Rheumatic Fever - Acute Rheumatism

The diet for acute rheumatism is the diet of acute fever (p. 267). Strong meat soups, however, should not be given until convalescence is well advanced. The patient should be encouraged to drink a large amount of fluids, which allays thirst and promotes elimination of the rheumatic poison. The imperial drink is a refreshing beverage.

Scarlet Fever

In uncomplicated cases the usual fever dietary, with a liberal supply of cold water or lemonade, is sufficient. It is important to keep in view the tendency to the development of acute nephritis, usually about the third week of the illness. The following is a good regime: -

(1) For the first four days the nourishment should consist exclusively of milk, with possibly the addition of some lemonade and soda-water. Plain water may be given freely.

(2) For the next four days an egg and any form of farinaceous food may be added.

(3) During the remaining four days the diet may include some weak broth, fish, fruit, and vegetables (see Convalescent Diet, p. 293).

(4) After this period, poultry, game, and meat may be gradually allowed, and the food administered as freely as desired. In young children and in adolescents it is surprising what amount of food can be consumed with impunity in cases when the diet has been restricted as above during the initial stages of the illness. On the other hand, the administration of a liberal mixed dietary in the initial stages of the disease is prone to induce nephritis, with albuminuria, etc.

If the condition is complicated with severe faucial ulceration, or submaxillary swelling, and swallowing is painful, the food administered should be of the most nourishing character, and given in small bulk, e.g., eggs and milk, raw-meat juice, beef or chicken essence. In some cases it is necessary to have recourse to nasal feeding. The onset of albuminuria necessitates an exclusive milk regime. Cardiac weakness calls for a liberal use of stimulants.

Whooping-Cough

During the whole course of the illness, milk, light soups, and farinaceous foods should form the chief ingredients of the dietary. In cases in which the vomiting is persistent and the paroxysms severe, the child may become greatly weakened. Under these circumstances the child should be fed with custards, rich egg flip, beef and chicken essences, fortified with Plasmon, which should be given after each paroxysm. The quantity should not be large, but must be regulated by the length of time between the fits. In very troublesome cases great benefit may be obtained by substituting whey for diluted milk. Treatment of these patients in the open air makes them much easier to feed.

Measles

The general directions for a fever dietary apply. During convalescence, special care is necessary in the case of young and weakly children. The too early administration of a strong meat or vegetable soup may induce a severe and troublesome diarrhoea.

Influenza

The dietetic treatment of influenza varies according to the presence or absence of (a) pyrexia and (b) gastro-intestinal derangement. The leading indication is to have recourse to a generous dietary as soon as the acute stages of the disease are passed. In febrile cases the rules laid down under fever dietary apply. As soon as the fever has abated, a convalescent diet may be given. In other cases a generous dietary is called for from the outset. The appetite of these patients usually requires to be tempted, and assistance in the selection and preparation of suitable foods will be found in the section on Diet during Convalescence. Care must be taken in prescribing alcohol in any form in this disease. It is usually uncalled for, but in certain cases recovery is accelerated by the judicious use of a small quantity of whisky, champagne, or Burgundy, which should be given once or twice a day with meals.

Diphtheria

The diet in diphtheria is the diet of acute fever. As soon as the temperature is normal, soft solids may be given. Occasionally, even in the acute stages, semi-solids are swallowed with greater ease than liquids, in which case the soups can be thickened with tapioca, sago, or arrowroot. The stock, carefully skimmed from fat, may be given in its jelly form. Veal jelly, custard, and curds are also valuable. In cases with much faucial trouble, nasal feeding may be necessary (see p. 225). If intubation or tracheotomy have been required, it is wiser to have recourse to nasal feeding, owing to the risks of inhalation pneumonia. Stimulants are frequently advisable, and may be given in 1 to 2 tea-spoonfuls of whisky, either diluted with water, or added to the egg flip.

Smallpox

The general directions for feeding fever patients are again applicable. There should be an abundance of fluids, and the foodstuffs should be those which give least trouble to the digestion. Cold drinks may be given liberally. Patients are usually quite ready for their food; if vomiting is persistent, nourishment must be given in small quantities, and in a concentrated form - eggs, essences, beef jellies; if no nourishment is retained, nutrient enemata should be administered. As the confluent form is exhausting, a generous dietary is called for (see Diet in Con-valesence, p. 292). Stimulants must be freely administered if the pulse becomes feeble and rapid.

Tonsillitis (Quinsy) is best treated by a milk and beef-tea regime (p. 268). Semi-solid diets are sometimes taken more easily than fluids, and in these cases the semi-solid diet for dysphagia (p. 438) may be recommended.

Typhus

Owing to the condition of the mouth and tongue, and in order to promote the elimination of toxines, these patients require a large quantity of fluid. It is absolutely necessary to supply water in abundance; this may be given simply as cold water, or as one of the mineral waters - Salutaris or Apollinaris. The water should be forced on these patients, as they are sometimes unable to ask for it; a quantity of five to six pints in twenty-four hours is advisable.

The digestion is much impaired, and a milk and meat soup dietary, such as outlined on page 268 for fevers in general, should be given. When there is great debility and manifest failure of strength, the more concentrated nourishment, such as essence of meat, or chicken, egg flip, or the prepared artifical foods, such as Wyeth's beef juice, Bovinine, Brand's beef jelly, are necessary. The food in such cases is best administered in small quantities every hour and a half. A dried milk preparation may also be used to further fortify the food (p. 158).

Malarin

The febrile stages of malarin calls for the administration of the fever dietary, p. 268; in the later stages the diet in convalescence (p. 292) or the light diet summarised on p. 548 is applicable.