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vomiting, great anorexia, and nausea. In severe, acute cases with great 
weakness of the heart, Baelz frequently observed good effects from large 
doses of cocaine given internally in amounts of from 0.05 to 0.15 
or 0.20 grams per day. In acute or subacute cases, with signs of 
dilatation of the right side of the heart, while the pulse is still good, 
encouraging results have been obtained by withdrawing several hundred 
cubie centimeters of blood from the median cephalic vein. However, 
when the pulse has become weak, this procedure is dangerous, because 
of the possibility of sudden heart failure. In the presence of dilatation, 
venous congestion and a pulse which, is already weakened, the withdrawal 
of blood by the aid of cups or leeches, applied over the precordial region, 
is often followed by a speedy amelioration of the symptoms of circulatory 
disturbance and of the difficulty of respiration. The author has seen 
a considerable number of Japanese soldiers sick with beriber1 who were 
greatly benefited by this method of bloodletting. However, the improve- 
ment is frequently only temperary and a repetition of the procedure 
may or may not bring about good results, or the unfavorable symptoms 
may increase in severity in spite of a temporary amelioration. 
Where there is a very marked hyperesthesia (which, however, is rare In 
beriberi), bromide of potassium or morphia internally or chloroform 
externally are recommended. Vomiting and dyspnoea are frequently 
greatly ameliorated by the hypodermic administration of small doses of 
morphia. . 
It is very important that the muscular atrophies and contractions, so 
common in beriberi, should receive early and proper treatment. How- 
ever, it is not advisable to begin the latter as long as there is marked 
cedema of the affected extremities. When the cedema has subsided, 
massage and passive movement are to be systematically practiced several 
times a day. As soon as the patient is able to do so, and when there is 
no longer any immediate danger of cardiac failure, moderate, active 
exercise should cautiously be begun. Should such exercise lead to a 
very marked increase in the pulse rate, it should be postponed. The 
_ atrophic muscles are to receive electrical treatment. When they still 
react to the Faradic current, the latter is to be used. Where there is 
complete degeneration reaction, the galvanic one should be employed, 
with the cathode situated peripherally over the nerve and the anode 
centrally applied. In the use of the Faradic current, Scheube recom- 
mends large sponge or roller electrodes, to be employed in a massaging 
manner. When there is paralysis of the phrenic nerve, M. Miura advises 
faradization, one sponge electrode being placed over the epigastric region 
and the other above and inside of the sterno-clavicular articulation, or 
the two electrodes may both be placed on the sides of the neck. 
The diet in beriberi should be light and nutritious and should include 
a considerable quantity of milk. Both in Japan and in Java beriberi 
patients frequently receive the adzuchki-bean (Phaseolus mungo var. 
