In addition. carbohydrates are well borne in fever if well mixed in plenty of water; barley flour soups, or soups (preferably meat broths) with flour added, are also to be recommended. A certain amount of sugar may be introduced, in lemonade, milk, flour-and-milk soups. cocoa, cereals, and preserves. The quantity of sugar may be increased if, instead of cane sugar, Soxhlet's 'Niihrzucker'• (without admixture) is used; this, however, constipates when used in large quantities. It is impossible to replace the loss of body albumins in fever by the admin istration of albumins in the form of eggs and meat, as these are absorbed only in small quantities even when given frequently and plentifully. and we must be satisfied with the quantity which can be given in the milk, and in starchy foods.
Nor is a preference for albuminous nourishment indicated when the appetite increases. inasmuch as a suitable combination of albumins, carbohydrates, and fats is best adapted to the physiological require ments. The nutritive value of carbohydrates in artificial preparations is indisputable. These baby foods may sometimes be of service in later childhood, as well as in infancy, although at this period it is better to give farinaceous foods which have been prepared in the kitchen. On the other hand. in infancy one can order malt extract or unfermented gape juice (alcohol free) occasionally. If offered in small quantity at the beginning of the meal, it also stimulates the appetite. Prepared foods whioh are rich in albumin (Puro, Sanatogen, ts-'omatose) are hardly of much importance as nourishment, as they are used only in small quantities; hut even they may be of value, either for their general effect or for their ability to stimulate the appetite, especially the latter. The action of cod-liver well as other oils, is not very clear. They appear to act, however, by stimulating the appetite. All these prep arations are to be disemitinued as soon as it disinclination for them arises, owing to their interference with the proper taking of food.
Aluch less clear is the significance of those organic and inorganie sub stances which are not utilized in forming or replacing body tissues, but which are intended to do functional work; yet they should not be under valued as nourishment. To prevent harming the patient through our lack of knowledge, we should allow suflieient play for choke and taste in the matter of food. For a long time, the theorist had difficulty in estimating the value of non-nutritious constituents which are present in more or less equally nutritious foods, Le., meat, eggs, vegetables, and fruit; and only the more recent investigations have shown, for instance, the importance of phosphorus combinations in building up (anabolism), and have demonstrated the value of fresh vegetables for the prevention of serious chronic diseases. But in spite of this, there are certain stimu lants (spices, alcohol) which are always to be avoided in excess, and are to be withheld entirely from certain children.
As a rule, the number of meals should not exceed five, among which two full meals are sufficient. Where it is impossible to take enough food at one meal, a greater number of small meals should be given. More over, a dessert may be added a short time after the meal itself. Night feedings are rarely necessary. Under certain circumstances it is wise to offer frequent draughts of fluid to stimulate the patient, or to keep the mouth moist. This holds good, however, only in severe fevers and wasting diseases. It is only rarely, as in the constant vomiting of whooping-cough, that a greater number of meals must he considered. Nourishment should not have, as was formerly supposed, an increase of the weight for its sole aim, for under certain conditions and in certain diseases its action should be different.
Under the title of "The Exudative Czerny has described what, for the most part, has been understood as scrofula. For the past few years, lie has advised in this condition the use of a vegetable diet with only small quantities of milk and meat. Ile prefers that eggs be avoided altogether, and gives no sugar, and but small quantities of butter. Leaving the question of exudative diathesis out of considera tion temporarily, it is nevertheless true that there is a very close rela tion between certain skin diseases and the nourishment. In infantile eczema (in which the face is principally and most severely affected) the nourishment and particularly the quantity of milk taken, should be restricted. In the very common condition of urticaria infantum it is desirable to diminish the quantity of milk taken as well as the butter; while eggs and raw fruit should be entirely avoided. There should he an increase of soups, vegetables, and starchy foods, but the number of meals should be decreased. A similar diet should he prescribed in intertrigo. In obesity, where it is found that a disproportion exists between weight and height, it is well to give a diet that is Inure filling than nutritious. It would, of course, be impossible and useless to attempt to influence excessive growth by a retrenchment of diet. In families with the gouty diathesis, children who are otherwise healthy but who show a preference for meats, had best he restricted to warm meat once daily, and perhaps some cold cuts once daily. A purely vegetable diet is hardly indicated in any of the chronic conditions. In neuropathic children, also, it is sufficient to withdraw meat broths con taining the extractives which stimulate, and to allow meat once a day. Meat is on the same plane with other 11 erVOUS irritants (alcohol, coffee, spices, confections). Ilv avoiding these things, an over-stimulation of the nervous system will be prevented, and especially of the awakening sexual desires.