ETIOLOGY OF BERIBERI. 371 



the calves of the legs. On the eighty-first day, the knee jerks 

 were still absent. Slight oedema of the legs had appeared. 

 There was marked hypera^sthesia of the muscles of the calves 

 of the legs. The patient said he felt weak in his legs. The 

 gait was not ataxic. The condition of the heart was not dis- 

 tinctly changed. Red rice was substituted for white rice in the 

 diet on this date, and dried codfish and potatoes were also added. 

 On the eighty-second day the pulse was 120. The pains in the 

 calves of the legs and tenderness on pressure continued. There 

 were no distinct areas of anresthesia of the skin. There was 

 slight prsetibial pitting on pressure over the ankles. On the 

 eighty-third day the note reads: Visible throbbing over the 

 cardiac area ; no distinct increase in the area of dulness ; 

 the heart sounds are clear ; the first sound is short ; the oedema 

 of the legs has almost disappeared; the pulse is 100. On the 

 eighty-ninth day it was noted that the strength of the legs was 

 gradually returning. On the one hundred first day the diet 

 was discontinued. The note at the end of the experiment reads : 

 Pulse 88, regular; fairly well nourished; no epigastric nor prae- 

 cordial pulsation ; the point of maximum impulse is not visible 

 nor distinctly palpable; the heart sounds are clear; the area 

 of dulness extends to about 1.5 to 2 centimeters to the left of 

 the nipple line and just to the right edge of the sternum; there 

 is no definite increase since the beginning of the experi- 

 ment; the pain, tenderness, and weakness in the legs are still 

 present; there is no oedema of the legs; the knee jerks are 

 still absent ; the urine contains no albumin nor casts. Three days 

 after resuming the regular prison ration he had gained 1.8 

 kilograms (4 pounds). 



CASE NO. 20 (GROUP IV) . 



Diet: White rice for 81 days followed by ] ^^^^j ^^^-^^ ^^ experiment, 

 red rice for 20 days, together with the I -.q-, jj„yg 



special diet common to all the groups. | 



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



Following is a summary of the notes of the case: Well-nour- 

 ished man ; auscultation and percussion of the lungs reveal 

 nothing abnormal ; the examination of the heart shows that the 

 area of cardiac dulness is not increased beyond the normal limits; 

 the point of maximum impulse is visible and not distinctly 

 palpable; both sounds are clear at the apex; the second aortic 

 sound is a little muffled, but there is no murmur; there is no 

 epigastric pulsation ; the pulse is 88 and the systolic blood pres- 



