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.

    23/660 (page 11)
    THERAPY OF VALVULAR LESIONS IN THE STAGE OF BROKEN COMPENSATION. Every 'valvular lesion demands increased work on the part of the heart. The right ventricle can endure this strain only imperfectly and for a short time, while the left ventricle can carry on the increased work much longer and more satisfactorily. Hence lesions of the mitral valve, or of any of the valves of the right heart, are much more often found in the stage of broken compensation than are those of the aortic valve. The following therapy, therefore, is particularly suited to mitral lesions and to those of the right heart, and applies to aortic valvular lesions only when the left ventricle is incapable of doing its work and there is congestion of the right heart. In that case it would be advisable even if the pulse were tolerably strong, and the heart action regular, only slightly hastened, or possibly even slowed. Rest.—With broken compensation, even very moderate exercise must be given up; the patient must have absolute rest, thus reducing, as Zuntz maintains, the work of the heart almost a third. Except under special conditions,—cerebral anaemia, for example, in which the patient natur- ally lies down,—he should sit rather than lie in bed, even if there is slight dyspnoea, as sitting or standing diminishes the blood pressure. As this enforced rest is very likely to cause constipation, special care must be taken to see that the bowels move regularly. Diet.—As long as there is no derangement of digestion or hydrops, the same diet may be followed as in fully compensated lesions, but as soon as these symptoms appear, the diet must consist in large part of milk:. Aside from its diuretic effect (see p. 32) milk seems to be extraor- dinarily easy to digest, and, on account of its composition of casein, milk sugar, and cream (proteid, carbohydrate, fat), it fulfils better than any other food at our command the requirements of (1) slight demands upon the organs of digestion, and (2) a satisfactory chemical combination. [During broken compensation a milk diet gives too much fluid and overtasks the heart. I limit fluids to 1000 or 1500 c.c. in 24 hours and supply most of this quantity with milk, and then increase the nutritive value by adding very well cooked cereals, dextrinized starchy food, such as shredded-wheat biscuits, crisped bread, toasted crackers, or zwieback, and unsalted butter. Later, soft-boiled or poached eggs, broiled honeycomb tripe, lamb and veal chops, chicken, quail, partridge, broiled scrod and halibut, and raw oysters may be given with benefit.] According to recent investigations, the diet when oedema is present should be so chosen as to contain a relatively very small amount of common salt. In many cases, though not in all, such a diet, as the author has proved, causes an almost complete recession of the oedema. Suitable articles of food are: potatoes, unsalted butter, green vegetables, fruit, milk, eggs, sugar, coffee, tea, cocoa, and bread made without salt, or cereals. Further details will be given in the discussion of the