The worst cases, particularly if there is any sign of serious cardiac implication, should remain in bed; but the mild cases had better spend the greater part of the day in the open air. If the disease break out on shipboard the dietary should be changed and the crew should be kept out of the forecastle, and, so far as possible, made to sleep on deck, properly protected from the weather by an awning.
With a view to diminishing to some extent the bulk of blood in the vessels and heart, the seriously affected patients should take little fluid, and keep the bowels very free by means of full and repeated doses of some saline aperient. In cardiac cases small doses of digitalis or of strophanthus seem to do good. Should signs of acute cardiac distress appear, full doses— three, four, or five drops of the 1 -per-cent, solution— of nitro-glycerine are indicated. The dose must be repeated every quarter- or half-hour, and kept up until the threatening symptoms pass away. In suddenly developed cardiac attacks inhalations of nitrite of amyl, pending the operation of the nitro-glycerine, may be given. It is well for these two drugs to be in the hands of properly instructed ward attendants, so as to meet cardiac complication on its earliest appearance. There is often no time to send for the doctor. Should signs of cardiac distension and failure persist and increase in spite of these means, there must be no hesitation in bleeding the patient, taking, if it will flow, eight or ten ounces from the arm, or, this failing for any reason, from the external jugular. Often, as the blood flows, rapid amelioration of the alarming condition sets in, and the patient is, for the time being, tided over an acute danger and given another chance. The bleeding should be repeated if the alarming symptoms recur, as they are almost sure to do. Oxygen inhalations, if available, are worth trying in cardiac attacks. Pleural and pericardial effusions
with good results. Under daily injections of cholesterin, polyneuritis avium rapidly subsided. If further experience confirm these results, we have in cholesterin a valuable remedy in our hands; further, the vitamine theory of beriberi will have to be revised.
