316 STRONG AND CROWELL. 



legs for several months; his knee jerks are absent; states that 

 he has never had beriberi ; age about 35 years ; the examination 

 of the lungs shows on percussion, anteriorly, general diminished 

 resonance on both sides, more marked on the right side; no 

 special areas of dulness; the respiratory sounds are slightly en- 

 feebled over the right upper lobe of the lung anteriorly ; evidently 

 there is an old thickening of the pleura ; on auscultation no rales 

 are heard ; there is no tubular modification of the breath sounds. 

 The examination of the heart show^s no increase in the area of 

 dulness ; the point of maximum impulse is not visible ; very indis- 

 tinctly palpable, 7.5 centimeters to the left of the median line 

 and 2.8 centimeters below the nipple line; on auscultation, the 

 first sound at the apex is slightly prolonged, but there is no dis- 

 tinct murmur; neither second sound is accentuated; there is no 

 epigastric pulsation ; the pulse is 96, and the systolic blood pres- 

 sure 102 millimeters Hg; the liver flatness extends from the 

 lower border of the fifth rib ; the liver is not palpable below the 

 costal margin; the spleen is not palpable. 



Although he ate fairly well at first, he lost rapidly in weight, 

 and after one month weighed 4.5 kilograms (10 pounds) less than 

 when the experiment was begun. On the thirtieth day of the 

 diet, the note made was as follows : Tongue swollen and reddened ; 

 slight erosions on the corners of the mouth; hordeolum on left 

 lower eyelid; pulse 104, rather weak; temperature 99, respira- 

 tions 18; complains of sore throat, and the voice is hoarse; there 

 is no tenderness of the calf muscles, and no oedema of the legs ; 

 there is impaired sensation to touch and pain over the skin about 

 the ankles. On the thirty-fourth day the following note was 

 made. Complains of sore mouth and throat; gastric pain and 

 soreness of the calves of the legs; the pain in the calves of the 

 legs has persisted for two days. He is somewhat constipated. 

 A mouth wash of tincture of myrrh and of boric acid, for hourly 

 use, and fluid extract of cascara sagrada, for nightly use, were 

 prescribed. The sores on the corners of the mouth and on the 

 lips were touched with a solution of silver nitrate. The patient 

 grew gradually weaker. A marked catarrhal conjunctivitis 

 developed, which was treated locally. On the fifty-fourth day 

 he was taken to the prison hospital with a temperature of 

 38°. 6. The same diet was taken to him at the hospital, and 

 he was not supposed to eat anything else, but we can not be 

 absolutely sure that during the time which he spent in the hospi- 

 tal he did not sometimes eat other food. It seemed possible that 

 his slight rise of temperature which continued for about two and 



