Quantity Of Milk Required

If milk is the only food, enough should be given, and the problem of what constitutes enough must be solved in each case separately. Much harm is done by overfeeding, which induces indigestion and restlessness, increases the pulse rate, and aggravates the abdominal symptoms - such as tympanites, diarrhoea or constipation, haemorrhage, and abdominal pain. Ingestion is very different from digestion.

There are many writers upon dietetics who give a special caution against the practice of overfeeding in cases of enteric fever on account of the fact that more or less gastric catarrh is usually present and that it is an undue tax upon the digestion of the patient to have to deal with a large bulk of food.

On the other hand, underfeeding causes malnutrition, favours the occurrence of complications, and prolongs convalescence.

For an exclusive milk diet the outside limits lie between one and three quarts per diem, depending somewhat upon the age and size of the individual, but more upon the condition of his digestion. A clean tongue, a soft abdomen, and natural milk stools, not too hard and without coagulae of casein or flakes of fat, indicate that the milk is being well digested.

The reverse of these symptoms suggests that the milk is supplied in too large quantity, or that it is not being digested, and one or more of three things must be done: (a) The quantity must be reduced; (b) the mode of administration must be changed - i. e., the milk must be predigested; (c) other foods must be substituted, either wholly or in part.

(A) When Milk Appears To Be Well Digested

When Milk Appears To Be Well Digested, but the patient emaciates rapidly early in the disease, he is not getting nourishment enough, and the quantity must be increased or other food must be added. As a general rule, from one and three fourths to two quarts of milk per diem (or six ounces every two hours, day and night), however diluted, is sufficient during the height of the fever to sustain the patient properly. It is best to give as much as can be thoroughly assimilated according to the symptoms above noted.

Johnston believes that from three to four ounces of milk given every two or three hours is sufficient. Moore states that very few patients digest over one and a half to two pints of milk, and "it is scarcely ever necessary to exceed the amount of one quart of milk in the twenty-four hours," or three ounces of milk in ten feedings at intervals of two and a half hours. This estimate, for uncomplicated cases at least, is too low. It may be necessary to reduce the allowance to this figure if severe gastro-intestinal disturbance occurs, or, in fact, with violent vomiting to temporarily discontinue the milk entirely, and give only cracked ice or half-ounce doses of iced champagne, but patients kept too long on as low a diet as that mentioned will emaciate, grow feeble to an alarming degree, and require excessive stimulation.