One of the functions of bile is to aid in the digestion and absorption of fats. When from any reason bile is prevented from getting into the intestine, the absorption of fats is interfered with, a state of detective digestion is induced, and the amount of fat in the stools is greatly increased. One is not surprised, therefore, to find that patients with jaundice show a marked repugnance to fat. The diet should therefore contain little or no fat. The diet should be simple, and should be largely protein in character. Milk in the form of skimmed milk, whey, buttermilk, or koumiss; and beef juice, albumin water, and well-cooked barley-water should form the dietary in the more acute stages, and in cases with irritability of the stomach. Later, soups thickened with barley, or sago, or tapioca, the lighter forms of fish, and different varieties of lean meat, with toast or roll, may be added. The more easily digested vegetables and fruits may also be given, such as spinach, onions, asparagus tops, and the flower of cauliflower, stewed apples, prunes, and figs. Potatoes should be given sparingly, and are best given cooked in their jackets, either boiled or steamed. With regard to fluids, the drinking of plain water or alkaline water should be encouraged; as much as 2 pints, or more at the outset, should be taken daily. Tea and coffee may be given in moderate amount; all stimulants should be withheld unless specially indicated. During convalescence the patient should be cautioned against eating to excess, or taking rich, stimulating, or coarse articles of food; and special care should be taken with regard to his return to the use of fats and fatty foods. One of the extract of malt preparations, such as Extract of malt, Maltine, or Homax, is a useful aid to digestion of the carbohydrate foods. The principles of treatment outlined above are applicable to all cases of jaundice. It may be advisable to amplify this by giving detailed examples of a dietary appropriate to two distinct groups of clinical cases, such as simple catarrhal jaundice, and jaundice due to inoperable malignant disease.
The diet here is of a fluid character, easily digested, largely protein in nature, and free of fats. Its nutritive value is small in amount, but is ample for the first three days or so of the illness Its use will promote a speedy return to a more liberal regime.
7 A.M. - 10 ounces mineral water. 8 A.M. - 10 ounces skimmed milk, thickened with white of egg or albumin water.
I slice of toast without butter. 10 a.m. - 10 ounces buttermilk.
1 P.M. - 10 ounces clear soup thickened with Plasmon; or 10 ounces beef-tea thickened with meat juice; or 10 ounces beef-tea thickened with scraped raw beef; slice of toast or roll.
As the stomach becomes tolerant and the appetite returns the diet can be gradually increased, as follows: -
7 a.m. - 10 ounces mineral water. 8.30 a.m. - Freshly made tea, with very little milk.
Roll or crisply made toast, no butter.
Fish (steamed), or slice of ham, tongue, or chicken. 10 a.m. - 10 ounces buttermilk; 1 sweet biscuit. 1 P.M. - Cup of barley or sago soup.
Fish (white, steamed or boiled); or Chicken or pheasant (roast or boiled), slice from breast; or Rump-steak, or tender eye of mutton chop; or Slice of roast beef or mutton, with gravy.
1 vegetable - spinach, or cauliflower, or stewed celery.
Stewed fruit, eaten with milk and biscuit. (Malt extract with Dinner.) 4 P.M. - Cup of tea; dry rusk, biscuit, or sponge cake. 7 P.M. - Two courses. Cup of soup, and a little meat or fish. (Malt extract with Supper).
7 a.m. -10 ounces plain water or mineral water.
8 A.M. - Cup of weak tea, with little sugar.
Slice of toast or roll, with a little jam or marmalade; no butter.
Fish, ham, or cold tongue.
11 A.M. - 10 ounces mineral water, or an equal amount of buttermilk.
I P.M. - Howl of clear soup.
Stewed fruit, with very little milk; no cream. 4 P.M. - Cup of weak tea, with little sugar, and half-slice of toast. 7 P.M.: Dinner (two courses). - Much the same as Lunch.
Steamed fish, or light entree.
Custard, or curds, or stewed fruit.
In this dietary the fats are cut off, the carbohydrates are reduced, and a simple, easily digested diet of protein nature is given. There is no reason for withholding any article of food for which the patient expresses a wish, unless it be of a nature likely to derange or still further weaken his digestion. The meals should not be large.
As the disease progresses the patient becomes unable to digest the above, and a more fluid dietary, along lines similar to that adopted for the earlier stages of simple catarrhal jaundice must be given.