R.Ray, AM/E&S, NV September 22, 1975 -2- - The next patient we saw was an old lady with auricular fibrillation. -* The There were some problem appeared to be one of giving her oral digitalis. injectable digitalis glucosides, that I felt certain should not be used even in the cautious hands of a cardiologist. We gave her digitalis by mouth. There was a bottle of digitalis leaf, which is probably the best form available, and he accepted this thought very well. Subsequent follow- up on this patient did show her fibrillation to be slower. Exercise tolerance, breathing and coughing were very much improved. Here was an object lesson for Jaramia and he took it very well, accepted the suggestion and was enthusiastic. The next case we Saw was a patient with diarrhea of several days standing. After examination presented no gross evidence of anything that could be related to his diarrhea and we did find some Kaopectate. It was suggested that he start on this and I would get some tetracycline from my supplies on the ship later. I was amazed to discover Jaramia pouring out an intravenous solution (normal saline). In asking him why he said that he needed a container to dispense the Kaopectate. He poured out 1,000 cc of I.V. solution that was still good for irrigating and washing off wounds as a relatively sterile cleanser even if it was outdated for intravenous use. ‘The Kaopectate in the amount given was 4 oz. or 6 oz. and was poured in this big bottle. I was discouraged to find some medication and useful material dumped out just to provide a container. Ja amia said he had nothing else. ‘he thought came to mj mind-that simple Plastic sandwich bags could be well used as containers. A double bag could be used as a container for liquids, pills and even creams. Ancther patient that we saw was a fellow who had eaten a Red Snapper caught in front of the camp just where the ship was tied up at Bikini. He had bcen ill about 6 days and was still very weak, perspiring, feeling cold around his mouth and cold in his extremities. Jaramia said all patient had to eat was fish. Even eating a lightly poisonous fish would make him more ill, in or liver. In most societies near the ocean, fish viscera are not discarded, Plankton. So here was some minimal information that could be useful to a that ciguatera is a cumulative poisoning. Patient was advised.to eat nothing but the smallest of the fish that were caught. The older and bigger the fish the more likely to have a large concentration of poison in its tissue. Also, it was suggested, that he should eat none of the viscera, guts especially the liver. He should eat fish that are pelagic which don't feed on the reef. Primarily it was suggested that he eat lobster or a fish called Uu Uu, mimpachi is the Japanese name and I think it was familiar to them. I feel that mimpachi is less likely to contain poison because it feeds on person who was quite sick. Again, I repeat, and I can't repeat too much, what a charming man Jaramia was and what a fertile ground for planting information. I had the privilege of meeting Jaramia's wife and cute little baby. The baby had a vesicplar rash on its abdomen that appeared to possibly be related to scabies. Jaramia was advised to treat the rash in a conservative manner, but the remote possibility of scabies came to mind and we had no scaficide.