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. ā 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 dis-
orders, 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 addi-
tions 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, ioffee, 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 Ruhrah:
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 or 30 grams panopepton
(57.5) 67.0
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FEEDING IN GASTRO-INTESTINAL DISEASES 261
Calories
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 127.0
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
FACrrORS INDUaNG GASTRIC DISTURBANCES
1. Errors in Diet. ā Overfeeding, underfeeding, im-
proper food, unbalanced diet.
2. Disturbed Secretory Processes. ā (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.
ā The peristaltic waves and muscular contraction of the
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262 DIETETICS FOR NURSES
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. ā 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. ā Acute and Chronic Gas-
tritis, Gastric-Ulceration, Gastric Cancer.
Treatment. ā Tests ā 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. ā A period of abstinence from food
is instituted in most of the gastric disorders, (a) to deter-
mine the extent and character of the disease, (6) to rest
the digestive tract.
Dietetic Treatment. ā Diet adjusted to meet the needs
of the individual case as determined by the medical exami-
nation.
Instruction to Patient. ā Individual warned against
overeating, drinking and constipation.
PROBLEMS
(o) Formulate a diet order for a patient suffering from
chronic gastritis. (Individual's food requirements must
be observed.)
(6) Formulate a diet for gastric ulceration. List the avail-
able 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.
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CHAPTER XII
DISEASES OF THE INTESTINAL TRACT
ACUTE AND CHRONIC DIARRHEA ( CATARRH), ENTEROCOLITIS,
DYSENTERY, CONSTIPATION, APPENDICITIS, CHRONIC CON-
STIPATION, AUTO-INTOXICATION
Diarrhea, like gastritis, may be a symptom of many
diseases and a result of many digestional disturbances. En-
teritis, enterocolitis, dysentery, typhoid fever, and certain
cases of tuberculosis and syphilis are all accompanied by an
inflamed condition of the mucous lining of the intestinal
walls, and in each of these pathological conditions we may
find diarrhea as a resulting symptom.
Causes. ā Diarrhea may be acute or chronic in char-
acter. It may be brought on by errors in diet, warm
weather, certain drugs, ptomaines, bad hygiene, polluted
water or milk, and by overeating. Idiosyncrasies against
certain kinds of food have been found in both adults and
children; these idiosyncrasies are manifested by pain and
diarrhea whenever the offending foods have been eaten.
Acute diarrhea has also been brought on in children by the'
drinking of cold lemonade when overheated.
Diarrhea in Children. ā All diarrheas in children, and
especially those developing during the hot months, must be
looked on with suspicion and given immediate attention
before they have an opportunity to develop serious features
which may terminate in death before the seriousness of
the condition is realized.
As a rule, almost any diarrhea in children will raise the
temperature. This does not occur so often with adults
unless the diarrhea results from infectious fevers, ptomaines,
263
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264 DIETETICS FOR NURSES
etc., in which case it may rise suddenly and to a considerable
height.
ACUTE ENTERITIS (dIARRHEA)
The Bowels. ā The symptoms of this condition are too
liquid or too frequent stools^ the number varying from three
to twelve or more a day. They may be greenish yellow in
color and contain particles of undigested food and mucus.
In prolonged diarrheal attacks the stools sometimes contain
blood.
The attack may be accompanied by more or less pain
of a colicky nature, due to the formation of gas in the intes-
tinal tract. In ptomaine poisoning this pain is sometimes
very intense. As a rule the intestinal tract is emptied by
means of salt, oil, etc., but this is generally directed by the
physician. A soapsuds or salts and glycerin enema to
flush the colon will often give quick relief by dispelling the
gas.
