~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 invite such disaster by overeating, or by the partaking of any food which is liable to bring about indigestion, either in the stomach or in the intestines. Most authorities advise four or five meals a day rather than the regulation three, and limit the fluids at meal time to a few ounces only, when any are allowed, and to a maximum amount of 1500 c.c. during the day, chiefly between meals.