Apr 3, 1909
British Medical Journal
the first weeliof treatment. In 1 case the pain continued during the whole stay in hospital. Haberman4 reported that, in 1906, 135 cases had been treated by ProfessorLenhartz in Hamburg, with 3 deaths, each of these fatal cases being very severe or complicated. A recurrence of haemorrhage took place in 8 per cent., as compared with 20 per cant. in 100 cases treated by the old method. Most were cdismissed cured before the eighth week, and no unfavourable effects were produced. Wirsing# reported 42 cases in 1906,14 of which had had recent haematemesis. In one case haemorrhage recurred. In 27 of these patients the acidity of the stomach contents was estimated; itwas found that during the treatment the amount -and percentage of hydrochloric acid was diminished, the latter on the average from 0.14 to 0.11 per cent. Some cases did not show this, and yet progressed as well as the others. The method of Senator, which has some similar features to that of Lenhartz, may be mentioned here. It consists of the administration of gelatine, butter, and cream from the beginning. He (see reference 13) has reported 50 cases fed upon this diet, of whom 2 died, that is, 4 per cent. Ewald9 uses nutrient enemas for three days after a haemorrhage, and then gives milk, butter, and eggs, followed by other foods, as in Lenhartz's plan. He reported 34 cases in 1906. The results, however, appear to be inferior to those of the Lenhartz method. In 14 cases death occurred either after operation or immediately after haemorrhage, and there was a recurrence of haemorrhage in 7 per cent. Ewald considers that the Lenhartz method cannot be justified on theoretical grounds and is not worth the risk. The above facts and figures, however, do not support this view, and, so far as data have been collected, it appears to be less risky than other methods of treatment. Lenhartz in 190610 reported 140 of his cases, all with recent haemorrhage by the mouth, or melaena. These include some of those reported by Wagner and Haberman. The mortality was 2.14 per cent.' He recommends that in such cases great care should be taken not to increase the bulk of milk too rapidly, and iu some instances quoted the eggs were given without the milk for two or three days. In one case, by the twelfth day only 17 oz. of milk per day was being taken. The stom %ch should never be distended. ile reports that in two of his patients who died, on the fifteenth and eighteenth day respectively, the ulcer was found to be smooth and healed. He recbmmends the diet strongly for patients who have recently had a gastro-enterostomy performed. Lambert 11 in 1907 published 5 severe cases, all of whom did well on the treatment. One was a woman of 32 years, who, after seven days' rectal feeding and seven days' careful feeding by the mouth with peptonized milk, still had occult blood in the stools anda haemoglobin percentage of 39, and the question of operation was being mooted. The Lenhartz treatment resulted in a cure. Another patient objected to the diet, even to the point of nausea and vomitigg, but nevertheless, after the cessation of the diet for one day, did well. In another haemorrhage went on uatil *the thirteenth day, and the case was regarded 'as below the safe limit for surgery, and yet made a good recovery on this treatment. A fourth case, with signs of peritoneal-irritation, leucocytosis, and a temperature of 1000 to 1040, also recovered. In a fifth case, in which the haemoglobin was reduced to 20 per cent., in spite of an attack of enteric fever upon the twenty-second day, the treatment proved successful. Lsmbert's fourth case resembles one which came to my notice after the figures which I have given had been collected. A young woman of neurotic temperament was treated bv Mr. G. E. Friend for gastric ulcer on the Lenhartz paln. She had no pain for four days, when vomiting recurred, with rigidity of the upper part of the abdomen. Perforation was discussed; the putient was put upon enemata, and made a good recovery. It is a matter of conjecture whether she would or would not have recovered equally well if, as in Lsmbert's case, the treatment had b3en persisted in. Berger, in a publication from the Hamburg school, points out that so efficient has the method of treatment been found in the Eppendorfer Krankenhaus that it has proved useful as a method of diagnosis, for in cases which fail to respond the diagnosis has, in many instances, been at fault. He quotes six cases in which the failure of the diet led to the diagnosis of cancer, which was confirmed by operation in four of them and in two by autopsy. In another case haemorrhage was found to arise from dilated veins about the oesophagus due to cirrhosis of the liver. He says, further, that in cases of pain without bleeding which do not yield, nervous diseases may be suspected. Schniitgen Is mentions in 190' that Lenhartz had then treated 201 patients, With a mortality of 3 per cent. This is about the same as the mortality in 195 cases treated by nutrient enemas by Leube, which was 4 per cent. Leube has altogether collected 556 cases, with a mortality of 2.2 per cent., but many of these were not of the hospital class. It appears, therefore, that the death-rate of patients treated by the Lenhartz diet is not greater thanthat of those treated in other ways. Finally, Dr. L3,ngdon Brown14 in a recent paper mentions that he has treated 11 cases by ths L.enhartz method with good results in 9 of them.