ETIOLOGY OF BERIBERI. 339 



GROUP III. 

 CASE NO. i:i (CKOUP III). 



Diet: White rice + rice polishings for 17 days ] 



followed by red rice for 100 days, toRether | ^otal period of experi- 

 with the special diet common to all the f ment 117 days 



groups. J 



Dried codfish and potatoes were added to the diet on the !>7th day. 



F'ollowing is a summary of the notes of the case: Well- 

 nourished man; percussion and auscultation of the lungs reveal 

 nothing abnormal; examination of the heart shows no increase 

 in the area of cardiac dulness; the point of maximum impulse is 

 visible and palpable 6.25 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 epigastric pulsation ; 

 the pulse is 80, and the systolic blood pressure is 118 millimeters 

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

 jerks are active. 



The notes during the earlier days of the experiment are un- 

 important, except that the patient lost steadily in weight. On 

 the seventy-fourth day he complained of weakness and pain in 

 the epigastrium, and the note states that he had been eating 

 little for the past five days. On the seventy-fourth day the note 

 made was as follows: Pulse 110; heart sounds clear; point of 

 maximum impulse distinctly visible and palpable as far out as 

 the nipple line ; no distinct change in the area of cardiac dulness ; 

 no tenderness of the calves of the legs; the right knee jerk is 

 present but is a little weak, the left is slightly stronger. He 

 was eating his rice well until the sixty-ninth day of the experi- 

 ment; since that day he has eaten but little. On the seventy- 

 seventh day the pulse was 104, and he complained of pain in the 

 epigastrium and back and of having sensations of cold below 

 his elbows and below his knees; he states that his hands feel 

 colder than his face or neck; there is marked throbbing over 

 the cardiac area; the impulse is palpable over an area of 4 to 5 

 centimeters in diameter; the respirations are 40; the heart 

 sounds at the apex are normal, while near the base the spacing 

 of the beats is more nearly equal; there is still no distinct in- 

 crease in the area of dulness ; the knee jerks can not be elicited 

 after repeated trials. At 4 p. m. the pulse was 110; there was 

 marked dyspnoea. On the seventy-eighth day at noon the note 

 reads: Still marked pulsation over cardia and well-marked dysp- 

 noea; right knee jerk not elicited, left questionable; pulse 104 

 before and 112 after slight exertion; the first sound at the apex 



