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SPECIAL DIETETICS; OR, DIET AS FITTED FOR VARIOUS DISEASES.

In the preceding chapters, dietetics have been fully discussed in a general manner, but as the indications for diet in the several diseases differ somewhat, we will now consider the subject in a special manner, taking up the more common affections and giving their proper treatment from a dietetic standpoint.

FEVERS.

Diet in Acute Diseases.—The proper diet in acute diseases varies somewhat according to the individual affection, but is subject to general principles which are sufficient guides for most cases.

When Food is Not Needed.—In acute febrile diseases which have a very short duration, from one to three days, it is not necessary that the patient take food, as his vitality is strong enough to tide him over. Again, during the first day or two of pneumonia, scarlet fever, or similar affections, there need be no alarm even if the patient take no food, as his strength is sufficient, and often he has absolutely no inclination for food,

When Food is Needed.—But after the fever has been prolonged more than one or two days, then, it becomes necessary to nourish the patient, even though it be against his will, for the tendency to fatal results in all such cases is through exhaustion, and much can be done toward preventing a failure of the vital power by proper feeding.

NOURISH THE PATIENT; DON'T STARVE A FEVER.

Food in Fevers.—The older writers upon dietetics taught that a fever patient was not to be fed, and some modern authors still follow the old teaching. However, fever is not a contra-indication to food—to be sure, if the stomach is overloaded with coarse food it will only augment the condition, but if proper care is taken in selecting a diet there will be few bad results and many good ones.

TYPHOID FEVER.

Liquid Foods.—All foods given in protracted febrile states should be in liquid form. This is especially true in typhoid fever, in which disease it should be continued until ten days or two weeks after the temperature has returned to normal.

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Milk.—Of all liquid foods, milk is by far the best and most serviceable in typhoid fever. It is taken, if not with relish, at least with less reluctance than other articles, and it has the great advantage of embracing in proper combination all the alimentary principles required for nutrition.

Pure Milk.—Care should be taken that the milk is of a good quality and comes from healthy cows. In preparing it for the patient it is often necessary that it be iced in order to make it more palatable, or, if it is thought to be questionable in quality, it should be sterilized or boiled.

Diluted Milk.—Should the stomach reject milk when taken as it comes from the dairy it may be diluted with ice-water, lime-water or barley-water. Again, if the regurgitated milk shows signs of non-digestion, it should be artificially digested with peptonizing powder (which can be procured at any pharmacy) before administering to the patient.

Quantity of Milk.—One or two ounces of milk should be taken every three hours during the day, and at night not more than four hours should elapse without food and stimulants being administered. While sleep is essential, yet a patient is not harmed by the partial awakening which is sufficient for the administration of a milk-punch. Again, a careful nurse can give food at frequent intervals without awakening him.

LIQUID MEAT FOODS.

Fresh Meat Juices.—This is the most nutritious of this class, but as a rule it is not taken well by the average patient, owing to its insipid flavor. It may be added to the patient's milk, or used in making broth, about a tablespoonful being given at a time. Beef juice is made by cutting prime, lean beef into small pieces and pressing until all the juice is extracted from the meat. A little salt added to fresh beef juice makes it more palatable.

Beef Tea has an undeserved reputation, for it has but little nourishing property, and to have any effect it must be given in large quantities. It is, however, slightly stimulating.

Liquid Peptonoids are by far the best prepared meat food in typhoid fever, containing as they do the active and nourishing principles of beef, they are especially adapted to the conditions found in typhoid fever. This preparation of beef is manufactured by all reputable pharmaceutical firms, and can be procured from any drug store. It should be given in milk, or alternated with it, every two or three hours, a teaspoonful to a tablespoonful constituting the usual dose.

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Soup and Broth resemble beef tea, in that they contain the extractives of meat, but they also contain nutritive substances, but vary greatly according to preparation, the lighter forms of soup being spoken of as broth.

Preparation of Broths.—To prepare broth, use young chicken, lean, fresh beef, or mutton, without fat, allowing the meat to boil slowly for four or five hours (until it falls to pieces), strain, cool and skim off what little fat appears. This liquid may then be seasoned and diluted to the strength required by the patient.

Administration of Broths.—As broths are stimulating as well as nutritious, they should not be administered to a typhoid patient until the third or fourth week, by which time the milk and peptonoid diet will have become exceedingly tiresome, and the new nourishment will be relished and at the same time adapted to the conditions of that period of the disease.

