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Charles G. Barnum, M.D.; Joseph C. Woodward, M.D.
JAMA. 1938;111(19):1749-1750. doi:10.1001/jama.1938.72790450001009.
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Mrs. A. R., an Italian housewife, aged 34, admitted to the hospital May 22, 1936, was a sextipara and septigravida, with parturition due May 30. For the previous two months she had noticed increasing weakness. Two weeks before admission she had begun to experience almost constant nausea, with frequent vomiting, and since then she had remained in bed. The weakness had increased to the point of dyspnea and palpitation on moving in bed. The skin had become yellowish and the urine scanty and dark. The bowels moved infrequently; the stools were brown, and there had been no diarrhea. For the previous week she had noticed numbness and tingling over the anterior surface of the right thigh, and on the day before admission she had a sudden attack of numbness involving the right side of the face and the right arm.

The diet had been low in protein and vitamins for


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