THE FEEDING OF ADULTS IN DISEASES OF THE GASTRO-INTESTINAL TRACT
ACUTE AND CHRONIC GASTRITIS
~Predisposing Factors.~--The majority of diseases affecting the
stomach have as their predisposing factors, and owe their development
to, one or all of the following conditions: (1) errors in diet; (2)
disturbed secretory processes; (3) disturbed motility and tone.
It is probable that in the beginning the first factor was the chief
offender in the case, bringing about the development of one or both of
the other conditions. The other factors to be considered in this
respect are heredity, occupation, poverty, and diseases which involve
to a greater or lesser degree the digestion of the stomach and
intestines. A child may inherit a weakened organism through excesses
or disease on the part of the parent. If this weakness is not overcome
while the child is growing, the probabilities are that the digestion
steadily declines until in adult life it becomes a pathological
condition. Lack of fresh air, poor and dirty food, unwholesome
surroundings, crowded and badly ventilated sleeping rooms,
insufficient water, and overwork, all act in making the digestion bad.
These must be overcome if permanent good is to result.
~Errors in Diet.~--Errors in diet arise more often through ignorance
than from any other cause. A child may be allowed to eat any and all
kinds of unwholesome and unsuitable food. When the stomach rebels,
showing the serious danger signals of nature, medicines are given but
the diet is unheeded, until the time comes when even the medicines
fail to give temporary relief, and the organs of digestion are in some
instances permanently impaired.
~Disturbed Secretory Processes.~--Consensus of opinion goes to show
that the majority of cases of acute and chronic gastritis (catarrhal)
and gastric ulceration are due primarily to a disturbance of the
secretory processes, while the impaired motility and lack of tone in
the stomach probably influence their development and aggravate the
disease already present.
~Composition of Gastric Juice.~--In a former chapter the processes of
gastric digestion were explained. The gastric juice, composed of from
0.2 to 0.3% free hydrochloric acid and several important enzymes and
lipases, which act upon the proteins and emulsified fats, must be
sufficient in quantity to assure good digestion, and when anything
arises to interfere with the secretion of this fluid a deviation from
the normal is bound to occur.
~Disturbed Motility and Tone.~--Again, it has been proved that good
gastric digestion, like good intestinal digestion, depends more or
less upon the way in which the food mass is mixed with the digestive
juices and moved along the alimentary canal. Anything which interferes
with the secretion of the juices or delays the food over its normal
length of time in the stomach surely exerts unfavorable influences on
the general metabolism of the food, for while, as we have already
found, gastric digestion is not essential to the final utilization of
the food in health, in disease it undoubtedly exerts a marked
influence upon the general nutrition of the individual.
HYPOCHLORHYDRIA
The lack of hydrochloric acid in the gastric juice lowers the
resistance to bacterial action, for this constituent exerts a decided
germicidal influence in gastric digestion, preventing fermentation
with the production of organic acids and probably alcohol. In
conditions due to hypochlorhydria (lack of hydrochloric acid) foods
which leave the stomach quickly must be given with enough of the other
necessary constituents in their simplest and most easily digested form
to balance the diet and prevent the occurrence of the other disorders
as troublesome as the original disorder.
~Dietetic Treatment.~--The following points must be kept in mind in
formulating a dietary for patients suffering from a deficiency of
hydrochloric acid: (1) boil the drinking water to destroy any bacteria
which may be present; (2) use carbohydrates in the form of starch
rather than sugar, since starch is less liable to fermentation from
bacteria than sugar; (3) limit the foods which delay the passage of
the food mass from the stomach; fats pass into the duodenum more
slowly than other foods and when fed with other foods delay their
passage materially; (4) avoid the use of soda bicarbonate, as it tends
to reduce the normal acid content of the stomach, thus preventing its
germicidal action upon the fermentative bacilli; alkaline carbonates
likewise inhibit the flow of gastric juices; (5) give especial
attention to the attractiveness of the food served; let it be
appetizing and savory, for by such means is the appetite juice and
incidentally an increased flow of the gastric juices stimulated; (6)
condiments and spices, meat broths high in extractives, and salt foods
such as caviar and endives may be given at the discretion of the
physician; it is seldom advisable to give the foods which are
indigestible, even when they act as stimulants to the secretory cells
of the stomach.
