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Phytotoxic experimental results with the muscle juices of animal meats confirm extraordinary concordance between the data and Scriptures.
Read before the annual meeting of the The American Oriental Society, Washington, DC, April 8, 1953
It is not intended in the compass of this article to give more than a bare outline of the principles of the dietetic treatment of disease, availability depending upon locale, local and religious customs aside.
Diet in Acute Diseases.
Two popular beliefs regarding the treatment of acute diseases have long held sway. One is that the strength should be maintained by generous and frequent feeding. The other, which is the opposite of the first, is expressed in the tag "Feed a cold and starve a fever," a misconceived idea which still holds sway in the public belief. A cold is just as much an acute condition as influenza or measles, so that if it is correct to feed a cold it is also correct to feed a fever, and equally correct to starve them both. As a matter of fact it is generally believed that often in the case of acute fevers of short duration the best results are obtained by what is called low calorie feeding, that is to say, starvation methods as far as energy-containing foods are concerned.
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When the organism is disabled by the toxic effects of an acute infection its capacity for the output of energy or work is reduced to a minimum, feeding or no feeding. Not only under such conditions are growth and repair arrested, but actual loss of existing tissues occurs and cannot be made good until convalescence sets in and the infective process is at an end. Further, the secretion of the digestive glands is arrested to some extent, so that less raw material for their manufacture is required and digestive functions are impaired in activity.
It does not follow, however, that, because energy-containing food is only required in nominal amount at this time, the accessory factors, and especially mineral elements are superfluous or unnecessary also; on the contrary, some of these are most urgently required to enable the waste produets which result from the fever to be rapidly removed from the system. The stimulating influence of such food factors as the mineral salts and the vitamins also is requisite for the maintenance of the activity of the heart, lungs and other organs concerned in the maintenance of the bodily funotions. The stimulating properties of some food substances may also be valuable in cases of prostration due to severe fever.
There is consequently a rational basis for dieting acute fevers with fruit juices, vegetable soups, herbal tea, beef tea and calf's foot jelly, which have practically no energy value. These supply the organism with an adequacy of mineral elements and vitamins, and with such stimulation as the organic functions require. Milk is accepted by most doctors as a natural diluted food, and therefore a good food in acute illnesses. In severe illness it is best given diluted, or, better still after peptonisation as fever subsides, or if it is prolonged, as in typhoid fever, Milk is usally combined with cereal foods but is not recommended as it tends to generate mucu.
Protein foods which are not digested in a normal manner undergo decomposition in the bowel, and by their toxic products add to the embarrassment and burden of the system. For the same reason fats are inadmissible, but sugar and other forms of carbohydrates which can be digested and assimilated possess certain advantages owing to the ease with which they can be assimilated and oxidised.
Whey, which contains all or nearly all the accessory factors required by the organism, is free from objection, and should be used much more largely than is usually the case. Sherry whey has an additional advantage in that it has also certain stimulating properties due to its contained alcohol. In acute fevers a considerable quantity of water is required to compensate for the loss of fluid, to promote perspiration and relieve the dryness of the mouth, often intense owing to the failure of salivary secretion. Water, especially mineral water, should therefore be given freely.
A diet so restricted in its calorie alone cannot be maintained for long periods. Thus in typhoid fever, for instance, much of the wasting which the patient undergoes is held to be due to the partial starvation involved in the more old-fashioned methods of treatment. To supplement it eggs, bread, cereals, sugar, cream and butter are given. There will be patients, of course, who are unable to digest more than milk, and others with whom milk disagrees. The mention of such exceptional cases leads to the observation that it has always been a golden rule in the practice of medicine that what must be treated is not the disease but the patient, and that general principles must therefore be sufficiently elastic, to adapt themselves to individual cases.
Diet in Acute Non-Infectious Disease.
There are not many acute illnesses which belong to this category, except gout, bilious attacks, and acute kidney disease or nephritis.