Starvation. ā The entire digestive tract requires abso-
lute rest for a certain period ; no food and very little water,
the latter in the form of bits of ice only, are given for a
period lasting from twelve to thirty-six hours or more, de-
pending upon the violence of the attack and the condition
of the patient. This is to allow the toxic substances which
are probably causing the disturbance to pass out of the
body, either in the feces or in the urine. When the acute
symptoms subside, that is, when the pain and distention
of the intestines have disappeared, and the bowel move-
ments become more normal in number and character, the
dietetic treatment suitable to the condition is instituted.
Dietetic Treatment. ā The first day the patient is given
a small cup of weak tea, half a glass of buttermilk or pep-
tonized milk, or a cup of well-skimmed meat broth, every
three or four hours. If the patient is weak, the nourish-
ment may be given oftener, and in those cases it is often
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DISEASES OF THE INTESTINAL TRACT 265
found advisable to give a small amount of alcohol in the
form of brandy in albumen water, or panopepton or liquid
peptonoids. These may be administered in tablespoonful
doses every two hours. Whole milk, unless it is peptonized,
and at times even then, is not advisable in diarrheal con-
ditions on account of its liability to form curds which decom-
pose with the production of toxic substances, known to be
exceedingly irritating to the already inflamed mucous mem-
branes lining the intestinal walls.
Increasing the Diet. ā As the diarrhea and inflamma-
tion subside, the following foods are gradually introduced
into the dietary, keeping in mind always that a return of
the acute symptoms is apt to occur. Hence the patient
must never be overfed. It is better to err on the side of
too little than too much food during the early convalescent
period.
Diet. ā Soft-cooked eggs, toast (slightly buttered),
cocoa made with water instead of milk, chicken, calf s foot
or wine jelly; later, well-cooked rice, junket, and soft cus-
tard; still later, lightly broiled beefsteak, lamb chops,
chicken, squab or quail, sweetbreads or brains. Not until
the patient is entirely free from all symptoms of diarrhea
or intestinal disturbance may the following foods be given :
cream or cream dishes such as cream toast, cream chicken,
or cream soup, raw or stewed fruit, green vegetables, salt
foods, spiced foods of any description, pastries, confection-
ery and desserts in general, unless they are simple in char-
acter and are sweetened with saccharin instead of sugar,
as the latter substance is particularly susceptible to fer-
mentation.
Anemia as a Result. ā Anemia is one of the most com-
mon results of prolonged diarrheal attacks, especially in
those toxic diarrheas resulting from infectious diseases,
dysentery, etc. The blood making tissues suffer from a lack
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266 DIETETICS FOR NURSES
of nourishment and are in consequence incapable of pro-
ducing blood of the best quality. Hence the starvation
treatment cannot be carried on over a very extended period
or the resulting anemia may be more difficult to overcome
than the original trouble.
Selecting and Regulating the Diet. ā The following
points must be kept in view when regulating the diets of
individuals who are prone to develop diarrhea:
Preparing the Diet. ā Only such foods as are known to
agree with the individual, and these prepared in the sim-
plest manner possible, must have a place in the dietary.
Fermentation. ā All foods that are subject to fermenta-
tion either in the stomach or intestines must be withheld,
at least until the attack is well over. Sugar is an example
of such foods; saccharin may be substituted when neces-
sary.
Avoidable Foods. ā Pork, veal, and shellfish must be
left out of the dietary, possibly for months, since they have
been found frequently not only to bring about a return
attack of diarrhea but also to have been the cause of the
original one.
Fatty foods of all sorts had best be avoided as long as
there are symptoms of diarrhea; these foods are handled
with difficulty by the digestive apparatus and impose extra
work upon the intestine, which is already taxed by the
disease.
Restricting Fluids. ā Fluid foods should be more or
less limited in the diet, since they require more effort on
the part of the intestines than the more concentrated foods.
Proprietary Foods. ā Certain proprietary infant foods ^
are at times found to be exceedingly valuable, since they
furnish food in a concentrated and digestible form. Among
these Mellin's Food, Racahout, and Imperial Granum may
be mentioned.
* Malted foods are contraindicated, as malt exerts a very laxative effect.
