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

21.8 Fluid Aliments

Fluid Aliments. Water. The best and the most universal beverage for the sick is water: but the qualities of water differ, according to the sources whence it is procured. The fewer foreign ingredients it holds in solution the greater are its diluents properties. Distilled water, or rain or river water filtered, and that of soft water springs which filtrate through siliceous strata, are the only kinds proper for the use of the sick room. Hard water, under whatever name it is found, whether as spring water, or pump water, or well water, should be excluded. The impurities of river and rainwater are merely held in suspension; consequently, they are readily removed by filtration. Water itself is aliment; many individuals under certain circumstances have lived for a considerable time upon it alone. Those who live chiefly on animal food require more drink than those who eat much vegetable matter. The influence of water on the animal economy may be regarded in two points of view: As an article of diet. As a medicinal agent. As an article of diet, in health, water is the beverage provided by nature for all animals, man not excepted. The sensation of thirst is the natural call for fluids, either to assist digestion, or to allay a dry, hot condition of the mouth and the gullet. The consequence of not satisfying this call is fever of a nervous kind; and, if it be long resisted, inflammation of the air passages. On the other hand, too much fluid is injurious; for although the vital powers of the stomach counteract the tendency which it affords, by over diluting the gastric fluid, to the fermentation of the aliment in the stomach, yet when it is in excess, those vital powers languish; hence spontaneous chemical changes in the contents of the stomach take place, and induce dyspepsia. For all the purposes of dilution in health, water is adequate, and it is the only truly wholesome beverage. As a medicinal agent, water is demanded in every disease in which a dry skin and an elevation of the natural heat of the surface, constituting fever, are present. In this case, the desire is for cold water or cooling fluids; and it should always be indulged. The degree of temperature, however, must be regulated by the condition of the invalid; but the best medium temperature is between 500 and 600 Fahr., although even 60' is too low, when the debility of the frame is considerable. The qualities of the various kinds of beverages proper, and generally employed in the sick room, should be known. Toast water, when properly prepared, which it seldom is, forms a useful beverage in the sick room. It is slightly nutritive, owing to its containing a small portion of gluten, in conjunction with fecula and sugar. It is one of the oldest and one of the best diluents demulcents; diluting at the same time that it softens the acridity of the secreted juices of the stomach, in febrile diseases. Gruel, whether made of groats or of oatmeal, is less mild and demulcent than barley water; and it is more likely to undergo the acetous fermentation in the heat of the stomach; a circumstance which is greatly favored by the sugar and butter which is sometimes added to it. Unless gruel be very thin, it can scarcely be regarded as demulcent; and when thick, it is too heating an aliment for patients laboring under febrile symptoms. Tea, in the form in which it is usually taken, is too stimulant and astringent to be a good diluents: and, when it is strong, the narcotic property which it possesses renders it improper for most invalids, whatever may be the nature of their diseases. As it is, nevertheless, agreeable to most palates, and very refreshing, it may be taken in moderate quantity, provided it be not strong, without any hazard. Sage, balm, and mint teas, are often substituted for common tea. Each of them undoubtedly allays the irritability of the stomach in some cases; but, as general beverages in disease, they are less useful than toast water. Raspberry vinegar, lemonade, tamarind tea, apple tea, and similar compound diluents, should never be administered without the consent of a physician. If a patient be taking an antimonial, they, will excite vomiting; if a mercurial, griping; and they are equally incompatible with many other medicines, and with many conditions of the stomach in disease. They are a description of beverage greatly recommended and largely distributed by the Lady Bountiful in the country, and have frequently been productive of serious mischief. Coffee is more heating, and consequently less admissible than tea; it may, however, be taken, if it be largely combined with milk. Cocoa and chocolate are still more objectionable than either tea or coffee in the sick room. Shells are good and nourishing. With respect to the Number of Meals, and the periods best adapted for taking them, it is scarcely requisite to remark, that, although in health three moderate meals, at proper intervals, are customary, and well adapted for the support of the frame, yet, under the changed condition of the system in disease, it would be improper to take any regular number of meals, or to observe any stated periods for taking them: hence no general rules can apply. As a general rule, in the decline of diseases, and on the approach of convalescence, when the desire for taking food returns, the best time for the principal meal, dinner, is about two hours after noon. If the breakfast be taken at nine o'clock, and the evening