Acute gout, whether as cause or effect, is e characterised by the accumulation of uric acid in the system, for the removal of which a liberal supply of alkaline salts or mineral bases is required. Protein-containing food should be temporarily reduced to a minimum, while, as sources of mineral, vegetable broth and fruits are specially indicated. Milk, green vegetables and farinaceous foods may be given in moderation, but for the time being fats are a contra-indicated.
Acute bilious attacks and sick headaches, , which are practically the same thing, are s usuahy of short duration, and can best be r treated by drastic starvation methods. The prevention of these conditions is of greater importance than their treatment, and, as far as diet is concerned in their production. they may be best obviated by a strictly limited intake of protein foods and a careful regard to the supply of mineral elements and other accessory factors. In children it is often necessary strictly to limit fats.
Although acute kidney disease or nephritis is generally due to infection, it is not usually included in the category of infectious diseases. It calls for special dietetic treatment by reason of the temporary inability of the kidneys to exerete the products of protein combustion, specifically urea, creatinine and uric acid. The obvious indication, therefore, is to reduce the protein intake. Milk, on account of its high protein content, is best omitted in severe cases, but may be given diluted in small quantities in milder conditions The same objection does not apply to carbohydrate foods or fats, the products of combustion of which are removed by the lungs and the bowel. Extractives are for the most part removed by the kidneys, and therefore meat soups and broths should not be given. Vegetable broths are much more suitable. The removal of water from the system is also largely dependent on kidney activity. It tends, therefore, to accumulate in the system, with the development of dropsy if the excess cannot be removed by the skin and the intestine. See Dropsy.
Dietetic Treatment of Chronic Disease.
The mistake most often made in the treatment of chronic disease is to deprive the system of certain classes of foods which contain elements essential for nutrition. such as the vitamins and mineral elements. Many a dyspeptic refrains from eating fruit and vegetables because they are, he believes, liable to add to his digestive troubles. Since deprivation of these essential elements leads in the long run to troubles of their own, such restrictions must not be encouraged. Nevertheless, if one particular variety of food which contains essential elements causes the development or aggravation of any particular symptom, substitutes may be provided in which these elements exist in a concentrated and digestible form.
For instance, in certain diseases fats are badly tolerated and cause symptoms of dyspepsia. Since fats contain the important vitamins, the fat-soluble A and D, there may be a deficiency of these particular accessories, if fats are altogether omitted from the dietary. Under certain conditions it is possible to supply the required vitamin in the concentrated form of cod-liver oil, or, in those cases in which they can be digested, in the form of green vegetables, or even in the concentrated condition now supplied by the extraction of the vitamins from their natural source. There can be little doubt that in chronic disease it is more important to make provision against deficiency of the accessory factors than it is to maintain a high calorie value of the food.
There are hardly any chronic diseases which demand high calorie feeding except tuberculosis. In pulmonary tuberculosis or phthisis a liberal well-balanced dietary is indicated so long as combustion can be maintained at a correspondingly high level by open-air treatntent and suitable exercise.
Diet in Convalescence.
When the acutc states of an illness are over, the patient is Ipromoted to what is known as light diet. 'lhe essentials of light diet are great digestibility combined with considerable nutritive value. Among the chief foods covered by the term are fish, egas, chicken, and many of the large range of dishes in which milk and farinaceous foods are the principal ingredients (i.e. custard, milk pudding, etc.). Potato and a number of vegetables are permissible, but some root vegetables, red meat, shellfish and lightly flavoured foods such as curry are forbidden to a patient on light effect. Small helpings of a meat soup will often aid digestion and appetite, but soups must not be looked to for their nutritive value.
Frying, an indigestible method of cookery, is unsuitable for a convalescent. Roasting should be avoided during the early part of the light diet period, at any rate. For poultry and fish steaming (q.v.) is by far the most suitable method of preparation, and the rather uninteresting appearance and flavour produced by this method of cooking can be offset by care taken in little touches to add to the flavour and look of the dishes.