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DISEASES OF THE INTESTINAL TRACT 267
CHRONIC ENTERITIS
The Stools. ā When the diarrhea is chronic in char-
acter, the character of the stools indicates the seat of the
inflammation. When there is a great deal of undigested
food found in them the upper part of the bowel is more
affected; when the stools contain more mucus than food
the lower bowel is the chief seat of the trouble. The fre-
quency and fluidity of the stools impose a great strain upon
the entire body, causing a progressive emaciation and
anemia.
The treatment is similar to that instituted in acute
attacks. The starvation regime cannot be carried out for
a long period. Efforts must be made to ascertain the cause
of the trouble and to overcome it. This is, as a rule, more
easily accomplished with adults than with infants and chil-
dren.
Dietetic Treatment. ā The diet is the chief point of
observation and attention. The same care must be ob-
served as is found necessary in the after-treatment of acute
diarrhea. The patient must be cautioned not to eat indi-
gestible foods or those which are known to cause trouble
in this respect. She must be warned against eating when
over-tired.
ENTEROCOLITIS
Enterocolitis is an inflammation of the lower intestines
and colon. The stools contain more mucus than those
occurring when the inflammation is higher up in the intes-
tines and blood is also more frequent in these stools. The
prostration is more marked and the fever apt to be higher
than in ordinary diarrheal attacks. However, acute attacks
of enterocolitis do not produce the marked anemia or the
emaciation which are so common in the chronic cases of
enteritis.
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268 DIETETICS FOR NURSES
Dietetic treatment the same as that used in acute
diarrhea.
ACUTE DYSENTERY
Dysentery is a disease in which the seat of inflammation
is the colon. The bowels are distended and tender, the
pain at times is acute and spasmodic, and the fever mod-
erate. The constant desire to defecate and the straining
which accompanies each effort, as well as the small stools,
containing both blood and mucus, furnish the characteristic
symptoms of this disease. Rest in bed is absolutely neces-
sary; the patient must be induced to use a bedpan.
Dietetic Treatment. ā The diet consists entirely of
liquids as in acute diarrhea, the same careful regime being
observed as in those conditions. The soreness in the abdo-
men is at times relieved by spice poultices or a hot turpen-
tine stupe.
CHRONIC DYSENTERY
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 dis-
ease, consists of rest and liquid diet. The medicinal treat-
ment is left entirely in the hands of the physician.
APPENDICITIS
Appendicitis is an inflammation of the vermiform ap-
pendix. It may be acute or chronic in form.
Symptoms. ā The disease is manifested by sudden pain
in the right side, tenderness over the seat of the inflamma-
tion, and a localized rigidity of the right iliac fossa. The
attack is as a rule accompanied by fever which may run as
high as 103Ā° or 104 "" F. Thepatient may suffer from nausea
and vomiting. Constipation is generally an annoying symp-
tom of the disease.
Rest in Bed. ā The treatment of the acute attack con-
sists of total abstinence from food for twelve or more hours
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DISEASES OF THE INTESTINAL TRACT 269
until the most acute stage has passed and the patient either
passes into the hands of the surgeon or the symptoms begin
to subside in violence. It is necessary that the patient be
kept in bed, not being allowed to rise for anything. The
nurse must make him understand that his recovery, possibly
his very life, depends upon his absolute quiet during the
early stages of the disease.
Dietetic Treatment. ā When the first acute symptoms
have passed, the diet must consist of fluids, well-skimmed
meat broths, buttermilk, peptonized milk, albumen water or
albumenized orange juice. No solid food must be given
until the acute symptoms have disappeared. When the ten-
derness in the right side has entirely left him and he no
longer suffers the pain or nausea, a gradual return to a nor-
mal diet may be made. The patient must be cautioned
against eating indigestible foods, as an attack of intestinal
indigestion may readily start up an irritation in the sus-
ceptible appendix and cause a second attack of appendicitis
which is often of a more serious nature than the first.
