Dietetic Treatment

While the fever lasts and other symptoms are acute, such as pain and swelling of the joints, the patient should be put upon a fluid diet. The majority of cases do best at this time with an exclusive milk or bread-and-milk diet. Those patients who cannot take milk, however, may be allowed soups and broths flavored with vegetable extracts, chicken tea, milk toast, barley or oatmeal gruel, clam broth.

1 W. Gilman Thompson, M.D.: "Practical Dietetics." New York. D. Appleton & Co.

Thirst is often a prominent symptom, especially if there be much fever, and it is advisable for the patient to drink fluid freely to assist in washing out the waste products from the body. Lemonade and slightly acid drinks of various kinds, such as dilute phosphoric acid or the effervescent mineral waters, are recommended. Boiled milk and Seltzer or Vichy may be drunk, or oatmeal or barley water flavored with lemon. Alcohol should be avoided while the acute symptoms last, unless the complication of inflammation of the endocardium or pericardium enfeeble the heart action, if prolonged and anaemia is considerable, alcohol may be given as a tonic two or three times a day in the form of a glass of claret or Burgundy (one to two ounces), or diluted whiskey.

During convalescence the appetite is not usually vigorous, and it is not necessary to urge the taking of much food at first. The diet should be principally farinaceous, but not saccharine.

Such articles may be given as rice (plain or spiced), arrowroot, oatmeal, cornmeal, semolina, wheaten grits, panada, milk toast, simple unsweetened puddings, wine jelly, blanc-mange and malted foods.

The return to solid diet should be gradual, and for a long time the patient should abstain from eating meats as well as from pastry and sweets. Fagge states that no meat or fish should be allowed for at least a week after subsidence of the fever and acute symptoms, or, better, for a fortnight, and many believe that beef tea is harmful. Meat can undoubtedly induce a relapse.

When convalescence becomes established, eggs, fish, oysters, and white meat of broiled or roasted chickens may be given, and one or two such vegetables as asparagus, spinach, or stewed celery, with a baked apple or fresh fruit, but sweets and alcohol should long be withheld.

The patient should be fed often, having one or two extra lunches during the day, for anaemia is apt to prevail for some time, and abundant nutriment is required.