OERTEL’S TREATMENT OF WEAK HEART.
THE term “Oertel’s treatment,” has become as familiar to us as “Banting’s” treatment, for obesity once was and is also as much misused as the latter has been. The “terrain treatment” was first suggested by Oetel, and had an enormous patronage, and it was only natural that the indications requiring such a treatment were greatly overestimated, and were not confined to those laid down by originators. Almost every person suffering from cardiac troubles thought that in this treatment he had at last found a panacea which would be sure to rid him of his trouble, and therefore hastened to one of the numerous places where the treatment was administered; once there would strain and overtax his already feeble heart until, in a few weeks, the penalty of his ignorance was paid by death.
In opening the debate Oertel gave a sketch of his experiences which I introduce here as shortly as possible:
Changes in the cardiac muscle which are due to disease must be considered quantitatively as well as qualitatively. The first consists in an increase of the heart’s muscle, which is both absolute and relative, and may affect but certain portions or the whole heart. This increase of the heart’s muscle may be usually traced to an increased activity of the valves, which is caused by pathological changes, and may be looked upon as a hypertrophy of compensation. The treatment, however, must not consist in a reduction of this hypertrophy; rather it is the duty of the physician to retain it, or, if it be lost, to call it forth again. Where symptoms of compensatory hypertrophy are not well marked, symptoms of a decrease of the heart’s muscle- insufficience will soon be observed, and will contraindicate further treatment in this line. Qualitative changes of the cardiac muscles are due to inflammatory processes, defective nourishment or degeneration, which may be caused by various diseases. In such cases the muscular fibres themselves show changes in their morphological composition. The most severe form of this kid of change in the heart’s muscle is that known as fatty degeneration of the muscular fibres. Finally, mention must also be made of one other change of the substance of the muscle, viz., the substitution of one part of the muscular tissue by connective tissue. Cardiac troubles caused by acute infectious diseases were not taken into consideration. The presence of chronic diseases of the heart’s muscle is recognizable in a decrease of the strength of the heart and an insufficience of the muscle. The disease always takes the phase of circulatory disorders. The principal troubles which are caused by a decrease of the heart’s strength are anaemia, thrombosis in the veins, collection of blood and serum and kidney affections.
The prognostic conclusions in such diseases must be based upon the severity and kinds of defects of nourishment observed, and upon other complications which exist outside the chronic diseases of the heart itself. The “curative method” instituted by Oertel for this class of diseases may be divided into two sections the dietetic treatment and the mechanical treatment.
The first is regulated by the nutritive or fatty condition of the patient. The following are the symptoms observed: 1. Abnormal condition of fat, plethora, with a diminishing of the heart’s strength. The diet in such a case should be an increased amount of albuminoid substances and a less amount of fatty substances. There need be little or no change in the amount of fluid given. Fatty degeneration, accompanied by serious plethora. The dietary indications in this case are as follows: Increase of albuminoids, decrease of fat-producing substances, and also a decrease in fluids. 3. Fatty degeneration in older subjects, accompanied by hydraemia, in which cases there is not alone a lessening of albuminoid matter, but also a decrease of fat. Here one must also give a large amount of albuminoids, together with a moderate or, in some cases, even a decreased amount of carbohydrates. At the same time the amount of fluids must be considerably lessened. 4. Existing inanition; weakness, with diminished strength of the heart; anaemia and hydraemia. The diet in this case should also consist in an increase of albuminoid matter, and also an increase of muscle-producing food, until a state of muscular hyperplasia supervenes.
The mechanical treatment forms an accompaniment to the dietetic treatment. Oertel first advises the practice of rising from various grades of a stooping or bending posture. Other authorities, such as B. A. Schott, recommend passive movements, also movements requiring a certain amount of strength.
The mechanical treatment is said to give a certain motoric impulse, and also to annul any circulatory disturbances. This result is reached by an increase of the heart’s activity. The heart’s power of aspiration is also increased; and as, during these movements, more venous blood is pumped into the larger veins, the blood flows in greater quantities into the right heart than when the body is at rest.
