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PLATES 59 TO 64.The modifications in the form of the T wave of the electrocardiogram which we report in this communication were observed in the course of detailed studies on the action of digitalis in patients ( I ) , It has been noticed frequently that the time when digitalis takes .effect is a matter of uncertainty, so that in a given instance doubt is often entertained as to whether the drug itself is active, and if active, whether it is effective in producing a result. To be certain that the drug is effective, it has been considered necessary to administer it until an alteration in the rhythm of the heart occurs. In our treatment of patients we have, therefore, looked for evidences of altered heart rhythm to indicate that the heart is really digitalized. During the period of treatment, electrocardiograms were made almost daily, and often more than o.nce a day. In examining these records we found the changes in the T wave which we describe in this report.Other observers have published studies dealing with the effect of a number of agents, including digitalis, on the electrocardiogram. The only investigation dealing with this subject in human beings has been made by Nicolai and Simons (2). Seven ambulatory patients were given powdered digitalis, o.3 gin. daily, for five days. In two women the treatment was not completed; in one normal man the T wave did not increase in height, but decreased instead (" verschlechterte sich') ; and in the other four the T wave increased. They limited the taking of records to the first lead (right arm to left arm). Even if the * A preliminary report was made to the Section on Medicine at the Seventeenth International Congress of Medicine, London, I913, Section VI, 255--258. Re-

A 62 year old woman admitted with a history suggesting acute myocardial infarction had thrombolytic treatment with anisoylated plasminogen-streptokinase activator complex, which resulted in submucosal haemorrhage in the oesophagus; this caused dissection of the wall of the oesophagus and complete dysphagia. The haematoma resolved spontaneously, leaving behind a diverticulum, with reduced peristalsis and delayed emptying but no obstruction. (Thorax 1992;47:835-836) Thrombolytic treatment is now an established part of treatment for acute myocardial infarction. Serious haemorrhagic sequelae, though rare, are a recognised complication of thrombolytic treatment. We describe a case of submucosal haemorrhage in the oesophagus that followed treatment with anisoylated plasminogen-streptokinase activator complex.

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