Preface To The Third Edition

The third edition of this work has been prepared to meet the demands of a constantly increasing interest in the practical application of dietetic principles. The book has been revised throughout, and much new material has been added, especially in those sections which deal with the dietetic treatment of disease. Important changes have been made in the sections upon Analysis of Gastric Contents, Intestinal Autointoxication, Milk as a Food, Diabetes, etc. In the Appendix a number of new tables will be found which are of practical application. It is rarely feasible to feed the sick upon any system of accurate food weighing, laboratory calculations of calories, or the results of single analyses of gastric contents. Such systems add scientific interest to the general subject of dietetics, but the problems of right feeding in disease must be studied in the light of clinical experience, and modified to meet ever changing conditions. One of the commonest of dietetic errors is the too long continuance of a dietary which, although at first beneficial, may result in anaemia or asthenia by becoming monotonous or failing to meet all the complex demands of nutrition.

Diseases apparently demanding opposite dietetic treatment may coexist in the same patient, and without great care starvation may ensue. No one food is curative of any disease, just as no one food may be said to be causative of any disease. These principles, which form the basis of the book, have been still further emphasized in the present edition.

W. G. T. iii.

Introduction To The First Edition

The subject of the dietetic treatment of disease has not received the attention in medical literature which it deserves, and it is to be regretted that in the curriculum of medical colleges it is usually either omitted or is disposed of in one or two brief lectures at the end of a course in general therapeutics. Upon examining the standard treatises upon the Theory and Practice of Medicine, as well as monographs upon important diseases, such as those of the circulation, nervous system, and skin, one cannot fail to be impressed with the meagre notice given to the necessity of feeding patients properly, and the subject is usually dismissed with such brief and indefinite phrases as "The value of nutritious diet requires mere mention," "A proper but restricted diet is recommended," and favourite, if not convincing, expressions are, "The patient should be carefully fed," and "General dietetic treatment is of primary importance." With such vague directions the dieting must indeed be very "general".

In many excellent works upon food and dietetics the space devoted to the practical application of dietetics to disease is comparatively insignificant, and much less emphasis is given to this matter in hospitals and in the training of nurses than is demanded in the interests of medical science.

A writer of wide experience in practical dietetics, Mrs. E. H. Richards, says: "At present there are comparatively few persons who are called upon to feed the sick to whom a glass of milk or a pound of beef represent any definite amount of food materials. Still fewer who can tell how much food value a glass of lemon jelly or wine whey represents, and yet the adult patient is dependent upon the attendant even more than the week-old infant for the requisite nutrition".

The present volume has been prepared with the view of in some measure making good such deficiencies by furnishing a text-book in which the practitioner of medicine may find detailed the appropriate diet for each disease which is at all influenced by right feeding.

Quite as much depends upon the suitable preparation of food as upon the selection and limitation of the food itself, and it has therefore been thought advisable to include a general account of the composition and uses of foods, and the changes which may be produced in them by cooking and other processes. In this first portion of the work, however, the practical application of such knowledge to the feeding of the sick has been constantly emphasised rather than unnecessary scientific detail.

The reader will also find a discussion of representative hospital dietaries, the official dietaries of Government institutions, and sections upon the proper feeding of infants and children. Numerous cross references and a complete index have been added to avoid undue repetition.

Bennett wrote, as long ago as 1858: "Of all the means of cure at our disposal, attention to the quantity and quality of the ingesta is by far the most powerful." While fully concurring in this view, that appropriate dieting is often more needed than medication, I distinctly disclaim the advocacy of any special dietetic system as a cure-all, as well as the specific influence of any one food in the general treatment of disease. It cannot be expected that the experience of a single individual should cover so extensive a ground as that which embraces the relative advantages of all foods, and I have therefore impartially introduced the views of others, especially where, as in such diseases as gout, diabetes, and obesity, opposing dietetic theories are held by clinicians of extensive experience and authority. Due acknowledgment of these references is made in the text, but the admirable researches upon foods of our own Government, found in the published reports of the Department of Agriculture, are especially to be commended.

W. Gilman Thompson.