Anorexia Or Gastric Symptoms of any kind may prove a serious hindrance to the administration of food. In these cases it is generally advisable to confine the patient to bed, though as much fresh air as is possible should be provided. The dietary should then be largely fluid, but it is probably wrong to restrict the variety or the amount of food-stuffs to the degree that may be necessary in the case of such a disease as chlorosis. The anaemia tends to impair the digestive secretions; the imperfect absorption of food leads to further deterioration of the blood; and the vicious circle perpetuates itself.
Milk is sometimes badly borne by these patients. The gastric juice is often defective in HC1 and pepsin, and both may be wholly absent and gastric digestion in abeyance. But an attempt should always be made to ensure the consumption of a certain amount, and any of the artifices already suggested may be utilized. Peptonized milk rarely gives rise to symptoms, but the taste may interfere with its consumption. White wine whey, whipped eggs, egg-nog, meat soups, beef-tea, etc., may be utilized if milk cannot be taken, and their nutritive value may be increased by the addition of extra protein in the form of protene, plasmon, etc., or of some of the finer farinacea underdone meat, if necessary finely minced or scraped, raw meat juice, scraped raw meat, preferably given as sandwiches, raw or lightly cooked ox marrow, are sometimes tolerated when a more bulky fluid diet is ill borne. The cooking, however, must be of the plainest variety, and rich sauces or large amounts of condiments must be prohibited. On such a dietary intestinal symptoms sometimes subside with great rapidity.
A largely protein dietary of this kind is almost invariably attended by great foetor of the stools, and the amount of indican and aromatic sulphates in the urine is generally notably augmented. The bowel should in these patients be flushed out at intervals, so as to limit as far as possible the intestinal decomposition. The administration of antiseptic drugs has on the whole proved unsatisfactory. Mercury in small doses is probably the most generally useful.
The chief objections to the use of raw meat are the disagreeable flavour, and the impossibility of ensuring a sterile diet. The former may be overcome by a partial cooking; the latter by utilizing the central parts of the flesh. The tapeworm parasites, etc., may of course be conveyed in such a way, but the danger in this country is probably less than elsewhere. In India it is said to be considerable.
The cases in which gastro-intestinal symptoms are in abeyance should be fed on ordinary lines. A fairly varied mixed diet of fresh food, with a maximum of the red meats and a fair proportion of milk, is usually well digested; but a careful watch should be kept upon the stools to ensure that digestion is complete Fever per se is no contra-indication to even over-feeding, if the digestion is good, but the coincidence is, unfortunately, often lacking.