Volume 1

A text-book of the practice of medicine / by James M. Anders.

  • Anders, James M. (James Meschter), 1854-1936
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of the practice of medicine / by James M. Anders. Source: Wellcome Collection.

    646/677 (page 627)
    (2) Management during the Stage of Compensation.—Three main ob- jects are to be accoiiiplisbecl: (a) The avoidance of every agency that tends to aggravate or maintain the lesion or lesions. Under this head the detection and removal of all causal factors is imperative. Thus, if the patient's avocation entails undue muscular effort, it must be aban- doned ; violent exercise, as running up flights of stairs, heavy lifting, or straining at stool, is also dangerous and must be prevented. If alcohol has been a factor, it must be discontinued ; if syphilis, it must be treated specifically. If there be present a rheumatic or gouty taint of the system, it must be overcome as far as possible by special meas- ures. The recognized causes of rheumatism, as fatigue and exposure, must be avoided, particularly if the patient be comparatively young. Emotional excitement and mental over-exertion injuriously affect the car- diac lesion; therefore tranquillity of mind should be insisted upon, though moderate and systematic mental exercise has no risks for the patient. In the case of children at school careful supervision of their studies as M'ell as of their recreative exercises is essential. Fright and sudden emotion must be avoided if possible. The use of tea, coffee, and tobacco should be rigidly prohibited. (h) The diet of the patient demands careful regulation. Only a very moderate amount of food, composed for the most part of readily digested albuminous articles (milk, eggs, the lighter forms of meats, and stewed fruits), is to be taken, since overloading the stomach will disturb the action of the heart; particularly is this true at night. The carbohy- drates may be allowed only in limited quantities, since they are apt to decompose and form gases that distend the stomach and intestines. For the same reason the coarser and more indigestible food-stuffs should be avoided. Small meals at brief periods is a plan of feeding that I can highly commend. The amount of liquids taken should not exceed the actual requirements of the patient, inasmuch as over-filling of the blood- vessel system increases the work of the already overburdened cardiac forces. Alcoholic beverages should not be used as a rule; but if the patient has been moderate in the use of alcohol, and particularly if he be advanced in years, light wines may be allowed in moderate quantity to aid digestion, [c] Cjarefxdly regulated exercise is beneficial, but it must be gentle and should be taken out of doors. As before intimated, a good general muscular development is an aid of no mean value to the conservative powers of the heart. Oertel, with a view to assisting the compensatory forces of the heart, has recommended graduated physical exercise; he advises that patients be instructed first to ascend Ioav ele- vations, and later mountains of a considerable height, the object being to bring about full compensation. Great caution is to be exercised by the physician, however, since this method has been found to be inapplicable to a large percentage of cases. Cardiac distress, palpitation, and dys- pnea are complained of by this large group of patients if other than the gentlest foi'ms of exercise be undertaken. With respect to exercise, then, the sensations and experiences of each patient must be consulted before the physician can advise judiciously. Woollens should be worn next to the skin during both the warm and the cold seasons. The skin should be kept clean by daily sponge baths, and if these be followed by friction of the surface, the bodily nutrition will be improved and the