HYPERCHLORHYDRIA
(Excess secretion of acid in the stomach)
~The Effect of Excess Acid.~--An excessive flow of hydrochloric acid
has been found to be the cause of much of the acute and chronic
gastritis, in fact more of the cases are traceable to an excess than
to a lack of hydrochloric acid. This acid is more or less irritating
in character, and the tender mucous membranes lining the gastric organ
being constantly bathed in a secretion composed chiefly of acid must
necessarily in time suffer a certain amount of irritation and
inflammation, causing the development of a pathological condition
which may be temporary or permanent, that is, it may result in acute
or chronic gastritis, according to the amount of acid secreted and the
length of time the hypersecretion is allowed to continue.
~Determining the Acid Content of Stomach.~--The difference between the
cases brought about by an excess flow of hydrochloric acid are more or
less difficult to distinguish from those caused by a lack of this
constituent in the gastric juice, chiefly because in the latter case
the organic acids formed as the result of bacterial action upon the
food exert an equally irritating effect upon the membranes of the
stomach, and the only sure method of determining the cause of the
disturbance is by an analysis of the stomach contents, by which means
the percentage of hydrochloric acid is determined.
~Lavage.~--It has been found advisable, in some cases of acute
gastritis which do not yield readily to rest and liquid diet, to wash
the stomach and allow a certain period of rest before giving any food;
in this way the organ is rid of all of the offending material and thus
has a better chance of a quick recovery.
ACUTE GASTRITIS
~Dietetic Treatment.~--The following dietetic treatment for acute
gastritis is advised: As the stomach is the chief seat of disturbance,
all unnecessary work must be taken from this region for a certain
period:
(1) That any obscure cause may manifest itself and the diagnosis may
be rendered more accurately and more quickly.
(2) That by resting the organ the offending materials may pass out of
the body and thus prevent further trouble.
~Starvation Period.~--Twenty-four hours of total abstinence from food
may seem extreme, but as a rule in acute cases of gastritis it is the
only sane and safe method of instituting a diet and thus beginning to
overcome the cause of the disturbance. After the period of starvation
the diet is begun with caution.
~Fluid Diet.~--Fluids should be given first in the form of
well-skimmed broths, which may be reenforced with egg or cereal flours
when the patient is very thin or anemic. Buttermilk, made with the
Bulgarian cultures, koumiss and other fermented milk foods, liquid
beef preparations such as peptonoids or panopepton, albumenized orange
juice, cereal gruels treated with Taka diastase when it is found
necessary, and peptonized milk. These may be given in from four to six
ounces at a time, every two hours on the second day.
~Increasing the Diet.~--On the third day if the attack is slight the
diet may be increased by adding toast, softened with peptonized milk,
an ordinary serving (3 ounces) of farina, cream of wheat or rice,
reenforced meat broth with two crackers, a cup of tea and a slice of
toast, and one or two soft-cooked eggs. If the acute symptoms are
still present on the third day, the diet advised for the second day
must be continued until they disappear.
~Convalescent Diet.~--On the fifth day, if progress is satisfactory,
lightly broiled chicken or a small piece of rare broiled beefsteak may
be added to the diet and the meals reduced in number from six to four.
~Relapse.~--The patient must be warned against overeating or eating
any of the articles which are known to cause an acute attack in his
individual case, since one attack predisposes to another, and chronic
gastritis may develop as the result of the continual gastric
disturbance.
CHRONIC GASTRITIS
The treatment in chronic gastritis is very like that in the more acute
form; that is, it must be combated by removing the cause. Lack of
fresh air and exercise have much to do with the development of chronic
gastritis, but even they combined with a judicious amount of rest
would be wasted without a proper adjustment of the diet to cover the
main points of the disturbance. As has already been mentioned, the
cause may be a lack of gastric juice or it may be an excess of it; it
may be intensified by an ~atonic~ condition of the organ or from the
food passing too quickly into the duodenum.