Eggs should be lightly boiled, poached or scrambled. Hard-boiled eggs are hard to digest, and fried eggs are taboo. Suitable milk dishes include milk puddings (preferably made with an egg to give increased nourishment, and made interesting with a little boney or a squeeze of orange juice), boiled and baked custards, cereals served with milk, and similar dishes. The pulp of sweet oranges may be given freely to invalids on light diet, and these, with jellies of various flavours, help to provide variety in the pudding course.
Milk puddings must be extremely vell cooked and should not be given too often; many people have an antipathy to them, due to having been given them too frequently in childhood. as small portions and a tempting appearance play so large a part in inducing convalescents to eat, the pudding course should always be served in individual form, and not as a helping from a larger dish. A teacup makes an excellent mould for a one-person pudding, while custard and jelly, which might otherwise be refused, often tempt a patient if served in a clear custard glass.
The Child Convaleseent.
In the case of children a new and exciting cup or dish will often do wonders in stimulating interest in a meal. The little convalescent will be eager to plunge a novel and pretty spoon into the dish the mother brings, or will reconsider a refusal to drink the soup on learning that there is a picture at the bottom of the bowl. Millz can be disguised in various ways. It can be made into a milk jelly, coloured and flavoured with fruit juice, or sent up in junket form faintly coloured with chocolate powder and with grated chocolate on the top. If taken in liquid form it can be served in a coloured beaker with two straws.
It is a mistake to use the common argument, to a convalescent unwilling to eat, "You must take this; it is so good for you." Children are quite indifferent to such a statement, and it merely irritates most older people. All that can be done is to use every effort to cook and serve the food attractively at the psychological moment and leave it to make its own appeal. As a rule the change from the much more monotonous low diet is enough to create a certain daily increase of appetite.
If the inclination for food is absent, it is unwise to stand over the patient and force him to tatse it because he is too feeble to resist the stronger will of the nurse; a meal eaten under these conditions does little or no good. the doctor can take his own measures to promote appetite if he considers it necessary; but the chances are that it will assert itse;lf gradually without special stimulation if the food is well prepared and served, and includes dishes which the patient likes.
One-Day Light Diet.
Meats for convalescents must be much smaller and more frequent than those of a healthy person. The following suggestions for one day's light diet will serve as a general guide :
Brealefast: Tea (not too strong), some toast buttered when quite cold and an orange. An orange should start the meal, as it is valuable in helping to prevcnt constipation.
Mid-morning: Cup of I3ovril, beef-tea, egg beaten up in milk, or sonp-the last frec from highly-flavoured inredients or condiments.
Lunch: Steamed fish or chicken (or a with toast, if this has not been taken at elevi Mashed potatoes may accompany the fish, stewed tomatoes or celery, cauliflower or onions in the poultry. For second course, an individual serving of milk pudding, custard, sweet jelly or some grapes.
Tea: Tea and thin bread and butter, in small slices and rolled. No cake or bread.
Dinner: An egg or some meat jelly on dry toast. If the paticnt will eat such a course, it should be chosen from that already given for lunch.
Bedtime: A glass of hot milk helps induce sound sleep; but do not press this if the patient is not inclined for it.
The duration of light diet and the quiet or slowness of its transition to full diet depend of course, upon the nature of the illness from which the patient is recovering an attack of iufluenza, with no complication of any gravity, six days at most should suffice to effect the patient's progress from low to full ordinary fare. In convalescence severe illness, such as pneumonia, food progress must be much slower, owing to the greater degree of exhaustion present. It possibly can take a full fortnight of carefully graduated meals from the time the temperature becomes normal before the sufferer safely risks a full diet again. In such a the light dietary should be rigidly adhered for the first eight or nine days, unless the doctor directs otherwise, and extra foods be introduced very cautiously after that of time. during the period of limitation of foods served should be varied as much as possible; it is a mistake to serve the same day however suitable, twice in succession.
It is a fact often overlooked after a severe illness that even when the patient to and about, and apparently quite well, his digestion is still easily disturbed.