53 



venous pulse, which 1 compared with U 

 and III shows that atropine does not ap- 

 pear to have modified the arrhythmia. 



Observation no 61 . 



Complete arrhythmia. Cardiac insuffici- 

 ency. Spasm of esophagus. 



P. N. A., black, female, 41 years old > 

 single, living in Vargem da Palma. 



Examined August 24, 1013. 



General slight edema. Turg^iditv of neck 

 veins. Gastric disturbances, lack of appe- 

 tite. Spasm of esophagus, gieat difficulty 

 in swallowing solid food so that she is 

 obliged to drink water after each mouthful. 

 Dyspnea on exertion and when lying down. 



Heart much enlarged, apex beat beyond 

 the anterior mammillary line. Right margin 

 5 cm. outside the midsternal line. First 

 sound accompanied by systolic murmur, 

 audible at the back. Number of beats lying 

 down 66; seated 72; standing 82. It is dif- 

 ficult to count as there is complete arrhyth- 

 mia. Tmx.— 135. Liver much enlarged. 

 Spleen not enlarged. Thyroid with large 

 goiter. 



August 28, 1912. 



Improvement of all the symptoms by 

 treatment; no change in cardiac area. 



Record no. 60. 



The radial, cardiac and jugular tracings 

 are similar; the latter has the aspect of 

 ventricular venous pulse. The waves are bi- 

 and trigeminal but the intervals between 

 them are most irregular. It is a tracing 

 of complete arrhythmia of auricular flutter; 

 the a waves do not appear on the jugular 

 tracing. 



Observation no. 62 



A. S., male, white, 33 years old, widow- 

 er, laborer, lesident in the neighborhood 

 of Lassance . 



Examined April 13, 1Q13. 



Very short but robust. Marked paleness 

 of skin with special coloring. Mucous 

 membranes rather discolored. Slight not con- 



stant edema of face. Previous history; noth- 

 ing worth mentioning. Had grippe during 

 the great epidemic. For about three years 

 he has had a feeling of fatigue on the slight- 

 est exertion; he gets tired after quick walk- 

 ing or climbing up hills, or even when at 

 his usual work. Sometimes has palpitation 

 and feels as if his heart were stopping. He 

 is subject to giddiness, which comes on 

 after exertion or even without any percep- 

 tible cause. Heart not enlarged. First sound 

 slightly muffled; second not altered; there 

 is mesosystoiic murmur in the pulmonary 

 area. 76 beats, with frequent extrasystoles, 

 which appear either isolated or in long bigem- 

 inal series. Arteries not hardened. Thyroid 

 enlarged, with cystic lobules. Examination 

 of other organs negative. 



In her house were found numerous in- 

 fected specintens of Triatoma 



Several electrocardiagraphic records were 

 taken of this patient. We g.ve n. 1 and 2 

 Complement fixation reacticn positive (with 

 heart of a dog infected by Tryp. Cruzi as 

 antigen). 



Record no. 6l. 



Was made with derivation 1 (right arm- 

 left arm). The time marked is 1/25 of a 

 second. The derivation of the galvanome- 

 ter is 2 cent, to O.OOl volts. The left 

 side of the record shows a succession of 

 rhythmic regular contractions, in which note 

 the deviations P. Q. R. S. and T. The PP. 

 waves have nothing interesting about them. 

 The space PQ is within the normal limits, 

 less than one fifth of a second. S phase 

 does not appear. T is inverted in all the 

 cycles. At the right side of record are seen 

 4 extrasystolic beats in bigeminal series. 

 The extrasystoles are of ventricular origin 

 and of the type which springs from the 

 area situated in the right ventricle. The 

 variation of the auricular systole appears in 

 the diphasic variation of extrasystole in nor- 

 mal time. 



Record 2 of the same patient. Deriva- 

 tion HI (left arm-left leg). Time 1/50 of a se 