~Test Meals.~--As a rule it is not safe to make a snap diagnosis as to
the cause of this disorder. Since in many instances the more serious
disorders may be traced to a disregard for nature's danger signals,
the physician as a rule advises a test meal, this meal consisting of a
glass and a half of water or a cup or two of tea without cream or
sugar and from one to two slices of toast or water rolls. In from
three-fourths to one hour or longer this is removed from the stomach
by means of a stomach pump and analyzed, the result of the chemical
and bacterial analyses forming the basis for diagnosis. This meal is
generally given in the morning before any other food has been
eaten.[92]
~Dietetic Treatment.~--The foods constituting the diet in chronic
gastritis must be of the simplest character and prepared in the
simplest manner. No fried foods are permissible. Pastries, griddle
cakes, rich puddings and sauces, candies, and alcoholic beverages must
be omitted from the diet as well as the following articles of food:
pork, veal, shellfish except oysters, sardines, canned meats and
canned fish, highly seasoned and spiced dishes, twice-cooked meats,
vinegar, pickles, olives, cold slaw, pickled beets, catsup, mustard,
coarse fibered vegetables such as cabbage, old onions, old turnips,
and cucumbers, strong tea, coffee, or chocolate, rich cream or dishes
made entirely of cream. In cases of excessive acidity due to a
hypersecretion of HCl the extractives of meat are contraindicated,
hence all gravies and outside parts of roasted meat must be omitted or
limited in the diet.
GASTRIC ULCERATION
Gastric ulcer may develop without an apparent cause. As a rule,
however, it manifests itself in individuals between the years of
fifteen and forty, particularly after prolonged digestional
disturbances, especially those accompanied by a hypersecretion of
acid. As the disease progresses, anemia is more or loss severe, adding
difficulty to the feeding problem. Many of the symptoms are like those
of chronic gastritis, such as pain. However, the character of this
pain may be different, beginning soon after eating and radiating
toward the back. This point may be affected by position. As a rule
there is a tenderness over the seat of the ulcer. This is detected by
palpation. Vomiting is one of the most general symptoms in gastric
ulceration. This may begin from one to two hours after eating when the
pain is at its height, or it may start as soon as food enters the
stomach. As a rule the latter condition is found more often in very
nervous women whose mental attitude affects the stomach to such an
extent as to make it difficult to give them sufficient food to nourish
them.
~Hemorrhage.~--Hemorrhage occurs in about half of the cases. The
bleeding may be profuse and the blood bright red, or it may be less
severe and the color of the blood changed by contact with the gastric
juices to a dark brown like coffee grounds.
~Excess Acid.~--Hyperacidity is present in the majority of the cases,
the percentage of HCl rising at times fifty per cent. or more. Other
cases occur in which all of the just mentioned symptoms except
dyspepsia are missing, the first intimation of the ulcer being
hemorrhage or perforation.
The patient with gastric ulcer may recover entirely and never have a
return of the trouble, but care and close attention are necessary,
since the ulcers are apt to recur, at times a series of ulcers
developing one after another. Death may occur from exhaustion or from
perforation and peritonitis. Surgical intervention is as a rule
necessary when the ulcers persist, as they generally develop at or
near the pyloric opening; and the constant development of cicatricial
tissue brings about an obstruction of the pylorus, which if not
relieved would allow the patient to starve.
~Diet Treatment.~--There are a number of treatments used in overcoming
this condition. After the test meal and the diagnosis, the patient is
placed upon a diet directed to overcome the chief symptom; for
example, if the ulcer developed as a result of hyperacidity, the diet
would be directed toward the relieving of that symptom. Boas[93]
divides the treatment into three stages: (1) hemorrhage; (2) the
intermediate stage; (3) the convalescent stage.
~Starvation Treatment.~--The majority of physicians institute a total
abstinence period for the first stage, allowing no food or water to be
taken by mouth. If the patient is very weak and anemic from the
extended course of the disease, nutrient enemas are given from four to
six times a day, alternating with saline enemas. This total abstinence
continues from three to six days. Some cases have been known to be fed
in this way for a month or six weeks with obvious success. However,
this is not the rule but the exception. The diet must be adjusted to
the needs of each individual, but a few general rules may be found
helpful.
~Dietetic Treatment.~--Milk is the food generally utilized in the
beginning. This may require peptonizing to be digested, or it may
have to be modified with limewater. Protein foods require HCl for
their digestion. If these foods are fed they will absorb some of the
excess acid, and in this way save the already irritated wall of the
organ from additional irritation. When protein foods are given they
must be in the form of soft-cooked eggs, scraped raw beef or beef
juice, milk soups, and like protein foods.
