Dietetics

“ Dietetic Treatment.—The dietetic treatment consists in abstaining from food or reducing the amount to a minimum while the attack lasts and while the intestines are being thoroughly emptied. All stagnant material which has clogged the bowels and which has been subjected to the activities of putrefactive bacteria must be gotten rid of. The diet must be especially low in fat. Oyster or clam broth, soft-cooked eggs, toast, cereal, or rice, with a little milk instead of cream and very little sugar, tea, and baked apple or stewed prunes are given. ”

“ Dietetic Treatment is most important. It constitutes the only rational method of ridding the body of its surplus fat. To do this it is necessary to regulate the diet both as to quantity and type. Fat-forming foods are those which the body utilizes most easily for the production and storage of fat. Any food, no matter whether it is fat-forming or [Pg 447] not, if taken greatly in excess of the needs of the body, will be stored as adipose tissue. ”

“ Care must be taken not to allow large amounts of even the non-fat-forming foods in the dietary, since under certain conditions the body will manufacture adipose tissue of any surplus organic material ingested. Breakfast must be limited as demonstrated in the tabulated diet sheet. ”

“ Reënforcing the Diet.—On account of the great increase in the rate of metabolism and because of the difficulty of furnishing the requisite number of calories in the diet, reënforcing agents such as lactose, eggs, some forms of casein, or beef preparations are used.
Idiosyncrasies against certain foods are, at times, manifested by patients. Efforts must be made to determine whether they are real or imaginary before eliminating any food which may be of importance to their future welfare. ”

“ The following menus may be used as guides in the treatment of obesity:
Amount of Food.—The amount of food is limited to a certain extent. Green vegetables may be eaten in abundance, but the protein foods such as meat, fish and eggs must be limited. [161] The bread (even gluten and bran breads) must be limited to 1-2 slices at each meal. All meals are eaten without fluids except breakfast, when one small cup of coffee or tea without milk, cream, or sugar is allowed. If fruit juice is to be served instead of fruit, it must be prepared with little if any water and no sugar. ”

“ Where the constitution is of a mixed nature, or a compound of two or more of the temperaments already described, a diet composed of animal and vegetable aliment in nearly equal proportions is under ordinary circumstances the best. But where any one temperament predominates, the diet ought to be modified accordingly. ”

“ Dietetic Treatment.—The meals must be carefully selected, well prepared and daintily served, that all of the psychical benefits from such efforts may be attained. A nutrient beverage such as cream, egg, and vichy, reënforced fruit beverages, malted milk, with egg and chocolate, cereal and milk gruels, etc., may be given between breakfast and lunch, lunch and dinner and before retiring. The meals must consist of the simplest foods that the digestion may not be overtaxed by the quantity ingested. ”

“ When the above conditions become chronic, the patient loses weight and strength rapidly, becomes anemic and emaciated. The treatment, like that used in the acute disease, consists of rest and liquid diet. The medicinal treatment is left entirely in the hands of the physician. ”

“ High Calorie Diet is one in which the fuel value of the food ingested meets or exceeds the energy expenditures of the patient. Foods composing the diet are, milk and eggs for the proteins, with carbohydrates and fats in their simplest and most digestible form to balance the diet. ”

“ All foods should be carefully selected, and properly prepared in order to derive the maximum benefit therefrom, and the regularity and attractiveness with which the meals are served have almost as much to do with the health and happiness of the individual, as the character of the foods included in the day’s dietary. ”

“ If a meal is made up of the right kind of foods, in the proper proportion, and each individual eats sufficient to assure the maintenance of the normal weight, is free from gastro-intestinal disturbances, and shows a normal resistance to disease, it is more than probable that a sufficient quantity is being consumed each day. ”

“ A light or soft diet is advised until the condition improves, resting the renal organs as far as possible. This diet may consist of fruit juices, strained cereals with cream, cocoa, milk, buttermilk, toast, butter, strained apple sauce, cream soups, except those made with beans or peas. The above diet is gradually increased by adding a mashed or baked potato, well-cooked green vegetables, stewed or raw fruit, rice and tapioca pudding, and chocolate blanc-mange. ”

“ If in these expectations he is not too sanguine, the future advantage to the race from the present diffusion of dietetic knowledge is as certain, and almost as encouraging, as if its effects were instantaneous on both old and young. ”

“ The number of physicians, and surgeons, and medical men, whose testimony is brought to bear on the subject of diet, in the chapter which follows, is by no means as great as it might have been. There are few writers on anatomy, physiology, materia medica, or disease, who have not, either directly or indirectly, given their testimony in favor of a mild and vegetable diet for persons affected with certain chronic diseases. And there is scarcely a writer on hygiene, or even on diet, who has not done much more than this, and at times hinted at the safety of such a diet for those who are in health ”

“ The patient's food habits, his tastes, inherited or acquired, are often vital considerations because the practical question in securing results is often not what diet the person needs, but what diet he can get or will take. Knowing the technique of adapting diets to individual needs in terms of food elements, calories, mineral content, vitamines, etc., is essential knowing the technique of adapting the diet in terms of the patient's food habits and financial circumstances is no less so. ”

“ The errors in diet which should be avoided are:—First, eating too fast; second, taking stimulants of any kind to provoke an appetite; third, the use of rich sauces and peppers; fourth, eating too much; and fifth, partaking of too many varieties at one meal. A man should eat with regularity and moderation, and frequently change his diet.
DRINK.—Pure water is the best, but water that will not wash is unfit for drinking or making food, withal. Cocoa, coffee, tea, and milk in moderation, and in summer whey and buttermilk are healthful drinks. ”

