The extremely depressing character of this infection, and the great exhaustion which it entails, would appear to mark it out as a disease in which liberal feeding is especially indicated. On the other hand it is well to remember that the forcing of too much nourishment on the patient may easily induce vomiting, and in no disease is vomiting to be regarded as more dangerous, owing to the strain it is liable to put upon a heart which is too often much debilitated. In selecting, then, a diet for diphtheria it is as well, while fully recognizing the importance of maintaining the strength of the patient, to be very careful that the food allowed is light and easily digested. All patients, moreover, and children particularly, should be watched for any sign of difficulty in deglutition, a complication which may appear comparatively suddenly, and occasionally has been responsible for death by choking.
As long as the temperature remains elevated, which as a rule is only for a few days, a fluid diet is perfectly sufficient, and this may be continued for some days after complete defervescence should the throat remain swollen or painful. The diphtheria patient, however, can usually swallow without much discomfort, and the difficulty of feeding in the acute stage is not nearly so great as is the case with a quinsy or as ordinary septic spotted throat. As in the other infectious diseases milk is by far the best and most convenient food. It must, of course, be given regularly and with due precaution, and it may be supplemented by the free use of ordinary beef or chicken tea. Should the pyrexia be prolonged, one or two beaten-up eggs may also be allowed in the twenty-four hours, as may calves' foot jelly and such foods as Benger's, plasmon, and other similar preparations. Remembering the importance of not overloading the stomach and causing an irritability which may be dangerous later on in the disease, it is usually better to wait till the temperature has fallen before making these additions. In the very severe cases, whether the temperature is elevated, normal, or subnormal, the simpler the diet is kept the better, and on the slightest sign of gastric irritability the milk may be with advantage peptonized. Should the patient appear much poisoned and the character of the pulse suggest a failing heart, the question whether to wake him every two hours for nourishment during the night may have to be seriously considered. In any case it is wiser to give something every four hours at least. Fortunately, in many cases of this sort the patient is drowsy, and is little disturbed by being frequently fed. Albuminuria at this stage need not, as a rule, modify the above diet. It frequently disappears early, and I cannot say that I have noticed that it is in any way affected by the food allowed. In diphtheria, as in the other toxic diseases, water and diluent drinks should be supplied liberally.
In the comparatively rare cases in which the inflamed and swollen condition of the throat is so marked as to prevent a reasonable amount of nourishment being taken, nasal feeding must be resorted to. Some suggest rectal feeding in preference, alleging the risk of the nasal tube inoculating the pharynx and oesophagus with diphtheritic material from the upper passages. In these days of serum treatment we may confidently assume that no such spread of the local condition is in the least likely to occur, and the value of rectal, as against nasal, feeding is so extremely limited that the latter should always be preferred. Unless there is very much septic, as well as diphtheritic infection, such cases may be said almost never to occur.
So far as diphtheria is concerned the term convalescence must be held to imply the period after the throat is free from membrane, a period in which the patient runs many of the most serious risks of the disease. In the majority of patients, however, the food may be increased from the moment the temperature touches normal, even if there is still some patching visible in the throat. Soft solids may first be given, milk puddings, baked custard pudding, oat flour porridge and farinaceous food generally. A little stewed fruit given with rice pudding encourages a child's appetite and may be safely allowed, as may fresh fruit such as oranges and bananas in moderation. Strong soups may now take the place of beef-tea, and eggs may be given with advantage either lightly boiled or served in a clear consomme. Fish may be added in one or two days and the patient's meals may be arranged as in health, milk or beef-tea being occasionally supplied in the intervals. The dietary might run on the following lines. First breakfast, porridge and milk. Second breakfast, two hours later, tea or coffee, bread or toast and butter, a boiled egg. Some time during the morning a glass of milk. Dinner, a good soup, fish and potatoes, milk pudding or cornflour with stewed fruit. Tea with bread, butter and jam - if desired a boiled or poached egg. Supper, a glass of milk, bread and milk, oat-flour porridge, or Benger's food, as preferred. During the night hot beef-tea once or twice as considered necessary. If this diet is well taken, chicken or rabbit or a cutlet can be given at dinner time.
It is not, of course, to be expected that every patient will manage to take so liberal a diet, but as a general rule diphtheria patients do best if they are well fed. The average convalescent, who feels quite well but who is kept rigidly in bed for fear of the appearance of sequelae, can be trusted to assimilate the dietary indicated. Those who, though their acute symptoms have subsided, still look "poisoned" and who have markedly irregular pulses are best restricted to soft solids. I am not accustomed to make much modification of the diet even if albuminuria is well marked, unless the amount of urine is very much decreased.