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.
16/660 (page 4)
![are drunk, to let the greater part of the gas escape, and stirred to get rid of the rest. Champagne, of course, is forbidden for the same reason. Tea and coffee have too stimulating an effect on the heart and should be used only in such individual cases as apparently are not affected by them, and then only in very diluted form. Tobacco.—Tobacco is forbidden, as it is likely to cause increased heart activity, irregularity, and intermission, and sometimes attacks of angina pectoris. The patient should avoid even remaining in a room full of tobacco smoke, the effect of which is almost as bad as that of smoking itself. In individual cases, the allowing of light beer from the cask or a light cigar after the principal meal may have a good psychical effect. Salt.—It has recently been strongly recommended, especially by French authors, that common salt be avoided in the diet of a person with a heart lesion, even in the stage of full compensation, or with involvement of the cardiac muscle; for the retention of chlorine, with its accompanying symptoms (dyspnoea, oedema, bronchitis, pulmonary oedema), is a forerunner of broken compensation. The intake of salt and excretion of chlorides should be determined to see if the purpose of reducing the salt is being attained. [We should not forget, in our enthusiasm over a scientifically proved point of dietetics, that the palate must also be catered to. With so generous a meat diet much more salt is, of course, ingested with the cooked food.] Rest after Eating.—In spite of the advice often given to the con- trary, the patient should keep still for at least an hour after eating. It is evidently a strain upon the heart if, at the height of digestion, almost two-thirds of the blood in the gastro-intestinal vessels is sud- denly drawn off to the peripheral muscles, thus causing increased arterial pressure and congestion in the veins and lungs. Two or three hours should elapse after eating before much exercise is taken. Exercise.—The exercise should be very carefully chosen so as not to cause any disturbance of the heart or lungs; e.g., dyspnoea. The patient may take walks over level ground or very easy grades, their duration to be determined by his own feelings, but never to exceed an hour or an hour and a half. He should not converse while walking if it gives him the slightest distress. With a fully compensated mitral insufficiency and an otherwise intact heart and vessels, he may ride a bicycle if he has learned to ride before his heart was at all affected, and if he experiences, with this exercise, no trace of dizziness, palpitation, or dyspnoea. [Many factors of importance will occur to all of us in establishing rules for such a patient's life. Age makes a decided difference. Each case must be balanced upon its own merits, but in a growing boy or young adult, even with an aortic leak (provided it is well compensated) more latitude should be allowed, especially some months after all signs of acute endocarditis have disappeared, and no subsequent dilatation has supervened. A boy with such a condition at school is made so miser-](https://iiif.wellcomecollection.org/image/b21169901_0016.jp2/full/800%2C/0/default.jpg)