When there is a dilatation of the organ there is more or less danger
of fermentation taking place, with the formation of organic acids.
These acids are exceedingly irritating, and every care must be
observed to prevent their production. The following dietetic regime
may be used as a guide in many cases of gastric ulceration:
~Milk Diet.~--1/2 glass (4 ounces) of milk peptonized at 115 deg. F. for
20 minutes, every hour for three or four days. After this the interval
between feedings is lengthened to two hours and the amount of milk
increased to 3/4 of a glass (6 ounces). This is continued from a week
to ten days. The patient may be given a cup of well-strained meat
broth, reenforced with an egg, once or twice a day, to vary the
monotony of the diet. During the third week the milk may be given in
the form of milk soups. These may be slightly thickened with barley,
rice, or farina flour. The soups may be flavored with beef extract,
but only a small quantity must be used, owing to the stimulating
properties of these substances.
~Water as a Stimulus to Gastric Secretion.~--Water is exceedingly
stimulating to the acid secreting cells of the stomach, hence it is
advisable to limit the amount of water taken by mouth, allowing the
patient just enough to wash out the mouth without swallowing any. The
thirst is relieved by saline enemas.
It has been found, in many cases of gastric ulceration, especially
those accompanied by hemorrhage, that glucose gives better results
when used in rectal alimentation, than any other substance. The
strength of the solution varies from a five to a twenty-five per cent.
solution. The number of glucose enemas given each day must be
regulated by the physician. The method used is the same as in other
rectal feedings, the enema is given "high," and the flow regulated
(drip-method).
~Convalescent Diet.~--During the fourth week, if the pain and
discomfort are decreasing, soft-cooked or creamed eggs may be added to
the diet, together with thoroughly boiled rice, farina, cream of
wheat, wheatena and other finely ground wheat foods, wine or fruit
jelly, sweetened slightly, or by using a small amount of saccharin for
the purpose, junket and plain vanilla ice cream. At the end of the
fourth week a very small portion of meat may be given once a day. It
may be scraped raw beef spread upon toast or zwieback, or very lightly
broiled beefsteak, broiled lamb chop or chicken (breast only), or
boiled or broiled sweetbreads or brains. Spinach or green peas pressed
through a sieve are the first vegetables allowed. After these young
tender carrots and string beans may be given. Tea, coffee, and
chocolate are eliminated from the diet. Milk flavored with coffee or
cocoa may serve as a hot drink in the morning when the desire or need
for such a drink is manifested. Butter is the best form of fat to be
used in cases of gastric ulceration, but this must be given with the
greatest caution. In cases where this fat is used in the form of
cream, the amount must be cut down or entirely abandoned when there
are evidences of butyric fermentation. Buttermilk, koumiss, and other
fermented milk drinks are often found very satisfactory adjuncts to
the diet. These may be given between meals, or at meals they may be
substituted entirely for the milk when other foods are being given.
They are not sufficiently nourishing to take the place of the milk
diet otherwise. Albumenized orange juice and cream, egg and vichy may
be given to add variety to the diet.
~Anemia.~--When anemia is severe, as is often the case in gastric
ulceration, the diet must be reenforced to overcome it. Some of the
concentrated milk foods such as plasmon, encasin, sanatogen, etc., as
well as the predigested meat foods, such as panopepton, liquid beef
peptonoids, and like preparations, may be used to reenforce the diet.
~Bland Diet.~--In certain cases of gastric ulceration it has been
found more advisable to use what is known as a bland diet. This
consists of farinaceous foods such as farina, arrowroot, cream of
wheat, corn meal, wheatena, malted breakfast foods cooked thoroughly
and given in the form of gruels, and some of the proprietary infant
foods, such as Mellin's Food, Eskay's Food, Racahout. These foods may
require the addition of Taka diastase to make them more readily
digested. They leave the stomach more rapidly than any of the others,
and for this reason will be found to give less discomfort than the
foods containing a high percentage of protein and fat. This diet,
however, cannot be prolonged on account of its lack of balance. If the
gruels are made with milk instead of with all water they become more
evenly balanced. Samples of the stomach contents may be taken for
analyses from time to time.
~Lavage.~--When lavage is necessary the patient must be allowed to
rest after the process before being given food, otherwise it is apt to
be vomited.
