ETIOLOGY OF BERIBERI. 319 



no albumin and no casts. He says he feels better than he did be- 

 fore the last change was made in his diet, but weaker than he 

 did before he began the experiment. He had lost 6.1 kilograms 

 (13.5 pounds) during the time he was on the diet. Although this 

 patient had some of the important symptoms of beriberi, a de- 

 finite diagnosis of the disease was not made. Three days after 

 the change to the regular prison ration he had gained 1.5 kilo- 

 grams (3.5 pounds) . 



CASE NO. S (GROUP II). 



Diet: White rice 97 days followed by red rice ] 



20 days, together with the special diet com- '^^^^^ P^""'^ <^^ experi- 

 mon to all the groups. | "'^"*^' ^^'^ <^^y^- 



Dried codfish and potatoes were added to the diet on the 97th day. 



Following is a summary of the notes of the case : Percussion of 

 lungs shows no dulness; on auscultation, respiratory sounds 

 slightly roughened at apices and somewhat enfeebled ; no tubular 

 modification of the sounds and no rales are present; posteriorly 

 the respiratory sounds are normal; examination of the heart 

 shows no increase in the area of dulness beyond the normal ; the 

 point of maximum impulse is invisible; it is palpable 7.5 centi- 

 meters to the left of the median line and 2 centimeters below the 

 nipple line ; the heart sounds are clear at the apex and base ; there 

 is no epigastric pulsation ; the pulse is 88, and the systolic blood 

 pressure 110 millimeters Hg; the spleen and liver are not en- 

 larged ; the knee jerks are active. 



The notes of this case up to the sixty-fourth day are unim- 

 portant except that he had lost 2.7 kilograms (6 pounds) in 

 weight. On this day there was slight bilateral prsetibial pitting. 

 There was no complaint of pain. On the seventy-first day the 

 note was made : Point of maximum impulse invisible and not dis- 

 tinctly palpable; no heaving of chest wall; pulse slow and reg- 

 ular; heart sounds normal and normally spaced; cedema of legs 

 distinct ; knee jerks active. On the seventy-fourth day he com- 

 plained of weakness and pains throughout the body. He re- 

 mained in bed and ate no dinner or supper. The pulse was 88. 

 On the seventy-seventh day the pulse was 80. He had been feel- 

 ing better since the last note was made. On the seventy-eighth 

 day he complained of pain and tenderness over the region of the 

 right shoulder. On the eighty-first day the pain was better. 

 The knee jerks were still active. On the eighty-fourth day the 

 knee jerks were active. The oedema of the legs continued, and 

 the calves were tender on pressure. On the following day the 



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