September 1, 1825
Mr. Rennie on the treatment of pulmonary disorders: "For this purpose, vegetable food, however nutrient, is very inadequate ; animal diet, on the contrary, stimulates the digestive functions, enriches the blood, invigorates the whole system, and, under judicious regard to existing circumstances, is unquestionably the most restorative of lost power."
Mr Rennie on the Treatment of Pulmonary Disorders - Monthly Journal of Medicine
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In recommending nutriment adequate to the increased demands of the system, it is not understood that stimulation also is indiscriminately advocated. ‘The object is not stimulation, but power, and that diet must be the best which is capable of imparting the greatest degree of vital power to the various textures, as well as to the blood itself. For this purpose, vegetable food, however nutrient, is very inadequate ; animal diet, on the contrary, stimulates the digestive functions, enriches the blood, invigorates the whole system, and, under judicious regard to existing circumstances, is unquestionably the most restorative of lost power.
Animal and invigorating diet has been, it is true, generally deprecated in pulmonary cases ; and increase of fever, with aggravation of organic disorder, are usually apprehended as the result. ‘That this idea cannot be always well-founded, the above cases decidedly demonstrate.
That in certain circumstances of pulmonary disorder injurious Consequences are to be apprehended from the liberal and indiscriminate use of animal diet, Iam ready to concede ; and also, that caution is necessary to adapt the kind and quantity to existing circumstances,—otherwise fever, disorder, and debility, will result, instead of vigour and health. But, on the other hand, I am convinced that, under groundless, or, at all events, mistaken fears of this kind, a system of exclusive abstinence is pursued to the certain aggravation of existing disorder, when a discriminating adoption of a system directly opposite to it is that which is indicated.
On this point, an interesting feature in the last-detailed case merits attention :—the exacerbation of the cough and febrile symptoms shortly after the adoption of animal diet. ‘This is a result which I admit is of very frequent occurrence in circumstances of great general debility, and in proportion to the degree of debility. It has been usual to regard such an occurrence as highly unfavourable, and as an immediate urgent ground for withholding animal diet in future, and for having recourse to less stimulating vegetable preparations. I am disposed to view the matter in a different light. Knowing, on incontrovertible principles, that the constitution, in these circumstances, absolutely requires the nutritious and invigorating influence of animal diet, the symptoms in question cannot be owing to these properties, but necessarily are due to some other coexistent circumstance. This, | believe, usually consists of such disorder of the alimentary viscera, whether dependent on general debility and habitual organic atony, or upon existing depravity of secretions, as is incompatible with the adequate conversion of animal diet to its proper use. It lodges unreduced in the duodenum, irritating to morbid action that organ ; and as the various secretions have been deficient or depraved, the excitement of the circulating activity locally takes place without corresponding activity of the glandular function of the liver, and the other secreting actions connected with digestion, whence necessarily morbid local action and febrile excitement. To relinquish measures so essential to restore the constitutional powers on this account, is a mistaken course. Correct the existing disorder; stimulate the secreting functions of the liver and the other secretions ; promote habitually the alvine evacuations ; and perseverance in animal diet is no longer injurious, but beneficial, and what the very debility, indicated by the febrile exacerbations in question, urgently calls for. It is an interesting practical fact that, in such circumstances, the excitement of fever by the use of animal diet is generally in a degree moon to existing debility; and as vigour is regained by the use of that means, the febrile exacerbations in question are less liable to occur, and, when occurring, produce much less influence either on the constitution or on the local disorder. In chronic catarrh and mucous secretion of the bronchiz dependent on slighter pulmonic congestions, increased freedom of expectoration supervenes after every meal, and seems, in such cases, a favourable symptom rather than otherwise, indicating the beneficial effects of food in restoring and invigorating the system. When, as in the above-detailed case, the same disordered condition is associated with great general debility, increase of expectoration is naturally to be expected from the remission of chronic congestion under an invigorating diet ; and in such circumstances, being analogous to the critical expectoration in acute inflammations, is rather favourably symptomatic of returning vigour, than an indication for farther reduction of power.
These remarks by no means imply the propriety of adopting animal diet in all cases indiscriminately. Where, from existing disorder of the lungs or digestive organs, or from extraneous circumstances of impure air, the digestive power is materially impaired and counteracted, what good can be effected by administering food ? The injurious consequences supervening are naturally in a degree proportioned to existing debility and incapacity Sr digestive action. A just estimate of the digestive capacity is not less essential than a just estimate of the existing demands of the debilitated frame.
The question naturally occurs, what was the real nature of the pulmonary disorder in the foregoing case? No evidence appearing of the existence of tubercles, the inference is, that the purulent expectoration proceeded from brochial secretion or ulceration. But regarding the attendant symptoms and the rapidly progressive decline of the powers, the result of porerarenes in abstinence and antiphlogistic treatment may e anticipated. As no criterion for judging of the existence of tubercles usually is afforded* farther than the symptoms manifested in this case, the practical deduction is, that an invigorating system of dietetics is now generally deserving of trial in sumilar cases. It may be objected that, however useful animal diet may be in chronic catarrh, purulent secretion, or even ulceration, this system of diet is not applicable to the case of tubercular ulceration.