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If this increase of the heart’s activity is kept up for some time, and the pressure of blood in the arteries becomes increased, it will cause, by a reflex action, a compensatory enlargement of the arteries, and a decrease of the tension of their walls. The outflow of blood from the left heart is facilitated, the quantity of arterial blood is increased, and the quantity of venous blood is lessened. The lungs are also benefited by the latter. There will be a marked expansion of the thorax during inspiration, an enlargement of the surface of the lungs and much greater ease in respiration. All these symptoms are far greater and more marked when a rising movement has been practiced than when any other movement has been resorted to.
Where it is desirable to increase the strength of a weak heart, it is of first importance to decrease, if possible, the work required of it. With this end in view, Oertel does not advise a diminishment of the quantity of blood, but a decrease, as far as possible, of the amount of water in the system. This may be accomplished by decreasing the amount of fluid food and drinks, and by increasing the quantity of fluid given off by the body. The latter may be accomplished by both increasing the flow of urine and by causing profuse perspiration by means of muscular exercise. The increase of urine will depend on the strength of the heart in a measure, for if the latter is very weak, the functions of the kidneys will be impaired.
Dr. Oertel now endeavored to explain the indications and contraindications for his method of treatment. Sclerosis of the coronary arteries is no contraindication rather an indication both for the mechanical as well as the dietetic treatment. The regular diet and methodical movements, such as walking, etc., have an undeniably beneficial effect upon the cardiac muscles in all chronic cases, yet the practice must be resorted to with the utmost caution. Chronic and frequently relapsing endocarditis, weakness of the cardiac muscles, long-standing compensatory and valvular troubles, cardiac aneurism, general atheroma and chronic diseases of the kidneys, in long-standing cases of heart- weakness, form the principal contraindications for the employment of Oertel’s method, or may be taken, as Oertel himself says, as a sign that the treatment should be used but moderately. In all cases, however, he says, it is well to proceed slowly and cautiously, unless all symptoms which would either indicate or contraindicate its use have already been discovered.
The second speaker on the subject was Prof. Lichtheim, of Berne. The stand taken by him in the case was different from that of Oertel in many particulars, although theoretically he had to agree wi th Oertel in many instances. He formulated his own observations in the following conclusions:
1. Oertel’s method is a veritable panacea in those cases of chronic heart disease which owe their origin to want of proper exercise.
2. In diseases of the heart which, on the other hand, are due to overexertion and continual strain on the body, or in any case where the increased expansibility of the cardiac muscle is due to other causes, Oertel’s method is not of the least value. Bodily exertion should be allowed only to a very mild and gradual degree in compensatory affections. Great care must be taken to prevent undue dyspnoea. Such cases must be treated with far greater caution than those with valvular troubles alone.
3. The medical treatment of compensatory affections with Digitalis, Strophanthus and Caffeine must be recognized as the most reliable manner of treating such cases. Where this treatment fails the “mechanical-dietary” treatment will also be powerless to render any aid. In its action in causing the absorption of dropsy, Oertel’s method can augment the medical treatment, but in no case can it ever substitute it.
4. During the period of intact compensation all medication is superfluous, aside from possible symptomatic indications. It is in such cases where the mechanical-dietary treatment may prove to be of great value, and Oertel’s method may be looked upon as a model of such a treatment.
Hale wrote Lectures On Diseases Of The Heart, Materia medica and special therapeutics of the new remedies Volume 1, Materia Medica And Special Therapeutics Of The New Remedies Volume 2, Saw Palmetto: (Sabal Serrulata. Serenoa Serrulata), The Medical, Surgical, and Hygienic Treatment of Diseases of Women, New Remedies: Their Pathogenetic Effects and Therapeutic Application, Ilex Cassine : the aboriginal North American tea, Repertory to the New Remedies with Charles Porter Hart, The Characteristics of the New Remedies, Materia Medica and Special Therapeutics of the New Remedies, The Practice of Medicine, Homoeopathic Materia Medica of the New Remedies: Their Botanical Description etc.