30 



Indimm University Studies 



help arrange for a different sort of diet for the child. A neighbor 

 was engaged to give the warm noon lunch and an organization of 

 the city was to bear the expense. This worked for a time, but 

 before long the girl felt that she should not be getting so much 

 unless the same was given to her brother. The plan then had to 

 be dropped. By this time, however, she seemed to realize that 

 she must be careful of her diet, so there has been no trouble of 

 that sort within the last year. 



The children are always instructed about playing too hard 

 or running until they are short of breath. Sometimes it has been 

 necessary to have the gymnasium work in the school left oft' 

 entirely or at least cut down. The teachers are found usually to 

 be very reasonable in all cases where the request is made thru a 

 doctor or this Department. 



There is another phase of treatment that must follow or 

 accompany the treatment for the cardiac condition. This has 

 been referred to in the chapter on Causes but may be mentioned 

 again here. That is the treatment of the primary disease or dis- 

 ease causing the cardiac trouble. 



CASE T.W. One girl was brought to the dispensary with a 

 very pronounced goiter. The doctor there feared a heart com- 

 plication, so had her examined at the hospital by the use of the 

 electro-cardiograph. She was found to have a vers^ weak heart. 

 From now on treatment at the dispensary will be guided by that 

 knowledge. Had it been found that there was no cardiac involve- 

 ment, an operation might have been turned to at once with no 

 fear of the outcome so far as the heart was concerned. The heart 

 will never be as strong as it should be so long as the goiter is 

 unchecked, but by rest and care it may become strong enough 

 to withstand the shock resulting from the goiter treatment. 



It is often very difficult to determine the disease causing the 

 cardiac condition. On a few record cards nothing is found 

 under diagnosis save the heart condition. On others such state- 

 ments as the following are found : ''heart trouble following 

 grippe", "cardiac condition, nephritis, following diphtheria", 

 "pyorrhea, heart trouble", "endocarditis, lues". The fact that no 

 disease causes the same heart condition in two patients makes 

 it impossible to say which disease is the cause in any one case. 

 If lues always caused one kind of heart lesion and pyorrhea 

 another, it would be much easier to prescribe treatment. 



The last thing to be done in the treatment of the patient is 



