298 STRONG AND CROWELL. 



The pulse was 104, and the knee jerks very active. On the 

 ninety-ninth day the note made was as follows: Pulse, 100; 

 slight visible epigastric pulsation; no visible throbbing over 

 cardiac area; the point of maximum impulse is visible and pal- 

 pable just within the nipple line; the heart sounds are clear; 

 the hoarseness is still present, but the voice is no longer whis- 

 pering ; the oedema has disappeared considerably and is no longer 

 distinct; there is no pain nor tenderness of the legs; the knee 

 jerks are active. Beginning on the one hundred third day, 

 20 cubic centimeters of the extract of polishings were given daily 

 in water in addition to the usual amount of 40 cubic centimeters 

 mixed with the rice. Owing to the general dissatisfaction 

 among the individuals undergoing the experiment regarding the 

 continuance of the diet, the prison officials felt that these pris- 

 oners should be allowed to return to the regular prison 

 ration. It, therefore, became necessary to discontinue the ex- 

 periment on the one hundred eighth day. The note made on 

 the case on this day reads: Subject fairly well nourished; 

 pulse 84, regular and of good volume ; respirations normal ; mod- 

 erate epigastric pulsation; point of maximum impulse visible 6 

 centimeters to the left of the median line and 3 centimeters be- 

 low the nipple line; no visible pulsation over the rest of the 

 cardiac area; area of cardiac dulness not apparently increased 

 beyond the normal limits; the heart sounds are clear; the con- 

 junctivae are of fairly good color; he complains of no pain in the 

 calves of the legs, and there is no tenderness on pressure; there 

 is no oedema of the legs, and the knee jerks are very active; the 

 voice is still somewhat husky, but there is no pain in the throat. 

 He says he feels well, but on closer questioning says that he was 

 much stronger before he began the diet. The urine contains 

 no albumin and no casts. The patient was placed on the reg- 

 ular prison ration (see Table III) and in twelve days had gained 

 4 pounds. His voice gradually became normal, and he has since 

 been well. A diagnosis of beriberi was not made in this case. 

 Nevertheless the symptoms were suggestive of this disease. 

 While it is a well-known fact that all cases of beriberi do not 

 show loss of knee jerks, nevertheless, in an experiment of this 

 nature, a definite diagnosis of beriberi was not made unless the 

 knee jerks had disappeared in addition to the occurrence of 

 other symptoms of this disease. It is impossible to state de- 

 finitely what would have occurred had the original diet been 

 persisted in for a longer period of time. 



