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.
3. To give abundant fluid with the object of relieving thirst and to wash out through the kidneys the waste matter produced by the increased rate of metabolism.
4. In some cases, to give alcohol as a food as well as a stimulant. In all fevers presenting periods of remission it is desirable to give the greater portion of the food while the temperature is lowest, so that it will be better digested and absorbed, for at this time the tissues appear to temporarily recover their assimilative power to some extent.
In mild cases, with remissions, if the appetite holds out, it may do no harm to allow some little variety in the diet; but if the fever is brief and the appetite fails, it is unnecessary to force the patient to take food.
As a rule, in fevers which are protracted or severe, nourishment should be given in fluid form. To offer solid food in serious fevers is practically to place foreign bodies in the alimentary canal which merely ferment and putrefy, causing discomfort with flatus, fetor, and diarrhoea. There are some exceptions to this, notably the fever of phthisis, some forms of protracted sepsis, and ague.
Milk being the first and "natural food" of man, it would seem most appropriate that it should constitute the staple article of diet in fevers in which the digestive powers are temporarily greatly enfeebled or wholly suspended. The danger from its continuous and exclusive use arises from its coagulating in lumpy masses, which act practically as solid food, but the many means which are at the disposal of the physician and nurse make it possible to overcome this 29 difficulty almost completely, and by processes of artificial digestion milk may be given ready for absorption, so that nutrition is rendered quite independent of stomach and intestinal digestion. In the majority of cases, therefore, milk is altogether the best food. The methods of giving it have been described in the section upon Adaptation of Milk for the Sick (p. 74), and the reader is also referred to the section upon the Treatment of Typhoid Fever (p. 432).
Next in importance to milk in the diet of fever are to be mentioned the various preparations of meat - infusions, extracts, juice, powder, broths, etc. (p. 112). The fundamental idea of all such preparations is the solution of the nutritious myosin of the muscle fibres and its separation from the much less digestible sarcolemma and the connective tissue constituting the sheaths of the muscle fasciculi. These preparations may be made from tender veal, chicken, roast beef, and beefsteak. Clear soups or consommes are nutritious and mildly stimulating in fevers, but if given often or in large quantities patients usually tire of them, and they may be considerably varied by flavouring with vegetable juices and extracts or aromatic herbs, which afford variety, and as a rule do no harm, unless exhausting diarrhoea be present.
Buss gives the following mixture to fever patients: Peptone, 100; grape sugar, 300; rum or Cognac, 200; water, 600 grammes - the quantity to be taken in twenty-four hours in addition to milk, yolk of egg, bouillon, etc. If this food is too sweet, tincture of gentian is added.
Purees may be given, made by thickening clear soup with well-cooked arrowroot, or finely ground rice, or thoroughly baked wheat-en flour. Bauer recommends the use of "fruit soups," which are prepared by boiling fruit, either fresh or dried, with the addition, if desired, of grape sugar, lemon peel, etc. The mass is then compressed and strained, and the fluid obtained has an agreeable taste and somewhat laxative action.
In cases of moderate severity and short duration, when the digestive organs are not greatly disturbed, it is not necessary to confine the patient to fluids, although solid food, especially meats, should be withheld. Semisolid food may be given, such as milk toast, cream toast, soft-cooked eggs, beef jelly, or plain rice pudding. Thoroughly boiled oatmeal gruel sustains strength while undergoing severe physical toil, and fever has some resemblance to muscular effort in its temporary arrest of digestive activity, so that sometimes substances of this class prove useful from their supporting power.
Many other varieties of farinaceous and other carbohydrate foods are suitable in febrile cases when carefully prepared in fluid form. Patients often object to these substances for the reason that they are tasteless and monotonous, whereas if prepared with a little care, by giving proper attention to their flavouring, they may be made very palatable. Thin gruels of rice, oatmeal, or barley, from which all solid matter has been very carefully removed by straining through a cheese-cloth bag, may be salted and flavoured with any desirable aromatic, such as cinnamon, clove, nutmeg, lemon or orange peel; grape sugar may also be added. Such gruels may be proscribed either alone or combined with meat extracts, or beef tea, or beaten eggs. The addition of grape sugar has been recommended by See and others because of its ready absorption, and from the fact that it is the form of sugar which is produced from the digestive fermentation of starches, and is to be regarded, therefore, as an easily assimilable carbohydrate which, to some extent, may prevent tissue waste by furnishing fuel to the body.
If a patient be fed upon clear farinaceous gruels alone during fever, he cannot thus obtain over eight or ten grammes of proteid material per diem, or one twelfth of the quantity required by a healthy man at rest, and obviously he will suffer within two or three days from tissue waste and inanition. Egg albumin, meat broths, or gelatin must therefore be added, or the soups must be thickened.
Eggs may be eaten, but they should never be boiled, and in fact they require but little cooking. They may be beaten with boiling water and strained and dropped into consommè or light broth or gruel. The yolk and the white may be used either separated or together. The yolk may be beaten with hot milk and water, or with hot tea sweetened with grape sugar (Yeo), or it may be added to brandy. The brandy mixture of the British Pharmacopœa (mistura spiritus vini gallici, Br. Ph.) is made as follows: The yolks of two eggs with half an ounce of refined sugar are beaten and added to four ounces of Cognac and an equal amount of cinnamon water, The brandy in this mixture may be still further diluted or reduced to advantage. Some patients prefer to take eggs raw, while others prefer to have them very slightly cooked by immersing them in water which has been boiling, thus cooking them very slowly at a temperature not exceeding 1800 F for ten or fifteen minutes. Eggs prepared in this way are uniformly and lightly cooked, and the albumin is coagulated in a soft gelatinous mass instead of the hard, white, tough coagulum which is produced by greater heat (see p. 106).
Cold meat jellies as well as simple sherry wine and lemon jellies may occasionally be given, but gelatin alone is not particularly nutritious, and, in proportion to the bulk occupied by this class of foods, comparatively little benefit is derived from them.
Gelatin given with other foods, especially those of proteid composition, is assimilated much better, and makes a desirable addition to the dietary in mild cases. When added to milk in the form of blancmange patients usually enjoy it.
Beef tea and chicken jelly in equal parts make an excellent combination.