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]
Catalogue details

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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    (stewed) cauliflower, carrots, beets, peas in puree form, and potatoes made into soup, mashed, or riced. Apple-sauce and stewed figs or cherries are good, on account of their laxative effect. Uncooked fruit is less ad- visable. Supper should come not later than 8 o'clock and should con- sist of some white meat, bread, and butter. [This dietary is rather rich in meat protein. While storing up energy for the heart muscle we must not forget that most cardiac cases depend upon their peripheral vessels and upon their kidneys for a long lease of life. As far as white meat is concerned, I believe that white meat, less meat expresses the true state of affairs. Influenced by Chittendon, we are to-day, perhaps, cutting down meat too much. Too liberal a carbohydrate dietary will certainly produce fermentation, which is a serious drawback to cardiac cases. A hearty breakfast and mid- day dinner with a light supper are the essentials; intermediate meals may be ordered for some patients, but by no means all. The patient's nutrition, body weight, and individual requirement should be the deter- mining factors.] Reduction of Fluids Ingested.—As for drinks, Oertel has shown that in cases of simple heart muscle disease, the patient does better with small quantities of liquid food. With insufficient heart activity, not more than 800-1000 c.c. (1^-2 pt.) in 24 hours should be given. Oertel explains the consequent good results by the fact that a diminished fluid intake corresponds to a diminished quantity of blood and hence less work for the heart. Zuntz finds a possible explanation in the fact that the blood becomes more concentrated—richer in oxygen—and hence able to give the heart better nourishment. He draws an analogy between reducing the ingested fluid in heart disease, and reducing the fluid in the body by sweating, in training horses and athletes. The author considers, however, that with a fully compensated heart such an extreme reduction is not necessary. The patient may be allowed 1500-2000 c.c. (1%- 2 qt.) in 24 hours. The intake of fluids and excretion of urine in 24 hours must be determined from time to time. [Variations between Oertel's lowest and the author's highest limit (800 and 2000 c.c.) must be de- cided in the individual case. The season, certainly, should be regarded. Even cardiac cases require more fluid during the hot months than in the winter.] Liquids Forbidden and Allowed.—Alcohol in general should be for- bidden. If, however, the patient is strongly wedded to its daily use, a small quantity of wine (a wineglass daily of table wine diluted with water, or a liqueur glass of heavier wine, e.g., sherry, Madeira, port, or Hungarian wine) may be permitted. Beer must be avoided on account of its carbon dioxide, and also because it dilates the stomach, and has been shown by Bauer and Bollinger to have an especially injurious effect on the healthy heart muscle. Mineral waters containing carbon dioxide can be permitted only when absolutely necessary {e.g., if no good water is obtainable), and then they should be uncorked several hours before they