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Page 32
As to the meals, I leave them to the patient's caprice, unless this is
too unreasonable; but I like to give butter largely, and have little
trouble in getting this most wholesome of fats taken in large amounts. A
cup of cocoa or of coffee with milk on waking in the morning is a good
preparation for the fatigue of the toilet.
At the close of the first week I like to add one pound of beef, in the
form of raw soup. This is made by chopping up one pound of raw beef and
placing it in a bottle with one pint of water and five drops of strong
hydrochloric acid. This mixture stands on ice all night, and in the
morning the bottle is set in a pan of water at 110� F. and kept two
hours at about this temperature. It is then thrown on to a stout cloth
and strained until the mass which remains is nearly dry. The filtrate is
given in three portions daily. If the raw taste prove very
objectionable, the beef to be used is quickly roasted on one side, and
then the process is completed in the manner above described. The soup
thus made is for the most part raw, but has also the flavor of cooked
meat.[28]
In difficult cases, especially those treated in cool weather, I
sometimes add, at the third week, one half-ounce of cod-liver oil, given
half an hour after each meal. If it lessen the appetite, or cause
nausea, I employ it thrice a day as a rectal injection; and in cases
where the large doses of iron used cause intense constipation, I find
the use of cod-oil enemata doubly valuable, by acting as a nutriment and
by disposing the bowels to act daily. This may be given as an emulsion
with pancreatic extract. This will suit some people well, and result in
a single passage daily, but in others may be annoying, and be either
badly retained or not retained at all, and may give rise to tenesmus.
The question of stimulus is a grave one. In too many cases which come to
me, I have to give so much care to break off the use of all forms of
alcoholic drinks that I am loath to resort to them in any case, although
I am satisfied that a small amount is a help towards speedy increase of
fat. Its use is, therefore, a matter for careful judgment, and in
persons who have never taken it in excess, or as a habit, I prefer to
give, with the other treatment, a small daily ration of stimulus: an
ounce a day of whiskey in milk, or a glass of dry champagne or red wine,
seems to me useful as an adjuvant, and as increasing the capacity to
take food at meals. Nevertheless, alcohol is not essential, and for the
most part I give none, except the small amount--some four per
cent.--present in fluid malt extracts. Even this is found to excite
certain persons, and it is in such cases easy to substitute the thicker
extracts of malt, or the Japanese extract, made from barley and rice.
So soon as my patient begins to take other food than milk, and
sometimes even before this, I like to give iron in large doses. In
hospital practice the old subcarbonate answers very well, being cheap,
and not unpalatable when shaken up in water or given in an effervescent
draught of carbonated waters. In private practice large doses of salts
of iron, as four to six grains of lactate at meal-time, are
satisfactory; but the form of iron is of less moment than the amount.
Very often I meet with women who cannot take iron, either because it
disturbs the stomach, causes headache, or constipates, or else because
they have been told never to take iron. In the latter case I simply add
five grains of the pyrophosphate to each ounce of malt, and give it thus
for a month unknown to the patients. It is then easy to make clear to
them that iron is not so difficult to take as they had been led to
believe, and when it has ceased to disagree mentally I find that I am
able to fall back on the coarser method. If iron constipate, as it may
and does often do when used in these large doses, the trouble is to be
corrected by fruit, and especially pears, by the pill of the watery
extract of aloes and ox-gall already mentioned, by extracts of cascara
or of juglans cinerea, which may be added to the malt extract ordered
with the meals, or by enemata of oil, or oil and glycerin, or a glycerin
suppository. The instances in which iron gives headache and sense of
fulness are very rare when the patient is undergoing the full treatment
described, and, as a rule, I disregard all such complaints, and find
that after a time I cease to hear anything more of these symptoms.
Unless some especial need arises, iron, in some form, is the only drug I
care to use until the patient begins to sit up, when I order nearly
always sulphate of strychnia, in rather full doses, thrice a day, with
iron and arsenic.
Probably no physician will read the account I have here detailed of the
vast amount of food which I am enabled to give, not only with impunity
from dyspepsia, but with lasting advantage, without some sense of
wonder; and, for my own part, I can only say that I have watched again
and again with growing surprise some listless, feeble, white-blooded
creature learning by degrees to consume these large rations, and
gathering under their use flesh, color, and wholesomeness of mind and
body. It is needless to say that it is not in all cases easy to carry
out this treatment.
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