i. Fattening Diet. • This is relatively rarely needed in childhood. After acute diseases of long duration (typhoid fever, empvenut, etc.) the weight will rise most astonishingly as soon as the mass norms has been removed and sufficient food can be given. The appetite is tremen dous, and the body will retrieve its losses without any further aid. Only at puberty and especially in girls may a fattening process be indicated, because we then often observe a rapid growth in length which far exceeds the general growth; this causes a lessened efficiency, which may induce us and still more frequently the family to demand a fattening diet. It is hardly necessary to emphasize that we must look for special indications in each case, and that we must not simply follow a fad.
In many a case we may do the children considerable permanent good, because a fattening cure is a rest cure as well and many a fidgety youngster who has tried the nerves of its family and especially its teach ers, emerges from this cure much Inure steady and easier to manage, owing to the phlegmatic temperament which goes with being fat. In such a fattening diet it is not only important what we feed but also what part of the food is retained. It is best at first to keep the patient lying clown in the open air all the time and later most of the time. Massage must take the place of all active motion. The food must be quite varied in order to retain the appetite, and the child's fancies and tastes must continuously be favored at the time. We usually increase the consump tion of fat and carbohydrates way beyond the amounts for the particular age, but not so much the proteids. Cream, whipped cream, ice cream (recipes Nos.-IS and 50), mayonnaise (recipe No. 52) with fish, cold meat or potato salad are some of the forms in which fat is well taken, pastry and puddings with their considerable amounts of sugar (also honey, marmalade, etc.) allow us to increase the carbohydrates. Let us give an example of our method from a concrete case: L. H., a girl of twelve years, exceptionally tall and lanky, extremely thin, with bones poking through all over, muscles flabby, very little fat. She is very fidgety and restless, has much headache and is quite tired from school. Used to be at the head of her class, but since she commenced growing her standing in school has deteriorated considerably and this has led to complaints from her teachers. Physical examination revealed nothing pathological except slightly irregular heart action, hemoglobin 85 per cent, blood count reds 5,000,000, whites 7,000, Pirquet negative, weight 33.0 kg.
She is made to rest out-doors all day with massage and respiratory exercises, to improve the shape of her thorax.
Large amounts of fat and carbohydrates are included in her food; as an example, we will give her menu for one day.
First breakfast: Cocoa cooked with milk, 140 Gm., and with 100 Gm. of cream: four slices of zwiebach with 30 Gm. of butter.
Second breokfast: Strawberries with 100 Gm. of whipped cream. binner: Veal roast, 1•0 Gm.; string beans, 200 Gm.; rice pudding, 150 Gm.; stewed peaches, 100 Gm.
Four o'clock lea: Chocolate ice cream 100 Gm.
One egg; milk, 180 Gm.; potato salad with mayonnaise, 200 Gin.; wheat bread, GO Gm.
Inside of three weeks her weight had risen to 3.5.1 kg., a gain of 100 Gm. daily. We now let her get up, at first for an hour at a time and then slowly half the day and letting her resume her daily routine and gradually reducing the amount of her food we sent her for some time to a farm in a wooded country. The result is permanent and the child is keeping up in school. She is energetic and lively, and continues to gain regularly though slowly.
Finally, we may remark that under some circumstances we may desire to feed the body one certain element of the food, an elective cell overfeeding, most frequently of iron, and we will then increase the vegetables rich in iron in the diet list. (See Supplement IV., p. 477.) G. Diet for requiring treatment is by no means rare in children. We may see a few- cases in young children, but the age preceding puberty shows this most frequently and a careful dietetic regime may do a great deal of good, but we must avoid any forcible cure.
Such a dietetic treatment, can best be carried out in a hospital or a sanitarium, because at the home it is impossible to earn: it out strictly, owing to the influence of the surroundings, and to the misplaced sym pathy of the family and to the lack of the continuous suggestion of the physician. All forcible measures have to be avoided and we must not try to reduce the patient's weight in the shortest possible time to one corresponding to its age. We should be satisfied with small losses and see that the patient gains only very little during the next few months or years. We will try to replace the superfluous fat and water of the tissues with muscles, bone, etc.