Mumps

The diet in mumps and other infections usually involving children, should obviously correspond in a general way to that appropriate to this age. Even the sick adult should be considered as a child, since the wide range and indigestibility or toxic action of many of the food stuffs and adjuvants to food commonly used by healthy adults with impunity, render it advisable that the diet" should closely approach the simple foods of childhood.

Mumps is seldom severe enough, in temperature, liability to renal involvement, general symptoms, or duration, to require a very strict diet. However, on account of the necessary confinement and lack of exercise, it is best to limit the food mainly to milk and cereals. Tea, coffee, alcoholics, spices etc., are contra-indicated by the tendency to orchitis and oophoritis, which renders any possibility of hyperaemia of the genito-urinary tract undesirable.

Baked apple with cream, apple-tapioca pudding, jellies etc., may be used. Fruit juices, such as lemon and orangeade, are theoretically indicated but often cause severe pain on account of the salivary stimulation. For the same reason, any distinctly sapid or hot food or drink, may be contraindicated.

In many cases, the parotids are so painful that the ordinary movements of mastication and deglutition are intolerable and the diet must be limited to milk, weak cocoa, broths etc., taken through a bent tube.

Measles, Roetheln, Varicella, Etc

In the mild febrile diseases generally, the staple diet is milk and cereals, including bread and crackers preferably toasted, of eggnog or soft custards, cereals soaked in milk, meat juice etc. Both-the local lesion and the seriousness of the disease interfere with the sense of taste and enjoyment of food, so that, except that the nourishment should be neatly served, little attention need be paid to stimulating the appetite. Indeed, the patient will usually regard the food in the same light as medicine and will take it only as a means of treatment.

Especially in genuine diphtheria, the danger of cardiac paralysis demands that the head should be raised as little as possible. A feeding cup with a spout or a drinking tube should, therefore, be used or, if the patient insists on using ordinary utensils, he should be fed from a cup or spoon, while-lying on the side, so as to prevent the danger of food entering the larynx, an occurrence whose danger lies not so much in the probability of direct asphyxiation as of strain from coughing.

In order to conserve the patient's strength as much as possible, the following routine should be observed: spraying the nose and throat, feeding, medication, repetition of spraying, bathing or other attention to the patient and his bed, quiet in a dark room for four hours or a little more at night.

If the condition of the throat prevents the swallowing of adequate amounts of nourishment, recourse should be had to gav-age through a buccal or nasal tube, or to rectal nutrition. The introduction of food into the upper part of the alimentary canal is necessary to complete digestion and thus, gavage should be preferred if it does not disturb the patient too much.

Predigestion of food may be practiced in any of this group of infections, although it does not amount to much.

In all cases of diphtheria, anginose scarlatina and even septic involvement of the throat, great care should be taken not to produce secondary lesions with any of the utensils or instruments employed and, for the same reasons, hypodermatic nutrition is to be regarded as a last resort.

Pertussis

Perhaps not a specific entity but a manifestation of influenza or other bacteria colonizing mainly in the larynx. See general discussion of respiratory diseases.

Variola

Diet as for scarlet fever or sepsis.

Typhus Fever

Diet about as for typhoid but somewhat more liberal. The old treatment at Bellevue was to administer egg nog etc., in abundance, feeding from a watering pot.

Cholera Asiatica, Dysentery, Amoebic And Bacfllar

See discussion of intestinal diseases.

Yellow Fever

The comparatively short duration of the disease renders stimulation more important than nutrition. Moreover, the morbid anatomy necessarily interferes with assimilation and the haemorrhages and vomiting often render it futile to attempt to feed. However, some authorities hold that nourishment should be forced and point to favorable results both with adults and with breast fed infants, by persisting in regular feeding.

Gelatin is theoretically indicated by the haemorrhages and hypodermoclysis or rectal administration of salt solutions are appropriate.

