LIQUID DIET generally includes milk, eggnog, alb.u.men water, broths, soup, beef juice, thin gruel, and beverages. Liquid diet makes least demand upon the digestive powers, because it consists of food already dissolved and therefore nearer the condition in which it can be absorbed. Moreover, it is less likely than other foods to contain excess of fat, improperly cooked starches, and other indigestible material.

Liquids must be given at regular intervals and at shorter intervals than solid foods; 6 to 8 ounces every two or three hours is not too much if the patient can take it. The doctor usually specifies the amount and the interval. Some patients will take more nourishment at one time if the interval is slightly increased.

SEMI-SOLID DIET includes all fluids and in addition soft milk toast, soft cooked eggs, well cooked cereal, custards, ice cream and ices, junket, and gelatine jellies. Liquid or semi-solid diet is commonly given in acute fevers because digestive juices and other fluids of the body are then diminished, and also because their digestion places a minimum of work upon a system already burdened with bacterial poisons.

LIGHT OR CONVALESCENT DIET generally means a simple mixed diet. In addition to the articles in the two preceding diets it includes oysters, chicken, baked potatoes, most fruits except bananas, simple desserts, white fish, and other meats and vegetables added judiciously until full diet is reached. Fried foods should not be included.

FULL DIET means an unrestricted menu, but even from full diets especially indigestible foods should be excluded. The principles of feeding sedentary persons as described in manuals of dietetics apply to patients who are obliged to be inactive although not really ill, as for example, a patient suffering from a broken leg. Ordinarily in such cases, as in other kinds of illness, the appet.i.te is greatly diminished, but a word of warning should be given against overfeeding patients whose meals are their chief interest. Such patients are only too likely to interpret full diet as anything they desire in any quant.i.ty at any time of day or night, and then to attribute their discomfort and irritability to their illness rather than to overeating.

Constipation is especially stubborn in sickness, since the patient is deprived of his usual exercise and variety of food. So far as possible the bowels should be regulated by diet. Laxative foods include most vegetables with a large amount of fibre, coa.r.s.e cereals and flour, oils and fats, and most fruits and fruit juices. Unfortunately many laxative foods are difficult for sick persons to digest and must therefore be used with caution. A gla.s.s of hot or cold water or orange juice an hour before breakfast may be helpful, and at bed time hot lemonade, oranges, prunes, figs, or other fruit if allowed.

It is essential for patients to drink water freely, and it should be given between meals and also between liquid nourishments. Persons inexperienced in the care of the sick frequently make the mistake of bringing water only when a patient asks for it.

Many acute illnesses begin with fever, headache, sore throat, and especially among children with vomiting, diarrha, and other digestive disturbances. In such cases all food should be withheld until the doctor comes, but boiled water, hot or cold, should be given freely. Efforts to tempt the appet.i.te are then mistaken; few people are injured and many are benefited by omitting food even for 24 hours at the beginning of an acute illness, and with few exceptions a doctor can be found in a shorter time.

SERVING FOOD FOR THE SICK.--Food for the sick should always be most carefully prepared and of the best quality, and in addition it should be as inviting, as varied, and as well served as possible. Neglect in these respects is inexcusable. Even slight carelessness in preparing or serving food may arouse disgust and thus banish permanently some valuable article from the dietary.

Trays, dishes, tray cloths, and napkins for the patient must be absolutely clean and as attractive as possible. Cracked or chipped dishes should not be used. Individual sets of dishes for the sick may be purchased, and their convenience makes them well worth their price.

Paper napkins may be used in many cases to save laundry work; clean white paper is always superior to soiled linen.

Before the tray is brought to the bedside, everything should be arranged so that the patient can eat in comfort. It is bad management to let the soup cool while the patient's pillows and table are being adjusted. In setting the tray great care should be devoted to placing the articles conveniently, and to the appearance and garnishing of the food. Careful serving requires more thought, but little if any more actual time than slovenly serving. Dishes should not be so full that food is spilled in transit; hot dishes should be covered; hot dishes should reach the patient hot, and cold dishes cold. Liquid nourishment in a gla.s.s or cup should be served on a small tray or plate covered with a doily. Neither gla.s.s nor cup should be held by the rim.

It is not uncommon to overload trays and to serve everything at once in order to save steps, but a patient is ordinarily more interested in a meal that is served in courses unless very long intervals elapse between. Moreover, if the meal is served in courses he is not tempted to eat dessert first and then to refuse the rest of the meal. If food is given sufficiently often it is safer to err on the side of serving too little at a time rather than too much, since the sight of large amounts of food is often disgusting.

