48 



Convulsions, fits of agitation, with intervals 

 of rest. Deatli followed from heart-failure. 

 A histopathologic examination of the heart 

 was made by Professor Crowell, this being 

 one of the cases which he has used for his 

 description of the specific lesions of the 

 heart in the chronic form of Chagas' disease. 



Record no. 51 



Pulse and cardiac tracing slow, 32 beats. 

 The phlebogram shows that the a waves 

 appear more frequently than the c waves, 

 without keeping up constant relations. To- 

 tal auriculo-ventricular disconnection. 



Record no. 51 A. 



The disconnection persistent The in- 

 jection of atropine half an hour previously 

 did not improve the conductibility. The 

 number of auricular beats diminished a little, 

 61 beats, instead of 66, as in the former 

 tracing. 



Record no. 51-B. 



An hour after the atropine injection the 

 auricular rate has returned to 66 per minute 

 without changing the auriculo-ventricular 

 dissociation. 



Observation no. 53. 



Total block. Stokes' syndrome. 



M. R. L., white, female, 38 years old 

 resident at Curvello. . 



The patient states that she has had un- 

 defined attacks of fever for about five years. 

 ■About ■> year ago she had fever again, with 

 edema. Traces of hypoovarism, deficient 

 menstruation. Very marked bronze coloring- 

 Thyroid slightly hypertrophied Convulsive 

 crises, which come on at irregular intervals 

 of a week or more. During the crises the 

 convulsions sometimes recur every five or 

 ten minutes. Painful sensations. A feeling 

 of pain and prickling over her tieart. Pulse 

 slow, 33 beats, accompanied by cardiac 

 beats. Sometimes extrasystoles. The analysis 

 of the tracing shows that it is evidently a 

 case of total block. 



Record no. 52. 



Radial pulse ample, slow, beating at 

 unequal intervals and with unequal amplitude 

 A perfect analysis of tracing cannot be made- 

 as the marking of the time was defective' 

 Heart tracing ample, the auricular waves' 

 with exceptional rises; it is only by their 

 location in different points with relation to 

 the rises of thf; ventricular systoles that the 

 diagnosis of cardiac block can be made. 

 The jugular pulse confirms this diagnosis. 

 The a a waves are vry frequently repeated, 

 and rhythmically, not in relation to the c c 

 waves. For each group of 10 f r waves 

 there are more or less 26 a a waves. The 

 block is total. 



Observation no. 54 



Tota/ block. Stokes-Adams' syndrome. 



G. S., white, male, 50 years old, mar- 

 ried, resident of a place near Lassance. 



First examined April 9, 1910. Previous 

 history obscure; he only mentions vague 

 attacks of fever. For about ten years he has 

 had giddiness and fainting [its which last 

 from fifteen to twenty minutes. Hypertro- 

 phy of the lateral lobes of thyroid. Pulse 

 slow, 37 beats; number of heart beats the 

 same. On auscultation there seems to be 

 a murmur added to the second sound, prob- 

 ably auricular. 



April 13, 1910. 



Pulse beats equal to heart beats; that is 

 29 General condition middling. Dyspnea 

 on exertion, after walking quickly, or heavy 

 work. When walking at ordinary pace the 

 patient can liowever do four leagues and 

 more without much fatigue. No dyspnea 

 when lying down and sleeps well in hori- 

 zontal position. No edema and no more 

 giddiness. Heart enlarged, apex beat in 

 fifth intercostal space at the level of mammil- 

 lary line. Transverse diameter 14 cm. First 

 sound lengthened and muffled. Systolic mur- 

 mur at apex with small area of propaga- 

 tion. Second sound reduplicated with pul- 

 monary accentuation. During the diastole a 



