TREATMENT 



1689 



patient being placed in bed, and care being taken to avoid anything 

 which is Hkely to bring on cardiac failure. Especial care is re- 

 quired if the patient gets up or moves about. A cardiac tonic, in 

 the form of strophanthus or digitaUs, is advisable, and amyl nitrite, 

 nitroglycerine, or trinitrin should be placed at hand, in order that 

 they may be used at once if a sudden cardiac attack takes place. 

 If the attack is severe, with great embarrassment of the right heart, 

 it has been advised to perform venesection, and remove some 

 eight ounces of blood. Oxygen is useful during the attacks of 

 dyspnoea. For the paralysis strychnine should be administered, and 

 the muscles massaged to prevent atrophy and cramps. Electrical 

 excitation is also good. 



If possible, the patient should at once be removed from the place 

 in which he is supposed to have acquired the disease. 



Braddon strongly recommends atropine either as the alkaloid in 

 hypodermic injections of to grain, according to the urgency 

 of the symptoms, or in the form of the tincture of belladonna. He 

 considers that the atropine is specially useful in cases of dyspnoea 

 due to cardiac failure and pulmonary embarrassment, while he 

 gives a mixture of tincture of belladonna ^ drachm, tincture of 

 scilla \ drachm, and citrate of potash ^ drachm, in 4 ounces of 

 water three times a day for three or more days. 



With regard to after-treatment, any deformity, such as club- 

 foot, must be rectified, as described in works on orihop?edic surgery. 

 Eraser and Stanton have prepared a remedial agent on the 

 lines indicated by their researches, and this should be tried 

 when available. Only harmless rice — i.e., brown rice with more 

 than 0'4 per cent, of phosphorus pentoxide — should be given 

 to the patients, and care should be taken that it is cooked in 

 ordinary pots, and not under pressure. Thomson and Simpson 

 recommend a full diet with i ounce of ^^east and 200 grammes of 

 katjangido-beans daily. Chamberlain and Vedder recommend 

 that 5 c.c. of an extract of rice pohshings be given daily to infants 

 suffering from beri-beri, and this is administered in 20-drop doses 

 every two hours. The patient must be placed upon a good nourish- 

 ing diet, with plenty of proteid and good vegetables, and rice 

 should be eliminated from this diet. Careful nursing is necessary 

 because of the danger of cardiac failure, and good hygiene is also 

 necessary. 



Prophylaxis. — Rice should be avoided as a staple article of diet, 

 but if it has to be used it should be in the form of the Indian, country 

 rice, or paddy, variously described as the cured, stale, unpolished, 

 or parboiled rice. Great care should be taken with the cooking, 

 for a good rice can be converted into a harmful rice by cooking, 

 which should always be performed in ordinary pots, and never 

 under pressure by steam. With regard to the different kinds of 

 rice, Schiiffner and Kuenen find that Rangoon rice contains 0*42 to 

 0.46 per cent, of P2O5, while Siam and Java rice is much lower. 

 They maintain that there should be a rice reform, and that a 



