As the diet which I personally feel most justified in recommending, and which has been already described in detail, includes the use of solid foods early in convalescence, it will be unnecessary to add much on this subject here. It is, however, interesting to note that both Barrs and Marsden were led to use solids during the acute stage by the success which they had obtained by the employment of liberal diet in the period of early convalescence. Most physicians, with much experience of enteric fever, will agree that nothing reduces a prolonged swinging temperature in the convalescence of a patient more than the use of solid food, always provided the patient is really hungry. As an instance of what may be done in the direction, I may quote the daily menu of a patient of Barrs', who after eight weeks' fever was getting into a dangerously exhausted state, the temperature having assumed the remittent type, with evening rises to 100° F. and over, the morning readings being somewhat above the normal line. She had been very strictly dieted and was extremely hungry. She was placed on the following diet: -
Morning temperature, 99° F. Breakfast: coffee, bread and butter, bacon and egg. Dinner : sweetbread, part of a chop, potato, stewed plums and sago pudding. Tea with bread and butter and sponge cake. Supper: porridge and milk. Evening temperature, 99.8°.
Morning temperature, 98.8°. Breakfast : coffee, toast, bacon, bread and butter. Dinner : lamb, potato, peas, custard pudding and stewed plums. Tea with bread and butter and tomatoes. Supper: porridge and biscuits. Evening temperature 100°.
Morning temperature 97.8°. Breakfast : coffee, toast, bacon, bread and butter. Dinner : cold lamb, potatoes, peas, rice pudding. Tea with bread and butter, a boiled egg, and tomatoes. Evening temperature 98.8°.
Thereafter the patient had the ordinary food of the family and the evening temperature was steadily normal after two days.
Without quite admitting the desirability of commencing by allowing such a large supply of food to a patient who had been strictly dieted, I should never hesitate in a case, where the fever had been prolonged, to give solids such as fish in small quantities, and potatoes well mashed in gravy as soon as the morning temperature has touched the normal line, or even sooner; and during the lysis, as recommended by Marsden, should the wasted and exhausted condition of the patient appear to call for it. The vast majority of patients, however, will do very well with a more gradual increase of diet at this period, especially if they have been carefully dieted throughout the fever. The general conclusion to be drawn from the study of these liberal dietaries is that they may be occasionally very useful but are not always necessary. The good rule is to treat the patient as an individual and not to be too much hampered by theories of dietetics. I may add here that, without being a keen supporter of intestinal antiseptics, such as salol, guaiacol, or naphthol, I think they may be especially useful in helping to limit any undue fermentation in patients who are being liberally fed. At a time when most of my cases were being treated with a liberal soft diet, those who had also intestinal antiseptics undoubtedly did better than those who had not.