Pathological Physiology

Mucous disease is an obstinate chronic affection in which large quantities of thick, ropy mucus are formed in the alimentary canal, but chiefly in the large intestine. The disease is accompanied usually by neurasthenia and disorders of gastric and intestinal digestion and absorption, of greater or less severity.

In the disease called membranous enteritis a similar condition is present, and the hypersecretion results in the formation of long tube casts of fibrinous mucus. The passage of the casts is sometimes accompanied by severe paroxysmal pains, and blood may appear in the stools. Although they may be separated clinically, the dietetic treatment of these two affections is the same. Young children normally secrete more mucus from the intestines than do adults, and the long continuance of an irritating diet of improper food may give rise to hypersecretion. Chronic mucous disease is sometimes a sequel of the infectious diseases which particularly affect children, notably whooping cough. There are a larger number and variety of bacteria found in the stools than are usually present, but this disease is not definitely attributable to the action of any one species. The disease is also sometimes associated with intestinal worms.

Symptoms

The appetite is very irregular. It may be exaggerated early in the disease, and fail completely later on. The food does not nourish the child, absorption being prevented by the mucus, and it causes flatulency and discomfort. Emaciation is progressive and extreme. Some of the stools consist wholly of mucus, fatty epithelial cells, and granular detritus, while others contain particles of undigested food, milk curds, meat fibre, etc., mixed with mucus.

Dietetic Treatment

The only hope of cure of this condition lies in the most rigid dietetic treatment, combined with regular habits, bathing, etc. In the worst cases only predigested fluid food should be given, such as pancreatinised milk, meat juice, and egg albumin. Beef tea, light broths of veal, mutton, or chicken, consomme, or milk punch may be allowed.

Sometimes it is necessary to give no food by the stomach for six or eight hours, and then commence to feed very slowly, giving tea-spoonful doses at fifteen-minute intervals. If the child has been living for long upon milk alone, and the stools show fat and undigested curds, it is best to make a radical change and proscribe it entirely. Jacobi gives instead a mixture containing five ounces of barley water, one to two drachms of brandy or whisky, the white of an egg, and a little salt and cane sugar. Dose, a teaspoonful every five or fifteen minutes. This is a fairly palatable mixture. It is considered best to withhold all farinaceous and saccharine articles until some sign of improvement appears.

Edwards prescribes the dietary of the London Northeastern Hospital for Children. (See Hospital Dietaries).

Dysentery

During an attack of acute dysentery the patient should be kept absolutely quiet in bed, and should not be allowed to rise for the movement of the bowels, making use of a bedpan instead. Throughout the active stage the diet must be strictly confined to easily digestible food, and in most cases it is wisest to give only predigested fluid articles. Peptonised or pancreatinised milk, or boiled milk, pressed-meat juice, whey, or raw egg albumin beaten with sherry and flavoured with nutmeg are recommended. Many patients do best upon a diet of raw scraped beef or meat balls (p. 113).

In cases of acute dysentery, and especially in the amoebic form, the loss of strength, anaemia, and emaciation progress very rapidly, and the strength must be supported by stimulation, for which brandy is preferable to whisky.

During convalescence the diet must be very cautiously increased, and confined to food which is promptly and completely digested, leaving but little residue. For this purpose animal food should be chiefly eaten, while fish, tender beefsteak, roast beef, boiled or broiled chicken, eggs, custard, blancmange, dry toast, junket, well-boiled rice, or wine jelly, may be given. All fruits and vegetables must be forbidden, and butter and cream should be taken sparingly.

If the disease occurs in infancy, the child, if possible, should be fed at the breast. Otherwise all milk given should be Pasteurised. Beef tea and mutton broth may be allowed in moderation, and special care should be observed not to overfeed.