meal at seven, the hour of two is the middle period of the day; so that, when dinner is taken at that time, the intervals between breakfast and dinner, and between dinner and supper, are not only equal, but neither is too short to limit the complete digestion of the previous meal, nor too long to injure the powers of the weakened stomach by protracted fasting. All acute diseases require more or less abstinence, especially when the object of the treatment is to lower the system; and in some chronic affections, abstinence is almost essential. If this be true, the necessity of the strictest observance of the directions of the physician on this subject must be obvious. It is one, however, which is not only neglected, but is often combated both by nurses and friends; and indulgences, which are supposed to be of too trivial a nature to cause any injury to the sick, have often been followed by fatal effects. But, although abstinence be requisite during the existence of an acute disease, yet it is injurious when it is too rigidly maintained after convalescence is actually established: it often induces a new train of symptoms, not very unlike those for which it was properly prescribed and the removal of which it has aided; namely, acceleration of the pulse, increased impetus of the heart, headache, and even delirium. General Diseases. HAPPILY, in febrile affections, the appetite of the invalid is not in a condition to desire food; and no stronger demonstration can be required of the impropriety of forcing it upon him under such circumstances. Simple fluids, such as diluents, are all that be desires, all that the stomach can bear; and such alone should be administered in fever, before that low condition of the system, which demands the use of wine or other stimulants, supervenes. In these cases, when the patient desires more nourishment than is usual, animal food ought not to be given, unless by the direct recommendation of the physician. Indeed, in general, the inclination of the invalid happily revolts from animal food, as much as experience condemns its administration. While febrile symptoms are present, farinaceous matters, little nutritious, such as barley. water, gruel, arrow root mucilage, or sago, acidulated with lemon juice, and sweetened to the taste of the patient, are most suitable; but even these should be given in small quantity, and at considerable intervals. The beverage generally most agreeable, and also most salutary, to those suffering under fever, is cold water. In the decline of fevers, even, as I have already remarked, although the severity respecting diet should be relaxed, yet much danger may result from mistaken kindness and over zeal, in urging animal and stimulant food at too early a period of the convalescence. Indeed, the necessity of caution at this time is greater than during the continuance of the fever; and the more acute the disease has been, the greater must be the caution in the convalescence, especially if the treatment has been of an evacuant and lowering description. The first change of diet, in the decline of fevers, should be to another article of the same kind of food which was allowed in the disease; for example, from simple arrow root mucilage to arrow root and milk , or to some other of the farinaceous compounds; whilst, at the same time, asses' milk may be given in small quantity in the morning. Rice, one of the farinaceous, is generally supposed to be astringent, but this is a mistake. It forms an excellent diet in all cases of early but decided convalescence. It should be Well boiled, and mixed either with broth and beef tea, or gravy which has been cooled, and the fat taken from it. In the transition to animal food, beef tea, chicken broth, and mutton broth, and other liquid animal decoctions, should be first resorted to; then whitefish, simply cooked; for, although fish is more digestible than animal food, yet it affords much less stimulant nourishment; it is therefore better fitted for the early stage of convalescence. When convalescence is completed, a more generous diet is admissible. With respect to beverage, water, toast water or lemon peel water, is sufficient, until the medical attendant declares that a little wine is requisite. In convalescence from fever, it is an error to permit the patient to get up too soon. He should not leave his bed until his strength be considerably advanced. No danger can result from too strict an observance of this rule; whereas much risk may be incurred by its neglect. If the head has been much affected, every mental exertion should be refrained from during the convalescence; and, according to the degree of suffering in any local organ, precautions must be taken to guard that part of the frame against a fresh attack of disease. Eruptive Fevers require more precaution in convalescence than general fevers, both as regards diet and exposure to sudden alternations of heat and cold. This is more especially essential after measles and scarlet fever. Measles are often followed by a distressing cough, and other symptoms of pulmonary inflammation; or by a harassing diarrhea, which wears down the strength; or by inflamed eyes, catarrh, or obstinate toothache. In infants, canker of the mouth occasionally makes its attack, and proves fatal. All these affections, after measles, might generally be prevented by taking care not to allow too soon a return to the use of animal food, or too early an exposure to cold or to night. air. Even in summer, flannel should be worn