CHAPTER XX.

INFLUENZA.

THIS is not the place to discuss the pathology of the disease to which the name of influenza has become attached, nor have we space to enter upon a consideration of the etiology of the affection, but the importance of dietetic treatment in all forms of the disease admits of no question.

Some cases require a diet similar to that which we should advise for patients suffering from any specific fever, but in others special measures for the support of the strength are undoubtedly necessary. The tendency is towards asthenia, and this is more marked in some cases than in others, though weakness is always a more or less prominent symptom. The resulting muscular prostration and depression of the nervous system are in most cases out of all proportion to the apparent severity and duration of the attack. Many patients complain of inability to walk any distance with comfort, or without feeling exhausted, and this is usually most marked in those who have not been able, during the attack, to take nourishment well. In others the most notable persisting symptom is feeble action of the heart, with a tendency to fainting after exertion, or if they have gone long without food.

Three different varieties, at least, may be distinguished, according as the brunt of the attack has fallen upon the lungs, upon the gastro-intestinal mucous membrane, or upon the nervous system.

In the first group there is bronchial catarrh, with elevation of temperature and some prostration, but fortunately without, as a rule, great repugnance to food. In these cases

we should advise a diet like the following at the commence

ment:

Six to eight ounces of milk, with one or two ounces of barley water, or of soda water, may alternate at intervals of two-and-a-half to three hours with like quantities of mutton-broth or chicken-tea or beef-tea. The broth or beeftea should be thickened with some farinaceous substance (see p. 140). After a few days, when in uncomplicated cases temperature will have fallen, a diet of four small meals a day, with intermediate supplies of light nourishment will be suitable, thus:

Early in the morning, a cup of milk flavoured with tea. 8.30. A lightly boiled egg, or a piece of fresh white fish, with toast and butter and one cup of weak tea with milk, or coffee and milk or cocoa.

11.30. A cupful of broth or beef-tea, with fingers of toast, or thickened with some biscuit (crumbled).

1.30. Fresh white fish or chicken, or other bird, with a little mashed potato and well-boiled green vegetable: some simple pudding.

4.30. A cup of weak tea with plenty of milk, toast and butter.

7.30. A meal like the midday one.

10.30-11. A cupful of prepared farinaceous food, or of gruel or arrowroot.

Stimulants. The amount will vary in different cases, according to the state of the pulse and the general strength of the patient. Where there is no special indication of weakness, a tablespoonful of spirit in water, with the midday and with the evening meal, will suffice. Others will require and will benefit by a larger allowance. A dessertspoonful at 11.30 and another at 7.30 in water, or in effervescing water, and one in the food at bedtime, will not in these cases be too much. As convalescence progresses a couple of glasses of champagne at the midday and evening meals may take the place of the spirits.

In the group of cases, where gastro-intestinal catarrh is a prominent symptom, careful dietary is very essential. Food must be bland, non-irritating, and easily digested, leaving little residue, and not such as is likely to set up fermentative changes. For details the reader is referred to pp. 39 and 40.

In the third group of cases, where the nervous system is profoundly affected, patients can take and can bear large quantities of food. In some cases, indeed, of this type, feeding must be kept up regularly through the night, sleep being obtained only after food has been taken.

A characteristic of many cases in this group is the absence of any rise of temperature, or other sign of febrile disturbance. The temperature, indeed, often falls below normal, and this is most noticeable when any considerable time has elapsed since the last supply of food has been taken.

In the class of cases we are now considering, it is not necessary to restrict the patient entirely to liquid nourishment. Solids may be given almost, if not quite, from the commencement, though of course food must be very simple. There should be three good meals a day, with some intermediate supplies between them, and light food should be given several times during the night.

Breakfast.—A couple of eggs, or egg and bacon, or white fish, with bread, or toast and butter; a cup of caféau-lait or of cocoa.

In the forenoon a small cup of soup or of good beef-tea thickened with some farinaceous material.

Luncheon.—Any light tender meat—chicken, game, or mutton—with a little mashed potato; any simple pudding. Beverage.-A couple of glasses of good claret or of champagne, or from one to two tablespoonfuls of whisky in a little effervescing water.

Afternoon Tea.-Tea, with plenty of milk, or cocoa; bread and butter or toast and butter.

Dinner. A meal like luncheon.

Beverage. A pint of claret or of champagne. Before settling for the night a cupful of prepared farinaceous food or of gruel, with a tablespoonful of brandy or whisky in it.

During the night milk or soda water, with a dessertspoonful of brandy in it, or beef jelly or beef-tea, warmed by being kept under a cosey, should be given once or twice. Stimulants. In the above directions the amount of stimulant mentioned is not more than would be required in an average case of the kind, but in many a considerably larger quantity may be given, not only without harm, but with great benefit.

APPENDIX.

SICK-ROOM COOKERY.

GENERAL CONTENTS-COOKING FOR INVALIDS: Beef Essences-Beef TeaNutritious Beef-Tea-Beef-Tea with Oatmeal-Mutton Broths-ChickenTea-Calf's-Foot Broth-Mutton Broth-Veal Broth-Egg and Brandy -Egg and Sherry-Caudle-Another Caudle-Milk and IsinglassArrowroot-A Gruel-Oatmeal Gruel-Tamarind Water-Arrowroot and Black-Currant Drink-Cream of Tartar (Potus Imperialis)—Rice Water-Snow Pudding-Lemonade-Milk Lemonade-Rice and Milk -Oatmeal Porridge-Milk Porridge-Whole Meal Porridge-Irish Moss -Toast Water-Barley Water-Milk, Eggs, and Brandy-Port-Wine Jelly-Bread Jelly-Wine Jelly-Chicken Panadas-Game Panada— Nourishing Soup-Tapioca Soup with Cream-Purée of Potatoes-Cream of Barley-Maccaroni with Milk-Maccaroni (Stewed in Stock)—Lamb's Head-Cow-Heel Fried-Ox Palates-Sweetbread-Sweetbread with White Sauce-Calf's Head-Tripe-Breast of Lamb with Vegetables— Kedgeree-Fish Soup-Calf's-Foot Jelly-Blanc-Mange-Arrowroot Pudding-Custards-Rice Pudding-Rice Cream-Corn-Flour-Hominy Pudding-Blanc-Mange-Cream-A Ripe Fruit Cream-Chocolate Cream-Summer Fruit Pudding-Apple Charlotte-Charlotte RusseOmelet Soufflé—Omelet Savoury-Peptonised Milk-Peptonised Gruel -Peptonised Milk Gruel-Peptonised Soups, Jellies, and Blanc-Manges -Peptonised Beef-Tea-Peptonised Enemata-Whey-White Wine Whey-"Tops and Bottoms in Milk."

1. Beef Essence.

Take one pound of gravy beef, free from fat and skin. Chop it up very fine; add a little salt, and put it into an earthen jar with a lid; fasten up the edges with a thick paste, such as is used for roasting venison in, and place the jar in the oven for three or four hours. Strain through a coarse sieve, and give the patient two or three teaspoonfuls at a time.