The principles of treatment and their applications in practical medicine / by J. Mitchell Bruce.

  • Bruce, J. Mitchell (John Mitchell), 1846-1929.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: The principles of treatment and their applications in practical medicine / by J. Mitchell Bruce. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    carbonic acid and water derived from the carbohydrates and hydrocarbons escape in the air of expiration as well as other- wise ; the salts and the water, greatly re-arranged in their cliemical combinations, are excreted through all the four channels. Although the elimination of these different sub- stances appears to be a simple affair, the therapeutist finds that he cannot afford to disregard it when he is planning invalid diet. Besides the usual physiological reasons for insuring com- plete removal of the products of food from the system, several considerations have to be kept before our minds in connexion with this subject in disease. The first of these is that elimination is already under heavy strain, consequent on increased waste and repair, whilst all the organs concerned are more or less disabled or impaired in their activities, partly by the morbid process directly, partly by the enforced rest and confinement inseparable from the treatment of many diseases. In the second place, the food of the sick is usually made particularly nutritious, attractive and digestible, as we have seen, and the amount of egesta will be correspondingly large. Thirdly, the dis- ordered metabolism of disease may give rise to certain products more difficult to eliminate than those of health, particularly uric acid; the water gets diverted from the kidneys; and all the excretions present characters (in fever, for example) suggestive of complete chemical disturbance. Acute gout may be cited by way of an extreme instance of several of the effects on the excretions referred to. An attack often originates in enforced rest after an accident, combined with invalid feeding; and the urine speedily reveals how marked the chemical disturbances are within the body. On the other hand, the familiar effect for good of a regular laxative during illness is no doubt to be explained partly in this way. Our knowledge of the chemistiy of foods, of their products, and of the channels of their final excretion is now so extensive and exact, and the control which we possess dVer the ingesta so complete, that all that is required in ordering dietetic treatment which shall be suitable in respect of elimination is a little trouble and intelligent effort. First, we must never forget the total excreta to be disposed of in