ow, which he thinks is filling up; but it might be
that the exudation on the bone immediately above and below the hollow
is somewhat reduced, as this would equally give the suggestion that
the hollow is filling up. There is a similar but rather smaller
irregularity on the left tibia also. He felt rather weak that day,
which he attributed to not having had his usual walk the day before.
The nasal cavity consists of a large grey septumless cavern showing
dry crusts. The issuing breath is most offensive. Patient had drunk
freely of water, he said, to the extent of 4 or 5 quarts a day during
the fast but when I said--do you mean that you have been taking over a
gallon of water daily?--he rather hesitated, and did not think it was
so much as that. He had not measured it and had taken it cold usually,
though occasionally hot, and had taken it without stint as he wanted
it. On the forty-eighth day of the fast he complained of being weak
but worst of all, he said, his breath was very offensive to himself.
It was so to me also--faint, fetid, putrid. His sense of smell was
greatly impaired, so much so that he could not smell the offensiveness
of the bowel-excreta which came away every day on using the
gravitation-enema, and which were horrible to by-standers. It would
seem from this as if his distress at the bad smell of his breath was
probably due to a perversion of the sense of smell, which can be
easily understood if we reflect that the disease-process was going on
in the region where the smell-apparatus is specially located. The
temperature was 96.2 degrees that morning the patient said. At 2 P.M.
when I saw him the pulse was 68, regular, even, steady. He says he was
feverish last night. I suppose he felt hot. He sleeps well, but says
he hears the clogs of the mill-hands as they go to their work in the
mornings. Has lost 2 lbs. weight in last 2 days. Temp. 93.6 degrees to
my observation 2.30 P.M. Says he feels "done at the stomach." His
voice is poor. Expectorates somewhat freely. A small blob of green
thickish mucus in ordinary white mucus came away in my presence. Urine
acid 1010. No glucose. Faint trace of albumin to heat and picric
acid: also to nitric acid. The right lachrymal punctum is blocked; the
tears run down the cheek; and I failed to get even a hair-thick wire
into it. Evening, pulse 65, temp. 97.2 degrees in bed with hot-water
bottle. Faeces most offensive, no bowel-excreta coming away except to
enema. Forty-nint