362 STRONG AND CROWELL. 



lost 2.7 kilograms (6 pounds) during the experiment; he had 

 not gained any in weight during the first thirteen days after he 

 received the regular prison ration. 



CASE NO. 21 (GROUP IV) . 



Diet: White rice for 92 days, in addition to 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 : Fairly well- 

 nourished man; percussion and auscultation of the lungs reveal 

 no abnormality; examination of the heart shows no increase in 

 the area of cardiac dulness beyond the normal limits; the point 

 of maximum impulse is invisible; it is palpable 8 centimeters 

 to the left of the median line and 1 centimeter below the nipple 

 line; the first sound is slightly prolonged at the apex; both 

 sounds are clear at the base; no epigastric pulsation is visible; 

 the pulse is 76, and the systolic blood pressure 160 millimeters 

 Hg (Faught) ; the liver is not palpable below the costal margin, 

 and the dulness is not increased; the edge of the spleen is just 

 palpable; the knee jerks are active. 



The earlier notes of the case are otherwise unimportant. 

 The patient gained 1.1 kilograms (2.5 pounds) during the first 

 19 days of the experiment. He then gradually lost in weight and 

 by the forty-eighth day had lost 7.2 kilograms (16 pounds). 

 On the sixty-ninth day the systolic blood pressure was 110 milli- 

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

 were added to the diet. On the eighty-third day the note shows 

 that there was marked epigastric pulsation but no throbbing 

 over the cardiac area; the point of maximum impulse was pal- 

 pable 8.5 centimeters to the left of the median line; there was 

 a soft systolic murmur at the apex not transmitted to the base; 

 the second pulmonic sound was distinctly accentuated; the pulse 

 was 80 before and 88 after slight exercise; there was slight 

 oedema of the legs; some pain in the calves was complained of; 

 the knee jerks were very active; the patient gained in weight 

 since the sixty-first day, in all 3.6 kilograms (8 pounds). On 

 the eighty-ninth day the note reads: Pulse slow; no complaint 

 of pain; the knee jerks are very active; there is marked oedema 

 of the legs; the urine contains no albumin nor casts. On the 

 ninety-first day the knee jerks were very active; the legs were 

 oedematous; there was no tenderness of the calves and no areas 

 of anaesthesia of the skin of the feet and hands; he was still 

 fairly well nourished; the pulse was 84; there was slight 



