or on exertion. 

 Lying down 55, standing 58, after exercise 

 56. Atropine test: bigeminism not modified- 

 beats accelerated: 80 per minute (v. tracing). 

 Left lobe of liver slightly enlarged and painful 

 on pressure. Spleen enlarged, not painful. 

 Thyroid enlarged with cystic nodules. 



August 17, 1913. Edema disappeared and 

 all the symptoms improved without any 

 change in the physical condition of the 

 organs. August 20, 1913. Gastric uneasiness 

 more intense. Strong palpitation. Increase of 

 dyspnea on exertion. 58 beats when standing 

 lying down 56. Bigeminism. Tmx.-=120. 

 Physical condition of organs unchanged. 

 On going out from the hospital for a short 

 walk this patient died suddenly. 



