348 STRONG AND CROWELL. 



of cardiac dulness is not increased beyond the normal ; the point 

 of maximum impulse is not visible, and is but faintly palpable 

 7 centimeters to the left of the median line and 3 centimeters 

 below the nipple line ; the heart sounds are rapid but clear at the 

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

 is 100; the systolic blood pressure is 100 millimeters Hg 

 (Faught) ; the spleen and liver are not palpable below the costal 

 margin; the knee jerks are very active. 



The earlier notes of the case are unimportant. On the forty- 

 fourth day a vesiculo-pustular eruption appeared over the back 

 and shoulders; this disappeared in a few days under local treat- 

 ment. The patient lost 5 pounds in weight at the beginning of 

 the experiment but later there was no further loss. The knee 

 jerks remained active and the patient remained in good health. 

 On the eighty-fifth day the systolic blood pressure was 105 milli- 

 meters Hg. On the ninety-seventh day of the experiment dried 

 codfish and potatoes were added to the diet. On the ninety- 

 ninth day the following note was made : Complains of head- 

 ache; pulse 120, it misses a beat about every 10th pulsation; 

 epigastric pulsation is visible ; there is slight throbbing over the 

 cardiac area; the impulse is palpable as far out as the nipple; 

 the heart sounds are evenly spaced; they are forcible at the 

 apex and much weaker at the base; there is no cedema of the 

 legs, and the knee jerks are active. On the one hundred seven- 

 teenth day it became necessary to discontinue the diet. On 

 the one hundred nineteenth day the following note was made: 

 Fairly well nourished; no epigastric pulsation; pulse 100, oc- 

 casionally intermitting a beat ; the point of maximum impulse is 

 not visible; it is palpable 7.5 centimeters to the left of the median 

 line; just below the apex, the first and second heart sounds are of 

 equal length; just above the apex, the first sound is a little more 

 prolonged than the second sound ; the sounds at the base are clear 

 but weak; the area of cardiac dulness is not increased beyond 

 normal; there is no oedema nor tenderness of the legs; he says 

 he felt stronger before beginning the experiment. The urine 

 showed no albumin and no casts. 