Convalescent Diet. ā The return to solid food is made
gradually as in other intestinal disorders, by giving the most
digestible foods first. Soft toast, soft eggs, fine cereal gruels,
well-cooked rice, well-baked white potatoes, meat, wine or
fruit jellies; then lightly broiled beefsteak, lamb chop,
chicken, sweetbreads, or brains given in small quantities
until the intestinal tract has regained its vigor.
Foods to Be Avoided. ā Highly seasoned foods must
be avoided on account of their astringent qualities, which
may cause constipation. Long, tough-fibered meats, coarse
vegetables, rich foods, in fact anything which may cause
intestinal indigestion, must be eliminated from the dietary.
A decomposition of the foods lying in the lower part of the
small intestine is dangerous to such individuals, since such
products are highly toxic in character and exceedingly irri-
tating to the already tender appendix.
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270 DIETETICS FOR NURSES
CHRONIC CONSTIPATION
Chronic constipation is so universal a condition tliat it
must be treated and overcome whenever it is possible. This
condition is not only the cause but the result of disease. It
may be induced by improper food, poor hygiene, sedentary
habits, lack of exercise, the taking of drug preparations such
as cough sirups which contain opium in some form, the
constant taking of cathartics and enemas, or it may be an
hereditary condition.
Diet, Exercise, and Fresh Air. ā The chief means of
overcoming this deplorable chronic condition is by regulat-
ing the diet and increasing the amount of exercise in the
fresh air.
At times it is necessary to resort to artificial stimulation
of the intestinal movements; at others, on account of the
disease of which it is only one of the symptoms, it is dan-
gerous to irritate the already inflamed mucous membranes
lining the intestinal wall. In these cases the physician pre-
scribes the method of procedure. In ordinary cases, how-
ever, the following suggestions may be used as a guide in
overcoming the condition.
Available Foods. ā It must be borne in mind that the
food must not be too concentrated in character or it will be
so completely absorbed as to leave little or no residue for
the feces, and since the waste products of metabolism, both
of food and body materials, must be eliminated, a certain
amount of fecal matter is necessary to assist in this work.
Vegetables, such as celery, turnips, lettuce, asparagus, string
beans, spinach, and beans, lentils, lima beans, and onions;
fruits, such as raisins, figs, and prunes; and cereals which
have not had all the bran removed, such as cut oats, cracked
wheat, etc., on account of the cellulose they contain, act ad-
mirably in overcoming chronic constipation. It is found,
however, that when even these are not sufficient in certain
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DISEASES OF THE INTESTINAL TRACT 271
cases, bran added to the food, either alone, with the break-
fast cereal, or in the form of biscuits, muflSns, or cookies,
will give just the necessary amount of ballast to the food
mass to make it stimulate the peristaltic movements by its
pressure upon the intestinal walls.
Stimuli to Peristalsis. ā Foods yielding certain acids
exert a stimulating action upon intestinal peristalsis.
Available Foods. ā Those particularly valuable for this
purpose are limes, oranges, apples, prunes, figs, raisins, and
most fruit juices (with the exception of blackberries, which
are constipating), tomatoes, and rhubarb. The fruit juices
may be diluted with water or carbonated water (in the lat-
ter case the action is increased because of the gas contained
in the water), and taken the first thing in the morning, or
the fruit may be eaten at night before retiring, and in the
morning on an empty stomach. Prune pulp or prune jelly
may be given to children as well as to adults. The action
of this fruit is augmented by the addition of senna leaves. A
conserve made of prunes, figs, and raisins given in teaspoon-
ful doses at night and before breakfast often gives splendid
results in curing chronic constipation.
Gas-forming Foods. ā The eating of foods which give
rise to a slight formation of gas owing to their tendency to
ferment likewise acts as a stimulus to intestinal movements.
