It will be observed that the above dietary is a strikingly libera] one. While it has given good results in a large series of cases, and does not appear to have been prejudicial in any recorded cases, it should certainly not be adopted as a routine method. Other authorities, and more especially American physicians, have adopted this system of feeding in a less prominent and more rational manner. They have found, in experimenting with a more varied diet, that no harm accrued from giving meat and milk, beef-tea thickened in various ways, and milk puddings, during the acute stage. Those who have experimented with this more varied diet have not found that its use was followed by a relapse more frequently than the ordinary system of feeding by an almost exclusive milk regime.

Many American authorities approve of a full diet along the following lines: -

1. Milk in various forms, such as hot or cold, with or without salt; may be diluted with lime-water, magnesia, or plain water, or with the aerated waters, e.g., Apollinaris, Vichy, soda-water. Peptogenic milk, or peptonised milk, milk with white of egg, buttermilk, koumiss, whey; milk with tea, coffee, or cocoa.

2. Soups - beef, veal, chicken, tomato, potato, oyster, mutton, pea, bean; carefully strained and thickened with rice flour, arrowroot flour, milk cream, egg, or barley.

3. Horlick's malted milk, Mellin's food, Somatose, etc.

4. Beef juice, meat'juices, Bovinine peptonoids.

5. Gruels (strained), barley-water, toast-water, and albumin water.

6. Eggs, soft boiled, raw, or with egg flip.

7. Finely minced beef, scraped beef, oyster, well-boiled puddings, blancmange, and jellies.

A liberal dietary is a very important factor in the treatment of convalescence. As soon as the morning temperature is satisfactory, solid food should be increasingly given, provided the patient be genuinely hungry. This increased dietary is not only of special service in the treatment of convalescence in cases running a normal course; it may be of great service in cases which show a prolonged swinging temperature in the convalescent period.

Dietetic Treatment On The Empty Bowel Theory

Ewart has drawn special attention to the advantages of a diet which leaves little or no residuum. According to this view, the ulceration is regarded as a preventable condition, rather than an integral part of the disease. A good deal can be said in favour of this view. The dietary recommended consists in from 2 1/2 to 4 pints of whey in the twenty-four hours, common salt being added in the proportion of 10 to 15 grains to each half-pint, in order to correct the deficiency in mineral salts in an ordinary milk diet. This diet is continued for three or four days. At the end of this period, sugar, albumin, and cream are successively added to the dietary - sugar, in the form of lactose, 2 drams to each half-pint of whey; albumin, in the form of white of egg, which may be given peptonised; and fat, in the form of cream, either taken alone, or in the whey, or as yolk of egg. Maltine is also useful. Thin vegetable soups, fruit juices, and jellies are also recommended. In determining each addition to the diet, we must be guided by the presence or absence of meteorism, the state of the stools, and the general condition of the patient.

Starvation Treatment

With the object of securing complete rest for the affected part of the intestines, and effectually excluding the possibility of fermentation of partially digested food, some writers have recommended systems of feeding which are really treatment by starvation. Thus it has been recommended that the treatment should be entirely rectal, a lemonade drink being the only food given by the mouth. A similar line of treatment has been advocated by Williams. In some cases this author gives water only for days at a time, and he regards half a pint of milk in the twenty-four hours as a liberal diet, which he seldom exceeds until the temperature is normal. In the hands of other clinicians this system of treatment has been found to answer remarkably well in certain cases. The patients so treated have not wasted any more than the patients more liberally fed, which seems to prove that in the latter the food was not being assimilated, and that, therefore, no advantage was gained by its administration. The main lesson which the success of this starvation treatment should convey is the advisability of judiciously starving the patient for a few days at the outset of the illness in cases where the power of digestion and assimilation is in abeyance, as revealed by marked gastric and intestinal disturbance.

Pneumonia Or Pneumonic Fever

In this acute condition, the diet must be fluid and light, and adapted to the enfeebled digestive powers. (The general directions on p. 267 apply.) The food should be given in small quantities and at short intervals. During the fever the total quantity of liquid food in twenty-four hours should not exceed 3 to 4 pints; cold water may be allowed freely in addition. Milk diluted in various ways is the staple diet. If the stomach is irritable, whey in some form is preferable, e.g.f whey and egg-water, whey and cream, or whey and white wine with cream. Any of the beef-tea and soup group (pp. 75 and 270) maybe used; beef-tea is best given as directed on page 76. Freshly made tea, with cream and a strip of toast or sponge rusk to eat with it, is allowable. Milk flavoured with coffee is an excellent stimulant, and is very refreshing in the morning after a bad night. Fresh fruit juice (grapes, oranges) is much appreciated.

As soon as the fever has abated, the patient may be placed on a convalescent dietary. In judging of the disappearance of the fever, we must remember that the fall of temperature may be a pseudo crisis, and not a real crisis. In the general run of cases, alcohol in any form is not called for. In elderly people and in alcoholic subjects the use of stimulants is more frequently indicated. The early routine use of alcohol in these cases cannot be too strongly deprecated. When the heart's action becomes weak, Irregular, and intermittent, and the general condition of the patient indicates increasing weakness, a stimulant is called for. It may be given in the form of whisky, brandy, or champagne. An average dose would be 1/2 ounce of whisky in twice the amount of water every four hours. In exceptional cases, when distinct benefit is apparently resulting from the stimulant, a considerably larger amount of whisky or brandy may be administered.