~Instructions to Nurse.~--The treatment for gastric ulceration is thus
seen to be strenuous. In the beginning the patient is placed on a
liquid or semi-solid diet, or is not fed at all for a time. This is
done that the diseased organ may have a chance to adjust itself as far
as possible and to give the physician an opportunity of studying the
changes taking place in that organ. During the course of the disease
the general symptoms which develop from time to time, causing more or
less pain and discomfort to the patient, are nervousness, which in
some individuals amounts to melancholia, extreme anemia and an utter
distaste for food, all of which require patience on the part of the
physician, the nurse, and the patient herself to overcome. The nurse
must see that the patient is not disturbed or made unhappy by having
business or home cares talked over in her presence; she must be kept
as cheerful and as comfortable as her condition permits and urged to
use care in her diet. After the ulcer is healed, to prevent a return
of the trouble she must be warned against eating too fast or when
over-tired, and she must be advised against very hot and highly
seasoned foods, for, in the observance of these simple common-sense
precautions only is she even in a measure saved further attacks.
~Special Diets Used for Gastric and Duodenal Ulcer.~--There are
several well-known diets used in these conditions. Among those that
have been found most satisfactory may be mentioned the Sippi diet, the
Lenhartz diet.
All of these diets require the most careful adjustment as to
regulation of intervals of feeding, type of food material used, and
method of preparation and administration of food.
The treatment is directed toward the reduction of the free
hydrochloric acid in the stomach in order that the ulcer may have an
opportunity for healing.
~Sippi Diet.~--Equal quantities of heavy cream and whole milk,
beginning with 1/2 ounce each every hour during the day. Alkaline
powders are given with the meal and one-half hour after the meal.
These consist of 15 grains each of sodium bicarbonate and bismuth
subcarbonate with the feeding, and 10 grains of light oxide of
magnesia and 15 grains of sodium bicarbonate between feeding. The
cream and milk are increased at the rate of one-half ounce each at
each feeding for two days, the powders are continued as on the first
day. On the fourth day an egg is added to the diet, the milk and cream
are given in quantities of one and one-half ounce each, every hour. On
the fifth day two eggs are added. On the sixth day one helping of
oatmeal or other soft cereal is added to the above diet. The diet is
in this way increased until the patient is taking three eggs and nine
ounces of cooked cereal each day in addition to the cream and milk
mixture. The amount given at one time must be small, never exceeding
six ounces (according to Carter, Howe and Mason).
An accurate control of the acidity of the stomach should be
maintained, this is accomplished by withdrawing a certain amount of
the gastric contents by means of the stomach tube.
~The Lenhartz Diet.~--This diet is likewise given in hourly feedings,
consisting of milk and raw eggs in the beginning, then a small portion
of sugar is added, next scraped beef is added to the milk, eggs and
sugar, already given, then boiled rice. Next a small quantity of
zwieback (or soft toast), and continuing in this way, chicken, and
butter are admitted. In the beginning the quantity of milk is 100 c.c.
and the number of eggs 2, given raw. It is served iced, and with a
teaspoon. When the sugar is added it is beaten up with the eggs (20
gm.). The milk and eggs are divided into separate feedings and given
at hourly intervals from 7 A.M. to 7 P.M. It is rarely possible to
give the amounts called for in the Lenhartz diet after the sixth day,
but as much as possible should be given without risking an acute
disturbance. Women, as a rule, find it more difficult to take the full
amount ordered than men.
The following outlines represent the diet for the first, third, sixth,
seventh and tenth day:
FIRST DAY
7 A.M. Egg
8 A.M. Milk, 20 c.c.
9 A.M. Egg
10 A.M. Milk, 20 c.c.
11 A.M. Egg
12 noon Milk, 15 c.c.
1 P.M. Egg
2 P.M. Milk, 15 c.c.
3 P.M. Egg
4 P.M. Milk, 15 c.c.
5 P.M. Egg
6 P.M. Milk, 15 c.c.
Total: Milk, 100 c.c. Eggs (raw), 2.
THIRD DAY
7 A.M. Egg; sugar, 2 gm.
8 A.M. Milk, 50 c.c.
9 A.M. Egg; sugar, 3 gm.
10 A.M. Milk, 50 c.c.
11 A.M. Egg; sugar, 3 gm.
12 noon Milk, 50 c.c.
