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March, 1947 RICE DIET—KEMPNER 129 a decubitus ulcer over the coccyx. Since June, he had had considerable soreness of the tongue. He was under medical care during all this time, and between January and July, 1946, he spent one hundred and twenty-six days in three different hospitals. In addition to digitalis for more than a year (1.7 grains of digi-tora daily since June 15, 1946) and a salt-poor diet, he was given salyrgan (seven injections since May 15, 1946), aminophyllin (twelve injections since May 15, 1946) and glucose intravenously, and ammonium chloride (3 to 6 Gm. daily from August 30, 1945, to May 15, 1946) , theominal, coramine, barbital, and other sedatives. In spite of this treatment, the cardiac failure increased. On July 29, a paracentesis was clone and 2 gallons of fluid were removed, but a week later the abdomen was swollen as much as before and the edema had become worse. Physical examination (August 5, 1946) : The patient's weight was 187 pounds, height 5 feet, 10 inches, temperature 37 C. (98.6 F.), pulse 86, respiration 16. His blood pressure during the first week averaged 126 systolic, 88 diastolic. He was a well developed, poorly nourished, white man in considerable respiratory distress. There was generalized anasarca, and the skin was pale. Over the coccyx was a decubitus ulcer measuring approximately 1 inch in diameter. The eyes had a marked stare; the eyegrounds showed only slight tortuosity of the vessels. The tongue -was very red, smooth, and sore, and along the lateral margins were several ulcers. There was engorgement of the neck veins, and rales were heard at both lung bases. The heart was markedly enlarged, chiefly to the left. The maximum apical impulse was in the fifth interspace 14 cm. from the midsternal line. The sounds at the base were forceful, and the second pulmonic sound was louder than the second aortic. The first sound at the apex was weak and was followed by a loud, long, blowing systolic murmur. During the period of this murmur, a high-pitched murmur of shorter duration was heard. The abdomen was large, round, distended, and filled with fluid. A non-tender liver edge was felt 6 cm. below the costal margin. There was marked sacral and scrotal edema and severe pitting edema of the ankles and legs. Accessory findings: The chest film showed a slight increase in the markings at botli lung bases. The heart appeared enlarged, especially to the left, and there was an area of increased density along the left border of the heart that was thought to be due to a myocardial aneurysm (Dr. J. G. Whildin). Further x-ray studies by fluoroscopy and films (Drs. G. Baylin and R. J. Reeves) confirmed the presence of a myocardial aneurysm of the postero-lateral wall of the left ventricle (fig. 1). Fig. 1 As is shown in table 1, the electrocardiogram showed right axis deviation; the venous pressure was increased, the renal reserve was diminished, and hypoproteinemia, hypocalcemia, and albuminuria were present. Impression: Myocardial aneurysm following myocardial infarction. Advanced myocardial failure. Course: On August 7, the patient was started on a 2600-calorie rice diet with 800 cc. of fruit juices, supplemented by vitamins A, B, C, and D, and ferrous sulfate (0.6 Gm. three times a day). All other medication was discontinued except digitalis (1 cat unit of digifolin daily), and oxygen inhalation. A paracentesis was done on the ninth hospital day; 8000 cc. of fluid were removed. Four days later, the patient had a chill and fever. The temperature became normal twenty-four hours after treatment with penicillin was started. The patient ate the diet well; it was increased to 2900 calories on August 30, and to 3100 calories on October 16. By the end of the fifth week, his weight
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1947 |
Identifier | NCHH-17-008 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 8 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-008.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-008 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Description
Fixed Title * | Page 131 (image) |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1947 |
Identifier | NCHH-17-008-0141 |
Form General | Periodicals |
Page Type | all; all images; photo; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | northcarolinamed81947medi_0141.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 8 |
Issue Number | 3 |
Page Number | 131 |
Health Discipline | Medicine |
Full Text | March, 1947 RICE DIET—KEMPNER 129 a decubitus ulcer over the coccyx. Since June, he had had considerable soreness of the tongue. He was under medical care during all this time, and between January and July, 1946, he spent one hundred and twenty-six days in three different hospitals. In addition to digitalis for more than a year (1.7 grains of digi-tora daily since June 15, 1946) and a salt-poor diet, he was given salyrgan (seven injections since May 15, 1946), aminophyllin (twelve injections since May 15, 1946) and glucose intravenously, and ammonium chloride (3 to 6 Gm. daily from August 30, 1945, to May 15, 1946) , theominal, coramine, barbital, and other sedatives. In spite of this treatment, the cardiac failure increased. On July 29, a paracentesis was clone and 2 gallons of fluid were removed, but a week later the abdomen was swollen as much as before and the edema had become worse. Physical examination (August 5, 1946) : The patient's weight was 187 pounds, height 5 feet, 10 inches, temperature 37 C. (98.6 F.), pulse 86, respiration 16. His blood pressure during the first week averaged 126 systolic, 88 diastolic. He was a well developed, poorly nourished, white man in considerable respiratory distress. There was generalized anasarca, and the skin was pale. Over the coccyx was a decubitus ulcer measuring approximately 1 inch in diameter. The eyes had a marked stare; the eyegrounds showed only slight tortuosity of the vessels. The tongue -was very red, smooth, and sore, and along the lateral margins were several ulcers. There was engorgement of the neck veins, and rales were heard at both lung bases. The heart was markedly enlarged, chiefly to the left. The maximum apical impulse was in the fifth interspace 14 cm. from the midsternal line. The sounds at the base were forceful, and the second pulmonic sound was louder than the second aortic. The first sound at the apex was weak and was followed by a loud, long, blowing systolic murmur. During the period of this murmur, a high-pitched murmur of shorter duration was heard. The abdomen was large, round, distended, and filled with fluid. A non-tender liver edge was felt 6 cm. below the costal margin. There was marked sacral and scrotal edema and severe pitting edema of the ankles and legs. Accessory findings: The chest film showed a slight increase in the markings at botli lung bases. The heart appeared enlarged, especially to the left, and there was an area of increased density along the left border of the heart that was thought to be due to a myocardial aneurysm (Dr. J. G. Whildin). Further x-ray studies by fluoroscopy and films (Drs. G. Baylin and R. J. Reeves) confirmed the presence of a myocardial aneurysm of the postero-lateral wall of the left ventricle (fig. 1). Fig. 1 As is shown in table 1, the electrocardiogram showed right axis deviation; the venous pressure was increased, the renal reserve was diminished, and hypoproteinemia, hypocalcemia, and albuminuria were present. Impression: Myocardial aneurysm following myocardial infarction. Advanced myocardial failure. Course: On August 7, the patient was started on a 2600-calorie rice diet with 800 cc. of fruit juices, supplemented by vitamins A, B, C, and D, and ferrous sulfate (0.6 Gm. three times a day). All other medication was discontinued except digitalis (1 cat unit of digifolin daily), and oxygen inhalation. A paracentesis was done on the ninth hospital day; 8000 cc. of fluid were removed. Four days later, the patient had a chill and fever. The temperature became normal twenty-four hours after treatment with penicillin was started. The patient ate the diet well; it was increased to 2900 calories on August 30, and to 3100 calories on October 16. By the end of the fifth week, his weight |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-008.pdf |
Document Sort | all; nchh-17 |
Article Title | Treatment Of Cardiac Failure With The Rice Diet |
Article Author | Walter Kempner |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-008 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
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