Treatment of internal diseases : for physicians and students / by Norbert Ortner ; ed., with additions, by Nathaniel Bowditch Potter ; tr. by Frederic H. Bartlett.
- Ortner, Norbert, 1865-1935.
- Date:
- [1913], [©1913]
Licence: Public Domain Mark
Credit: Treatment of internal diseases : for physicians and students / by Norbert Ortner ; ed., with additions, by Nathaniel Bowditch Potter ; tr. by Frederic H. Bartlett. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
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![Dietetic Therapy: Object.—In every heart lesion, no matter how perfectly compensated, there are increased demands upon the cardiac muscle. The object of the dietetic therapy is, then, (1) to maintain and if possible to increase the strength of the heart muscle, and (2) to avoid anything which might increase the demand upon it. It is clear that the old method of keeping the patient on a low diet could do nothing but harm. On the contrary, the food should be as strengthening as possible. It is best given every 2 hours in relatively small amounts, in order to avoid the strain on the heart produced by too great distention of the stomach and intestines, which would crowd up the diaphragm and cause hypergemia of the digestive organs, especially the liver, with consequent relatively increased flow of venous blood into the right auricle. [In compensated valvular lesions I have rarely found such frequent feedings necessary or advisable, and generally adhere to three regular meals, with the third a light one. Throughout this book the reader will be struck with the author's generous dietary. Germans and Austrians eat more and oftener than we do.] Naturally all foods that irritate the heart must be avoided (condiments, vanilla, cinnamon, mace, coffee, tea, alcohol (see below), and too hot food). All foods that tend to cause flatulency must also be forbidden, as they dilate the stomach, and so mechanically and reflexly increase the heart's work, as shown by short- ness of breath and palpitation. Examples of such foods are sauerkraut, cabbage, black bread, peas, beans, potatoes, and drinks charged with carbon dioxide. Carbon dioxide has the further disadvantage of increas- ing the peripheral blood pressure, and so adding to the work of the cardiac muscle. The patient should stay in bed until 8 or 9 a.m., having breakfast as early as his inclination directs. For this first breakfast he may have a pint of milk with some bread, and perhaps butter. If he dislikes milk (sweet or sour), he may have added to it salt or a very small amount of weak tea or coffee, or malt or barley coffee, or, even better, one of the substitutes for coffee. [If coffee is chosen as a flavoring there is no special disadvantage in permitting a very small amount—a demitasse—of freshly prepared black coffee. It certainly tastes better and is useful if constipation exists. If such a patient awakes at 5 to 7 a.m., and is accustomed to remain awake, a cup of hot milk, with or without flavoring, hot gruel, or hot broth upon awakening, will generally help to counteract the fatigue of dress- ing.] Or he may begin with a smaller quantity of milk and gradually increase the amount. He may have two soft-boiled eggs or a piece of cold meat. The latter, however, is better reserved for the second breakfast, two or three hours later. This may consist of a cup of bouillon, bread, and a small piece of fowl, chicken, pheasant, or par- tridge, roast veal or veal cutlet, ham, or beef fillet. The mid-day meal should come between 1 and 3 p.m., and should include soup, a little white meat, fish which is not too fat, with vegetables and a light pudding. The vegetables to be preferred are spinach, Brussels sprouts, lettuce,](https://iiif.wellcomecollection.org/image/b21169901_0014.jp2/full/800%2C/0/default.jpg)
