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L. C., a man aged 29, had been examined intermittently over a four-year period.
At the age of 20 the patient had an uncomplicated operation for ruptured appendix. He was then well until the age of 22, when severe diarrhea, anorexia, and vomiting developed. The onset was acute, but the symptoms became chronic, associated with great loss of weight and accompanied with bouts of distention, cramps, and fever. At the age of 25 a laparotomy was performed, and a "peptic ulcer" is said to have been "sutured." Three weeks after the operation the wound opened, resulting in a persistent fecal fistula. The patient was described as having been profoundly debilitated at this time.
Two months after the operation the patient was admitted for the first time to the Massachusetts General Hospital, and an ileotransversostomy was done. After this he was put on a regimen of intravenous feedings for a week,
Cogan DG. DIVERGENCE PARALYSIS AND PARALYSIS OF THE NEAR REFLEX ASSOCIATED WITH A MALNUTRITION SYNDROME (PRESUMABLY WERNICKE'S POLIOENCEPHALITIS). AMA Arch Ophthalmol. 1951;46(4):436-437. doi:10.1001/archopht.1951.01700020447010