Eggs may be given cautiously throughout the disease in combination with milk as egg-nog, which is made by adding the yolk of an egg to half a pint of milk, with a tablespoonful of whiskey, wine or brandy, and then beating in the white of the egg. This should be given sparingly in any delicacy of the stomach.

Stimulants are given by many physicians throughout the disease, but unless the individual case requires stimulation from the beginning it is best to defer the administration of alcoholics until the middle of the second week, or until the time when the organism requires energetic artificial stimulation.

What Stimulants to Use.—Whiskey, brandy and the light wines can all be used, either slightly diluted in doses from a teaspoonful to a tablespoonful, every two or three hours, or incorporated with the medicine or food. As mentioned above, whiskey or brandy can be given in the form of egg-nog, or milk-punch, thus exhibiting both the stimulating effects of the liquor and the nourishment of the milk and eggs. A light, powerfully stimulant beverage is made by the addition of champagne to milk, and is especially applicable to a weak stomach.

Feeding by Enema.—In extremely serious cases of typhoid fever, or when the stomach will not retain proper nourishment, it is often necessary to sustain strength by rectal feeding, For this purpose, strong, black coffee, solutions of beef peptonoids, beef tea, beaten eggs and milk, etc., are injected well up into the intestine by means of a long rectal tube. In this form of feeding a very much larger quantity of food should be used than by the mouth.

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Diet of Convalescence.—After the acute symptoms have all subsided and the temperature has been normal for ten days or two weeks, the diet may gradually be increased. For the first few days boiled rice, cornstarch pudding, oat-meal porridge or sago porridge may be given in small quantities. This may be followed by a portion of a soft boiled or poached egg, or milk toast made from old bread. On the fifth or sixth day a little dry toast with a baked apple or potato may be eaten; this can be followed by finely chopped lean beef, broiled, and light bread which is a day or two old, with a little fresh butter.

Increase of Diet.—From this diet gradually increase to a tender piece of chop or steak, small quantities of well-cooked green vegetables, and so forth, always remembering that the seat of the disease is in the intestine, and standing ready to cut the diet down on the appearance of diarrhoea, a return of fever, or other unfavorable symptom.

During convalescence it is not usually advisable to continue the use of stimulants, although the malt liquors, as ale, porter and malt extract are at times beneficial.

CEREBRO-SPINAL FEVER.

Cerebro-Spinal Typhus, Meningitis, Spotted Fever.

Generous Diet Needed.—This disease may be very rapid in its course and terminate in from four to seven days, or again, it may continue for six or eight weeks, according to the length of its stages and their particular conduct. Consequently a generous and sustaining diet must be inaugurated from the onset.

Items of Diet.—Milk, eggs, beef juice, liquid peptonoids, mutton broth, and so forth, should be given every three hours, day and night, to avoid paroxysms of weakness in the early morning. Very often food cannot be taken by the mouth, in such cases nutritious enemata should be used as in typhoid fever. The alcoholic stimulants: whiskey, brandy, wine, and so forth, should be given freely every few hours.

PERNICIOUS FEVERS.

Pernicious Malarial Fever. Congestive Fever.

Full Diet Heeded.—The diet in pernicious malarial fever should be full; plenty of meat, milk and eggs. During the attacks it should be cut down to liquid food, often repeated. In the gastro-enteric variety of the disease the diet should be the same as in acute dysentery.

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INFLUENZA.

La Grippe. Contagious Catarrh.

Diet Required.—Food consisting of milk and eggs should be administered at frequent intervals and in most cases, especially in elderly individuals, alcoholic stimulants should be given. When the pulse is soft and the stomach irritable, champagne will be found to be a most serviceable remedy.

Diet in Convalescence.—The prostration and loss of strength is very great after an attack of influenza, even though the duration has been short; and convalescence must be watched with much care. The diet should be increased as soon as possible to thick soups, rare beef and mutton and the easily digested vegetables. Malt liquors, porter, ale, stout, and so forth, are often indicated.

The rapid increase of consumption since the advent of influenza, a few years since, is very significant: convalescing patients should receive the most nourishing of food, in order to fortify the organism against any tendency to chronic complications.

SCARLATINA.

Scarlet Fever.