1 P.M. Egg; sugar, 3 gm.
2 P.M. Milk, 50 c.c.
3 P.M. Egg; sugar, 3 gm.
4 P.M. Milk, 50 c.c.
5 P.M. Egg; sugar, 3 gm.
6 P.M. Milk, 50 c.c.
7 P.M. Egg; sugar, 3 gm.
Total: Milk, 300 c.c. Eggs (raw), 4. Sugar, 20 gm.
SIXTH DAY
7 A.M. Egg; sugar, 4 gm.
8 A.M. Milk, 100 c.c.
9 A.M. Egg; sugar, 4-1/2 gm.; scraped beef, 12 gm.
10 A.M. Milk, 100 c.c.
11 A.M. Egg; sugar, 4-1/2 gm.
12 noon Milk, 100 c.c.
1 P.M. Egg; sugar, 4-1/2 gm.; scraped beef, 12 gm.
2 P.M. Milk, 100 c.c.
3 P.M. Egg; sugar, 4-1/2 gm.
4 P.M. Milk, 100 c.c.
5 P.M. Egg; sugar, 4 gm.; scraped beef, 12 gm.
6 P.M. Milk, 100 c.c.
7 P.M. Egg; sugar, 4-1/2 gm.
Total: Eggs (raw), 7. Milk, 600 c.c. Sugar, 30 gm. Scraped beef, 36 gm.
SEVENTH DAY
7 A.M. 1 soft-cooked egg
8 A.M. Milk, 100 c.c.
9 A.M. Egg; sugar, 13 gm.
10 A.M. Milk, 100 c.c.; scraped beef, 23 gm.; boiled rice, 33 gm.
11 A.M. 1 soft-cooked egg
12 noon Milk, 125 c.c.
1 P.M. Egg; sugar, 13 gm.
2 P.M. Milk, 125 c.c.; scraped beef, 23 gm.; boiled rice, 33 gm.
3 P.M. 1 soft-cooked egg
4 P.M. Milk, 125 c.c.
5 P.M. Egg; sugar, 14 gm.
6 P.M. Milk, 125 c.c.; scraped beef, 24 gm.; boiled rice, 34 gm.
7 P.M. 1 soft-cooked egg
Total: Eggs (raw), 4; (soft-cooked), 4. Milk, 700 c.c. Sugar, 40 gm.
Scraped beef, 70 gm. Boiled rice, 100 gm.
TENTH DAY
7 A.M. 1 soft-cooked egg
8 A.M. Milk, 166 c.c.
9 A.M. Egg; sugar, 13 gm.
10 A.M. Milk, 168 c.c.; scraped beef, 23 gm.; boiled rice, 66 gm.;
butter, 4 gm.
11 A.M. 1 soft-cooked egg; zwieback (or soft toast), 20 gm.;
butter, 4 gm.
12 noon Milk, 166 c.c.; minced chicken, 25 gm.
1 P.M. Egg; sugar, 13 gm.
2 P.M. Milk, 166 c.c.; scraped beef, 25 gm.; boiled rice, 66 gm.;
butter, 4 gm.
3 P.M. 1 soft-cooked egg; butter, 4 gm.; toast or zwieback, 20 gm.
4 P.M. Milk, 168 c.c.; minced chicken, 25 gm.
5 P.M. Egg; sugar, 14 gm.
6 P.M. Milk, 166 c.c.; scraped beef, 24 gm.; boiled rice, 67 gm.;
butter, 4 gm.
7 P.M. 1 soft-cooked egg
Total: Eggs (raw), 4; (soft-cooked), 4. Milk, 1000 c.c. Sugar, 40 gm.
Scraped beef, 70 gm. Minced chicken, 50 gm. Butter, 20 gm.
Boiled rice, 200 gm. Toast or zwieback, 40 gm.
GASTRIC CANCER
As a rule the seat of the gastric cancer is the pylorus. The patient
gives evidence of chronic gastritis with continued pain, localized
tenderness, vomiting of partially digested food and at times
dilatation from extreme fermentation. The hemorrhages are as a rule
not large, the blood having changed to a brownish color resembling
coffee grounds. Vomiting, in cases where the pylorus is involved,
generally occurs several hours after eating, the vomitus being in an
advanced state of fermentation. Upon analysis of the stomach contents
there is found to be a lack of free HCl.
