FOOTNOTES:
[96] Warren Coleman, University and Bellevue Hospital Medical College, Visiting Physician, Bellevue Hospital, New York City.
[97] “Diet in Typhoid Fever,” by Warren Coleman, “Journal of American Medical Association,” Oct. 9, 1909, Vol. LIII.
[98] “Diet in Typhoid Fever,” by Warren Coleman, reprint from “Journal of American Medical Association,” June 9, 1909.
[99] Determined by calorimeter observation from the Russell Sage Institute of Pathology in affiliation with the Medical Division of Bellevue Hospital, under Warren Coleman and Eugene DuBois.
[100] “American Journal of Medical Sciences,” January, 1912, by Warren Coleman.
[101] F. P. Kinnicut, “Diets Used in the Presbyterian Hospital,” New York City.
[102] “Journal of American Medical Association,” Aug. 4, 1917.
[103] See urinalysis, p. [323].
CHAPTER XV
DISEASES OF THE RESPIRATORY TRACT
TUBERCULOSIS, PNEUMONIA, AND TONSILLITIS
TUBERCULOSIS
The dietetic treatment for tuberculosis must, as in any other pathological condition, depend largely upon the general condition of the patient, and the symptoms manifested at the time.
Character of Disease.—The disease may have reached an acute stage in which the rise of temperature is marked and the progress of the tuberculous symptoms rapid, or it may be found to be an old chronic condition in which the progress is slow.
Again, the patient may be found to be suffering from a tuberculosis which is neither acute nor very slow. Each of these stages requires slightly different treatment which, however, for the main part is much the same.
Individuals having an incipient form of tuberculosis have been known to develop an acute form of the disease upon being subjected to a strenuous treatment for some other and entirely different condition. This has been especially noticeable in certain individuals to whom the starvation treatment is given.
Dietetic Treatment in Acute Stage.—The dietetic treatment of the acute tuberculosis under such circumstances must necessarily be adapted to that of the original disease for which starvation was believed to be necessary. The forbidden foods must still be omitted from the dietary, but in these cases it is found advisable not to prolong the starvation treatment but to substitute foods which will do the least harm under the circumstances. This is necessary to cover the energy requirements of the body and to make good the tissue wasted through the development of the specific disease.
Dietetic Treatment in Chronic Stage.—The diet for tuberculosis has been so widely discussed and so universally used that a few words only seem necessary here. One of the chief points to be emphasized is the danger arising from gastro-intestinal disturbances. The digestive apparatus of the tuberculous individual is more apt to be impaired, so that any undue exertion required to digest a meal is likely to bring about disturbances more or less serious in character.
Method of Administering Diet.—For this reason it is no longer the custom to stuff the patient in an effort to overcome the inevitable tissue waste, since such treatment in many cases defeats the end for which it was intended, bringing on acute indigestion, or at times diarrhea, which might readily cause a greater loss of body weight than could possibly be produced by the surplus food given.
Adjusting the Diet.—More and more is it coming to be understood that the diet must be adjusted to suit the individual. Three wholesome meals a day are insisted upon, with lunches given between the morning and midday meal and during the course of the afternoon. Many patients are found to sleep better after they have partaken of a light lunch, consisting of hot milk, malted milk, or like beverages and crackers, so that this third meal is added to the other five. In this way the individual suffering with tuberculosis is assured of an efficient diet to meet the needs of the body without overburdening the digestive apparatus or overtaxing the excretory organs. The increased metabolism taking place in such patients, due both to the specific bacteria and to the febrile condition, is, as far as possible, provided for.
Schedule of Diets.—The following dietary régime may be useful in formulating menus for tubercular patients:
Breakfast
Fruits.
5 oz. cereals with cream.
1 or 2 eggs, simply prepared to prevent indigestion.
2 slices of bacon, ham; fish cake or chop.
2 slices of toast or crusty rolls with butter.
Coffee, tea, or cocoa, with or without cream.[104]
Lunch
Vegetable or cream soups.
Cold meat, lamb chops, oysters, or fish.
Baked white or sweet potato.
1 green vegetable,—greens, cabbage, spinach, or string beans.
Stewed fruit or baked apple.
Rice or tapioca pudding.
Tea.
Bread and butter.
At the end of the meal one glass containing two-thirds milk and one-third cream. If the latter disturbs the digestion reduce the amount temporarily, or add one-half the contents of a tube of peptonizing powder, or one-quarter of a glass of limewater.
Dinner
Meat, lamb, mutton, chicken, duck, game, or fish.
Mashed or creamed potatoes.
1 or 2 green vegetables.
Simple salads.
Simple desserts consisting of puddings, custards, wine or fruit jellies, ices or ice cream, sponge cake or angel food cake.
The milk and cream is taken at the end of the meal as directed above.
Lunches
11 A.M., 4 P.M., 9 P.M., consisting of milk, malted milk, junket, buttermilk, albumenized broth, albumenized fruit juices, cream, egg, and vichy, eggnogs, served with crackers or sponge cake; cereal gruels and raw eggs taken with water, milk, or sherry may likewise form a part of this diet, since the nourishment in them is both concentrated and palatable.
Use of Eggs.—The old method of forcing the patient to eat a dozen or more raw eggs a day is no longer used, but three or four a day will be of undoubted value to the patient, provided they agree. There are patients, however, with whom eggs act almost as a poison, and in these cases it is decidedly unwise to force them.
Use of Milk.—Milk is to be used abundantly. If it should disagree, it may be peptonized or modified with limewater. At any rate, every effort should be made to enable the patient to drink at least one quart a day, and more, if possible.
If it fails to agree even when so treated, it should be abandoned, since the discomfort caused under the circumstances is more detrimental to the welfare of the individual than any benefit which he may gain by the small amount which may be absorbed.
High Calorie Diet.—As long as the patient is in bed the diet cannot be as full as it is made when he is up and about, as the body is then using more material to provide for the extra exertion and needs more food to replace that which has been utilized. Consequently the high calorie diet[105] will be found as a rule sufficient. As soon as the patient is able to receive more food without incurring digestional disturbances, it should be supplied, keeping ever in mind the danger of its upsetting his digestion.
Advice to Patients.—The patient must be impressed with the necessity for living a simple, wholesome life, free from excesses of all kinds. The need for a regular régime in the beginning must be strongly emphasized. Too strenuous exercise and the consequent over-fatigue at times completely overcome all the good which has been accomplished in weeks or even months of studied effort, so that rest is an essential part of the tuberculous régime. The patient should sleep from eight to ten hours out of every twenty-four, and if this sleep is taken in the open, that is, in a tent or on a sleeping porch, the benefits derived therefrom are inestimable.
The Bowels.—The bowels should move every day, even if some gentle laxative or an enema has to be used to bring about the desired result. In a majority of cases, mineral oil or bran muffins, prunes, raisins, and figs prepared with senna will be entirely sufficient, however, and these substances are much less harmful than drugs, for the habit of taking purgatives becomes a fixed one in a short time, and is especially liable to become so when the patient is forced, by reason of the sedentary life, to depend on some such measures.
Massage.—Massage has been found beneficial in many cases, giving the needed exercise to the body, which it is otherwise unable to obtain.