A HIGH temperature acts on all the tissues of the body, causing alteration in normal metabolic processes, and derangement, more or less severe, of the whole alimentary tract. Associated with the high temperature there is rapid wasting of the albuminous tissues, with an increased combustion of the structural elements of the body.

As a consequence of this, there is an excessive excretion of urea, which is eliminated in the urine, but which may for a time accumulate in the blood. There is, also, although to a less degree, an increased excretion of carbonic acid.

At the same time, the functions of the digestive and assimilative organs are gravely disturbed. There are morbid changes affecting the peptic and other secreting glands in the digestive tract. These changes are usually accompanied by loss of appetite, and even disgust for food, which, if administered, is often vomited.

Principles Of Feeding

The following are the guiding principles in treatment: -

1. An adequate supply of albumins, carbohydrates and gelatines must be given, to neutralise the increased combustion in the tissues resulting from the high temperature.

2. No food should be administered which cannot be readily absorbed and assimilated, for if the enfeebled digestive organs are overloaded, the undigested food will undergo fermentative changes, which will lead to gastro-intcstinal irritation. With suitable feeding, the wasting is less, the patient docs not become so reduced, and, consequently, the convalescence is more rapid.

3. An abundance of fluid should be given. This overcomes the dry and parched sensation in the throat and fauces, trashes out through the kidneys the waste matter produced by the increased rate of metabolism, and promotes the elimination of the toxins.

4. Food must be given in measured quantities at regular intervals, and should be daintily served.

It is specially important to attend to the toilet of the mouth in fever. Regular cleansing of the mouth and teeth with an antiseptic mouth-wash at least three or four times daily checks fermentative processes, and enables the patient to take his food to the best advantage.

Food, in all cases of pyrexia, should be administered in the fluid form, the quantity small, from 3 to 4 ounces at a time, and given at short intervals (every one and a half to two and a half hours) during the day. At night, if the strength is being well maintained, simple drinks to quench the thirst are all that is required; by this arrangement the digestive organs obtain rest.

The Diet Must Be Selected From The Following Substances, Viz

milk, whey, eggs, meat teas, meat infusions, meat juices, meat extracts, soups, meat jellies, calfs-foot jelly, grape sugar, starches, fruit juices, fruit soup, and beverages of low nutritional value. This diet may be suitably varied by changing the flavouring substances.

Milk And Its Derivatives

Milk is pre-eminently the diet for the febrile state. It is also the most convenient form of food, but it must be borne in mind that milk forms a solid curd when acted on by the gastric juice. On this account some persons, even in health, find milk indigestible.

If there is any doubt of the milk being thoroughly satisfactory and fresh, it should be scalded. The necessary dilution of the milk depends greatly on the digestive powers of the patient. The effect of the diluent on the milk and its action on the density of the curd have already been considered (p. 33). The milk may be given hot or cold, but it is best to be slightly warmed. The following methods may be adopted: -

(a) Simple dilution with boiling water, clear or thick barley-water (p. 34), toast, or rice-water, in the proportion of equal parts.

(b) Dilution with an effervescent water - milk and Vichy or Vals water, equal parts, or milk one part with two portions of potash, soda, or Apollinaris water. In some patients effervescent drinks set up distension of the stomach and troublesome flatulence; this quickly subsides when the aerated water is stopped.

(c) Dilution and mixture with an alkali. This method is advisable if there is pain and flatulence after the simply diluted milk. The addition of 10 grains of soda bicarbonate and 10 grains common salt, added to equal parts milk and water, often prevents pain and lessens the constipation. Lime-water, in the proportion of one part lime-water to three parts of milk, is useful if there is pain and a tendency to diarrhoea. As to quantity, 2 ounces of the milk, diluted as recommended, may be given every one and a half hours. If this does not disagree, the amount may be increased. Three to four pints of milk daily are readily taken by most adult patients. In those cases where a milk regime for a lengthy period is necessary, attention should be directed to the points in its administration (referred to on p. 278).

Repugnance to milk can be overcome by modifying the flavour of the milk; for example, tea can be infused with boiled milk, or a very weak cocoa made with Allenbury's milk cocoa can be specially recommended for this. Horlick's malted milk made with milk is very palatable. A small amount, e.g. 1/2 a teaspoonful of a meat extract such as Bovril, Oxo, Lemco, or Vigoral, added to a cup of warm milk or milk and water, is an excellent way of varying the flavour.

(D) Modifications Of Milk

Occasionally cases occur where diluted milk is not digested, and whey will then be found useful. It will also be found an agreeable change in the monotony of a milk diet The proportions and method of preparation are described in detail on page 40. Whey is practically milk minus the curd and fat, which have been got rid of by a process of coagulation and straining. Its nutritive value may be increased by the addition of strong beef-tea, raw-meat juice, egg-water, or Plasmon. Koumiss and Kep/iir, fermented milks (p. 44), can sometimes be retained by an irritable stomach when everything else is rejected.