FOOTNOTES:

(a) Give a sample diet order, using liquids only. Raise the fuel value of the diet from 2000 to 3000 calories.(b) Formulate a diet order, using the high calorie diet, fuel value 3500 calories.

(a) Give a sample diet order, using liquids only. Raise the fuel value of the diet from 2000 to 3000 calories.

(b) Formulate a diet order, using the high calorie diet, fuel value 3500 calories.

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.

[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.

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 thestarvation 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

11A.M., 4P.M., 9P.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.

In chronic tuberculosis, the patient should be instructed in the care necessary for his protection. He should be advised to report to the physician any symptoms occurring during the course of the disease, especially any hemorrhage. He must be reassured of the chances of recovery, even after hemorrhage has occurred. It is not well to encourage the habit of taking the temperature or weighing daily, since the knowledge of the fluctuations which inevitably occur inthese conditions may worry the patient to such an extent as to interfere with his final recovery.

Rest, Sleep, and Fresh Air.—Moderation in physical exertion, wholesome food at regular intervals, plenty of rest and sleep, preferably in the open, and an effort made to look forward to a complete recovery will go far toward bringing about the desired result. The tuberculous patient who sets his mind on recovery, refusing to be discouraged by the numerous setbacks which may from time to time occur, has a much greater chance of living a long and useful life than the patient who makes no effort in this direction.

Reënforcing the Diet.—The following reënforced foods have been found valuable in the diet for tuberculosis, especially in those cases which are confined to bed and in which the effort to eat causes more or less gastric distress:

Milk, whole milk, milk and cream, milk diluted with Apollinaris water, peptonized, modified milk, reënforced with egg or egg white or reënforced with one to four tablespoonfuls of lactose, malted milk, buttermilk, cream, egg, and vichy, milk shake, milk punch, malted milk shake, chocolate or cocoa malted milk, albumenized fruit juices, egg and orange, egg and wine, reënforced, if desired, with lactose, albumenized broths, proprietary infant foods, such as Eskay’s Food, Nestlé’s Food, Mellin’s Food, Racahout, cream soups reënforced with lactose or egg, junkets, and ice cream.

The diet in pneumonia is of considerable importance, since in this condition the strength of the patient is taxed by reason of the character of the disease, and the only means of attaining endurance to carry him through this trying period is by providing proper nourishment.

Dietetic Treatment.—The same general outline of diet is used as in acute infectious fevers, milk forming the basis of the diet. The patient is given an abundance of water andother beverages in addition to the other fluid foods to relieve the thirst which is so often a common symptom in this disease.

It is sometimes found advisable, however, on account of the vomiting which may occur, to give a more concentrated form of nourishment, in which case liquid peptonoids, trophonine, and panopepton furnish a form of nourishment which is both strengthening and stimulating in character, and for these reasons particularly desirable. Freidenwald and Ruhräh advise against the use of starches and sugars in most cases of pneumonia.

Daily Diet Schedule.—The same fluid diets used in acute fevers and administered at two-hour intervals are advisable here. The following régime is used in pneumonia:

Night feeding consisting of milk, malted milk, or reënforced broth may be given at 12M.and 4A.M.if patient is awake.

The above diet may be varied by adding some of the beverages mentioned in the diet for tuberculosis or fevers.

Convalescent Diet Schedule.—As the acute symptoms subside and convalescence advances, the following diet may be instituted:

III

The diet may be reënforced with lactose and meat added only when convalescence is well established.

Tuberculosis Nursing.—The nurse must keep in mind that the lungs are in a condition more or less out of commission, and their work of excretion is forced upon the kidneys. For this reason, as well as on account of the increased strain upon the heart, it is necessary to keep the diet light and avoid all foods which may in any way exert an unfavorable influence upon either the kidneys or the heart.

Milk Diet.—A strict milk diet has been found necessary in certain cases of pneumonia, but this is used only while the febrile condition lasts, after which the diet is gradually increased, as in the case of acute nephritis and in diseases of the heart, to meet the needs of the individual.

Dietetic Treatment.—The diet in this condition is much the same as that used in other acute febrile conditions, that is, a fluid diet, the basis of which is, as a rule, milk.

The development of nephritis and certain cardiac symptoms at times follow attacks of tonsillitis, and for this reason the urine must be examined frequently and the dietcarefully adjusted to avert, if possible, this danger. When acute nephritis does follow the attack of tonsillitis, the diet must necessarily be adjusted to meet that condition rather than that of the original disease.

Special Diets.—The Mosenthal diet, and at times the Karell Cure, is used with more or less success. This, however, is adjusted by the physician. It remains for the nurse to report any unfavorable symptoms as soon as they occur, and to carry out the line of dietetic treatment deemed advisable by the physician.

Form.—Acute and chronic in character. The chief aim of the treatment in the former is to prevent its development into a chronic form.

