29 



The histopathologic examination of the 

 heart was made by Professor B. C. Crowell, 

 who found lesions peculiar to trypanosomi- 

 asis, this case being one of those which 

 enabled him to establish the histopatholo- 

 gic characteristics of ihe cardiac lesions in 

 the chronic form of Chagas' disease. 



Record no. 28 and 28-A 



I) The radial tracing is that of a slow 

 arrythymic pulse, with cycles varying very 

 much in length; in some ther^ are extrasys- 

 tolic beats. 



The cardiac tracing is of bigeminism; 

 the groups of bigeminal beats vary in their 

 succession. Some of the auricular waves are 

 well marked in some points of the cardio- 

 gram. 



The first beat of the extrasystolic group 

 is of the dominant rhythm. The jugular pulse 

 shows that it is always preceded by an 

 auricular wave and that the a—c interval is 

 lens^thened. The second beat of the bigeminal 

 group is extrasystolic. The origin of the 

 extrasystoles is in some points frankly auric- 

 ular. Others seem to be auricular, like that 

 which accompanies the radial beat II and 

 that which is marked in the right half of 

 the tracing. Others are probably nodal, like 

 those which are registered bv acute and 

 high waves in tracing II. 



II) The rate of the auricular waves is 

 arrhythmic and some are blocked. The causes 

 of the arrhythmia of the pulse are con- 

 sequently multiple and very difficult to ana- 

 lyse. Atropine had no appreciable action to 

 be seen on the tracing, except acceleration. 



Observation no. 30. 



Extrasystole, 

 interval. 



Lengthening of the a—c 



D. M. da C. ; negress, 60 years old, 

 widow, resident in the neighborhood of 

 Lassance. 



Examined March 9, 1913. 



Previous history obscure, intellect of 

 very low order, so that it is very difficult 

 to question the patient. She complains of 



palpitation, dyspnea on exertioii, dyspnea 

 when lying down and at night, so that she 

 cannot sleep. No edema. Heart much enlarg- 

 ed, apex beat outside the mammillary line 

 at 11 cm. from the niidsternal line. Right 

 margin 4 cm. outside the midsternal line. 

 Irregular beats with numerous exiiasystoles 

 sometimes in bigeminal series. Sounds muf- 

 fled, no murmurs. Pulse 56, irregular and 

 arrhythmic. Tmx.=145 Left lobe of liver 

 slightly enlarged. Spleen not palpable. Ner- 

 vous system negative. Thyroid enlarged. 



Reexamined April 19, 1913. Dyspnea 

 on exertion, when lying down and at night. 

 Sleeplessness. Generalised though slight ede- 

 ma. Bases of the lung congested. Frequent 

 cough. Heart enlarged; apex beat in the 

 fifth space on a level with the anterior axillary 

 line. Heart sounds muffled, principally the 

 first. IVlarked swelling of the neck veins, 

 with scarcely noticeable pulsations. Pulse 55. 

 Liver rather enlarged. 



Record no. 29 



The radial and cardiac tracing show 

 bigeminism, with some beats of the domi- 

 nant rhythm at the right side of tracing. 

 The second beat of the bigeminal group is 

 extrasystolic ; the extrasystoles are nearly 

 all ventricular. The marking of the tracing 

 indicates our interpretation of it; a c inter- 

 val lengthened so that the conduction of the 

 contractile stimuli is delayed. 



Observation no. 31. 



Ventricular extrasystoles. Lengthening of 

 the a—c interval. 



iVl. P. dos S.; mulatto, female, 33 years, 

 married, resident at Lassance. 



Examined April IS, 1913. 



Has been ill for about twelve year? 

 and thinks her illness began after child birth, 

 when she had fever for fifteen days. Her 

 subsequent confinements aggravated her 

 condition and after the last, a year ago, she 

 became much worse. Present condition: 

 Slight icterus. Cyanosis. Edema of the lower, 

 extremities aud trunk, however not very 



