CONDITIONS REQUIRING SPECIAL DIETS
Diet After Appendicitis.—After a simple operation for appendicitis the same régime is carried out as in stomach and intestinal operations: fluids on the second day, soft diet on the third, and solid food of the simplest character and prepared in the simplest way may be given on the fifth and sixth days. When, however, the operation has been of a more serious character, for example, when there was pus formation or a gangrenous appendix, the feeding by mouth must not be instituted for five days or more, nutrient enemas being used instead. Patients have been known to die from exhaustion after operations upon the stomach and intestines, not on account of the operation but on account of the lack of reserve power and endurance to carry them through the ordeal without a sustaining diet to overcome it. Under the circumstances Dr. F. Ehrlich[109] advises the following routine method: “So soon as the nausea from the anesthetic has worn off the patient gets tea, red wine, and gruel; on the day after the operation he is given sweetbreads in bouillon even if it nauseates him; if the nausea is persistent, his stomach is washed. On the second day finely chopped cooked squab, chicken, or veal, is added; on the third day, beef, potato purée and cakes; on the fourth, chopped (raw) ham, soft zwieback, and soft-boiled eggs. On the fifth, white bread and spinach. After the seventh day the meat is not chopped, and the patient returns gradually to normal diet. The bowels are regulated by oil enemas.”
Diet After Operation upon Gall Bladder or Liver.—The dietetic treatment in these cases is like that of any other abdominal operation except for the character of the food. Fats are not well handled by the body of such individuals and should be eliminated as far as possible from the diet. Broths must be skimmed carefully to remove fat, and milk when given should be skimmed or given in the form of buttermilk or koumiss.
Diet After Operations upon the Kidneys.—The diet administered after operations upon these organs is logically one in which those foods which are entirely dependent upon the kidneys for their elimination are restricted. In a former chapter the fate of the foods in metabolism was explained; the protein foods were seen to be the ones leaving the body chiefly by way of the kidneys and for this reason in the diet after operations upon these organs, as well as in that administered in disturbances affecting their functioning powers, this food constituent, the protein of meat in particular, must necessarily be restricted. The upsetting of the nitrogen equilibrium is for so short a period after kidney operations that this feature need not be considered here. The diet under the circumstances is essentially the same as that given during acute attacks of nephritis.