Among these may be mentioned honey, molasses, cauli-
,^ flower, cabbage, spinach, and onions. If the honey and mo-
lasses are poured on bran muffins or biscuits, on breakfast
food, or added as sweetening agents to cookies, they will be
found particularly valuable. Care must be taken, however,
not to give too much of either of these foods or they will
disturb the digestion and do more harm than good.
Use of Salt Foods. ā Foods such as herring, caviar,
anchovies, ham, etc., on account of the salt they contain,
exert a stimulating effect upon the movements in the small
and large intestines. Graham bread, spread with brown
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272 DIETETICS FOR NURSES
sugar, molasses, or honey, makes an acceptable addition to
the meal of the majority of children and to that of many
adults.
Fats and Mineral Oils. ā The use of fats is often rec-
ommended; olive oil may be given in tablespoonful doses
before breakfast and at night or it may be served on v^e-
tables and salads. If one or two tablespoonfuls are taken
at night and before breakfast, it may act as a laxative. In
many cases, however, this oil is completely absorbed in tiie
small intestine and hence there is none left to lubricate the
passage for the food mass. When vegetable oils do not
prove satisfactory, mineral oils may be substituted. These
oils have absolutely no fuel value and are not digested in
the intestinal canal but mix with the fecal mass, softening it
and stimulating its passage through the large intestine.
There are certain individuals with whom the mineral oils
do not act as lubricants and instead of softening the feces
and lubricating the passage will slip through Uie intestinal
canal without carrying the feces along.
Sample Diet Sheets. ā The following menus are sug-
gested for the use of individuals suffering with chronic
constipation :
7 A.M. Orange juice and water.
8 A.M. 1 bran muflSn with honey and cream.
1 or 2 slices of bacon.
Whole wheat biscuits.
A cup of coffee, cereal Coffee, or hot milk (not boiled).
Luncheon
1 P.M. Casserole of beef made with lean beef.
Turnips and potatoes.
Graham bread or muffins and honey or preserves.
Milk or " hot water " tea.
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DISEASES OF THE INTESTINAL TRACT 273
Dinner
Tomato bouillon.
Roast lamb.
String beans.
Potatoes baked with jackets on.
Celery salad, dressed with plenty of oil and lemon
juice.
Prune jelly with whipped cream.
Breakfast
Prunes and figs cooked together.
Slice of ham with 1 soft-cooked, poached, or scram-
bled egg.
Whole wheat or bran biscuits.
Coffee with cream and sugar.
Luncheon
V^etable soup.
Pork and beans.
Boston brown bread.
Baked apple (skin eaten).
Oatmeal wafers.
Dinner
Roast beef.
Spinach or cauliflower served with butter sauce.
Cold slaw.
Pineapple jelly (pineapple left in), whipped cream,
or
Date and fig pudding.
AUTO-INTOXICATION
Auto-intoxication is a condition produced by the absorp-
tion of the decomposition products of food in the intestinal
canal.
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274 DIETETICS FOR NURSES
Absorption of Toxins. ā As a rule the condition occurs
in individuals suffering more or less from constipation
which may be due to errors in diet or a lack of tone in the
intestines, giving rise to a sluggishness in the peristaltic
movements in this region of the alimentary canal. In cer-
tain individuals the liver is more or less sluggish, or in some
way fails to do its regular work of detoxifying the products
of metabolism brought in by the blood stream, in which case
these toxins are reabsorbed into the system and induce a
condition known as auto-intoxication.
Care of Bowels. ā As a rule the patient has more or
less fever, nausea and at times vomiting. The head aches
and the abdomen may be distended by the formation of gas
in the intestines. The treatment is like that used in the
majority of intestinal disorders. The bowels are emptied
by means of soapsuds or salts and glycerin enemas. Cer-
tain physicians recommend an enema made with equal
quantities of milk and molasses, with enough hot water
added to make a thin, warm solution. Care must be used
in preparing this flatus enema on account of the danger of