Rest.—Sleep, preferably in the open air, in a tent or on a sleeping porch.

Proper Surroundingsshould be striven for. The patient should be kept tranquil in mind and body, free from disturbing worries and assured of the possibility of recovery with proper care.

Dietshould be adequate without being too abundant; stuffing the patient is no longer considered necessary, in fact it is believed that forcing the eating of large quantities of eggs, etc., defeats its own ends, upsetting the digestion and causing a disgust for food almost impossible to overcome.

Gastro-intestinal Disturbancesare apt to develop as the disease progresses. These are treated as in other conditions so complicated, except that the period of starvation must necessarily be limited on account of the metabolic waste already taking place from the disease itself.

The Lungs, as in pulmonary tuberculosis, are the seat of infection and are temporarily hampered in their work of excretion.

The Kidneysbear the brunt of the extra work caused by the impairment of the lungs, consequently all unnecessary work must be spared these organs if they are to be prevented from being overtaxed.

Nephritisis one of the complications apt to develop when the kidneys are not sufficiently strong to carry on their own work and that generally done by the lungs.

The Heart.—Cardiac symptoms are also likely to develop during attacks of pneumonia and make the disease one to be dreaded and guarded against.

The Diet.—The dietetic treatment in pneumonia is like that used in acute infectious diseases, fevers in general, fluids constituting the form of diet and milk the chief food, as long as there is an elevation of temperature.

The Heart.—As in pneumonia, the development of cardiac symptoms must be guarded against. These symptoms may not develop at once but show later during or after convalescence.

The Kidneys.—Nephritis also develops in some patients and the treatment is directed as far as possible to prevent its developing into a chronic form.

Dietetic Treatmentis the same as used in acute infectious conditions, fevers of short duration, taking care to institute the diet for acute nephritis should the patient show evidences of this disease.

Write a diet order for a tuberculous patient weighing 135 pounds, allowing 3000 calories and fifty per cent. of the protein to be derived from animal sources.

FOOTNOTES:[104]The addition of cream to coffee produces acute indigestion in certain individuals, hence the nurse must be governed by this point in formulating the diet.[105]See “High Calorie Diet for Typhoid Fever,” ChapterXIV.

[104]The addition of cream to coffee produces acute indigestion in certain individuals, hence the nurse must be governed by this point in formulating the diet.

[105]See “High Calorie Diet for Typhoid Fever,” ChapterXIV.

The dietetic treatment which is essential before and after operations is deserving of attention here, since it constitutes one of the points so frequently overlooked or slighted. As a rule the treatment depends (1) upon the character of the disease for which surgical intervention is necessary, and (2) upon the general health and physical condition of the patient in question.

Preparatory Treatment.—In many cases it is found to be advisable to build up the patient before subjecting her to the shock of an operation, and the more serious the operation the more necessary this “building-up” process.

The character of the disease also has much to do with the preliminary diet. In certain pathological conditions involving the gastro-intestinal tract, for example, the patient comes to the surgeon after medical treatment has failed to give relief and surgical intervention is necessary to save life. The body is found to be in a condition bordering on starvation, anemic and exhausted from insufficient nourishment. The functions of the blood-making organs have become out of gear, as it were, and the blood consequently is deficient in one or more of its essential elements. For such patients it is wise to attempt to reënforce and strengthen their bodies before operation, that they may have more endurance to withstand the shock which is more or less unavoidable.

Adjusting the Diet.—In any case where preliminary diet is prescribed the condition for which the operation is necessary determines the nature of the diet; for example, if the operation is to be upon the kidney, the diet beforehand would naturally be in the nature of a nephritic one to save the diseased organ unnecessary work. If the stomach or intestinal tract required surgical care, the diet would necessarily be formulated to meet the particular needs of the organ in question, an analysis of the stomach content furnishing the keynote of the diet. In any case the food must be simple in character and well prepared. All food in any way liable to bring about indigestion should be studiously avoided.

Habits.—The habits of the patient must be regulated so that she may not “overdo”; at the same time, gentle exercise may be the very thing needed to give an impetus to the appetite and thus assist in the adding of strength for the approaching ordeal. Many patients respond readily to a change of air and scene and frequent small meals instead of a few large ones,—a lunch in the mid-morning and mid-afternoon hours, consisting of a glass of milk and a cracker or malted milk chocolate or reënforced fruit juices. A cup of warm milk before retiring induces the much-needed sleep, hence is advisable under the circumstances.

The Bowels.—The bowels must be kept open. Coarse bread such as that made from bran or graham flour is advisable. Prunes and figs cooked with senna leaves are likewise simple laxatives which are both palatable and effective. For stubborn cases of constipation it is often found that a teaspoonful of a conserve made with a third of a pound each of raisins, prunes, and figs ground fine, with an ounce of senna leaves added, taken at bedtime and before breakfast, will overcome the condition and make the patient more comfortable and the general health better.