During the stage of calm, poached eggs on toast, custards, beef juice, peptonized milk etc., should be administered as liberally as possible but at least two hours should be allowed between feedings.

Malta Fever And Relapsing Fever

Diet as for typhoid, with loss necessity of guarding the alimentary canal during the fever and with greater freedom in the remissions.

Pneumococcic Disease

Feed about as for typhoid, with loss restriction to fluids. Salines, including the saline laxatives and sodium chlorid should be given abundantly to combat the tendency to coagulation. See discussion of respiratory diseases.

Erysipelas

Light, semisolid diet tending toward that for sepsis.

Rheumatism

(Acute Infectious.) Milk, cereals, no meat, abundance of fruit juices, but not fruits containing oxalates. Cranberries, on account of containing benzoic acid, may be given. Alkalies. It should be borne in mind that the urine is by no means always excessively acid or concentrated or surcharged with urates. Yet there is generally an indication for the administration of an abundance of water, as in lemonade and orangeade.

Hydrophobia, Tetanus, Anthrax, Equinia, Malignant Oedema

On account of the bad prognosis, no treatment is liable to be successful. In the first two, the convulsive tendencies often contraindicate the introduction of food or drink but salt solution may usually be given by the bowel. In order to minimize the tendency to convulsions, all food and drink should be of the body temperature, unless extremes of temperature are craved and well borne. Peptonized milk may usually be given if water can. It may be found that introduction of food or water by stomach tube is better borne than attempts at swallowing. If the jaws are locked, it may be advisable to extract a tooth or two to allow the introduction of a feeding tube or stomach tube, or the nasal stomach tube may be employed. In the last three diseases, the diet is as for sepsis.

Filariasis

No special regimen.

Influenza

Treat as for any mild febrile affection.

Chancroid

Diet about as for gonorrhoea, in order to allay any erotic tendencies that may be present.

Gonorrhoea

See Urinary Diseases.

Bubonic Plague

Diet as for sepsis.

Dengue

The severity of the fever, its short duration and the almost invariable recovery, render it advisable to administer little or nothing during the fever, except water, fruit juices etc., although there is no objection to employing peptonized milk, broths, or the standard diet for typhoid, if tolerated.

Non-Specific Sepsis

An abundant semi-solid diet should be employed. Milk, cereals, egg nog, custards, eggs on toast, tender steak, chops, chicken breast etc., are the mainstays. Moderate amounts of alcohol are allowable to stimulate gastric secretion - l_3% of alcohol in a feeding. Four or five meals should be given in 24 hours. Predigestion should often be practiced or digestants may be given immediately after the meal.

Trichiniasis

This form of cysticercus disease is due practically solely to ingestion of raw or imperfectly cooked pork.

Smoking, salting etc., do not kill the trichinae. Hence the invariable rule should be followed, by everyone, to eat no pork of any kind, that has not been cooked thoroughly, to the center. If this rule is followed, the presence of trichinae in the meat apparently does no harm. There is no special regimen for the disease itself.

Malaria

During the febrile periods, nutrition may be suspended or modified to conform to the standard for fevers generally. In the intermissions or remissions, an abundance of easily digested food should be given. On account of the anaemia, it should be relatively rich in meats or blood or one of the organic preparations of iron should be given. Various bitter stomachics may be employed.

Beri Beri, has variously been ascribed to mouldy or otherwise contaminated rice, to specific bacteria not necessarily, accord-ins; to some authorities, conveyed by foods, and to a systemic state the opposite of scurvy, due to lack of meat foods and superabundance of vegetables in the diet. While meat-eating peoples do not develop the disease endemically and are usually less susceptible to it in its geographic habitat, various accidental causes and prophylaxis along other lines are sufficient to account for the difference and the disease is probably a specific infection. Even so. it is probably carried by foods, especially rice, and an avoidance of suspicious sources of supply is wise. A liberal dietary, rich in protein and containing at least small quantities of meat is also appropriate.