Causation

It has not been proved that any special articles of diet lead to the development of rheumatism, although indulgence in sweets, starchy foods, and malt liquors is sometimes held responsible for it. Poor living seems to favour the attacks, but the prevailing opinion is that acute rheumatism is an infectious disease.

If this fact be established, there is no reason that diet should exercise any primary aetiological influence in producing rheumatism or in preventing recurrent attacks, beyond the obvious fact that a diet which disorders digestion or gives rise to malnutrition places the system in a condition more susceptible to the inroads of any microbic disease - in other words, it lowers resistance. This statement, however, by no means precludes the fact that during an acute attack diet may exert profound influence as it does in many other febrile diseases which it does not originate.

Dietetic Treatment

While the fever lasts and other symptoms are acute, such as pain and swelling of the joints, the patient should be put upon a fluid diet. The majority of cases do best at this time with an exclusive milk or bread-and-milk diet. Those patients who cannot take milk, however, may be allowed soups and broths flavoured with vegetable extracts, chicken tea, milk toast, barley or oatmeal gruel, clam broth.

Thirst is often a prominent symptom, especially if there be much fever, and it is advisable for the patient to drink fluid freely to assist in washing out the waste products from the body. Lemonade and slightly acid drinks of various kinds, such as dilute phosphoric acid or the effervescent mineral waters, are recommended. Boiled milk and Seltzer or Vichy may be drunk, or oatmeal or barley water flavoured with lemon. Alcohol should be avoided while the acute symptoms last, unless the complication of inflammation of the endocardium or pericardium enfeebles the heart action to such a degree as to make stimulation necessary. If convalescence is prolonged and anaemia is considerable, alcohol may be given as a tonic two or three times a day in the form of a glass of claret or Burgundy (one to two ounces), or diluted whisky.

During convalescence the appetite is not usually vigorous, and it is not necessary to urge the taking of much food at first. The diet should be principally farinaceous, but not saccharine.

Such articles may be given as rice (plain or spiced), arrowroot, oatmeal, cornmeal, semolina, wheaten grits, panada, milk toast, simple unsweetened puddings, wine jelly, blancmange, and malted foods.

The return to solid diet should be gradual, and for a long time the patient should abstain from eating meats as well as from pastry and sweets. Fagge states that no meat or fish should be allowed for at least a week after subsidence of the fever and acute symptoms, or, better, for a fortnight, and many believe that beef tea is harmful. Meat can undoubtedly induce a relapse.

When convalescence becomes established, eggs, fish, oysters, and the white meat of broiled or roasted chicken may be given, and one or two such vegetables as asparagus, spinach, or stewed celery, with a baked apple or fresh fruit, but sweets and alcohol should long be withheld.

The patient should be fed often, having one or two extra lunches during the day, for anaemia is apt to prevail for some time, and abundant nutriment is required.

Diet In Chronic Rheumatism

In the dietetic treatment of chronic rheumatism, especially if the patient is anaemic, animal food cannot be excluded, but the basis of the diet should be farinaceous food with a few fresh green vegetables. Fish, eggs, and fowl may be eaten, but dark meat is not desirable. Sweets and alcoholic beverages should be omitted from the menu, and all foods should be plainly cooked and eaten in moderation.