47 



Records no. 50-A, 50-B. 



They show that atropine had no influ- 

 ence on the conductibility, accelerating the 

 auricular beats slightlv. The ventricular rate 

 slower owing to the lesser number of ex- 

 trasystoles. 



Observation no. 52. 



Complete block. Stokes-Adams' syndrome. 



I. F., mulatto, female, 20 years, single, 

 resident at Bananal, near Lassance. 



Less than average height. Earthen pale- 

 ness. Cretin-like appearance with slight ex- 

 ophthalmia. No noticeable asymmetry of face. 

 Complains of fatigue, giving way of legs, 

 general trembling which prevents her from 

 working. Strong, measured heartbeats, bring- 

 ing on agony, a feeling of oppression, 

 agony in the chest and the throat. Almost 

 constant feeling of depression and discour- 

 agement with weeping fits without any 

 real cause. She has had giddiness and ver- 

 tigo, sometimes with loss of consciousness. 

 Constant uncalled-for sadness, always agony; 

 general limpness. During the examination, 

 the emotion brought on an attack of strong 

 and uncomfortable beats. The rate and 

 rhythm of the beats, however, did not dif- 

 fer from those observed at other times. 

 Dyspnea on exertion and when lying down. 

 She has been ill for a long time, having 

 grown worse in the last three months. 



Does not mention edema before, nor 

 has she any at present. 



Heart much enlarged, apex beat in the 

 sixth space at the level of the anterior axil- 

 lary line. Right margin 4,5 cm. from the 

 niidsternal line. Transverse diameter 16,5 

 cm. Precordial shock strong and diffuse. 

 First sound lengthened and accompanied by 

 murmur audible in the whole of the car- 

 diac area, with slight propagation towards 

 the axilla. Second sound reduplicated. Pulse 

 slow and ample, the number of beats va- 

 ries from one moment to another, oscilla- 

 ting between 27 and 32. Different! polygraph- 

 ic records were taken. Tne atropine test 



was also made and did not increase the 

 number of pulse beats. Liver enlarged, pain- 

 ful on pressure. Spleen slightly enlarged 

 (previous history includes malaria). Mo mark- 

 ed digestive trouble. Appetite good; digest- 

 ion good; does not complain of indigestion. 

 Thyroid enlarged, with large goiter. Regu- 

 lar menstruation at right time, scanty, ac- 

 companied by abdominal pains and colics, 

 general condition being much worse at such 

 times. Feeble intellect. Apathetic. Uneasy 

 and uncertain movements. Patellar reflexes 

 slightly exaggerated. During the two and half 

 months in which the patient was under ob- 

 servation there was little change in her con- 

 dition . The "agony" continued and also the 

 inability to work, frequent fits of weeping, 

 undefined and constant sadness. Sleepless- 

 ness. Profuse perspiration especially of hands 

 and feet. Cardiac area unchanged. Pulse 

 varying between 27 and 36. 



Examined ¡Warch 7, 1911. 



Complains of general indisposition, head- 

 ache, profuse perspiration, pains in her legs, 

 giddiness even when lying down; all these 

 symptoms have become worse in ¡the last 

 few days. On the day of examination she 

 had bilious vomiting with marked epigas- 

 tric feeling of anxiety. Icterus. Furry ton- 

 gue, with constant bitter taste. The patient 

 complains of heat although the temperature 

 does not rise above 36,8. Rapid emaciation 

 ill the last few days. No perceptible change 

 in heart as compared 'to the result of 

 former examinations. Cardiac area not mod- 

 ified. Pulse, 32 beats. Liver enlarged, but 

 not very much. Urine: no albumen. Abun- 

 dant bile pigments. This state]with a slight 

 change for the worse until ninth. 'From the 

 ninth to the tenth frequent convulsions 

 came on with loss of consciousness. Pulse 

 feeble, oscillating betwenn 25 and 28. Su- 

 perficial respiration interrupted by deep 

 sighs. The attack came on at ever shorter 

 intervals, the patient comatose,'the coma last- 

 ing for about twelve hours During the 

 coma the pulse was irregular, sometimes 

 slower, sometimes more rapid, at times verv 

 slow with pauses of from 10 to 15 seconds. 



