Chapter 21 - Domestic Management of the Sick Room
Choice of the Sick Room
Fumigation
Freezing Mixtures
Attendants
Prognostics
Bed Sores
Diet in Disease and Convalescence
Fluid Aliments

21.7 Diet in Disease and Convalescence

Diet,ect. in Disease and Convalsecence In numerous instances, much hazard often exists after disease has disappeared, and when the patient is declared convalescent; and as this period in the removal of diseases is left to the management either of the patient himself or of his friends, some general remarks respecting it, and also in reference to particular diseases, are requisite. In every recovery from sickness, whether external or internal, before the salutary advantages obtained from the treatment be confirmed, the organ or part which has suffered must be either left at rest or be used, according to the nature of the case. Thus, if any part have suffered from inflammation, it must not be used for some time after the inflammation is subdued. If the eyes have suffered, the person must neither read nor write, nor expose the eyes to the heat of the fire, nor to a strong light, until some days after every trace of the disease has disappeared. If the arm has been affected it must be kept at rest; and if the leg, not only should walking be refrained from, but the limb should be placed rather higher than the trunk of the body. If the previous disease has affected the brain, every mental exertion must be avoided; and so on, whatever may be the organ which has especially suffered. Even when the exercise of the organ is resumed, it should not be carried to fatigue, nor, on any account, should it be such as to produce excitement. At the same time, it must not be forgotten that, in the treatment of external injuries, when it has been necessary to keep the limb long in a sling, in one position, as, for instance, in fractures, the muscles which bend the arm acquire from the habit a contraction which cannot be overcome by the antagonist muscles, owing to the length of time they have been on the stretch, weakening their contractile power. The arm, therefore, should be frequently taken from the sling, and, being rested upon the elbow, a moderate weight should be held in the hand, and friction with oil employed upon the contracted muscles. It is true that surgeons usually give directions for this operation, before they quit the management of the case; but surgeons, as well as physicians, are sometimes dismissed before the convalescence is complete; on which account, arms and limbs have remained contracted for life, from a want of the knowledge necessary to counteract the evil at an early stage. I say nothing respecting the continuance of remedies during convalescence from many diseases, except urging the necessity of regulating the bowels. The most important part of the management of convalescence certainly refers to air, exercise, and diet. The errors daily committed in all these matters, exert the most powerful influence in retarding complete restoration to health; and often, indeed, induce evils of a more formidable kind than the diseases from which the patients have just emerged. 1. Air. In every convalescence, whatever may have been the nature of the disease, if it has been so severe as to wear down the strength of the invalid, country air is essential. The benevolent Author of our existence has made medicinal the bills, the vales, the groves, and all the harmonies of nature; and in the repose of these man finds a balm, not only for a wounded spirit, but for his stricken body. In selecting a country residence for a convalescent, care must be taken to ascertain whether any source of malaria exists in the neighborhood; as, in that case, even if all other circumstances be favorable, the place is exceptionable. 2. Exercise. In convalescence, much caution is requisite in apportioning the exercise to the degree of returning strength. When the convalescent is still too feeble to take sufficient exercise on foot, the best substitute for it is riding horseback; but, as soon as walking can be borne, it should be preferred to either horse or carriage exercise. 3. Diet. In health, diet may be left, in a great degree, to the inclination or the taste, as far as regards the quality of the food; and, although diseases occasionally originate from repletion, yet, in general, the appetite may be considered as the best regulator of quantity, when the food is simple, and the appetite is not pampered by high seasoning and rich sauces. In disease, however, a very opposite rule is to be observed; the regulation of both the quantity and the quality of the food is of the utmost importance. The taste is often so perverted as to desire that which would prove injurious; and were appetite to be the guide of quantity, diseases would frequently not only be increased in severity, but life itself would be brought into jeopardy. As soon as solid animal food can be taken with impunity, that which is most digestible should be selected. An opinion has generally prevailed that gelatinous matters, and meats which readily yield jelly, such, for example, as veal and lamb, are the most easily digested, and at the same time are also the most nutritive. This is a mistake; for, with the exception of poultry, the flesh of young animals is stringy and of a lax fiber, and is even less easily digested than that of too old animals, which presents great density of texture. The middle aged animals afford the most digestible food. Nothing tends to lessen the density of the fiber of every kind of animal food so much as keeping it for a certain time before it is cooked. In this case the tenderness is the result of incipient decomposition or putrefaction; but the utmost caution is requisite to prevent this from advancing so far as to present the slightest trace of taint in the food of the convalescent. In the low state of vitality in convalescence, the change which commencing decomposition (putrefaction) causes, renders animal food in that condition a source likely to occasion either a relapse into the disease from which the patient has recovered, or