No account of the dietetics of enteric fever can be considered adequate without some reference to the interesting dietary suggested by the Russian physician, Bushuyev. His published results did much to stimulate experiments in the direction of a more liberal diet, especially in America, and if few have followed his plan in its completeness many have modified it and have been satisfied with the results obtained. Bushuyev's treatment is to give solid food to all who can take it from the moment they come under observation. Meat, bread, and boiled eggs are all allowed. The number of patients treated was 398, and only four of them suffered from haemorrhage and one from perforation. It would appear, therefore, that the ulcerative complications of the fever were very much less frequent than is ordinarily the case, and even allowing that the type of the disease may have been less severe than usual, it is fair to conclude that solid feeding does not predispose to these dangerous conditions. No figures relating to the occurrence of relapses are given by Bushuyev, which is unfortunate, as it is particularly alleged against solid feeding that it renders relapses more common. The mortality of the cases was 8.2 per cent. The Russian physician is convinced that, once the patient's interest can be stimulated in his diet, his general condition is rapidly improved. Even patients, extremely ill, with temperatures exceeding 102° F., sit up in bed and are able to feed themselves, only few requiring the help of the nurses. Every effort must be made to stimulate the appetite and to avoid disgusting the patient with his food.
The following is the dietary suggested by Bushuyev for the acute stage : -
7 a.m..... Tea with a roll.
8 a.m..... Oatmeal, barley, or wheat liquid porridge with butter (about 13 fluid oz.).
9 a.m. One or two boiled eggs, hard or soft, as the patient prefers. 10-11 a.m. ... A glass (about 7 oz.) of milk, a roll, half a cutlet and a piece of boiled meat. 12-12.30 p.m. . . A plate (7 oz.) of chicken soup, or ordinary soup, and a cupful of jelly.
3 p.m..... Tea with a roll.
6 p.m..... A cup of chicken or beef-tea, semolina pudding or milk, a bit of chicken.
8 p.m..... Milk with a roll.
During the night . Coffee or tea with milk two or four times, coffee with cognac.
In addition to the above the patients receive from 1-3 oz. of wine in the morning and half an ounce of Stoke's mixture of egg and brandy every two hours. The diet altogether seems excessive, but it is interesting to know that it can be given without harming the patient. To most of us it would appear adequate to nourish a healthy man in full exercise.
In England Barrs, whose results were published a year earlier than those of the Russian physician, while believing equally in the value of solid food, takes a less pronounced and more rational view of the question. He does not recommend that the patient's appetite should be forced. " To give a patient with dry and shrivelled tongue, teeth covered with sordes, semicomatose from pyrexia, and utterly indifferent to all around him, and especially to food, meat, or any other solid would be to my mind as silly and as cruel as to withhold it from a patient who expresses himself as genuinely hungry and who looks so, because his temperature curve is not normal, or because his bowels are acting a little too frequently." The appetite of the patient, once the physician has satisfied himself that the hunger is really genuine, is to be regarded as the indication for solid food. Barrs considers, from a study of his cases, that there is no reason to believe that diarrhoea is rendered worse by a liberal diet, or that perforation occurs more frequently in liberally fed patients. Meteorism, again, is less likely, he thinks, to occur on a diet which contains a reasonable quantity of solids than on one exclusively fluid. Meat and bread are allowed throughout the acute stage. The meat is usually minced at first, as otherwise it is difficult to take, unless the patient is allowed to sit up, which it is certainly most dangerous, notwithstanding the views expressed by Bushuyev, to allow any enteric patient at the height of his fever to do.