A Supporting Diet Needed.—As this disease runs a rapid, definite course, the diet must be supporting and nourishing from the start; milk, beef peptonoids and eggs fulfilling the indications. Alcoholic stimulants are indicated in proportion to the frequency and feebleness of the pulse, together with general prostration. Alcoholics are to be given with discrimination however, their precise effects being noticed. The malignant type of the disease requires that stimulants should be used freely. In children, wine-whey, milk-punch and egg-nog are eligible forms for their administration.

Water Diet.—If the urine is scanty and high colored, the patient should be permitted to drink of water very freely, also milk and lime-water and cream-of-tartar lemonade, in order to promote proper renal secretions.

DIPHTHERIA.

Putrid Sore Throat. Malignant Quinsy.

Milk Diet Required.—The diet should be concentrated and highly nutritious from the onset, embracing the necessary variety of alimentary principles. Milk meets preeminently these requirements.

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Difficulty of Nutrition.—A serious difficulty in the treatment often arises from the invincible repugnance to nutriment, and sometimes from the persistence of vomiting. Owing to the difficulty of alimentation in such cases, and sometimes a want of appreciation of its importance, death takes place from innutrition.

Items of Proper Diet.—Milk, eggs, broth, peptonoids, beef juice or essence, peptonized oysters, eggnog or milk-punch should be given at intervals of every two or three hours. If swallowing is so difficult as to prevent the patient from taking a proper amount of food, resort must be had to nutritious enemata. The following is a suitable formula: 

      Milk ........................................... 1   ounce
      Whiskey ........................................ 1/2   "
      Egg ............................................ 1
          Add a little salt, beat up and warm.

Stimulants.—Stimulants should be used boldly from the start, guiding the dose by the effects. It is surprising to observe the large amount which can be taken even by the tenderest subject, without bad results. Usually a child of two years requires from thirty to sixty drops of whiskey or brandy every two or three hours; an adult, from two to three teaspoonfuls every three hours. However, this amount can be greatly increased if necessary. It is a mistaken idea to wait until symptoms of debility appear in diphtheria before using alcoholic stimulants.

Measles.—The diet needs nothing more than casual mention. Milk constitutes the chief article of diet, especially if there is a trace of albumen in the urine. Iced drinks, calf's-foot jelly, custards, rice and tapioca pudding are very acceptable to the little patient, and can be given in moderation. Stimulants are seldom required.

Constipation.—Above all other means for removing constipation are those hygienic applications derived from the natural stimulus of the intestinal movements—food. If there be no contra-indications, those foods which leave a considerable residuum—as Graham flour, bran, rye and corn bread, groats, oatmeal, cracked wheat and oats, and so forth—can be used with advantage, fresh vegetables as lettuce, spinach, celery, onions, the various vegetables known as greens, and so forth, and fruits as apples, dried peaches, figs, dates, tamarinds, prunes, and so forth.

A large draught of plain or carbonated water should be taken before breakfast. The alkaline mineral waters, as Saratoga, Pullna or Hunyadi, taken in this way usually give excellent results. As a sedentary life induces constipation, it follows that sufficient excercise must be enjoined in all such cases.

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Diarrhoea.—The diet, in quality and quantity should of course be adapted to the digestive powers. Chickens, eggs and tender meats plainly cooked are most likely to be digested; but as before mentioned a milk and farinaceous diet is found to be preferable. Crude vegetables are to be interdicted, but ripe fruits in moderation may frequently be taken without inconvenience and with advantage.

Cholera Infantum.—In a "hand-fed" child boiled flour, powdered biscuit or barley water may be added to the milk. Very often in such children who have been judiciously fed, the meat foods will be found to act better than milk. Thin broths, beef tea, beef juice, liquid peptonoids or raw scraped beef are used generally with much benefit.

Dysentery.—As in this disease the nutrition suffers severely the correct diet is important from the beginning. If the stomach is irritable, milk, with one-fourth lime-water, is the best food. If there is but little nausea, and especially if the digestion remains good, the patient can take milk, eggs, beef juice (which is particularly adapted to this condition), ice cream, boiled custard, oyster soup, mutton, chicken and beef broth, and similar articles. But solids leaving much residuum, and especially coarse articles, are highly objectionable.

