should be sought for, and, if deemed to be interfering in the slightest degree with the circulation or respiration, drawn off with the aspirator.
Provided the patient is placed on a suitable diet and has been removed from the spot where he fell ill, and provided he can be tided over the first fortnight, he will probably recover; but, on the other hand, should he persist in a diet of white rice and remain in the place where his disease was acquired, though he may get over one or two cardiac attacks, he will almost surely die.
In the case of breast-fed beriberic infants, they should be removed front the mother and handed over to a healthy wet nurse, or placed on the bottle. Sometimes this is impracticable; in such cases in the Philippines a preparation of extract of rice polishings, called " tiqui-tiqui," has the reputation of being wonderfully efficacious. It is given to the extent of 5 c.c. a day in 20-drop doses every two hours. At the end of 24 hours the most alarming symptoms disappear and the child is well in three days. If the case is a very severe one double doses should be given, and the tiqui-tiqui continued so long as there is any aphonia.
For the atrophy of the muscles and anæsthesia of the skin, faradization and massage are of service, and should be employed so soon as the muscular hyperæsthesia has begun to subside. Strychnine, arsenic, and nitrate of silver are in repute as tonics in these circumstances. Care should be taken that permanent deformity does not occur from contraction of muscles. Foot-drop should be counteracted by Phelps's talipes splint with an elastic accumulator, and any other threatened deformity appropriately met. Relapses must not be risked by a return to the original diet or source of infection. 'The seaside or a sea- voyage has often a marvellously restorative effect.
When beriberi breaks out in a school, jail, or similar institution the place should be emptied of its inmates as soon as possible; at all events, those parts of the building in which the disease has appeared ought to be cleared out, and not reoccupied until they
