324 STRONG AND CROWELL. 



meters Hg (Faught) ; the liver and spleen are not enlarged; 

 the knee jerks are active. 



The patient at first lost 2.2 kilograms (5 pounds) in weight. 

 The notes up to the seventy-fourth day of the diet are otherwise 

 unimportant. On the seventy-fourth day he complained of head- 

 ache and weakness. The pulse was 100. He ate no dinner nor 

 supper. On the eighty-first day the knee jerks were still active. 

 The patient seemed better and did not complain. On the eighty- 

 fifth day the systolic blood pressure was 92 millimeters Hg. On 

 the ninetieth day the knee jerks were weak; the patient stated 

 that he felt well. On the ninety-fifth day the knee jerks were 

 weak ; there were no apparent changes in the condition of the 

 heart. Owing to the complaints of this prisoner, on the ninety- 

 seventh day dried codfish and potatoes were added to the diet. 

 On the ninety-ninth day the following note was made : Point of 

 maximum impulse 7.5 centimeters to the left of the median line 

 and 3 centimeters below the nipple line; pulse 84; at the apex 

 the first sound is accentuated; there is a tendency to pendulum 

 spacing between the beats, while there is diffuse throbbing over 

 the cardiac area, extending from the sternum to the nipple ; there 

 is slight visible epigastric pulsation and moderate oedema of the 

 legs ; there is pain and tenderness of the calves ; no hypersesthesia 

 of the skin; the knee jerks are very weak. One hundred fifth 

 day : Complains of pain in chest and legs ; calves tender on pres- 

 sure, and he walks with a slight limp ; pulse 96 ; there is no oedema 

 of the legs; the knee jerks are not elicited. On the one hundred 

 sixth day the knee jerks could not be elicited. There was no 

 oedema of the legs. The tenderness of the calves continued. On 

 the one hundred eighth day it became necessary to discontinue 

 the diet. The following note was then made : Sparely nourished 

 individual; pulse 88; pulsation over cardiac area seems a little 

 less marked than at the time of the last note, but is easily pal- 

 pable over the whole cardiac area; slight epigastric pulsation; 

 first sound at beginning much roughened and prolonged; pen- 

 dulum spacing between the heart sounds has disappeared; the 

 sounds are clear at the base ; the point of maximum impulse is 9 

 centimeters to the left of the median line ; the dulness extends to 

 the left 2 centimeters outside the nipple line and to the right just 

 beyond the edge of the sternum; there is slight oedema of the 

 legs and hypersesthesia of the calf muscles; the knee jerks are 

 absent. Thirteen days after his return to the regular prison 

 ration he had lost 4 pounds more. This man evidently suffered 

 from beriberi. 



