Dietetic Treatment

The feeding of the patient must be based upon the principle of giving all the nourishment which can be assimilated. The stools should be carefully watched from day to day to make sure that the milk or other articles of food are thoroughly digested. Nourishment should be given at brief intervals, which must depend somewhat upon the amount of time allotted to sleep, but in cases of great exhaustion patients should not be permitted to go more than four hours at any time without food, and sleep must be interrupted for feeding, if necessary. In other cases when sleep so interrupted is readily resumed, food may be given with regularity once in two hours throughout the day and night, as in typhoid fever. When improvement is attained, the intervals of sleep will naturally be longer, and it will be both unnecessary and unwise to awaken the patient for feeding. The basis of the diet in most cases should be milk, and by studying the taste and digestion of the patient it is usually possible to prepare it in such a manner that it is well borne. (See Adaptation of Milk for the Sick, p. 74).

In commencing the milk diet the objection of the patient often has to be overcome, and it is advisable to begin slowly, giving skimmed milk in tablespoonful doses four or five times a day for two or three days until the patient is accustomed to it. Other food is of course allowed at first, but this is to be gradually reduced and the milk substituted for it in increasing quantity until four ounces of skimmed milk are taken every two hours. It is finally given up to eight or ten ounces at the same intervals. The taste, if disagreeable, may be overcome by the addition of a little black coffee or caramel. If it produces weight and epigastric oppression or causes flatulence and eructations it is to be diluted by one half or one third with lime, barley, or rice water or Vichy. One of the "prepared foods," such as Nestle's or Mellin's, may be added, or the milk may be pancreatinised or temporarily replaced by koumiss or zoolak. The exclusive milk diet tends to make the patient drowsy and to allay irritability in all the organs of the body, and it is actively diuretic.

The constipation which the milk occasions may be overcome by a pill of ox gall or a dose of bitter water in the morning, or by enemata of warm soapsuds, when the latter do not produce the exhaustion which occasionally follows their use.

Many patients do very well on the exclusive milk diet for a week or two, and they may be fed very much as typhoid-fever patients are, excepting that they may take more milk. If they can digest it, two and a half or three quarts a day should be given as recommended by Weir Mitchell, who was the pioneer of this method of treatment in this country. After five or six days of such treatment a chop or a poached egg may be added at noon. The next day bread and butter or bread and milk is given, besides, for supper, and then an egg or a little meat at breakfast, until the patient is taking three good meals of plain food daily, but in addition at least two quarts of milk. The exclusive milk diet is believed to prepare the digestive system for the assimilation of other foods.