49 



muffled isolated tone is heard correspond- 

 ing to auricular systole. Pulse rate: stand- 

 ing 25; lying down 24. 



before -24 ps. Tmx. 105. 

 Katzenstein ^ during-25 ps. Tmx. 100 

 after -25 ps. 



in! 



Liver and spleen not enlarged . 



Examination August 17, 1913. 



General condition middling. Subjective 

 symptoms almost nil. No edema. Heart en- 

 larged. Transverse diameter: 15,5. Pulse 

 rate 29, not changing in different positions. 

 Tmx.:=130. Sounds muffled. Auricular tone 

 with non-transmitted auricular systoles, dis- 

 tinctly audible during the ventricular dias- 

 tole. Beats of neck veins very visible. Liver 

 slightly augmented, not painful on pressure. 

 The patient died suddenly in 1916 whilst at 

 work . 



Records nos. 53, 53-A and 53-B. 



I) The radial and cardiac records simi- 

 lar; beats slow and rhythmic, rate 30 per 

 minute. 



lu the venous record there are more 

 frequent auricular waves, one ventricular 

 wave to every three auricular waves, of 

 which two are blocked; there Is regular 

 block in the rhythm of 3:1. Is it block or 

 simply coincidence that the auricular is three 

 times more accelerated than the ventricular 

 one? It is impossible to decide this point 

 by the record of the tracing. 



II) and III) These records taken at in- 

 tervals of one or two years from the pre- 

 ceding clearly show the complete block. 

 The ventricles beat at their own idioventric" 

 ular rhythm. In record II the beats are nox 

 rhythmic, there being slight variations be. 

 tween one cycle and the other. 



Observation no. 55. 



Total block. 



J. C. B., white, male, 30 years old, 

 resident at Paraopebeba. 



Previous history obscure. The patient 

 complains of dyspnea on exertion and gid- 



diness. No vertigo. Lateral lobes of thyroid 

 hypertrophied. Liver enlarged . Pulse slow 

 and regular, accompanying the heart beats. 

 Rare extrasystoles. Pulse rate 34 beats. The 

 simple inspection of neck veins already 

 shows distinct signs of alterations of con- 

 ductibility. 



Examined August 24, 1912. 



Qenerel condition middling, with relat- 

 ive compensation. Good appetite, normal 

 digestion. No dyspnea either at night or 

 when lying down. Dyspnea on exertion. 

 No giddiness or seeming epileptic fits. No 

 edema. The patient states that his feet and 

 hands go to sleep and feel cold. Heart en- 

 larged; apex beat 11.5 cm. from the mid- 

 sternal line. Right margin 4 cm. from the 

 same. Sounds muffled. In the ventricular 

 diastoles is heard a short tone of isolated 

 contraction of the auricles, without fixed 

 relation to the ventricular systoles. 38-40 

 beats to the minute. Tmx. =110. Liver en 

 larged, hard, painful on pressure. 



Records nos. 54 and 54-A. 



February 12, 1911. 



Cardiogram and sphygmogram of slow 

 regular rhythm, exactly corresponding to 

 one another. In the diastolic phase on the 

 cardiogram are seen auricular waves which 

 are not in relation to the ventricular systo- 

 le. These waves are also marked in the 

 catacrotic phase of the pulse. It is these 

 characteristics that allowed us to affirm 

 that there is a total block which is confirm- 

 ed by the analysis of the venous record. 

 The a waves more frequent than the ven- 

 tricular waves which do not depend on them. 

 The ventricles beat according to their own 

 idioventricular rhythm. Record 54 a is not 

 to be distinguished from the preceding; it 

 shows the persistence of the block at an 

 examination made a year and a half later. 



Observation no. 56. 



Auricular tacky systole (auricular flutter) 



F. N. , male, 25 years old, resident at 

 Lassance. 



