ly returned to the
strict milk diet. When edema is prominent, it is treated as already
described in the treatment for the like condition in nephritis by the
Karell or salt-free diet.

The dietetic treatment given here is merely a guide to be used under
certain conditions. The physician formulates the diet, and the nurse
must understand what to expect and how to apply the treatment as the
symptoms arise.

SUMMARY

~Dietetic Treatment~, adjusted to relieve the weakened heart muscles
and to save the organ from all possible strain.

~Three Stages~, during which the treatment changes according to the
extent and progress made by the disease.

First Stage: The diet is practically normal. Compensation is good,
consequently no dietary measures save the limiting of alcoholic
beverages are necessary.

Second Stage: The compensation is only moderate and the heart cannot
perform its normal functions, hence the diet must be directed toward
relieving any pressure upon the organs from other organs and toward
lessening the work of the heart itself.

Third Stage: In which the compensation is decidedly impaired and for
this reason the dietetic treatment undergoes a decided change.

~Digestional Disturbances~ in which there is an evolution of gas in
the stomach or intestines may cause a pressure against the heart which
is distinctly bad for it.

~Limiting the Fluids~ in the diet in heart disease is necessary when
the compensation is only moderate, as they impose an extra burden upon
the organ to eliminate them.

~Amount of Food~ must also be limited. The meals must be small and
taken without fluid. The latter should be taken between meals.

~Edema~ occurs in a number of cases and must be treated as in
nephritic conditions by limiting the fluids and by confining the diet
to "salt-poor" foods.[136]

~Karell Cure~ or modification thereof has been used with good results
in many cases of heart disease.

~Exercise~ must be limited in amount and confined to types which will
not impose a tax upon the weakened heart muscles. Exercise after
eating is especially to be discouraged, as this, together with the
efforts required for the digestion of food, might readily prove too
much for the heart to accomplish.

~Elderly Patients~ must be warned against exercises of all kinds, not
only on account of the condition of the heart, but also on account of
the condition of the arterial walls. These harden with age and break
down under undu