Diet In The Acute Stage

The usual rules for feeding in fever may be observed as long as the temperature remains elevated. Milk in regular quantities at regular intervals is usually quite sufficient. If looseness of the bowels is present, it may be modified by the addition of suitable quantities of lime-water. The short duration of the febrile period, lasting as it does seldom more than a week, renders it quite unnecessary to attempt to feed up the patient, who, as a rule, has little or no inclination for food. In very feeble or badly nourished children, or in those who may have contracted measles after some exhausting disease it may, of course, be necessary to be more liberal. In such cases the suggestions for dieting in the acute stage of enteric fever may be found useful. Water must be supplied liberally to all patients, and there is no objection to orange or lemon juice being used freely to flavour it.

Diet In Convalescence

When the temperature has touched normal, eggs, farinaceous food, milk puddings and similar preparations may be given, and one or two days later the diet may be increased by the addition of white fish, potatoes, and stewed fruit in moderation. There need be little or no limitation put upon the dietary of healthy adults in this stage. In their case digestive complications are uncommon. With children, on the other hand, and particularly young children, it is well to exercise some caution in making additions to the diet. Diarrhoea may occur at any period of measles, and may be sometimes very intractable in convalescence. How far the enteritis of a dysenteric type, which is not infrequently seen a week or ten days after the eruption, is due to the measles poison itself, or how far to a superadded infection affecting a weakened mucous membrane need not be discussed. But as long as we recognize that diarrhoea of this type is often a real danger in convalescence, it is obviously foolish to give anything to the patient which is likely to encourage looseness of the bowels or to be badly digested. I have seen an ugly outbreak of what might fairly be described as dysentery occur in a group of children who were allowed a thick vegetable soup, the other children in the same ward, who had been more rigidly dieted, escaping. Undigested vegetable matter was found mixed with the blood and mucus in the stools. A diarrhoea of this sort once set up is exceedingly difficult to keep in check, and in weakly children may be fatal. Strong meat or vegetable soups, therefore, should not be allowed, and vegetables and fresh fruit, except oranges, are usually undesirable. Especially harmful may be the grapes which parents often seem so desirous of giving to their children. On the other hand, weak chicken-broth, with a little rice added, may be allowed, and this with white fish, mashed potato, milk puddings, jellies and bread and butter will be amply sufficient for a fortnight after the disappearance of the eruption, when normal diet may be resumed.

As regards the complications of measles there is little to be said. It is often not easy to maintain adequately the strength in broncho-pneumonia. The dyspnoea and the tendency to cough make mastication and swallowing a matter of considerable difficulty, and it requires careful attention on the part of the nurse to see that the child receives enough nourishment. The marked wasting which often accompanies this condition, and the tendency of the lungs to become tubercular, renders liberal feeding almost a necessity. In addition to milk, or whey, albumin water, beaten-up eggs, raw meat juice, and such foods as plasmon, sanatogen, etc., should be given. I have found the open air treatment of broncho-pneumonia of the greatest service in increasing the desire for food on the part of the patient. Only too often the appetite is entirely lost, and everything should be done to encourage it. Half the success of open air treatment depends on this increased willingness to take nourishment.

Of the other complications enteritis alone requires mention. This also may last a considerable time and cause much wasting. I usually restrict these patients to milk and lime-water, with occasionally a little raw meat juice or bovinine. Albumin water may also be given.

Alcoholic Stimulants In Measles

These are seldom required in the acute stage, and are only necessary in the prolonged complications. Cases of broncho-pneumonia are often benefited by free stimulation, but there is no need to prescribe alcohol as a routine. In enteritis, again, it may be necessary to stimulate, and brandy should be given for choice. Young children take white wine whey very well, and I have found it useful in both the complications mentioned.