next the skin for some weeks after the disease has disappeared. Scarlatina is frequently followed by dropsical symptoms; which, however, might generally be avoided by the same attention to diet and regimen as after measles. Small Pox, when severe, and especially when confluent, is very apt to awaken into activity the dormant seeds of scrofula, if any hereditary taint exists in the constitution ; hence abscesses, ulcers, and swelled glands make their appearance. These demand the aid of the physician or the surgeon. But if the convalescent be properly dieted, and recourse be bad to a change of air as soon as his strength will permit, these evils may be avoided. Erysipelas not unfrequently attacks convalescents from small pox and other eruptive fevers. When it occurs, independent of any prior disease, the same attention to diet and regimen is requisite as in other eruptive fevers. Convulsions, it is well known, are not unfrequently the result of errors in diet, in individuals with an irritable condition of the stomach and bowels. Advice should always be demanded respecting the diet of those who are liable to, and who suffer from, convulsions; but it must not be supposed that when they occur in children and have been subdued, a system of starvation is necessary to prevent their recurrence. U far as regards convalescence in such cases, it will be proper to bear in recollection the following rules: 1. When the patient is of a full habit, has a short neck, and a tendency to diseases of the head, the diet should be spare. The use of animal food, indeed, in such a habit, should be wholly prohibited in childhood, and very sparingly employed by adults; whilst vegetables, farinaceous matters, milk and weak broths, may be allowed. 2. When the habit of body is spare, and when languor and chilliness are present, the diet, although free from stimulus, yet should be nourishing, and consist of the lighter kinds of animal food; namely, poultry and fish, with a moderate share of vegetable matters. 3. Under all circumstances, and at every period of life, fermented liquors and wine, should be either wholly avoided, or very sparingly used, in almost all convulsive diseases connected with affections of the head. In convalescence from some varieties of convulsive diseases the nature of the diet must depend on circumstances which cannot be judged of by the attendants of the sick room; hence it should be referred solely to the medical attendant. In St. Vitus's Dance(chorea), for example, although tonic plan of treatment may have been successfully pursued, yet the diet may be required to be mild and wholly free from stimulus. Attention to diet in Hysteria is most important. When the disease is connected with indigestion, the meals should be moderate: and Test in the horizontal posture should be indulged for an hour afterwards, and then moderate exercise taken. Fluid food, such as broths and gruel, are improper; yet animal food should be eaten only once a day. Tea and coffee should be very sparingly taken; and the simplest beverages, even water and toast water, should be taken in great moderation after a mea~ and should not be drunk during dinner. In convalescence from hysteria, change of scene and air are absolutely requisite. The mind should be directed to solid studies, and everything which can cherish morbid sensibility of the nervous system avoided. Dropsy. An opinion was long maintained that fluids are to be withheld from dropsical patients. No opinion was ever founded on more erroneous principles. Dropsical patients, indeed, should be allowed the free use of fluids. With respect to diet, it should, generally speaking, be light and unstimulating: but much depends on the causes of dropsy. There is, however, less necessity for a rigid adherence to low diet in this than in other inflammatory affections. In Palsy, abstinence from all stimulating food, solid or fluid, must be rigidly observed; and the restriction should not be discontinued in convalescence. At the same time, change of air and of scene is always of decided advantage. In every instance, an easy state of mind, and freedom from every source of irritation, as well as from the anxieties of business, are indispensable. Gout and Rheumatism. In no diseases affecting the general habit are abstinence and repose more essential during the attacks than in the two which bead this paragraph, when they assume an acute form. When they occur in weakened or in broken down habits, it is too often supposed that the opposite plan of diet is to be pursued, and that stimulating food and a liberal supply of wine should be indulged; but nothing is more likely to prove injurious. When the paroxysm subsides, it is too customary to permit the invalid to glide into his usual habits with respect to diet and regimen; consequently the plethora which originated the disease gradually returns; and the same plan being continued, paroxysm follows after paroxysm, at shortening intervals, until scarcely any interval occurs, and life is sacrificed on the altar of self indulgence. For some weeks after the paroxysm of gout has subsided, in a young or middle aged man, animal food should be sparingly taken, and fermented liquors altogether avoided. Chlorosis, or Green Sickness, is a state of the habit which seems to depend on an impaired condition of the blood itself. Its treatment is well understood, and recourse to medical advice should never be neglected; otherwise it may terminate either in mental derangement or in sudden death. In