Pneumonia.—Food must be carefully administered from the beginning without waiting for depression to come on. Beef juice, milk, milk-punch, egg-nog, wine-whey, mutton or chicken broth, liquid peptonoids should be given systematically every three hours. In weak subjects stimulants are necessary from the onset.

Consumption..—The diet should be generous as regards quality, quantity and variety, the articles of food being highly nutritious and adapted to the digestive powers. All the varieties of wholesome food which the patient is able to take with relish should be allowed, and the appetite should be encouraged as much as possible.

Chronic Bright's Disease.—The nutrition of the patient is of the first consequence. The diet should be simple and consists of milk, eggs, a little fresh meat (once a day) and fruits, if diarrhoea does not exist.

Rickets.—Good cow's milk, diluted by one-third to one-fourth of lime-water is the most suitable food. In older children the food should contain an abundance of animal fat, nitrogenous principles, and salt. The quantity of animal fat should amount to at least one-fourth of all the solid food taken, the nitrogenous food to one-third, and the starches to one-third. The fat is best administered in the form of cream or rich milk, but if this cannot be obtained cod-liver oil may be substituted. Raw or beef cooked very rare is one of the best articles of food in this disease for older children.

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Gouty.—Gouty patients may, for the purpose of dietetic discussion, be arranged in three classes: first, those who are robust and vigorous; second, those who with a distinct feebleness of constitution and sluggishness of habit have a marked tendency to the accumulation of fat; third, those whose nutrition and general vital forces are habitually on a low level.

In robust gouty persons it is essential that the quantity of food be lessened; such persons should be taught to habitually rise from the table with the appetite not entirely satisfied. In the second class of patients some control over the appetite is not rarely imperative, while in the third class of patients it is often equally essential to administer food beyond the cravings of the stomach.

What to Avoid.—There are certain articles of food which should be denied to all gouty subjects. First of these is cane sugar, acid fruits, including the tomatoes and strawberries, are also to be avoided by all gouty subjects, while non-acid fruits, if ripe. are almost invariably of great service and should be taken freely. The harm done by acid fruits is largely due to their irritating effects upon the organs of digestion.

Nervous Affections.—Nervous prostration; nervous exhaustion. The question of feeding is one of great importance, and requires the utmost care and attention; the end to attain is to feed the patient as much as can be digested, but not to overfeed and derange the digestion.

Food should be given at intervals of two or three hours, and must be both light and nutritious. It should, at least at first, consist largely of milk, except in those rare cases in which this fluid does really disagree with the stomach and is not merely thought to do so. The milk should be skimmed or given in the form of koumiss.

Beef juice, or other concentrated meat essences are valuable as stimulants, and may be used as the basis of soups. Various farinaceous articles of food may be added to them; if an egg be broken into the concentrated bouillon or beef essence just as it ceases boiling, a nutritious and palatable dish is obtained. When constipation exists, oatmeal porridge, Graham bread and fresh or dried fruits may be allowed if they are readily digested by the patient.

Full and Low Diets.—The terms "full diet" and "low diet" are often used by physicians in their directions to nurses. Pavy gives the full or extra, the middle or ordinary, and the low diet of Guy's Hospital as follows:

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Full or Extra Diet.—Fourteen ounces of bread; one pint of porter for males, half a pint of porter for females; six ounces of dressed meat, roasted and boiled, alternately, with eight ounces of potatoes; half a pound of rice pudding three times a week: half a pint of mutton broth in addition on days when boiled meat is given (which is four times a week); or, occasionally, one pint of strong vegetable soup, with meat and rice pudding, twice a week; one ounce of butter each day; porridge, gruel and barley water as required.

Middle or Ordinary Diet.—Twelve ounces of bread; half a pint of porter; four ounces of dressed meat roasted and boiled, alternately, with eight ounces of potatoes; half a pound of rice pudding three times a week; half a pint of mutton broth in addition on days when boiled meat is given (which is four times a week); or, occasionally, one pint of strong vegetable soup with meat and rice pudding, twice a week; with the full diet allowance of bread; one ounce of butter each day; porridge, gruel and barley water as required.

Low Diet.—Ten ounces of bread; half a pint of beef tea, mutton broth, rice, arrowroot, or sago, when specially ordered; three-quarters of an ounce of butter; gruel and barley water as required. Wines and spirits, if used, must be mentioned each time the physician or surgeon attends.

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