a. The Restriction of Liquids in Diseases of the Blood Vessels, the Stomach, the Heart, the Kidneys, and in Diabetes Insipidus

The attempt has been made to utilize in manifold diseased conditions the powerful influence which may be exerted upon the body by a restriction of liquid ingesta.

It was in the treatment of certain affections of the vascular apparatus that the advantages of under-nutrition and of thirst-cures first came to be appreciated.

Hippocrates (1) was the first to advise rendering a patient with heart disease "siccum et siccissimum" by limiting the amount of solid and liquid ingesta. Several clinicians of the Middle Ages, among them Valsalva, Albertini (2), and Montagni (3), advised a similar procedure, and in addition recommended repeated blood-letting as a valuable step towards reducing the quantity of the blood, when combined with a gradual reduction of solid and liquid food. Later reports by Bellingham (4), Tufnell (5), and Vanizetti (6), in cases of aneurism treated in this way, bring us down to the modern literature on the subject.

The marked and significant symptoms of aortic aneurism explain why, particularly in this disease, physicians returned again and again to restriction cures. S. Laache (7), Moritz Schmidt (8), when they saw the surging blood current finally burst the vessel walls, what was more rational than striving to lessen the amount of the blood?

But restriction of food was then considered equally or even more important than restriction of liquids, and the cures reported by the above-named authors cannot, therefore, be designated as pure thirst-cures. As to these deprivation cures, the credit for having placed in the foreground the restriction of liquids especially, and for having recognized correctly its effect in thickening the blood, belongs to Schroth (1800-1856). He instituted what was called a "roll cure" (Semmelcur), and allowed his patients to eat as many dry, thoroughly baked rolls as they cared to, and, in addition, mushes made from rice, barley, etc. The only liquids that the patients were allowed to take during the first week of the cure were a little oatmeal gruel mixed with sugar and lemon-juice; the quantity of this liquid pabulum was gradually reduced to a wineglassful daily, until finally the patients were allowed this amount only every other day. The patients were forced to subsist on this minimum of liquids for weeks; if the thirst became insufferable they were allowed a piece of roll dipped in wine or half a glass of wine. Cold packs given every evening were made a part of this treatment.

Carried out in this rigid manner, Schroth's cure was naturally a very severe procedure. Some of the cases developed signs of scurvy, and a few of them died.

A rise of temperature above 40° C. was reported in a considerable number of instances.

Juirgensen (9), who tested the value of this method, added half a bottle of wine to the dietary. He also showed conclusively that no vicarious absorption of liquids through the intact skin occurred, as Schroth had postulated. He obtained definite therapeutic results in cases of old syphilis, in gastrectasis, and in chronic peritoneal exudates.

Schroth's cure in the form proposed by its originator naturally did not maintain its popularity for a long time. The method was far too trying and inconvenient to the patients; and, in addition, its inventor seemed incapable of fairly judging of its limitations, so that he proclaimed it a universal panacea for all ills. However, the good results indisputably obtained by Schroth in many disorders attracted the attention of the profession to his method. Thus Jiirgensen relates as follows:

"Professor Bartels found several years ago that a case of gastrectasis that he had treated without success for a long period of time was cured in a so-called 'Schroth Institute.' This induced him thenceforth to try a similar method in suitable cases that came to his clinic."

Since that time the use of a dry diet has occupied a prominent place in the treatment of gastric dilatation, notwithstanding some of the objections that have recently been formulated against it by Albu (10), for instance. In this disorder the advantages of the dry diet are quite clear. Whenever the evacuation of the gastric contents becomes difficult the greater curvature of the stomach is stretched and dilated and occupies a position considerably lower than the pylorus. It is clear that solid ingesta can more readily be raised to the level of the pylorus than fluids, for the latter are mechanically more difficult to propel upward than solids. Fluids, moreover, are more voluminous in proportion to their nutritive value than solid articles of food. When we consider, furthermore, that practically no water is absorbed by the walls of the stomach and that it consequently acts as a dead weight in the stomach whenever it cannot readily pass through the pylorus, we can easily understand why a dry diet spares the organ when it is dilated and the tone of its musculature is weak. As a matter of fact fairly good results are obtained from a restriction of liquids in such cases. I need hardly emphasize that the good effects derived from this practice are more striking and more rapid in cases of simple atony of the stomach than in pyloric stenosis.

[On the other hand there are conditions in which the moderate drinking of water or other non-irritating liquid during, or shortly after, meals may lessen the danger of overdistention and dilatation of the stomach. This is especially true of spasmodic contraction of the pylorus (pyloro-spasm), from either hydrochloric or organic acid excess - hyperchlorhydria or any form of marked hyperacidity. The noneffervescent alkaline waters are, of course, particularly effective in overcoming such contractions, since they facilitate the onward propulsion of the gastric contents by diluting them as well as by directly neutralizing their excessive acidity. In organic acidity, however, from fermentation, associated with a diminished secretion of hydrochloric acid, prolonged alkaline treatment would be injurious by still further depressing such secretion. In cases of this kind, therefore, plain water, neither ice-cold nor very hot, is preferable and will often, by merely diluting the over-acid contents, relieve the spasm and thus help to unload the viscus. Manifestly the acid wines and malt beverages would aggravate, instead of remedying, the conditions just described. - Ed.]