This section is from the book "Practical Dietetics With Special Reference To Diet In Disease", by William Gilman Thompson. Also available from Amazon: Practical Dietetics with Special Reference to Diet in Disease.
Fractures, wounds, bruises, ulcers, and all surgical injuries naturally heal the sooner the better the condition of the blood. Abundant nourishing diet, properly selected in regard to its ready digestibility, is therefore indicated. Starvation promptly impoverishes the blood and retards all healing processes.
In feeding surgical patients who are confined to bed, or who, from the nature of their injuries, are unable to exercise, care should be taken that the channels for removal of waste from the body do not become choked and inert. In the zeal to promote rapid healing by a liberal diet it is quite possible to overcharge the blood with products of nutrition and defeat the object in view by burdening the liver and other organs, and inducing "biliousness".
The patient's appetite should not be the only guide, but the condition of the tongue, the stools, and the urine should be examined to insure the proper assimilation of all the food taken. In the absence of sepsis, fever, and all affections of the alimentary canal there is usually no harm in allowing the full diet of animal and vegetable food to which the patient is normally accustomed, or, if the appetite flags, considerable variety in the dietary may be advantageously permitted.
If there has been no loss of blood and no severe shock, as soon as an ordinary antiseptic operation is over the patient is practically as well as he was before it was performed.
Cheyne says: "After operations performed aseptically there is no reduction of diet even for a few days. A hospital patient remains on full diet, and a private patient may have anything he fancies, provided it is wholesome, and the more nutritious the food the better." In fact, after opening a psoas abscess or a carious joint the appetite soon returns and "hunger becomes the chief trouble".
As a rule, stimulants are unnecessary if the appetite is keen, but otherwise beer or Burgundy or dilute whisky may be prescribed in moderation as an aliment, to be taken with the meals only. Hard drinkers who receive bad injuries, such as severe fractures, frequently develop delirium tremens in the course of a few days, and this may occur even when they have not been indulging in stimulants for some weeks previously. In such cases it may become necessary to allow a certain quantity of alcoholic stimulation at stated intervals between meals, in order to tide them over an emergency which threatens an immediately fatal result, trusting to reduce the quantity as the delirium subsides.
If severe pain has preceded an operation, if the operation has been prolonged, or if there has been much shock, even under anaesthesia, the diet must be supervised with great care. Pain is a strong depressant, and after severe shock rest and stimulation is usually more desirable than food. Positive harm results from overfeeding. Black coffee is very serviceable for such cases or whenever there is lack of nerve energy, and it may be appropriate to keep the patient for three or four days upon a diet of milk or pan-creatinised milk. Broths, meat extracts, and beaten eggs may be added when the stomach regains its tone. If nausea, anorexia, or disgust for food exists, or if there is much distention of the stomach, it is unwise to urge food upon the patient. It is better to utilise the rectum in such cases, and coffee, pancreatinised milk, egg albumin, 47 and alcohol are to be given in enemata. Opium or other necessary medication may be added.
If extensive loss of blood has occurred, the volume of fluid should be replaced in the body as soon as possible, and liquid food is needed, such as milk, beef broths, peptonoids, and brandy or whisky, if the stomach retains them. Salt-water injections, or in severe cases hypodermic injections of saline solutions, help restore the lost fluid to the blood and improve vascular tone.