The patient's likes and dislikes should be considered as far as possible, but most patients should not be consulted about their menus beforehand. Great variety in one meal is not necessary; it should be introduced by varying successive meals. An article that has been especially disliked should not be served a second time, unless it can be disguised beyond a possibility of detection. An article of food to which a patient objects should be removed at once; one may appear disappointed if it seems wise, but should never argue. When patients persistently refuse necessary nourishment a difficult situation is presented; persuasion and every form of ingenuity must be used, and the doctor's cooperation enlisted. When, for example, a strict milk diet is ordered for a patient who announces that he never takes milk in any circ.u.mstances the situation may seem hopeless but it is not necessarily so.

TO FEED A HELPLESS PATIENT.--Helpless and weak patients must be a.s.sisted to eat or drink. A napkin should first be placed under the patient's chin. The attendant should place her hand under the pillow, raise the head slightly, and hold the gla.s.s to his lips with her other hand. An ordinary tumbler can be used by a patient lying down if it is not more than a quarter full, or a special feeding cup may be purchased. Bent gla.s.s tubes may be used for cool liquids; they should be washed immediately after use. A child who can sit up sometimes takes more nourishment if it is given through a soda water straw.

If the patient must be fed with a spoon care should be taken that the liquid is not too hot, but the attendant should not blow upon it to cool it. It should be given from the point of a spoon placed at right angles to the lips, and plenty of time between mouthfuls should be allowed. A swallow should not be given at the moment when the patient is drawing the breath in. Great patience is required if a helpless person is to be fed acceptably. The attendant should sit by the bedside rather than stand, should present at least the appearance of having unlimited time, and should endeavor not to deprive the patient in any way of the satisfaction he may derive from his nourishment.

EXERCISES

1. What needs of the body do food substances supply?

2. Give an outline of the digestive process.

3. Describe the effect of different mental states upon digestion, and give examples of the ways by which a knowledge of these effects may be utilized in feeding patients.

4. Why is the problem of nourishing the body of especial importance in sickness?

5. Name the four ordinary cla.s.ses of diet for the sick, and mention all the articles you can belonging to each cla.s.s.

6. Why is constipation a common ailment among patients confined to bed, and what attempts should be made to overcome it by the diet?

7. Why is it necessary for sick persons to drink water freely, and what efforts should the attendant make to encourage them to do so?

8. Describe the proper serving of a patient's tray.

9. How should helpless patients be a.s.sisted to eat?

FOR FURTHER READING

Health and Disease--Roger I. Lee, Chapter II.

The Human Mechanism--Hough and Sedgwick, Chapters VIII, XIII, XIX.

Notes on Nursing--Florence Nightingale, Pages 63-79.

How to Live--Fisher and Fisk, Chapter II.

Bodily Changes in Pain, Hunger, Fear and Rage--Cannon, Chapter I.

Food for the Invalid and the Convalescent--Winifred S. Gibbs.

Practical Dietetics--Pattee, Chapters IV, V.

Feeding the Family--Rose.

Diet in Health and Disease--Friedenwald and Ruhrah.

Feeding Children from Two to Seven Years Old--New York City Department of Health.

American Red Cross Text Book on Home Dietetics--Ada Z. Fish.

Emergency Cooking--Pamphlet 708, American Red Cross.

War Diet in the Home--Pamphlet 706, American Red Cross.

Red Cross Conservation Food Course for Children and Special Cla.s.ses--Pamphlet 705, American Red Cross.

CHAPTER X

MEDICINES AND OTHER REMEDIES

ACTION OF DRUGS.--Modern medical practice increasingly emphasizes diet, baths, exercises, and other hygienic measures in the treatment of sickness. Drugs are given far less than they were a generation ago; yet medicines are still the most familiar of all remedies, and the most abused by those who persist in treating themselves. Misuse of medicine even by intelligent people is astonishingly common.

Problems of sickness and health would be enormously clarified if the uses and limitations of drugs were more generally understood. Many people still believe that every disease can be cured by a drug if only the doctor is clever or lucky enough to think of the right one to give.

Such beliefs result naturally enough from centuries of faith in charms and magic, and occasionally are confirmed by remarkable cures apparently brought about by drugs, but really pure coincidence or the result of suggestion.

It is a fact that a few medicines are known which if rightly used actually do cure certain diseases. An example of their action is the curative effect of quinine in malaria. Such medicines, unfortunately, are few. In the great majority of cases medicines do not cure disease; their beneficial action is ordinarily indirect and is due to their power either to increase or to check certain processes within the body.

It is here that the abuse of drugs comes in. Disordered bodily processes give rise to symptoms of disease; and it is the symptoms of disease, not the disease itself, that trouble the patient. A patient with typhoid, for example, is not conscious of the toxins in his blood, but of headache, weakness, and fever; the man with eyestrain is not aware of an imperfectly shaped lens, but of headache and indigestion. What the patient wants is to have his symptoms relieved; in some cases they can be controlled by drugs, and the sufferer then considers himself cured.

But the original condition persists: it may in the meantime be improving, but it may on the other hand be growing worse.