If attention has been given to the foregoing explanation, which has been rendered as clear and simple as the difficulties of the subject allow, it is evident that the aim of dietetic treatment in fever must be to prevent the excessive waste of the albumen of the tissues, and to supply the body with albumen and salts, which are being rapidly burnt up in the system, so that when the fever passes, emaciation and weakness may not be so extreme as to greatly retard convalescence.

Beef-Teas

The almost universal custom is to feed the patient on beef-tea. This treatment is from time to time attacked on the ground that beef-tea is neither a strengthening nor an albuminous food, but is mainly stimulating, and contains only gelatine and not albumen. This is true, but beef-tea still remains a very valuable food in fever. It is a preservative food; it preserves the tissues from destruction, and thus indirectly maintains strength. The muscles and blood corpuscles are being destroyed in the fever process. If therefore a nitrogenous food can be presented for combustion in their place, they are saved. Such a food is beef-tea, containing, as it does, a large amount of soluble gelatine. Beef-tea also contains salts and extractives of the greatest use to the patient; and if, as I have elsewhere advised, a little muslin bag full of chopped vegetables be stewed in the beef-tea and the juices be squeezed into the liquid before serving, vegetable salts, which are necessary to the depleted system, will be added.

Peptonised beef-teas can be used with advantage, and in prolonged cases meat pulp may be given mixed with broth or beef-tea. Of the prepared extracts Armour's nutrient wine of beef peptone is one which should be of the greatest value in fever. Each pint contains one pound of predigested beef. Here, therefore, peptones, not gelatine, are the nitrogenous food administered. This excellent preparation can be obtained, I believe, in a non-alcoholic form.

Dr. Burney Yeo says, "The unpleasant taste and smell of peptonised foods are opposed to their general adoption". There is no reason, however, why these foods should have an unpleasant taste and smell if carefully made. Celery seed should be boiled with the beef-tea; or a roux, made with a very small quantity of fried onions or baked flour, be added to the cup of beef-tea, or a flavouring may be given by vegetables or herbs. These flavours may be varied from day to day, and peptonised foods be thus made palatable and pleasant.

Test For Peptones

It may be interesting and useful to the scientific nurse to know how to test a beef-tea or beef-extract for peptones. Dilute the beef-tea with five or six times its volume of water, render the mixture alkaline with caustic potash, and add a small quantity of sulphate of copper. If peptones are present a brilliant rose-red colour is produced, if the proteids are unchanged a violet tint appears.

Farinaceous Foods

Duodenal digestion is not so profoundly altered in fever as stomachal digestion, and hence farinaceous foods are more easily digested. Gruel and arrowroot are most useful articles of diet in the sick-room, and as they are generally the vehicle for milk they are excellent foods. The use of milk must, however, be carefully watched, not only to see if it agrees with the patient, but to ascertain if it passes through the digestive track as hard and irritating curds. In this case its use must be discontinued. Junket is an excellent dish not sufficiently used for fever patients.

In cases where there are periods of remittance of the high temperature, as in intermittent fever, it is advisable to give the patient solid food during the periods of intermission, if it does not provoke vomiting and diarrhoea.

During convalescence the return to solid food must be gradual; to overfeed a convalescent is as unwise as to starve a fever patient. The food must be selected especially with the object of repairing tissue waste. It should therefore be albuminous, and of a kind and variety not to overtax the weakened digestive power. The ball of a grilled muttor chop, braised fillet of beef, roast and boiled chicken are among the best and most digestible foods for the convalescent from acute fever.