35 



Record no. 36-A 



A quarter of an hour after the injection 

 of 0,g 001 of atropine the pulse has become 

 regular, there remaining a perceptible 

 lengthening of a c interval. The acceleration 

 of the rhythm is as follows 77:83. 



Observation no. 38. 



Partial block. Bi- and trigeminal rhythm, 



E. S., male, about 30 years old. Previous 

 history obscure. Cretinised appearance. Mouth 

 half open, with saliva running down at the 

 corners. Defective speech with marked gen- 

 eral trembling. Bilateral dysbasia, the pa- 

 tient admitting previous paralytic condition. 



Patellar reflex on both sides very much 

 exaggerated. Intellect much below the nor- 

 mal. Liver and spleen much enlarged. Nu- 

 merous glands in the neck, in the axilla 

 and in the inguinocrural region. Thyroid 

 not noticeably enlarged. Pulse arrhythmic, 

 with bigeminal appearance, sometimes tri- 

 geminal, sometimes with beats in regular 

 succession; there appear to be extrasystoles. 

 Pulse lying down 52: standing 57. Tmx.=; 

 135. Signs of cardiac insufficiency; partial 

 fatigue on exertion; giddiness and uncom- 

 fortable palpitation which prevent him from, 

 working. 



Record no. 37. 



The tracing of the heart and pulse have 

 bi-and trigeminal appearance, interrupting 

 a succession of slow beats. This is caused 

 by the partial and irregular block of auric- 

 ular waves. The auriculo-ventricular rhythm 

 is sometimes 1:1, sometimes 2:1. The slow 

 beats show the rhythm of the block to be 

 2:1 and 3:1. The origin of some beats, as 

 for instance X, is doubtful; it is perhaps 

 heterogenetic, not depending on a 13 as 

 might also be interpreted. The polygraph is 

 not enough to decide this question. 



Observation no. 39. 



Partial block; irregular rhythm 2:1 and 

 /:/; Cardiac insufficiency; Sudden death, 1 



G. N., mulatto, male, 40 years old, la- 

 borer, married, resident of Burytys. Novem- 

 ber 11, 1913. Previous history includes at- 

 tacks of malaria, gonorrhoea and probably 

 syphilis. Does not mention rheumatism. For 

 some time past has suffered from palpita- 

 tion, rapid, strong and annoying beats, with 

 respiratory difficulty, localized in the precor- 

 dium and the vessels of the neck, coming 

 on in attacks provoked by emotion or with- 

 out perceptible cause. Dyspnea on exer- 

 tion and at night. He is always short of 

 breath. Gastric pains and headaches. This 

 patient has had attacks of intermittent fever 

 and has frequent giddiness. 



He is above middle height and of strong 

 constitution. 



Intense jaundice; at present he has no 

 edema, nor does he mention any in the 

 past. General trembling, when examined 

 very intense from emotion, afterwards di- 

 minishing. Heart much enlarged, apex beat 

 in the fourth space, 13 cm. from the mid- 

 sternal line. Right margin 6 cm. from the 

 mtdsternal line. Precordial shock ample, out- 

 side the nipple, the third and fourth inter- 

 costal spaces retracted in the precordium. 

 First heart sound very muffled, followed by 

 murmur with an area inside apex. Second 

 sound reinforced in the pulmonary area. 

 Rhythm of three beats at apex, the addition- 

 al tone clearly separated from the first 

 murmur. Pulse slow, irregular, arrhythmic 

 with frequent lapses; the number of beats 

 varies from 52 to 56. In the long pauses of 

 ventricular systoles is heard a shock, and 

 also a sound synchronous with the venous 

 wave of the jugular; auricular systole not 

 transmitted. The beating of the neck veins 

 is clearly seen as also that they are more 

 numerous than those of the pulse; clearly 

 perceived are also the venous waves which 

 coincide with the cardiac sound as well as a 

 slight shock, without ventricular contraction. 

 Tmx.==]10. Liver and spleen much enlarged. 

 Thyroid enlarged; has cystic nodules. 



November 13, 1912. After resting and 

 treatment this patient got much better. All 

 his symptoms diminished. Cardiac area per 