Preliminary Light Diet.—The day before the operationthe diet must be light; the intestinal tract must not be filled with a food mass which is difficult to get rid of. On the morning of the operation the patient is given no food if the operation is to be performed at an early hour, otherwise a cup of tea, coffee, weak cocoa, or broth with a cracker is given. Some physicians give a glass of milk at this time, while others do not. It is the physician who must decide the question if there is any doubt about it. The stomach must be empty before administering the anesthetic.

In certain emergency operations when it has been impossible to prepare the patient ahead, the difficulties attending the administering of the ether are sometimes greatly increased. The cleansing of the stomach and intestinal tract oftentimes eliminates or materially decreases the nausea and vomiting which so often forms one of the most dreaded sequences of the operation. For this reason many surgeons require the patient to be given lavage before leaving the operating room.

Total Abstinence.—No food is given for twenty-four hours following the operation (1) on account of the nausea and vomiting which so often follows the giving of an anesthetic—ether particularly—and (2) because the entire organism is better for a complete rest.

Routine Treatment.—The routine treatment in uncomplicated cases is rest, then water, very hot or iced, or carbonated, or vichy in spoonful doses, then albumen water, broth, etc., then milk, buttermilk, koumiss, etc., after which the semi-solids, etc., until a normal diet is reached. After a week or more the character of the operation certainly determines the dietetic treatment. To quote Dr. Thomas S. Brown,[106]“To give the same diet after pyloroplasty, gastro-enterostomy, gall bladder operation, or gastric resectionas we would after operations for fracture of the thigh or cancer of the breast shows a basic ignorance of the pathologic physiology of the former group of cases.” “We should remember that hyperacidity remains long after the underlying cause has been removed and it is tempting providence, to say the least, to ply these patients with tomato soup, salad dressing, and coarse food in the early stages of their convalescence.”

Character of Diet.—It must be kept in mind that the character of the diet is of vital importance, especially in the after-treatment of operations upon the stomach. In gastro-enterostomy, for example, the food mass passes from the stomach directly into the upper part of the small intestine through the new opening. Thus the semi-liquid food highly acid in character comes in direct contact with the delicate intestinal walls which are accustomed, not to the acid, but to a neutral or alkaline medium.

Adjusting Diet to Disease.—Thus it is demonstrated that unless care is used in selecting the diet this portion of the intestinal tract will be injured; hence the nurse must understand which foods are liable to stimulate an excess flow of acid in the stomach and avoid them. She must also keep in mind that the foods given must be in a semi-liquid or very finely divided condition, since the mechanical efforts made by the musculature of the gastric organ act as a direct stimulant to the secretory cells of that organ.

Much of the responsibility thus rests upon the nurse whose business it is to administer the diet. The efforts of the best surgeon in the world may be entirely overcome by a careless, thoughtless, or ignorant nurse.

Rectal Feeding.—In some cases it is found necessary to nourish the patient more than is possible by mouth. This is especially so with emaciated and very weak patients and for those who have undergone operations upon themouth or throat and in some of the above-mentioned stomach cases when the passage of any food over the newly-operated-upon surfaces is inadvisable. In these cases rectal feeding is resorted to and from two to three nutrient enemas[107]alternated with saline enemas are given daily.

Under ordinary conditions when the patient has not been operated upon for gastro-intestinal disorders, gall bladder or kidney diseases, the dietetic régime is as follows:

Postoperative Feeding.—First day: starvation, a little hot or cold water or carbonated water may be given if there is no nausea or vomiting. If nausea or vomiting persists, a few spoonfuls of champagne or clam broth or juice will often check or relieve it entirely. Fluids alone must be given during the first forty-eight hours after the operation. When stimulation is necessary, albumen water or coffee containing a spoonful of brandy[108]will be found useful. When nausea entirely disappears, well-skimmed broth milk, clam or oyster broth, buttermilk, koumiss, malted milk, may be given. A gradual return to the normal diet is made, adding soft toast, soft-cooked eggs, junket, ice cream, meat, wine, or fruit jellies before solid food is introduced into the dietary.

After-care in Feeding.—Care must be observed to prevent indigestion after almost any operation, but especially after abdominal operations there is a great tendency to form gas, hence anything which in any way increases the tendency may bring about a condition of extreme discomfort and even acute pain to the patient. For this reason it is unwise to follow too closely the desires of the patient as to the food to be eaten; for example, corned beef and cabbage may be the thing of all others desired by the patient, but it would be the height of folly to risk such a meal until all danger of digestional disturbances is at an end. Itis wiser to avoid such disturbances than to trust to relieving them after they occur. The digestion of even a perfectly normal individual is at a disadvantage when that individual is deprived of outdoor exercise. How much more so will it be when the entire organism is taxed by the ordeal through which it has just passed. Convalescence is never hastened by imprudent eating, and a condition as bad as the original may be brought on by lack of care on the part of the one whose business it is to feed the patient.

