366 STRONG AND CROWELL. 



examination of the heart shows the area of duiness not increased 

 beyond the normal Hmits; the point of maximum impulse is 

 invisible; it is palpable 7 centimeters to the left of the median 

 line and 1.5 centimeters below the nipple line; the mamma 

 moves very slightly with the systole of the heart; the heart 

 sounds are somewhat rapid but clear; the pulse is 98; the 

 systolic blood pressure is 120 millimeters Hg. The liver and 

 spleen are not palpable below the costal margin. The knee 

 jerks are active. 



The earlier notes of this case are otherwise not important; 

 the patient had lost 5 pounds by the forty-eighth day of the 

 experiment; the knee jerks remained active. On the sixty- 

 ninth day the systolic blood pressure was 120 millimeters Hg. 

 On the eighty-first day dried codfish and potatoes were added 

 to the diet. On the eighty-third day the note reads: Visible 

 throbbing over the cardiac area from the third interspace and 

 sternum downward to below the nipple and outward 1 centi- 

 meter beyond the nipple; the point of maximum impulse is 9 

 centimeters to the left of the median line; the area of duiness 

 extends 2.5 centimeters to the left of the nipple line, a slight dis- 

 tinct increase ; there is slight epigastric pulsation ; a soft systolic 

 murmur is heard at the apex, but is not transmitted to the base ; 

 the second pulmonic sound is moderately accentuated; there is 

 visible pulsation of the vessels of the neck ; the respirations are 

 24, the pulse 104 before and 124 after slight exertion; he com- 

 plains of pain in the calves of the legs, and there is marked 

 oedema of the legs; the knee jerks are active. On the eighty- 

 fourth day the pulse was 110 and of full volume. On the eighty- 

 fifth day the note reads : Pulse 96 ; complains still of pains in the 

 legs ; there is marked oedema ; the knee jerks are active ; the urine 

 contains no albumin nor casts. On the eighty-eighth day the 

 pulse was 92. There were no pains in the legs this date, but some 

 oedema was present. The knee jerks were active. On the nine- 

 tieth day the knee jerks were very active. The oedema of the 

 legs continued. There was no hypersesthesia of the calves of 

 the legs. On the ninety-second day it became necessary to dis- 

 continue the diet. The following note was made on that date: 

 Pulse 92 and of good volume. Well-nourished individual. Car- 

 diac pulsation visible; extends to the left as far as the nipple 

 line, and distinctly 1.5 centimeters outside the nipple line. Point 

 of maximum impulse 9.75 centimeters to the left of the median 

 line. Duiness extends to the left 3.5 centimeters outside the 

 nipple. The first sound is roughened and prolonged at the 



