372 STRONG AND CROWELL. 



sure is 108 millimeters Hg (Faught) ; the spleen is not palpable; 

 the liver dulness begins at the lower border of the fifth rib; 

 the edge is palpable just below the costal margin; the knee jerks 

 are active. 



The earlier notes of this case are not important except that 

 the patient steadily lost in weight and by the sixty-third day 

 of the experiment he weighed 5.8 kilograms (13 pounds) less 

 than when he began the diet. The note made on this date reads 

 as follows: Apex beat not visible nor distinctly palpable; pulse 

 86; no change in the condition of the heart apparent; the knee 

 jerks are present but are weak. There was no change in his 

 condition for the next few days. On the sixty-ninth day the 

 systolic blood pressure was 90 millimeters Hg; he complained 

 on this date of sharp pains in his fingers : From the sixty-ninth 

 to the seventy-fifth day he continued to complain of pain in the 

 ends of his fingers. On the latter day the pulse was 84 and he 

 also complained of tenderness in his toes. On the seventy-sixth 

 day the following note was made: There is marked weakness 

 of the hands which are held semiflexed, and the grip of the hands 

 is weak; the pulse is 100; the knee jerks are not elicited; there 

 is no change in the heart sounds; there is slight epigastric but 

 no prsecordial pulsation and no oedema of the legs ; there is hyper- 

 sesthesia of the skin of the fingers and toes and ankles ; the patient 

 winces when pressure is made over the calves of the legs. On 

 the seventy-eighth day the note reads as follows : Pulse 78 ; pa- 

 tient in bed and not eating — complains of pains in the legs and 

 arms ; knee jerks not elicited ; there is no oedema of the legs ; the 

 power in the hands is very weak. On the seventy-ninth day he 

 was up and walking about; the pulse was 76 ; the gait was a little 

 unsteady but not ataxic, though his body swayed when he stood 

 with his eyes closed ; the heart sounds were clear ; there was no 

 visible pulsation over the cardiac area ; the hands were held semi- 

 flexed but could be extended; there was no wrist drop. On the 

 eighty-first day it became necessary to substitute red rice for 

 white rice, and on the following day dried codfish and potatoes 

 were added to the diet. On the eighty-second day the note reads : 

 The grip of the hands seems stronger but he still complains of 

 pains in the fingers, legs, and toes. On the eighty-third the point 

 of maximum impulse is not visible; the heart sounds are rapid 

 and clear at the apex and feeble at the base ; there is marked visi- 

 ble pulsation over the cardiac area; the pulse is 100; there is no 

 distinct increase in the area of cardiac dulness. On the eighty- 

 ninth day the strength of the hands seemed to continue to 