“ The full adult weight is not attained before the twenty-fifth year. When the final growth of the body and development of the vital organs is completed, the function of food is simply to replace waste with new material and to furnish material for the development of force.
Diet.— The diet should be a mixed one, consisting of the various kinds of fresh meats, fish, milk, eggs, poultry, vegetables, fruit, and fat in the shape of cream, butter, and the fat of beef and mutton. Animal food improves the condition of the muscles, which are made firmer than they would be through a vegetable diet. ”

“ A diet may meet the total energy, the protein, the carbohydrate, and the fat requirements, yet may be lacking in certain essential mineral materials. It is especially necessary to include food containing phosphorus, iron, and calcium in one's diet.
THE APPETITE AND FOOD REQUIREMENT.—The appetite is the most common measure of daily food requirement. If one relies upon his appetite as an index of the quantity of food he should consume, and if his health and weight remain normal, the appetite may serve as a guide for daily food requirement. ”

“ The diet should be graded to the ability of the stomach to digest and the body to assimilate. Our chief reliance will be upon milk, plain or peptonized, eggs, and beef given in the various forms of acceptable preparations, so as not to impair the tone of the stomach nor clog the appetite by sameness. Such vegetables and fruits as agree with the patient may be allowed. I have tried exclusive diets of milk, farinacea, and meat without marked benefit. All stimulants, tea, and coffee should as a rule be interdicted. ”

“ As to the choice of food and the amount that is necessary for the average person, generally the appetite is a safe guide; but the accurate observations of physiologists have gone so far as to determine the exact requirements of the body. Not the least important principle taught by these investigations is to avoid dietary fads, for in arranging a satisfactory diet the problem to be solved is not, What is it possible to live on? but, What serves best as nourishment? The experience of countless generations has taught us that we thrive best on a diet which includes all five food-stuffs. ”

“ But practically, it has everywhere, and in all ages, been found that the best and most healthful diet is a proper combination of animal and vegetable foods. Our starches, for instance, which furnish most of our fuel,—though they give us comparatively little to build up, or repair, the body with,—are found, as we have seen, in the vegetable kingdom, in grains and fruits; while most of our proteins and fats, which chiefly give us the materials with which to build up, or repair, the body, are found in the animal kingdom. ”

“ All excretions from the patient should be buried, and not committed to privies to communicate disease to those who frequent them.
The Diet contains a very important relation to health. During the process of acute disease, the appetite is generally much impaired, if not entirely absent. It should then be the study of the nurse to devise such articles of nourishment as will [pg 381] be acceptable to the patient and suitable to the condition. The food should be light, nutritious, and easy of digestion.
Each individual disease requires a diet adapted to its peculiarities. ”

“ The necessity for occasionally changing or varying the diet, is seen in the fact that no single article comprises all the necessary principles of food, and that the continuous use of any one diet, whether salt or fresh, is followed by defective nutrition and disease. ”

“ The Determination of Diet.—The first principle in making a dietary is that it must be mixed, containing all the necessary constituents, proteids, hydrocarbons, carbohydrates, water, and salts. No one of these alone will support life for any considerable period. Carbohydrates (sugar and starch) can be most easily dispensed with; fats, on the other hand, are essential for the maintenance of health. ”

“ Persons, whose solids are weak and relaxed, ought to avoid all viscid food, or such things as are hard of digestion. Their diet, however, ought to be nourishing; and they should take sufficient exercise in the open air.
71Such as abound with blood should be sparing in the use of every thing that is highly nourishing, as fat meat, rich wines, strong ale, and such like. Their food should consist chiefly of bread and other vegetable substances; and their drink ought to be water, whey, or small beer.
Fat people should not eat freely of oily nourishing diet. ”

“ When we consider the organization of the human system, the form and arrangement of the teeth, the structure of the stomach and intestines, we are led to conclude, that both animal and vegetable food is requisite, and that a mixed diet is most conducive to strength, health, and long life. ”

“ What should be eaten at this meal? Everything and anything agreeable to the appetite and as much as one wants. Eat a mixed diet; the system needs all kinds of food from which to select the new fuel for its new release of interior substance, and a single diet will not satisfy the demands of the physical cells. ”

“ Vitamins a New Factor in Nutrition.—But recent investigation has proved that something more is essential for the maintenance of growth and well-being than protein, carbohydrates, fats, and salts; that food contains a minute portion of accessory bodies, and that when they are deficient or absent from the diet the immature body does not grow, the mature body does not maintain its condition, and there are manifestations of more or less serious disease. ”

“ Doctors, again, are more and more recognising that nutrition depends not only upon the chemical composition of food but upon our appetite, and that we can become aware of our appetite and to some extent control and direct it by our will. ”

“ Before discussing the question of suitable foods for individual needs or the ill-health which is so likely to follow an unrestrained or unwise diet, it will be well to trace briefly the passage of food through the human body, with the various changes which take place in its mass from the time it enters the mouth until it is absorbed by the stomach. ”

“ We need a far more complete knowledge than we possess at present of the laws governing nutrition; we need fuller knowledge of the methods by which the most complete, satisfactory, and economical utilisation of the diet can be obtained; we need to know more concerning the minimum diet and the minimum amount of proteid or albuminous foods on which health, mental and physical vigour can be permanently maintained ”

“ The diet must be of the most nourishing, and should consist mostly of food containing starch and sugar, such as good fresh butter, rich milk, cream, fruits both raw and cooked, macaroni, fish, corn, sweet potatoes, peas, beans, ice creams, desserts without pastries, and nourishing broths. Cereals, poultry, game, chocolate and sweet grapes are all excellent. Avoid all spiced, acid or very salty foods. While plenty of outdoor life is most essential, a great deal of exercise is not. ”