Femina, A Work for Every Woman

by John A. Miller

An aversion to food is also no criterion of the patient’s need for nourishment, for the sense of taste is generally blunted or perverted. The desire for food is lost in all diseases of a catarrhal nature of the mouth or stomach, and in those that are characterized by high temperature. In typhoid fever and diseases of a typhoid nature this is always the case.

With children this aversion to food is greater and more general than with adults; and it must be made a rule that their refusal to take nourishment must not be extended beyond several days, otherwise they fail so rapidly in conjunction with the disease as to perish from exhaustion.

The repugnance to food arises from abnormal conditions that are generally localized in the mouth and especially in the parts of the tongue which are supplied by the nerves of taste; these nerves are the lingual branch of the trifacial and the glasso-pharyngeal. But notwithstanding that the food is almost tasteless, when it gets into the stomach it is retained and properly digested and the patient feels better for having taken it. An appetite can be thus cultivated, and after a few days of coaxing or perhaps of forcible feeding, which in children who are failing rapidly becomes necessary in order to save them, the taste and desire for nourishment become natural or restored. Quite often patients beg and plead not to be given food; but in wasting diseases it should be insisted that some at least should be taken (always liquid of course), and when they are sufficiently rational they will always afterward admit that the nourishment did them good.

Liquid food or nourishment and no other is suitable for a sick person; an invalid can drink food when it would be impossible for him to swallow solid material. I have often seen the whim of patients who craved meat indulged; they got a juicy porterhouse steak with the understanding that it was to be thoroughly masticated before swallowing. As a rule, the patient is disappointed with his own bill of fare, and after trying one or two mouthfuls orders the meat taken away with the remark that it is as dry as a chip. But this same person will drink a milk punch, a thin gruel with the yellow or all of an egg beaten into it, with some degree of relish; salt should always be added and indeed, as much as the taste will permit, but sugar should be used as sparingly as possible. Salt is what is needed above all other seasoning; the system requires the chlorides for they are wasted in fevers, but even in health, the chlorides are very essential and salt is the best one we have; salt is the source of the hydrochloric acid in the stomach and one of the most important factors in albuminous digestion.

The saliva is not secreted in sufficient quantity in fever to allow insalivation of food, or to moisten the solid morsel sufficiently to permit its being swallowed without a choking sensation as it glides into the stomach. A person prostrated by disease has not the strength to masticate solid food and that is another reason why liquid food is to be given.

The famous physiologist, Dr. E. Brown-Séquard, is the author of a method for feeding the sick peculiarly his own, namely, that of administering small quantities of food at short intervals. He would give a glassful of milk punch in tablespoonful doses, repeating every ten or fifteen minutes; this method is advised for the treatment and cure of dyspepsia, anæmia, chlorosis, nervous diseases and even organic diseases of the stomach. No particular kind of food was selected for this treatment; butter, milk, cheese, and meats, bread and potatoes were alike to be given in small quantities and at short intervals. One or two mouthfuls even to be eaten at a time, and then repeated in ten or fifteen minutes, until thirty to forty ounces are consumed daily. This system never became a recognized expedient, it is wrong in theory, and certainly in practice; while it may be applicable in isolated cases, they would be so very few that this method of feeding forms the exception and not the rule.

Cases are frequently met with, especially in infants and older children whose digestion has been completely ruined by being fed too often. These cases are not really overfed, because the entire amount in the twenty-four hours, does not exceed the requisite quantity; but giving the food in driblets and at short intervals, causes lactic fermentation, or in plain English, the food sours on the stomach and does not digest, as it would do if a proper time were interposed between each feeding. As soon as the patients are fed at regular and longer intervals, say, from two to four hours, the indigestion corrects itself. During the interval, between the time set for feeding, the children will naturally cry; this is interpreted by the mother or nurse as a sign of hunger, but nothing is oftener further from the truth. The child cries generally for one of three reasons: one of these may be that it wants to be taken up, and dandled or rocked, to which previous indulgences have accustomed it; or it may have pain in the stomach and bowels as a natural result of indigestion or flatulence; or the child may cry from thirst or a sensation of dryness in the mouth and throat; in any event, additional food would only prove injurious. There is no objection against giving nurslings cold water between their meals when they are thirsty or feverish, but warm aromatic tea is so very much superior that I consider it one of the essentials of the nursery. I mean fennel seed tea, of which a sufficient quantity should be prepared every morning to last twenty-four hours; this should be strained and sweetened, then set aside for further use. When the child is restless, between meals, some of the tea should be warmed, and given from the nursing bottle until it is satisfied, for the tea soothes the pain, quenches the thirst and dispels the flatus.

There are also physiological reasons for these longer intervals between nursing; they allow the stomach sufficient time to dispose of its contents before another mess is given to disturb the digestion of former food, which is as yet incomplete. There is another immense advantage in having the length of time between two meals from two to four hours; it allows time for medication and other necessary management of the sick, for sponging off with cold water in fevers, and many other things which are necessary for the patient’s comfort and convalescence, and which can only be carried out between the times the nourishment is given. A memorandum should be kept in the sick room and the time and hour noted when everything becomes due in proper order; this avoids confusion and lessens labor.