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_Small-pox_, by far the most dangerous of them, has found a b...
Direct Laryngoscopy In Children
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Anesthesia For Peroral Endoscopy
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Interpretation Of Tracings
The interpretation of the arterial tracing shows that the nea...
Diseases And Disturbances Of The Skin
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Foreign Bodies In The Insane
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Nerve Centres Failing
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Length Of Pack Perspiration
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Source: Disturbances Of The Heart
At Nauheim, under the direction of Dr. Theodore Schott, baths form
an important part of the treatment. These baths are of two kinds,
the saline and the carbonic acid. The medicinal constituents of the
saline bath are sodium chlorid and calcium chlorid, the strength of
each varying from 2 to 3 percent The baths at first arc given at a
temperature of 95 F., and as the patient becomes used to them and
can take them without discomfort, the temperature is gradually
reduced. The patient remains in the bath from five to ten minutes.
After the bath he is dried with towels and rubbed until the
cutaneous circulation becomes active. He must then lie down for an
hour. These baths are repeated for two or three days, and are
omitted on the third and fourth days, to be resumed on the following
day. After a few baths have been taken, the carbon dioxid baths are
commenced, beginning with a small quantity of the gas which is later
gradually increased. This course of baths should be continued from
four to eight weeks. Unless there is some special reason for taking
them at some other period of the year, they are taken more
advantageously during the warm months.
Besides the baths, all important part of the treatment at Nauheim
consists in the exercises against resistance. These are usually
given an hour or more after a bath, and are taken with great
deliberation; their effect is carefully watched by an intelligent
attendant so that no harm may be done by the exercise.
During this treatment the food is, of course, carefully regulated
with the aim of giving a mixed, sufficient, easily digestible and
easily assimilated diet. All highly seasoned dishes, all
effervescent drinks and anything that tends to cause gas in the
stomach and intestines are prohibited. Coffee and tea are not
allowed, except coffee without caffein; and it may be noted that it
has recently been shown that caffein is one of the surest of drugs
to raise the blood pressure, and is therefore generally not
desirable when the heart muscle requires strengthening. Because of
its tendency to raise blood pressure and weaken cardiac muscle,
tobacco is entirely forbidden at Nauheim, except in a few individual
instances, and then the amount allowed is a minimum one. Large
amounts of liquid are not allowed because they distend the stomach,
raise the blood pressure and increase the pumping work of the heart.
One of the greatest advantages of the treatment at an institution
like Nauheim is the general hopeful spirit instilled into the
patients, who are so many times seriously depressed by the knowledge
of a heart weakness and the realization of their physical inability
to do what other persons are able to do. Also, it is of great value
to send a patient to a resort where the climate is good and the
scenery is lovely and soothing. No disease, perhaps, needs
cheerfulness and pleasantness and lack of anxiety, or frets more
than does cardiac weakness. A tuberculous patient may sit on a
mountain top with snow blowing about him, and recover; a heart
patient must have sunshine and comfort.
The results of such sanatorium treatment of heart disease are often
evident not only to the patient by an increase of general muscle
strength, the ability to do ordinary things and perhaps even sustain
muscular effort without dyspnea and cardiac discomfort, but also to
the physician by the physical signs. The contraction of the heart
becomes stronger and the normal sounds more decided; murmurs which
were entirely due to dilated ventricles and insufficiency disappear,
while the permanent murmurs may become louder from a more forceful,
normal action of the heart muscle. The pulse becomes slower, and the
blood pressure, from being too low, becomes normal for the age of
the individual. The heart will often also actually decrease in size,
and the apex beat become localized rather than diffuse, The liver
becomes reduced in size; the urine is less concentrated, and if
there were traces of albumin after exertion, these disappear.
It should perhaps be emphasized that not a little benefit from these
resort treatments may be due to the withdrawal of unnecessary drugs.
Many heart patients are overdrugged.
This sort of treatment is contraindicated in some kinds of heart
disease, as heart weakness due to arteriosclerosis with high blood
pressure, to aneurysm of the thoracic or abdominal aorta, and to
So many heart patients have been improved by the Nauheim treatment
that the question arises as to whether the treatment can be
conducted at home or in a sanatorium near home, when the patient is
unable to go to this resort; that is to say, Can we establish this
treatment for the majority of patients who have chronic heart
disease? Of course, even at home, the sodium chlorid and calcium
chlorid baths may be given, and one may obtain the salts all
prepared to make the carbon dioxid bath; the exercises may be given,
and walking on various ascending grades may be inaugurated. All
patients will be more or less benefited, provided they will carry
out the treatment. Unfortunately, the surroundings at a patient's
home are generally adverse to perpetuating these treatments long
enough to develop the muscular strength of the heart to the reserve
desired. If a patient appears pretty well, especially if he is
stimulated by his family to believe that he is well, he thinks the
continuation of the treatment entirely unnecessary, and unless he
goes to a resort where he sees other patients with similar
conditions able to do what he is not able to do, and therefore is
stimulated to acquire their ability by the treatment outlined, he
will not follow his physician's directions. There are several
sanatoriums in this country where the diet, hydrotherapy and
exercise necessary for developing heart strength are carried out,
and patients are sent to some of them with great advantage.
It has been found that these stimulant baths do not act well in
mitral stenosis, if the left ventricle is small. If the left
ventricle is unable to receive and therefore send out into the
systemic circulation sufficient blood to dilate the peripheral
capillaries under the irritation of the baths or the vasodilator
effects of the baths, the bath treatment does harm instead of good.
A patient who has mitral stenosis and also a small left ventricle
will be found to be poorly developed, badly nourished, and to have
poor peripheral circulation.
As elsewhere stated, the improvised carbon dioxid bath, to stimulate
the skin so as to reduce the blood pressure, is not satisfactory.
Other methods of reducing blood pressure, when it is too high, are
much more effective.
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