~Dietetic Treatment.~--In the dietetic treatment of cancer of the
stomach the most digestible forms of foods must be given, milk forming
in this, as in other gastric disorders, the chief article of diet. As
too much food cannot be tolerated, the meals must be small, even if
given more frequently. The patient is often found to evince a distaste
for meat, in which case fish may be substituted. When meat is given,
it must be simple in form and preparation, such as boiled or broiled
sweetbreads or brains, scraped beef or stewed chicken. Rice, farina,
cornmeal mush, and other fine cereals, cooked with or without milk,
are valuable additions to the diet. Well-cooked and strained spinach,
green peas, cauliflower, carrots, and tender string beans and boiled
or baked potatoes well mashed may be recommended. Tea, coffee, or
cocoa may be used to flavor the milk. These must be given in small
portions. The following diet list is recommended by Friedenwald and
Ruhraeh:
_Calories_
8 A.M. 100 grams of milk with tea 100.0
30 grams of milk toast 130.0
10 A.M. 100 grams of baked trout 106.0
100 grams of milk 67.0
or 30 grams panopepton (57.5)
10 grams of butter 81.0
50 grams of toast 130.0
50 grams of sherry 60.0
12 M. Bouillon with 5 grams somatose 16.0
100 grams of chicken 106.0
or 100 grams squab (100)
or 100 grams of calves' sweetbreads (90)
or 100 grams of calves' brains (140)
60 grams of macaroni 212.0
or 100 grams of mashed potatoes (127)
or 100 grams of spinach (166)
or 100 grams of asparagus (18)
25 grams of stale wheat bread 65.0
4 P.M. 20 grams of toast 130.0
20 grams of butter 162.0
40 grams of caviar 52.0
7 P.M. 130 grams of milk (100) with 5 grams
somatose (16) 116.0
100 grams of rice cooked in milk 177.0
50 grams of wheat bread 130.0
9 P.M. 30 grams of panopepton 57.5
------
2024.5
SUMMARY
FACTORS INDUCING GASTRIC DISTURBANCES
1. ~Errors in Diet.~--Over-feeding, under-feeding, improper food,
unbalanced diet.
2. ~Disturbed Secretory Processes.~--
(a) Over- or under-secretion of gastric juice.
(b) An excess or deficiency of hydrochloric acid in the juices.
3. ~Impaired Motility and Tone of the Gastric Organ.~--The peristaltic
waves and muscular contraction of the stomach walls becoming sluggish
prevent the food mass from passing into the intestines at a normal
rate of speed, thus giving rise to a fermentation of the food and a
consequent dilatation of the organ from the gas thus produced.
~Other Factors.~--Lack of fresh air and exercise, indoor occupation,
bad hygiene, unsanitary surroundings, heredity, certain diseases which
are accompanied by gastric disorders.
~Diseases of Gastric Organ.~--Acute and Chronic Gastritis,
Gastric-Ulceration, Gastric Cancer.
~Treatment.~--Tests--Test meals, X-Ray examinations (pictures and
Fluoroscope). Patient is given no breakfast on day of test. In X-Ray
laboratory a bismuth or barium meal is given, this meal consists of a
pint of fluid, either buttermilk or malted milk, into which a certain
amount of bismuth or barium chloride is mixed.
~Starvation Period.~--A period of abstinence from food is instituted
in most of the gastric disorders, (a) to determine the extent and
character of the disease, (b) to rest the digestive tract.
~Dietetic Treatment.~--Diet adjusted to meet the needs of the
individual case as determined by the medical examination.
~Instruction to Patient.~--Individual warned against overeating,
drinking and constipation.
PROBLEMS
(a) Formulate a diet order for a patient suffering from chronic
gastritis. (Individual's food requirements must be observed.)
(b) Formulate a diet for gastric ulceration. List the available foods;
the avoidable foods.
(c) Outline a diet to be used in case of gastric cancer; show how it
differs from the one used in gastric ulceration.
FOOTNOTES:
[92] It is also customary to give the patient a bismuth or barium meal
in order that an X-ray and fluoroscopic examination may be made to
determine the character and extent of the disturbance.
[93] "Diseases of the Stomach," by Boas.