360 STRONG AND CROWELL. 



meters to the left of the median line ; slight cardiac impulse visi- 

 ble and palpable in the third and fourth interspaces; throbbing 

 more marked near the apex; the heart sounds are very forcible 

 after slight exertion; there are no distinct murmurs; he com- 

 plains of pain in the legs and arms; the grip of the hands is 

 feeble ; there is slight tenderness of the calves and there is slight 

 oedema over the tibise; the knee jerks are still present but very 

 weak; the patient complains of tingling and numbness over the 

 feet and legs; there is no distinct loss of sensation; the urine 

 shows no albumin and no casts; he weighed 2 pounds (0.9 kilo- 

 gram) more at the close of the experiment than at the beginning 

 of it. He was placed on the regular prison diet, and in twelve 

 days had gained 2 more pounds. 



CASE NO. 20 (GROUP IV) . 



Diet: White rice for 92 days, together with the 1 Total period of experi- 



special diet common to all the groups. J ment, 92 days. 



Dried codfish and potatoes were added to the diet on the 81st day. 



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

 nourished man of small stature; examination of the lungs re- 

 veals no abnormality; the area of cardiac dulness is not in- 

 creased beyond the normal limits ; the point of maximum impulse 

 is visible and palpable 6 centimeters to the left of the median 

 line and 0.5 centimeter below the nipple line ; there is no epigastric 

 pulsation; the pulse is 88; the systolic blood pressure is 100 

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

 the knee jerks are active. 



The early notes of the case are unimportant except that he 

 lost 2.2 kilograms (5 pounds) in weight during the first sixty- 

 one days. The knee jerks remained active throughout this time. 

 On the sixty-ninth day the systolic blood pressure was 90 milli- 

 meters Hg. On the eighty-first day dried codfish and potatoes 

 were added to the diet. On the eighty-third day the following 

 note was made: Epigastric pulsation marked; visible throbbing 

 over the cardiac area; point of maximum impulse palpable 8 

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

 extends to the left 3 centimeters outside of the nipple, but is not 

 increased to the right of the sternum; the second pulmonic 

 sound is markedly accentuated at the base; there is a slight 

 systolic murmur at the apex transmitted about halfway to the 

 base ; the pulse is 88 ; the heart sounds are occasionally irregular ; 

 he complains of pains and tenderness of the calves of the legs; 

 there is no oedema of the legs and no areas of anaesthesia of the 



