ETIOLOGY OF BERIBERI. 



361 



skin; the knee jerks are active; he saj's he can not see well at 

 night. On the eighty-ninth day the knee jerks were doubtful. 

 There was no oedema of the legs, but the calves were tender on 

 pressure; the pulse was 108. On the ninetieth day the knee 

 jerks were absent; there was still no cedema, but there was 

 marked tenderness of the calves of the legs. On the ninety- 

 second day it became necessary to discontinue the diet and to 

 return him to the regular prison ration. On this date the fol- 

 lowing note was made : Fairly well nourished ; pulse 108, of good 

 volume; the point of maximum impulse is visible and palpable 

 8 centimeters to the left of the median line; the first sound is 

 still considerably prolonged at the apex; the second pulmonic 

 and second aortic sounds are accentuated; there is moderate 

 epigastric and cardiac pulsation ; he complains of pain in the 

 chest and in the stomach; the pain and tenderness in the legs 

 still persist; there is no oedema of the legs; the knee jerks are 

 still absent; the urine contains no albumin nor casts; the patient 





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