convalescence from it, the diet should be mild and light, but nutritious; the exercise should be much within the limits of fatigue, and consist of both walking and horse exercise, daily, in the open air; the body, more especially the lower extremities, should be warmly clothed; the mind ought to be amused; all sedentary occupations thrown aside; and confidence placed in the honor of the physician, who should be made the repository of any mental anxiety, especially connected with the tender passion, which may be preying upon the vital energy of the body. Affections of the Head. WHATEVER it may be the cause of Apoplexy, no disease requires more prompt and energetic treatment: the alarming nature of the symptoms is always sufficient to prevent any time from being lost by attempts to relieve the sufferer without medical assistance. Should the attack not prove fatal at the time, and should it not be followed by palsy, still the utmost caution is requisite to prevent a recurrence of the disease. It is scarcely necessary to insist on the strictest adherence to temperance, both as to meat and to drink; and the importance of daily exercise, when the attack is over, and indeed for the remainder of life. Prolonged study and intense thinking must be given up; the violent and exciting passions should be subdued; and even the pleasurable moderated. Inflammation of the brain is one of those diseases which require, as observed respecting apoplexy, the most energetic treatment. When convalescence has fortunately been established, the attention of the physician is still requisite, during several weeks, until complete recovery be fully confirmed; for the brain, after suffering from inflammation, is very apt to relapse into the same state, from the excitement of too full a meal, or over exercise, or even slight mental exertions or emotions. On this account, the convalescent must be kept perfectly quiet, and completely free from the smallest excitement, and the strictest regimen observed. His diet should not only be mild and unstimulating, but small in quantity. Inflammation of the eyes requires the same caution when convalescence is secured as other inflammatory affections; namely, quiet, great moderation in diet, and avoiding exposure either to much light, heat or cold, or whatever can stimulate the still highly excitable organ. Affections of the Chest. Inflammation of the Lungs (Pneumonia) 7 In convalescence from this disease, the temperature of the room in which the patient sits should not exceed 601 F.; and it should be free from currents of air; but at the same time it should not be close. The necessity for continuing the same elevated position of the shoulders when in bed which is demanded during the existence of the disease, remains even when the convalescence is advanced. The patient should be pre vented from talking, and from exerting any muscular motion that can accelerate the circulation. The diet should be of that description which will support the strength without exciting or producing repletion. As the convalescence advances, and exercise is permitted by the medical attendant, it should be regular, but not hurried nor violent; and evening air should be sedulously avoided. Pleurisy. Inflammation of the lining membrane of the chest requires the same attention to diet and regimen during convalescence as the last mentioned disease, except that a greater strictness with regard to abstemiousness in food is requisite; the least deviation being likely to bring on a renewal of the inflammation. When the disease assumes a chronic character, and when the object is to remove fluid effused into the cavity of the chest, and pressing upon the lungs so as to circumscribe their action, the same degree of strictness with respect to diet is not necessary; but, as in this condition of the habit the physician must continue his attendance, the regulation of the diet devolves upon him. Angina. In that condition of the habit which is connected with a predisposition to gout, but in which, instead of a regular paroxysm, the heart and the pulmonary organs become affected, and the disease assumes that form which has been denominated diaphragmatic gout (Angina pectoris), the regulation of diet is of vital importance; and it should be of as low a standard as the constitutional powers will admit. It should not be "of a description either to nourish much, or to augment or to cause fullness of habit; mild animal food, in moderate quantity, may be allowed; but the staple should be of a farinaceous kind: every stimulant, whether solid or fluid, should be avoided; and wine and malt liquors regarded as poisons. The invalid himself should be made aware that whatever tends to excite or to hurry the circulation is calculated to bring on a paroxysm; nor is it sufficient that be avoids all stimulating viands and beverages; he should also be instructed that the same deleterious effects are likely to follow a full meal, even of the most proper and mildest food. The same attention to diet, both as regards quantity and quality, is essential in palpitations depending upon organic disease of the heart. Asthma. In no affection of the chest is attention to diet so important as in asthma. Sir John Floyer, who himself suffered from the disease, recommends almost a degree of abstinence; which is correct in reference to quantity; but the diet, although of a light, yet should be of a solid, kind. This is especially necessary when dyspepsia is present to aggravate and excite the disease of the