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.

Factors Affecting Dietbefore and after operations must be considered under two heads, namely, the character of the disease for which the operation is considered necessary and the general physical condition of the patient at the time.

Emaciation and Anemiaare often encountered inpatients having certain gastro-intestinal disturbances for which surgical intervention was found to be necessary. At times a preliminary up-building treatment is required before it is considered wise to submit the patient to the shock of so serious an operation.

Adjusting the Dietaccording to the character of the disease for which the operation is to be performed is most important. It is not always possible to build up the body beforehand, but in many cases it is necessary to make the effort. At times the reënforcing of the diet and a certain amount of gentle massage will enable the patient to pass through the trying ordeal more comfortably than would otherwise be possible.

Selecting the Dietto conform to the character of the disease is as important a factor in the recovery of the patient as food itself. This selection is left largely to the nurse, consequently it is necessary that she should understand just which foods are indicated or contraindicated under the circumstances, and adjust the diet after the abstinence period accordingly. For example, the diet fulfilling all the needs of a patient who has just undergone an operation for a broken leg might be highly injurious for a patient just operated upon for some disturbance of the liver or kidneys. The diet given after must be essentially like that given just before the operation, in order that the affected organ may have an opportunity to heal and return to its normal functioning power.

Gastro-intestinal Disturbancesmust be avoided, both before and after the operation. In the preliminary treatment, when every effort is being made to increase the strength and endurance of the patient, such disturbances do away with any gain brought about by judicious dieting. After the operation, attacks of indigestion not only cause pain and discomfort as a result of the gas formation, butmay cause symptoms far-reaching and even dangerous in their effects. The diet, then, must be composed of the simplest food and prepared in the most careful manner, the amount of food given at a time must be small—it is wiser to feed the patient oftener than to run the risk of indigestion by giving more than can be readily handled by the already taxed digestive apparatus.

The Bowelsmust be kept open in the majority of cases. Peristalsis is stimulated by the giving of water and fruit beverages as soon as it is advisable to give anything by mouth.

Reënforcing the Dietis at times necessary in order that the patient’s strength may be kept up. In such cases lactose, eggs and some of the predigested casein or beef preparations are found to be valuable.

Before the Operationthe patient must be made ready to take the anesthetic. This is done by preventing an accumulation of food in the intestinal tract. The day before the operation, then, it is necessary to limit the diet materially by giving food in small amounts. The light diets prescribed in acute conditions are as a rule suitable, unless otherwise indicated.

The Day of the Operationa cup of tea, coffee, or broth may usually be given, with a cracker, unless the operation is to be performed early in the morning, in which case the patient is given no food at all. Some physicians allow a glass of milk on the day of the operation, but this is left entirely to the physician in charge.

After Operationa period of total abstinence from both food and water is necessary in order not to increase or induce nausea and vomiting. As soon as these symptoms subside, unless otherwise indicated, a certain amount of hot, cold, or carbonated water may be given. After this, albumen water may form the first nutrient administered. Milk, broth and fruit beverages follow the giving of albumenwater, after which the semi-solids, such as soft eggs, gelatin and milk soups, constitute the convalescent diet.

The Character of the Dietafter the operation depends wholly upon the nature of the disease for which the operation was deemed necessary.

Diet After Gastro-enterostomymust be adjusted in order not to increase the acid content of the gastric organ, otherwise the delicate mucous linings of the intestines would be subjected to direct contact with materials which are irritating in character, owing to the fact that the mass passes through the new opening and has thus been deprived of the neutralizing agents found in the upper part of the intestinal tract. Under the circumstances milk, albumen water and fine cereal gruels are the best foods from which to formulate the diet after the necessary period of abstinence and fluid diet.

After Appendicitis, as a rule, no food is given for five days in cases where there has been a pus formation and the appendix gangrenous. Otherwise the routine treatment diet is given—water, then albumen water, followed by broth, milk and fruit beverages, fine cereal gruels, etc.

After Liver and Gall bladder Operationsthe character of the food must be considered. The fats are not well handled in such conditions and must be avoided as far as possible. Broths must be well skimmed and the milk fat free. Buttermilk and koumiss are probably the most suitable forms in which to give milk in these cases.

After Kidney Operationsthe work of elimination through kidney must be limited as far as possible in such cases. While it is impossible to rest the organ entirely, the giving of a proper diet under the circumstances will do much toward relieving the strain placed upon it. The protein foods, with the exception of milk, must be excluded from the diet. The régime practiced in acute nephritis gives the most satisfactory results.

Back to Index Next