to form a new disease. In examining the relative value of other articles of diet adapted for the sick and convalescent, the first which presents itself to our notice is Milk. As milk is the food of almost all young animals, its digestibility appears at once evident; and there can be little doubt that it is very digestible, when it is drunk immediately after it is drawn from the udder of the cow or the goat, before its components have time to separate. When this separation is effected, either spontaneously by time, or by means of rennet or other agents, its properties are altered, and its digestibility is lessened. Cream, when intimately united with the other components of milk, namely, the curd, or the caseous part, and the whey, is not the same substance as after its separation. In the milk, it is more easily digested, and is the most nutritive part of the milk. But in its separate state it is ill adapted either for the sick or convalescent except in the form of butter, which is not unwholesome unless it be eaten in excess or be melted. Although cream is not as digestible as milk, yet it is much less liable to turn acid in the stomach; it is often beneficial to dyspeptics, either alone or diluted with water. In the same manner the separate curd is indigestible; and whey itself, although highly nutritive, yet is flatulent; nevertheless, it is an excellent demulcent in many cases of disease. But none of the components of milk are equal to milk itself. It is often necessary, in convalescence, to dilute it with water. Eggs. It is not uncommon to hear that the yolk of a raw egg, beaten up with water and sugar, with the addition of a small quantity of white wine, is a light and nutritive aliment in convalescence, and even in some states of disease; but eggs are much less digestible in this form than when they are lightly boiled. In jaundice, however, arising from viscid mucus obstructing the orifice of the common duct, the yolk of a raw egg beaten up with cold water is serviceable. Fish, at least the white kind, stimulates much less than the flesh of land animals; hence it is a proper food for those laboring udder some acute diseases; and also for convalescents, when a sudden return to more stimulating food would prove hurtful. But it is not adapted for convalescents when the object is to bring up rapidly the strength of debilitated habits. Raw oysters have been erroneously supposed to be both easy of digestion and nutritive. The latter opinion is, in some degree, true; but the former is erroneous. Raw oysters are less digestible than plainly cooked oysters. Both are improper for the sick and for early convalescents. Lobsters, crabs, prawns, cray fish, scallops, and other shell fish, are still more objectionable. If fish of any kind be admissible, it should be simply boiled; fried fish is even worse for invalids than the outside or the brown of roasted meat. Vegetables. In reference to vegetable diet, it is only the mildest description of esculent roots that are fitted for the use of the sick. In preparing all of them for the sick room, they should be well boiled in two distinct waters, until they are soft and very soluble, and in a state not to leave un dissolved anything which could act as a mechanical irritant on the intestinal canal. When properly cooked, they are moderately nutritive, and free from any stimulant properties; and they are well adapted for the stomach of the sick, unless in cases in which the torpor of the organ is such as to permit them to run into acetous fermentation and to prove flatulent. Fruits. With respect to fruits, they produce the most diversified effects; and, consequently, are more or less proper for invalids, according to circumstances, either connected with themselves or with the condition of the patient at the time. The stone fruits, with the exception of the ripe peach, or the nectarine, are to be rejected. The apple tribe, except very soluble pears, are still less admissible. The apple, however, when roasted, and when the seeds and the hard central parts, as well as the skin, are removed, is less objectionable ; and, as it possesses laxative properties, the roasted apple is well adapted for the sick, when food is at all allowable, and when the bowels are torpid. The orange, if fully ripe, is grateful and wholesome to all invalids, and is only equaled in these qualities by the grape; but in using the orange, the pulp should be rejected. The juice of the grape fruit is good and refreshing, but care should be taken not to use any of the pulp, on account of its bitter taste. Care also should be taken not to swallow either the skin or the seeds, of the grape. Strawberries are a little stimulant, of easy digestion, and more cooling than the other small fruits; mulberries are also unexceptionable; but currants and gooseberries, and even raspberries, are not free from objection for invalids laboring under acute diseases. With the exception of oat and wheaten bread, especially that made from Franklin Mills flour (see receipt), all the varieties of farinaceous aliments may be regarded as modifications of starch, containing little nutritive matter, and therefore well adapted for the sick room. It has been supposed that arrow root, sago, tapioca, and similar substances, are very nutritive, because they form mucilage with boiling water; but this is not the fact; and were they very nutritive, they would be ill adapted for invalids. Rice, in every case where the stomach is in an acescent state, is preferable to the other farinaceous, because it is less fermentable. The farinaceous food which is ordered in the convalescence of children from acute diseases, is often made of bread so as to constitute pap. No description of food has a greater tendency than this to become sour; a quantity only sufficient for a single meal, therefore, should be made at a time; for what remains is always sour before the next meal; and even if the quantity be small, and it be mixed with fresh pap, it communicates its faculty of becoming sour to the whole mass.

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