ETIOLOGY OF BERIBERI. 321 



of the legs. The knee jerks were absent. On the following day 

 the pulse was 92, and on the one hundred fourth day it was 

 76. The patient's condition did not change much during the next 

 two weeks. During this time he had not gained in weight. On 

 the one hundred seventeenth day the diet was discontinued, and he 

 was placed upon the regular prison ration. Two days later the 

 following note was made : Pulse 88 ; no epigastric pulsation ; the 

 point of maximum impulse is invisible; it is palpable 9.25 cen- 

 timeters to the left of the median line ; the first sound of the heart 

 is prolonged at the apex ; there is no distinct murmur; the cardiac 

 dulness extends 2 centimeters to the left of the nipple line and 

 to the right not beyond the edge of the sternum ; the nutrition is 

 fair; there is still marked pain and tenderness in the calves of 

 the legs; the oedema of the legs has disappeared; the knee jerks 

 are absent; the examination of the urine showed no albumin and 

 no casts; he states that he feels somewhat stronger since the 

 change in diet. Three days after his return to the regular prison 

 ration he had lost 1.3 kilograms (3 pounds). He gradually re- 

 covered. This man evidently suffered from beriberi. 



CASE NO. 'J (GROUP II). 



Diet: White rice 97 days, together with the special diet common to all the 

 groups. 



Following is a summary of the notes of the case : Fairly well- 

 nourished individual; percussion of the lungs shows no dulness; 

 on auscultation the respiratory sounds are normal ; examination 

 of the heart shows no increase in the area of cardiac dulness 

 beyond the normal; the point of maximum impulse is invisible; 

 it is palpable 6.5 centimeters to the left of the median line and 3 

 centimeters below the nipple line; the heart sounds are clear at 

 the apex and base ; there is no visible epigastric pulsation ; the 

 pulse is 86, and the systolic blood pressure 100 millimeters Hg 

 (Faught) ; the liver and spleen are not enlarged; the knee jerks 

 are active. 



The notes of this case are unimportant up to the thirty-fifth 

 day, when erosions about the comers of the lips appeared. These 

 were touched with a solution of silver nitrate. On the fifty-third 

 day the note was made that for some days he has complained of 

 soreness of the skin over the epigastrium, and has lost 2.2 kilo- 

 grams (5 pounds) in weight since the beginning of the experi- 

 ment. By the seventy-fourth day he had lost 9.5 kilograms (21 

 pounds). The note on this day reads: He has been complain- 

 ing for some days of pain in the abdomen and chest and seems 



