The quality and quantity of solid food must be as far as possible maintained at a uniform figure in order to avoid great differences in the amount of water it contains. In plethoric patients who have nor mal heart action, and who pass less urine when the amount of fluids taken is diminished, since there is no accumulation of water in their blood and tissues, the fluids supplied need only be limited in propor tion to the amount which exceeds the physiological quantity. The burning up of the fat, however, will be considerably increased by diminishing the fluid supply below the physiological measure. In order to accustom the patient to the diminished supply of fluids and in order to prevent nervous excitement, it is advisable not to effect a sudden diminution of fluids (not so, however, where experimental in vestigations are being carried out), but to do it gradually though not in a protracted manner. A large size of body and a high out-of-door temperature call for a correspondingly larger supply of fluids, as al ready pointed out.
If the diminution of the fluid supply is followed by an increased excretion of urine as is the case in the hydrtemic form, and rarely in the anmnic, taking it for granted that a sufficiently powerful heart action is present, it is necessary to keep the fluid supply always be low the physiological measure and to diminish it, often to quite a con siderable extent. In individual cases, all circumstances bearing upon this being duly considered, it may be fixed at as low a figure as 1,200, 1,000, 800, or even 750 c.c.
The result attained by diminution of the fluid supply together with the burning up of the fat, as in the cases previously mentioned, is often a considerable decrease in weight because the weight of the body is dependent not only upon the amount of fat, but also upon the amount of water in the body.
If hydrtemia is proven to be present, through observation and ex amination (determination of the specific gravity of the serum), and if after the diminution of the fluid supply there is no increase in the secretion of urine on account of a marked insufficiency of the heart, it will be necessary in such case to endeavor to maintain the quantity of fluid supply at a figure which will be fixed by frequent examina tion, and which will represent the amount producing the largest uri nary secretion.
In these cases considerable albuininuria is present and the indica tion for dietetic-mechanical treatment is of minor importance. Now the weakness of the heart's action and the circulatory disturbances demand medicinal treatment, which will be materially reinforced by the diminution in the quantity of fluid supplied.
I, as well as a number of authors after me, have proven that cligi talis, which amne would have no effect in such cases, will act, often in a most energetic manner, if a smaller quantity of fluid is taken into the patient's circulation, i.e., if the work of the heart is diminished.