Severe Form

In severe cases a complete rest for the stomach for forty-eight hours is advisable, rectal saline injections being administered.

A milk diet is not suitable - a dry diet is advisable so as to reduce the bulk, the fluid being restricted to 20 to 30 ounces of fluid by the mouth in twenty-four hours. To quench thirst, rectal injection of salines may be commended.

Food should be taken hot; meals should be small and frequent. All the nourishment given should be of the highest nutritive value, and the more easily digested the better. It must be slowly masticated, to allow of oral digestion to proceed as far as possible. Meat should take the form of underdone steak, chop, or roast, sweetbreads, oysters; green vegetables are bulky, and not as a rule suitable.

Rest for an hour after the three large meals is a useful measure.

Outline Of Treatment - I. Mainly Protein Diet

8 A.M. - Milk or peptonised-milk cocoa, 5 ounces, not more. Fish (steamed), or boiled egg; toast and butter.

10. 30 A.M. - Sandwiches made of Plasmon and raw meat, 1/4 lb. Milk, 5 ounces I P.M. - Sweetbreads cooked with cream; or Chicken cream, or souffle; or Oysters, or raw-meat mince, 1/2 lb.

Toast and butter.

Milk, 5 ounces.

Raw-meat soup, 5 ounces, containing 1/4 lb. of raw meat scraped; or Savoury custard (p. 49).

7 P.M. - Fish (steamed); souffle, pudding, or cream; or Egg and cheese custard (milk, 5 ounces); or Cheese souffle. 9.30 P.M. - Veal or chicken jelly (p. 163), with Plasmon added; or Allenbury food and milk, 5 ounces, with Plasmon.

As the condition of dilatation improves, chicken, mutton, game may be allowed, all being well masticated, also blancmanges, jellies, and cream, potato puree, and vegetable souffles.

The carbohydrates must be introduced with great caution, the predigested ones coming first (p. 183).

In some cases where the power of digesting proteins is diminished, the carbohydrates may have to form a larger portion of the diet, notwithstanding the flatulence they may induce, as follows: -

II. Mainly Carbohydrate Diet

8 A.M. - Milk, 5 ounces; toast and butter.

Gruel with cream and Plasmon, and Malt extract (p. 181). 10.30 a.m. - Milk, 5 ounces, and I egg (scrambled) and toast. 1 P.M. - Milk, 5 ounces; custard, flavoured with Bovril, cheese, or sugar; or Raw-beef juice mince, 1/2 lb., and slice of toast. 4.30 p.m. - Milk, 5 ounces, with Plasmon, flavoured with peptonised cocoa. 7.30 P.M. - Allenbury food and milk, 5 ounces.

9 P.M. - Beef-tea or chicken tea, 5 ounces, thickened with egg or cream.

Somatose, Carnrick's peptonoids, Fairchild's panopeptone, Denaeyer's albumose-peptone mixture, may be used in the place of some of the milk.

Diet In Dilated Stomach - Less Severe Form - Patient Going About

The meals to be eaten slowly, and the patient to rest for fully one hour after breakfast, lunch, and dinner, etc.

8 A.M. - Milk or milk cocoa, 5 ounces.

Toast and butter, one and a half slices.

Egg or fish, or crisply fried bacon. IO.30 A.M. - Milk with Plasmon, 5 ounces.

Panopeptone, 1 tablespoonful; rusk or dry biscuit; or Raw-meat sandwich. I P.M. - Milk, 5 ounces, with a slice of toast and butter, and a two-course dinner, from the following: -

Fish. Blancmange.

Chicken.

Fruit puree with cream.

Raw-beef juice. Savoury custard, or Vegetable puree.

4 P.M. - Egg beaten up in 5 ounces milk.

7 p.m. - Same as 1 o'clock Lunch.

9.30 p.m. - Cup of soup thickened with egg or Plasmon.

In convalescence the diet should be largely dry, little fluid being given with meals. The meals should be fairly concentrated, thoroughly masticated, and slowly eaten. Farinaceous foodstuffs should be very cautiously added to the dietary.

With obstructive conditions any dietetic treatment is only a preliminary to operative treatment.

The carbohydrate should be given as Lactose, adding 1 tablespoonful of milk sugar in 8 ounces of milk. Peptonised and pancreatised foods are of the greatest value, especially Peptonised milk, Panopeptone, Brand's peptonised jelly, Benger's beef jelly (peptonised), Valentine's meat juice (see Predigested Foods, p. 176).