Treatment

In complete inanition lasting twenty-four hours or longer, the treatment consists in carefully administering easily digestible fluid or semifluid food in not too large amounts. It is quite natural that the famished are inclined to devour greedily any food that is accessible. If, however, they take too much or too coarse food it readily causes serious trouble in the exhausted intestinal tract. The chief duty of the physician, therefore, consists in proceeding with caution and restriction with regard to the taking of food during the first few meals. If after eating the exhaustion of the patient has disappeared, he may then return to his usual mode of life.

The treatment of incomplete inanition or subnutrition is altogether different. Here we must first combat sitophobia, if it exists, because otherwise the existing malnutrition can hardly be removed. It is important to encourage the patient to eat in spite of the pain. Usually the latter is in reality not so severe, and in nearly all cases we will succeed after a while in banishing the fear of food. Soon the patient can take ordinary nourishment. Even articles of diet which formerly caused severe pain are now tolerated without difficulty. The stomach, or rather the intestinal tract, seems to accustom itself to the greater demands made upon it.

It is, of course, advisable in some cases at the beginning of the treatment to diminish the sensitiveness of the digestive apparatus by bromides or similar drugs. These medicines are, however, not essential, but rather bridge over the first few days by facilitating the carrying out of the directions in regard to eating.

Another point of great importance is to improve the nutrition of the patient. At first we have to see that the patients take as much food as is necessary to maintain their equilibrium, and that no loss of weight occurs. This alone, however, is not sufficient for a complete cure; for many of these patients are very much run down, and, while they will not lose any more weight with an amount of food that is just sufficient for their needs, they will, however, remain in their weakened condition. It is, therefore, very important that an increased quantity of food should be given, in order to make the patient gain in weight.

At first sight the accomplishment of this seems hardly possible. In reality, however, it is not so difficult, and can easily be done in most dyspeptic conditions (except carcinoma of the stomach and bowel).

In laying out a plan of alimentation the following points should be considered: The first change in diet must not be too great. If we have to deal with patients who have lived for a long time on fluid food only, it is best to begin with liquid or semisolid food, as, for instance, milk, beef tea, raw eggs beaten up in milk, or broths, strained barley or oatmeal soups, gruels, and jellies. We must, however, see that a sufficient quantity of nourishment is taken. This light transitional diet should be increased daily by some article or other approaching more nearly to the ordinary bill of fare. At first soft-boiled eggs, zwieback, tender meat, mashed potatoes, white bread, butter; later, light vegetables, boiled fruits, etc., are added.

As soon as the patients partake of the usual articles of food they should be instructed to eat about as much as their neighbors at table, only taking more butter (at first one-eighth, later one-quarter pound daily), and taking a glassful of milk and a slice of buttered bread regularly between meals. With a diet like this we succeed nearly always in obtaining an increase in weight.

Thus in all the three cases mentioned above, which have been picked out at random from my journal, the patients gained even in the first few weeks after beginning this regimen.

The first case (Mrs. Sadie M ---- ) gained two pounds the first week; the second (Mrs. F. H ----- ) fifteen pounds in five mouths after the beginning of the treatment; the third case (Mrs. Lena F ----- ) gained three pounds in the first three weeks, and eight pounds in seven weeks after commencing treatment.

The increase in weight, of course, continues as long as this excessive amount of food is taken. At the same time we find a general increase in bodily strength, so that patients who were invalids for a long time and a burden to their families and themselves could again resume their work and become useful members of society.

Simultaneously with this strengthening of the body the original complaints, usually not due to organic lesions, can be at the same time removed by medical skill. Alimentotherapy, therefore, in these cases is the fundament of complete recovery.