lungs. In Whooping cough, the diet, whether the patient be an adult or a child, should be of the mildest description; and perhaps no nutriment is so well adapted to support the tone of the body, without exciting it, as milk. In infancy, nothing but the breast should be given; the system of the nurse, at the same time, being kept as cool as possible by mild diet, and her mind in a tranquil state. If convulsions occur, these sometimes depend on the nature of the milk: in which case the nurse should be changed. It is still customary with non professional persons to consider change of air essential in whooping cough; but it is only after the malady has run its course, and convalescence is progressing, when the cough remains as a habit, that change of air is really beneficial. It is unnecessary to combat the absurd opinion, that a change even to a worse air is salutary. Affections of the Stomach and Bowels. ALTHOUGH acute inflammation of the stomach rarely occurs, yet there is a chronic form of that disease, in which, during its actual existence, and also in convalescence from it, much of the safety of the invalid depends upon domestic management. Every source of excitement should be avoided; the sick room should be airy, and its temperature that of summer. The food should be of the blandest kind, given cold, or iced, and in small quantity: even when the convalescence is established the diet should consist of farinaceous matters, mixed with small quantities of beef tea, or weak broths; and this severe diet should be persisted in for a considerable time after recovery. Enteritis. When inflammatory action extends to, or exclusively exists in, the mucous lining of the bowels, constituting this disease, the diet, during the early stage of it, should be confined to cold water, or iced almond emulsion; after which, milk and barley water,, or weak chicken or veal tea, may be given in small quantities; namely, two or three tablespoonfuls, at intervals of three or four hours. Nothing stronger should be ventured upon, unless expressly ordered by the medical attendant. Atonic dyspepsia, or simple indigestion. During the attack, abstinence, to a certain degree, is necessary; but, if this is not essential, the diet should be somewhat stimulant, but simple; namely, a small cup of moderately strong coffee, with little sugar or milk; or beef tea, with a small quantity of dry toast; and, as the stomach begins to regain its tone, a little animal food of easy digestion, such as mutton or poultry. During the intervals of the paroxysms of indigestion, attention to diet is of the first importance. As a general rule, the patient should be confined to a spare animal diet, with a moderate share of well boiled vegetables, and a considerable restriction with respect to the use of fluids. Dysentery, which implies inflammation, acute or chronic, of the same membrane as in enteritis, but confined to the larger and lower bowels, requires the diet to consist of the mildest farinaceous matters, strictly avoiding all solid animal food. It should be given in small quantity at a time, and the whole allowance for the day should be moderate. The farinaceous food should not be either solid, nor yet altogether fluid; the former may prove injurious as a mechanical irritant; the latter is liable to excite griping, from the extrication of much flatus. Diarrhea. Much of the domestic, as well as the medical management of diarrhea depends on the nature of the attack, and its causes; but too much attention cannot be paid to the regulation of the diet. It should be both small in quantity, and mild in quality. In the early stage, and the acute form of the disease, barley water, arrow root made with water, rice or grit gruel, and light broths, are proper. In chronic diarrhea, rice, properly boiled, and mixed with a small quantity of beef tea, forms an excellent diet, as it nourishes moderately, and leaves scarcely any feculent matter behind it. In Cholera, convalescence is often tedious; and nothing is so likely to cause relapse as even slight irregularities of diet. For weeks after the feverish symptoms have disappeared, the diet should consist of a very moderate quantity of vegetable matter only. The feet should be kept especially warm and the whole body clothed in flannel, to prevent that irregular distribution of blood which so strongly characterizes the disease. After inflammation of the lining membrane of the cavity of the belly (peritonitis) has been subdued, the invalid should still observe the strictest diet and regimen. He should return very gradually to the use of animal food and wine. The bowels should be moderately and daily opened, the feet kept warm, and the skin maintained in a healthy condition by wearing flannel next to it, for a very considerable time after every trace of the disease has disappeared. Diseases of the Liver. In all cases of recovery from these diseases, whether inflammatory or otherwise, every precaution should be taken to guard against the deleterious influence of alternations of temperature, and also of damp, by clothing in flannel next the skin. Errors in diet should be avoided; and fermented liquors and stimulating beverages of every kind refrained from. When pains of the side continue, after all the other symptoms of the disease have disappeared, the introduction of a seton, if prescribed, should not be objected. to; as the greatest benefit has often followed that mode of counter irritation.

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