It is now generally recognized that lobar pneumonia is a fever, with local manifestations in the lungs, and complicated in many cases with inflammation in other tissues. The diet during the attack, therefore, will be on the same line as that of fevers generally. It is important to remember that the duration of the disease is usually limited to from 7-10 days, and that cardiac failure is the most common cause of death in fatal cases.
The food materials to be used are milk, or preferably whey, beef, mutton, or chicken-soup, and coffee or tea with an egg in it. As a rule thirst is marked, appetite is lost, and digestion is very much impaired owing to the high temperature and the toxaemia present. One and a half pints of whey or milk, one pint of soup and one egg daily will represent a sufficiently full dietary. The milk may be rendered more palatable and digestible by the addition of lime-water, barley-water, or Apollinaris water. It may also be thickened by the addition of Benger's food, or boiled bread or rusk, which renders it more digestible for many patients. Farinaceous preparations and sugar must be given in small amount owing to the tendency they have to induce indigestion and flatulence. Sugar of milk may be given (from 1/2-1 oz. daily), as it is nourishing, digestible, and not so apt to induce flatulence as other forms of sugar. The soups should not be concentrated, and should be made from fresh meat or fowl rather than any preserved essence or jelly. The latter substances serve a function in forming a change for the patient, and being easily taken when the appetite flags, but they have not the nutritive value of the freshly made preparations, and many of them have no nutritive value at all. It is sometimes pathetic to see the implicit confidence of the patient's friends in some bottle or tin of meat essence, while they despise such foods as milk and eggs.
The meals should be small in amount, and given frequently, every 2 or 3 hours during the day, and every 4 hours during the night. The danger is not from underfeeding but from overfeeding. Nature has taken away the appetite because the digestive organs are weakened. As the fever is a short one, no harm will follow from allowing only a small amount of food, and the patient will be much more comfortable. Instead of increasing the patient's natural powers of resistance to the disease, which, after all, will prove his chief safeguard, we are only weakening them by pouring into the system more food than he can properly assimilate. In the full-blooded healthy pneumonic subject one can do more good by what is practically a starvation diet than by giving the most nutritive foods in excess. In debilitated subjects and in elderly people the low state of vitality is an indication for the employment of as much nourishing food as the patient can take. More concentrated soup, egg and milk, raw meat-juice, and even cream may be given, but the digestion must be carefully watched and must not be overtaxed. Above all things, flatulent distension of the stomach and bowels must be avoided, as the effect on the heart and lungs from upward pressure may prove most prejudicial to the patient's chances of recovery. If gastric disturbance is present, the food should be peptonized and given in small amounts frequently, 2-3 oz. every hour during the day.
Thirst may be relieved by drinking freely of water, lemonade, barley-water, etc. These may be given cold, but should not be iced unless they are taken in sips, so as to avoid chilling the stomach. The action of the skin will be aided by the plentiful use of fluids, hot or cold, and in addition the elimination of the poison in the blood will be largely helped by free diuresis. If water is not taken freely by the mouth, and if the secretions are scanty, hot saline injections by the rectum, or subcutaneously, should be employed. Elimination of the poison is most desirable, and this can best be effected by the passage of plenty of water through the system. A careful distinction should be made between the fluids which are given as food and those which are given as drinks. The times of feeding are to be rigidly adhered to, and the drinks given between meals should not have any milk or soup added, or anything which will call for digestion.
During the first four or five days of the illness feeding on the above lines can usually be carried out satisfactorily, but in the precritical stage some extra precautions are called for. Exhaustion may now be showing itself, delirium or semi-consciousness may be present, the appetite may be lost entirely, and a condition of general toxaemia may be present. What the friends notice is the increasing weakness, and what they demand is more food for the patient. This natural desire on their part must be strongly combated. For the time being the patient's power of digestion has gone, and even if predigested food were given, his powers of assimilation are in abeyance. The stimulation which he requires at this time cannot, therefore, be given by food, or only to a very slight extent. The period on which he is entering is not a long one, and a plentiful supply of water, with very small quantities of milk, beef-juice, or white of egg, is all that is really called for. During the pre-critical stage and at the crisis the question of food may be left out of consideration, and attention directed to the temporary stimulation of the patient by means of alcohol, etc. After the crisis has passed more food can be taken and should be given, but the food materials should be the same as during the fever for a few days at least. Returning appetite will soon indicate the return of digestive powers, and more solid food may be given. Within a week the patient is usually able to take fish, fowl, and meat.