In many diseases, especially those accompanied by fever, the powers of digestion are much impaired. For this, as well as other reasons, it is necessary that all food given should be in a liquid form. Milk, except under certain conditions, is at such times considered the best food, as it contains in a dilute form all the constituents of the solids, namely: albumen, fat, sugar, the inorganic salts of lime and potash, and water.
If curds appear in the stools, or vomiting ensues, it shows that the milk is not being properly digested. This difficulty may often be overcome by diluting it with seltzer or other effervescent water, by the addition of lime water or bicarbonate of soda (ten grains to a pint), or by peptonizing the milk. (The recipe for the latter will be found at the end of the section.)
A good substitute for milk is white of egg, beaten to a froth, diluted with an equal quantity of water, and flavored with lemon juice.
Patients on fluid diet should, as a rule, be given six ounces every two hours, or half the quantity every hour. Of course there are times-as after operation, or when the patient is nauseated-when less must be given.
When a patient is on liquid diet it is especially imperative to give her nourishment at stated times and regular intervals. In giving see that it is taken very slowly.
As a rule, when a patient is sick enough to be on fluid diet it is necessary for her to maintain the recumbent position, even while drinking, and there are several devices to facilitate this. There is the old-fashioned feeder with the spout, but the drinking tube or "ideal glass" are preferable. When raising the head slip the arm under the pillow; take care not to throw the head forward, and by so doing make it difficult to swallow. Never bring a glass to the patient in your hand, but on a small tray or plate, and with it a napkin to fold under the patient's chin and prevent drops soiling the sheet.
When a patient is on milk diet her mouth should be washed out after every feeding, with listerine or boric acid, otherwise it will soon become coated and sore. Directions for doing this were given in the section on the care of the teeth.
A convalescent patient should be given solid food only by degrees, beginning with the so-called soft diet, which includes broths, strained vegetable soups, soft cooked eggs, milk toast, junkets, custard, jellies, and raw beef sandwiches. Then comes "light diet," which means the addition to the "soft diet" of underdone steak, chops, chicken, baked potatoes, and farinaceous puddings.
Pastry and all rich or highly seasoned food should be avoided until the patient has, in every respect, resumed her usual routine of life.
In diseases such as rheumatism, Bright's disease, diabetes, dyspepsia, etc., where fever is not the most important symptom, but where the effect of certain foods must be taken into account, a special diet is prescribed. As the patient's general condition must be considered in the prescribing of such, I think it wise to make only a few general remarks on the subject, as a great deal of harm is frequently done by following set rules for medication and food, by those who are unable to recognize symptoms contra-indicating their use.
In many forms of febrile disease, as for instance tuberculosis, light diet can be given even while there is fever, nourishing food being a most important item in the treatment.
In diabetes, sugar and starchy foods, most fruits, and alcoholic drinks must be avoided. Gluten bread should be used, and that not too fresh; saccharine should be used instead of sugar for sweetening not only tea and coffee, etc., but also in cooking. Fresh milk should not be taken, but buttermilk and koumyss are allowed.
In rheumatism and gout, as in diabetes, all sweetening should be done with saccharine, and sweets of all kinds are prohibited, also pastry, puddings, jellies, pork, veal, and all fried meats. Fruit except strawberries and bananas, is allowed.
Too great stress cannot be laid on the necessity for a dainty serving of the patient's meals. They should be either very hot or perfectly cold, as the case requires. Have clean napkins, spotless china, and shining silver and glass. Be careful in carrying the tray not to spill any of the fluids, and, as has been said before, do not have too much on the tray at a time.
Care of the Chile
Furthermore, that the patient may thoroughly enjoy the meal, it is necessary that she should be perfectly comfortable. Therefore, before bringing in the tray, wash her face and hands, shake up the pillows, and decide where it is best to set the tray. If there is no bedside table or tray with feet, it is a good plan to have two blocks of wood to put on each side of the patient. They should be about the width of the tray, and high enough to hold it off the patient's chest. Magazines will answer the purpose if the blocks cannot be obtained. Always protect the night-gown and bed clothes with a towel or table napkin.
Tray With Feet