The special indications in the treatment of this condition are :
1. To prevent irritation of the diseased area.
2. To prevent excessive peristalsis.
To fulfil these conditions the diet must be composed of foodstuffs which are fairly completely absorbed and leave only a small amount of unirritating residue; the total bulk of food taken must be small and the diet fairly dry.
The following food-stuffs are of service in this condition :
Raw meat either in milk or better still in sandwiches; raw meat is very readily absorbed and leaves little residue.
Underdone meat is suitable for the same reasons. Well done meat should be avoided as irritating fragments are apt to be left undigested.
Leube-Rosenthal meat solution is a very useful food-stuff in these cases; half a tin may be given daily in addition to other meat.
Milk should not be given in excessive amount as the hard curd which is frequently formed unless the milk has been specially prepared is apt to irritate. It is better to give a considerable proportion in the form of Benger's food which, when prepared, is partially digested and incapable of producing a hard curd; or the milk may be pancreatized.
Eggs are most useful and should be used freely.
Cheese is a suitable food-stuff if carefully dissolved and the free acid neutralized by the aid of bicarbonate of soda; the solution can then be used in the preparation of various savoury dishes.
Butter and cream should be given freely in place of much of the carbo-hydrate of the ordinary diet.
Bread is best taken toasted and plain biscuits may be given with advantage.
Most puddings, particularly the custards, blancmanges, creams and some milk puddings will be found satisfactory.
The following food-stuffs should be avoided:
Porridge, soups, potatoes, green vegetables and fruit (except in very small amounts), tea and coffee (except for flavouring). Casein preparations tend to set up diarrhoea and should be used very carefully.
Finally, food should be given in small quantity at fairly short intervals in the majority of cases.
The following dietary may be found useful and serves to illustrate the main points.
8 a.m......Two eggs scrambled.
Steamed fillet of fish, 2 oz. Toast, 2 oz. Butter, 1/2 oz. Milk coffee, 1/2 pt.
11 a.m......Leube-Rosenthal meat solution.
1 p.m......Underdone meat (minced), 3 oz., or raw meat sandwiches. Toast and biscuit, 2 oz., butter, 1/2 oz. Blancmange, milk pudding, etc., 5 oz., with cream, 2 1/2 oz. Tumbler of milk.
4 p.m......Milk tea, 1/2 pt. (or Benger's food).
Toast, 2 oz. Butter, 1/2 oz., egg.
7.30 p.m.....Steamed fish, 2 oz.
Underdone meat, 3 oz. Toast, 2 oz. Butter, 1/2 oz.
Sweet pudding, 5 oz., with cream, 2 1/2 oz., or cheese custard.
10 p.m......Benger's food, 1/2 pt., or Leube-Rosenthal meat solution.
Approximate nutritive value of above dietary : Protein, 163; Fat, 165; Carbo-hydrate, 220; Calories, 3,100.
It is a very important matter, in the treatment of tuberculosis, to make sure that the diet prescribed for any patient is taken properly. When insisting that a patient should eat the whole amount of food ordered for him, it is absolutely essential that the diet be most carefully constructed. Undoubtedly diets are often prescribed which are obviously too large, on the principle that the patient will certainly leave some of the food. This is a very unsatisfactory method of trying to make sure that a patient takes an adequate diet; at the best, it is quite haphazard, and, indeed, often fails in its object. It is clearly far more satisfactory to work out very carefully the necessary diet; the physician can then with confidence urge upon the patient the necessity for taking it all. As a matter of fact, the necessary diet is by no means a big one, and can be readily taken by the ordinary patient, whereas the sight of a very large diet disheartens him. In sanatorium practice, it is best to practise those people who serve the prescribed meals in determining the weights of various food-stuffs. If the meals are weighed regularly for a little time, the eye gets very well trained to various weights, and diets of definite nutritive values can thus be readily given as prescribed. In private practice, we advise patients to buy a light pair of French scales and, at first, to weigh out the various food-stuffs, as prescribed, very carefully. After a little practice, patients become sufficiently experienced to guess the amounts with quite sufficient accuracy to ensure the taking of the prescribed amounts. If patients are in the habit of leaving a material amount of their meals, what is left should also be weighed and recorded by some responsible person. The mere fact that such a record is kept, is often a very wholesome stimulus to the patient.