a7 
August 21: The hypesthesia around the mouth has disappeared. The mouth can 
be closed normally. The extension of the fingers is improved. The hypesthesia 
of the abdominal wall has almost entirely disappeared; that of the extremities is 
much improved. ‘The motility in the knee joints is better. The feet and toes 
‘an now be moved in a normal manner. The appetite is good. Stools three 
times a day. The patient can now walk with the aid of a cane. 
August 28: Hypesthesia is present only below the elbow and below the knee 
joint. , 
September 6: Pulse 72. The heart’s dullness on the right side is found in the 
left sternal line and on the left side in the left mamillary line. Heart sounds 
pure, Second pulmonic is not accentuated. The extension of the fingers is 
still somewhat insufficient. The patient can now walk well with the aid of a 
cane; however, his gait is still a little unsteady. 
CASE No. II. 
S. O., 23 years old; infantry. here is no hereditary taint. The patient has 
always been well and has never suffered from any severe disease. Some time 
before the beginning of November, 1904, he noticed a loss of appetite, palpitation 
of the heart, and edema of the legs. He also had a pain in the calves, and it was 
noticed that the patellar reflex was absent. The heart’s area of dullness was 
increased both toward the right and toward the left. Accentuation of the heart 
sounds. 
November 22: Pulse 108. There is no fever. There is violent palpitation of 
the heart. The first mitral sound is impure, and the second pulmonary sound 
is accentuated. There is edema over the whole body. The abdominal wall and 
the lower extremities are hypesthetic. 
Therapy: Infusion of digitalis and kali aceticum. 
December 10: Appetite is good. All the symptoms are improved. 
December 13: The pulse is 100 and the temperature 36.7. There is one stool 
daily. The patellar reflex is absent. 
January 27 (1905): The heart dullness at the right side is in the mid-sternal 
line. This patient came to the Shibuya Hospital with the foregoing history on 
February 8. 
Status praesens: Poorly nourished, medium-sized man. Pulse 124; tempera- 
ture 36.°8. Tongue clean; extremities very much emaciated. The first mitral 
sound is impure; the second pulmonic sound is accentuated. Appetite good. 
Stools once daily. The patellar reflex is absent on both sides. Paresthesia and 
hypesthesia on the lower extremities are confined to the feet. The muscles of 
the calf are sensitive to pressure. The dorsal flexion of the left hand is insufti- 
cient. All the fingers are in a flexed position and can not be extended. However, 
the hand and the fingers of the right side are almost normal. The motion at the 
knee joints is almost normal, but the feet and toes on both sides are totally 
immobile. 
April 10: The left boundary of the heart’s area of dullness is one finger’s 
breadth inside the left mamillary line. At the apex the first sound is dull; the 
second pulmonic sound is accentuated. Pulse 120. Patellar reflex slightly 
present. The muscles of the calves are not so sensitive to pressure as previously. 
The motility of the hands and fingers is improved. 
Therapy: Decoctum chine. 
April 11: The thenar and hypothenar eminences are much emaciated. 
April 22: The muscles of the legs show complete E. A. R. (reaction of de- 
generation). — 
April 26: Both feet are in an equino-varus position, in consequence of which 
they can not be used. 
