Keating's Diet

Keating's diet for neurasthenia is adapted to patients who need not be kept constantly in bed. It is as follows:

At 6 a. m., a tumblerful of strong hot beef tea; 8 a. m., a half tumblerful of iron water, and breakfast of fruit, steak, coffee, and a goblet of milk; 8.30 a. m., a goblet of milk with a dessertspoonful of malt extract, six grains of citrate of iron and quinine; 10 a. m., electricity; 12 a. m., a goblet of milk and malt; 2 p. m., dinner, preceded by a half tumblerful of iron water and a third goblet of milk and malt; 6 p. m., third dose of iron water. Light supper of fruits, bread and butter, and cream; a fourth goblet of milk and malt; 10 p. m., beef soup, four ounces, preceded by massage with cocoa oil for an hour.

Two quarts of milk are taken daily, in addition to all other food. The patient on this diet is allowed to be out of bed for four hours every day, one of which may be spent in business.

If milk can not be made to agree with the patient in any form, meat broths and purees and light farinaceous food may be prescribed. Eggs may be given dropped into bouillon or any of the preparations of egg albumin. Meat essences and extracts, such as Liebig's or Valentine's, are serviceable, but the latter are so merely for their stimulating effect upon digestion. If the condition of the stomach is good, the constipation resulting from so concentrated a diet may be overcome by the use of oatmeal porridge for breakfast, wholemeal bread, and fresh fruits, such as the juice of the shaddock or dried or stewed prunes. A reference to the receipts given at the end of this book for the several kinds of fluid food will enable the physician to prescribe sufficient variety to stimulate the appetite of the patient, and in many cases a slightly different menu can be ordered for each day in the week. Most patients after a fortnight to three weeks of semisolid diet are able to digest meat and other solid foods.

As an example of an excellent typical dietary for this stage of the treatment, the following is given by H. C. Wood:

At 8 a. m., rolls or toast, cocoa, weak coffee or roasted wheat coffee, beefsteak, tenderloin, or mutton chop; 9 a. m., bathing; 11 a. m., oatmeal porridge with milk or else a half pint of molasses; 12 noon, massage; 2 p. m., dinner, bouillon with or without egg, beefsteak, rice, white potatoes roasted; dessert of bread pudding, blancmange, or similar farinaceous articles; 4 p. m., electricity; 5 p. m., milk toast; 9 p. m., a half pint of skimmed milk or koumiss.

Bilfinger believes that a modified vegetable diet is most useful in the treatment of neurasthenia, being less irritant to the nervous system than a preponderance of animal food, and for anaemic subjects who require proteids he prescribes milk and oatmeal porridge and preparations of ground meal of legumes. He allows chocolate and cocoa for beverages. A vegetable diet is useful in certain chronic cases in which the patient is much worried over the smallness and infrequency of the stools. Accompanied by large draughts of water such diet gives copious and ready evacuations. For this purpose such vegetables should be prescribed as celery, string beans, spinach, peas, and potatoes and beans in purees. Sago, rice, and cracked or shredded wheat may be also eaten. Meat should not be allowed more than once a day. Milk, butter, and cream toast are excellent foods for these patients.

Electricity

The use of the electric current is of service in promoting the nutrition of the body during the period of absolute rest from voluntary movement. It should be distinctly remembered that the electric current itself possesses no special nutritive value or "vitalising" influence, such as is often claimed for it, but that it acts favourably upon the muscular system by causing the muscles to contract, and in that way also quickens the circulation. The contraction of muscles compresses the contents of their lymphatic vessels and venous radicles, thereby aiding circulation, while the phenomena are accompanied by metabolism which involves the appropriation of the ingredients of the food which have been absorbed. The faradic current is used for this purpose. It may be applied to special groups of muscles at first, and subsequently to the entire body. Care should be taken not to fatigue individual muscles, and the current should be carefully regulated and applied in accordance with the condition of the patient. The use of electricity in relation to the treatment of constipation has been referred to under that heading.

It is doubtful whether the local application of elec-41 tricity over the abdominal wall exercises any definite influence upon the digestive processes which may be going on in the viscera beneath the electrodes.