Feeding In Acute Disease

The preparation of food for those who are seriously ill is a matter of vital importance, for the life of the patient often depends either upon the maintenance of strength during the acute period of the disease or on the recovery of power during convalescence. Since acute disease is accompanied by fever, we must consider the effect of feeding in cases where the temperature is febrile in character; also the amount of food, its quality and quantity, together with other conditions affecting its absorption.

In acute disease accompanied by fever, what are the conditions? The body loses weight, urea is increased and carbonic acid and water are excreted in larger amounts than in health. All of this loss is not dangerous if permitted to go on for a few days only, and if the amounts do not exceed certain limits. But to replace these losses we are at a disadvantage as regards the ability of the system to assimilate food. In fevers the appetite is small, or may be completely lost. The saliva, the gastric juice, pancreatic fluid, the bile, are less efficient in action or diminished in amount during high temperature.

The stomach is very sensitive, in part, perhaps, through sympathy with the increased sensitiveness of the nervous system as a whole. If there is much hypersesthesia of the digestive tract, as in typhoid, in peritonitis, in dysentery or gastroenteritis, one must be careful not to give too much food at a time, and it should be in a liquid form and partially pre-digested. Note Typhoid Diet, page 337.

Evidences Of Digestion

Our attention should be devoted not only to what is put into the alimentary canal, but also to what goes out. For instance, if curds of undigested milk are found in the stools of a typhoid patient, the quantity of milk should be diminished, or it should be diluted.

Every careful observer of the sick will agree that many patients are starved, simply from the want of attention to the means which alone make it possible for them to take food. For example, if the patient has a fever with remission and intermission, it is of the first importance to remember that the ability to digest food at these intermissions is greater, and it is then that the most nourishing portions of diet should be given.

It must be borne in mind that, contrary to the prevalent notion, the increase of body heat is not entirely responsible for the wasting of the fever patient. The emaciation is due partly to the inability to receive and digest the food, which in turn arises from the irritable state of the stomach and bowels and the defective secretion of the digestive fluids.

It is the administration of unsuitable food that must be guarded against, and also the giving of nourishment in quantities and at times unsuited to the digestive powers of the patient. All food is changed into liquid in the process of digestion before it can be absorbed into the blood. Liquid food, therefore, is given to the very sick because it can be digested with the smallest amount of labor to the body.

Predigested milk possesses the decided advantage in that it aids the assimilation of the milk without adding to its bulk, as do lime water and other substances.

By diluting milk, stimulants and gruels too much, the quantity of the fluid is so great that the patient soon tires of swallowing, and stops before enough nourishment has been obtained. One should not give what cannot be digested, nor less than can be assimilated. So the attendant must have a constant watch over the condition of the patient's powers of digestion, and it is necessary for her to know how to choose such variety in the diet as to include both what is palatable and what will afford a proper amount of nourishment.