Eggs in form of panada, souffle, omelet, savoury.
Fish or chicken (made as cream, souffle, or quenelles).
The author of this treatment claims, from observation of a large number of cases, that the results are equally satisfactory, and more speedily attained than by the system of graduated feeding which is in general use. The writer has had no practical experience of this specially liberal regime, but in a slightly modified form it has given excellent results in some cases.
It is convenient here to refer to the dietetic treatment of cases of haemorrhage from the stomach, unassociated with the presence of an ulcer. This occurs especially in young women, the bleeding being due to a small erosion in one of the capillaries of the gastric mucous membrane. The bleeding is usually small in amount, but may be considerable, the condition then being almost indistinguishable from that of gastric ulcer. The absence of defined localised abdominal pain and of antecedent symptoms of indigestion in gastrorhexis are of value in the diagnosis. Further, gastrorhexis is more prone to occur at or about the menstrual period, when the bleeding may be vicarious in character. The dietetic treatment of the two diseases is different; whereas in gastric ulcer it is, as a rule, advisable to increase the diet slowly after the manner already indicated, in gastrorhexis the diet can be increased rapidly, the patient being able to take at the end of ten days to a fortnight the same diet as is recommended for a case of gastric ulcer at the end of the fifth week.
The diagnosis of a chronic gastric or duodenal ulcer is often a very difficult matter. In some cases the symptoms, physical signs, and past history of the patient point conclusively to the existence of an ulcer, and in these circumstances the treatment is essentially surgical. In many cases, however, it is by no means easy to say whether the condition is due to a gastric ulcer or to a so-called functional derangement of the stomach (hyperchlorhydria), and in the latter case the dietetic treatment is of very great importance. If medical and dietetic means fail, reliable evidence is thereby afforded of the condition being one calling for operative treatment. Operative means (gastroenterostomy) gives immediate and usually permanent relief. It is very striking to observe after a case of chronic ulcer has been treated for weeks or even months with all kinds of light dietaries with little or no success, the immediate and as a rule permanent relief which follows the operation of tro-enterostomy. In this connection reference may be made to the post-operative dietetic treatment of these cases.
For the first twenty-four hours all food is withheld, the nourishment being restricted to the administration of 10 to 12 ounces of normal saline per rectum every four hours. On the second day milk is administered, diluted one-half or one-third with water or barley-water, and as much as one pint may be given in the twenty-four hours, with 6 to 8 ounces of beef-tea. On the third day the amount of milk and beef-tea can usually be doubled, and a couple of eggs may be added to the dietary. Various invalid foods (like Benger's, Allenbury) can be made use of if desired, and also proprietary meat preparations. A dose of calomel followed by a morning saline should be given on the third night. On the fourth day a slice of bread and a light milk pudding can be added, and on the following day a little porridge and small amount of chicken or fish souffle may be given once or twice in the course of the twenty-four hours. In tabular form this dietary is as follows: -
Milk diluted (1 and1) with lime-water or barley-water; give I ounce every hour - 24 ounces = 12 ounces milk. 2nd day. - Milk diluted (4 to 1) as above - 5 ounces every two hours nine meals, 45 ounces= 1 1/3 pints milk. 3rd day. - Same dilution as second day; add to every second feed, small quantity of carbohydrate - arrowroot, Benger's, Allenbury. At the end of a week a full carbohydrate diet may be reached (p. 334). By the end of the second week, fish and chicken (pounded) and eggs may be given.
By the end of three weeks the full convalescent gastric ulcer diet can be taken, and this should be maintained for some months after the operation, as follows: -
Porridge and milk, and bread and butter, and cup of tea. Dinner - Clear soup, fish or chicken, and one vegetable.
Milk pudding or stewed fruit. Tea - Tea and bread and butter, with cake. Supper - Fish or chicken, or mill: and bread and butter.