36 



ceptibly reduced. Apex at 10,5 cm. from the 

 midsternal line and right margin at 4,5 cm. 

 The pulse remained irregular. Sometimes 

 longer and sometimes shorter pauses. Num 

 ber of beats varying from 50 to 52. The 

 atropine test regulated the pulse, as is seen 

 in the tracings, though there appeared rare 

 occasional extrasystoles. Liver and spleen 

 still enlarged. We did not see the patient any 

 more, but heard that he died suddenly in 

 July, 1913. 



Records no. 38 and 38A. 



These tracings were taken on successive 

 days and show the same characteristics. 



The radial pulse shows occasional, per- 

 ceptibly rhythmic, beats, whose sequence is 

 interrupted by shorter cycles, which appear 

 irregularly. The cycles of long pauses are 

 twice less than those of short pauses. All 

 the heart-beats are amply represented in the 

 radial pulse. 



In the venous pulse the auricular waves 

 are rhythmic and more frequent than the 

 ventricular ones; not all the auricular waves 

 are followed by the corresponding ventricu- 

 lar wave. Thus a I and a III are blocked, 

 not being accompanied by ventricular sys- 

 tolic wave, a II corresponds to radial beat 

 I with the a c inteival lengthened with re- 

 tarded conduction of the stimulus. 



In the radial beats 2 to 3 and 4 to 5 

 the a waves are successively accompanied 

 by ventricular c waves, with the ac interval 

 gradually lengthening from one cycle to 

 another. 



Collectively the tracing registers a par- 

 tial block in rliythm 2:1, with irregular re- 

 turn to rhythm 1:1. 



The tracings 38 b, 38 c, and 38 d show 

 the action of Og 00075 of atropine. 



In tracing 111 may be seen extrasystolic 

 beats with complete compensating period 

 of rest. They are ventricular extrasystolic 

 beats. The stimulus is conducted through 

 all the auricular waves biU the a c interval 

 is lengthened. 



In tracings 38 c and 38 d the pulse is 

 perfectly rhythmic, but the lengthening of 

 a c continues. 



The elective action of atropine on the 

 conductibility must be noticed, and there is 

 no perceptible acceleration of the auricular 

 beats. 



Observation no. 40. 



Partial block. 



J. S., male, 11 years, white, resident at 

 Lassance. 



First consultation March 3, 1913. Born 

 at term; normal development. Family history 

 obscure. Former illness: repeated attacks of 

 malaria. This patient complained of fatigue 

 and general weakness. Skin discolored and 

 slight general edema. His face was swollen 

 with marked subpalpebral infiltration; base 

 of the thorax enlarged; abdomen flaccid 

 aud voluminous. Liver enlarged, passing the 

 costal margin by two fingers and measuring 

 11 cm. in the mammillary line; the edge sharp 

 and hard and not painful on pressure. Spleen 

 enlarged and hardened. Epigastrium promi- 

 nent with marked gastric tympanism. Thy- 

 roid enlarged. Cervical and inguinal glands 

 enlarged. Bronchitis of the larger bronchial 

 tubes diminishing. Nothing noteworthy in 

 nervous system. Circulatory system: Heart 

 enlarged, apex beat in the fifth spsce outside 

 the mammillary line, 9 cm. from the midster- 

 nal line; right margin 4cm. from the mid- 

 sternal line; upper margin reaching the sec- 

 ond rib. Arrhythmic beats, with frequent 

 lapses; no sounds to be heard during the 

 lapses. The first sound not perceptibly chang- 

 ed except that it is slightly muffled. Meso- 

 systolic murmur at apex, musical, not pro- 

 pagated. Second sound reduplicated, with 

 pulmonary reinforcement. Number of beats 

 lying down 82; standing 118. Tmx.=105. 

 Katzenstein: before compression of the fem- 

 orais 82 beats; arterial tension 105; during 

 compression 86 beats; tension 105; after 82 

 beats. An injection of 3/4 of a milligram of 

 neutral sulphate of atropine produced the 

 following modifications; 104 beats per min 



