food
material in the stomach and intestines the flatulence arising from the
evolution of gas in those organs is slight and the pressure upward
upon the heart inconsiderable.

~Restricting the Fluids.~--The heart must be spared all unnecessary
work. This can only be accomplished by limiting the amount of food and
fluids ingested. The latter imposes an extra burden upon the impaired
organ to eliminate. Consequently, the amount of fluid should be
limited to 1500 c.c. a day at most, and in many cases considerably
less than that quantity.

~Regulating the Meals.~--The meals should be small and the intervals
of feeding regular. It has been found best to give the fluids between
meals rather than with the food. In many cases of heart disease, as in
certain nephritic conditions, edema is a prominent symptom, so that it
is necessary to direct our efforts toward overcoming that particular
condition. The Karell Cure[134] and the salt-poor diet are used with
excellent results. The latter is not so low as the former, and in many
cases will accomplish all that is required. A modified Karell diet is
used in the Michael Reese Hospital[135] in Chicago as follows:

"MODIFIED KARELL TREATMENT

(Salt-free)

"Milk 200 c.c. at 8 A.M., 12 M., 4 P.M., and 8 P.M., for five
to seven days.

Eighth day--Milk same as above.
10 A.M. one soft egg; 6 P.M. 2 slices of dry toast.

Ninth day--Milk as above.
10 A.M. one soft egg and 2 slices of toast.

Tenth to twelfth day--Milk as above.
12 M. chopped meat, rice boiled in milk, easily digested vegetables.
6 P.M. one soft-boiled egg.

The diet is gradually increased until a full tray is reached. All
meats and vegetables should be chopped or scraped at first, and the
heavier foods should be given only when the heart is practically
compensated."

~Rules and Regulations.~--There are a few general rules which it has
been found advisable to impress upon individuals suffering from a
disease in which the muscles of the heart have become weakened. The
compensation of the organ may improve, but there is still a danger of
a reoccurrence or a further development more or less serious, and at
times fatal. So for this reason, certain rules must be observed
throughout life:

First: the necessity for keeping the meals small, simple, and
digestible. Death at times occurs with symptoms of gastric
disturbance, which is, after all, due to the heart. Consequently it is
not wise to