The Stomach

The dangers of overfeeding with milk have already been considered upon page 433. Milk disagrees with 30 many patients sooner or later, and the fermentation processes of which it is capable produce large quantities of gas and sometimes elevation of temperature. Small doses of salicin or cerium oxalate with each tumbler of milk often prevent dyspepsia, and the milk, if sterilised, may be retained and digested where vomiting has been extreme. If there is the least indication of ordinary milk disagreeing, it should be at once changed for some other form - peptonised, or sterilized, or boiled. With a clean tongue, and -with sterilized milk in the stomach, much may be done to favour the further digestion of milk in the intestine.

The Intestine

Many typhoid patients are severely constipated by an exclusive milk diet. Constipation favours abnormal fermentation, and begets the flatulency which is so injurious. Such cases should not, as a rule, be allowed to go more than forty-eight hours without encouraging a movement with an enema. While it is not possible to render the alimentary canal in any sense truly aseptic throughout, a great deal may be done to favour the vital conditions of nutrition by preventing the opposite extreme of excessive ingestion of bacteria of various kinds and the production of malfermentation. This appears to be at present a more encouraging field for germicidal efforts than treatment directed against the seat of war in the Peyer's patches. The judicious daily use of rectal enemata never excites intestinal haemorrhage, but excessive constipation provokes meteorism, stretches the thin ulcerating surfaces to the point of rupture, and tends to keep the temperature elevated. If relapses are due to reinfection or to simple septic absorption through ulcerating intestinal surfaces, there is all the more reason for the prevention of accumulation of too much food in the intestine.

Convalescence

As the fever subsides, it becomes an important question how soon to allow a return to solid food. Relapses are very easily induced by indiscretion in this regard.

The patient's appetite is always a dangerous guide to follow in this disease. After four or five weeks of an exclusive milk or milk and broth diet, when the temperature subsides, and often before it has become normal, he becomes ravenous. Like a long-starved man, he thinks of nothing but food, and demands something new to eat every day. A hospital ward containing a dozen convalescing typhoid-fever patients is difficult to manage, as a bread riot is constantly menaced. Ill-advised but sympathetic friends attempt to smuggle in all manner of forbidden fruits, and the patient just arrived at the hungry state is tempted to steal solid food from his more advanced neighbour.

In the milder cases it is undoubtedly both safe and wise to allow a strengthening diet at an early date, and it will greatly prolong convalescence to forbid it. Light farinaceous diet - tapioca, rice, vermicelli, cream-toast, a cracker soaked in cream, etc. - may be given with impunity in cases which have run a mild course as soon as the temperature remains normal. Meat broths may be thickened with rice, sago, or vermicelli. In a day or two more the soft part of oysters or a chop are permissible. In cases which have presented no serious complications, if there is good stomach digestion there is no need of prolonging a fluid diet for fear of intestinal injury.

The following is a list of foods suitable for the different days of convalescence, commencing a day or two after disappearance of all fever. Milk should still be given until gradually wholly replaced by solid food.

First Day

Chicken broth thickened with thoroughly boiled rice. Milk toast or cream toast once only during the day. Beef juice.

Second Day

Junket, mutton broth, and bread crumbs. Cocoa. Milk toast. A piece of tender steak may be chewed but not swallowed. One of the prepared farinaceous foods, such as Mellin's or Horlick's, may be given with a cup of hot milk.

Third Day

A small scraped-beef sandwich at noon. A soft-cooked egg or baked custard for supper. Boiled rice or potato puree strained. Arrowroot gruel.

Fourth Day

The soft part of three or four oysters. Meat broth thickened with a beaten egg. Cream toast. Rice pudding or blancmange and whipped cream, or Bavarian cream.

Fifth Day

Scraped-beef sandwich. A tender sweetbread. Bread and milk. A poached egg. Wine jelly or calfs-foot jelly. Macaroni.

Sixth Day

Mush or crackers and milk, scrambled eggs, chicken jelly. Bread and butter. The soft parts of raw oysters.

Seventh Day

A small piece of tenderloin steak or a little breast of broiled chicken. Bread and butter. Boiled rice. Wine jelly. Sponge cake and whipped cream.

Eighth Day

A slice of tender rare roast beef, a thoroughly baked mealy potato served with butter or mashed with cream. Other foods as before.

Ninth Day

A little broiled fresh fish for breakfast. Beefsteak at dinner. Rice, macaroni, eggs. Sago, rice, or milk pudding. A baked apple.

Tenth Day

Mush and milk. A squab or breast of partridge or roast chicken. Other foods as before. Ice cream.

For the next four or five days the patient may select articles from the menu of the previous day, so that three good meals a day are taken, besides three or four glasses of milk between meals.

It is often desirable to give a little alcoholic stimulant, especially if there is much difference in the frequency of the pulse between lying and sitting or standing", or if the pulse rate is very slow, say 56, as it sometimes is. A glass of sherry or of good sound Burgundy or a tumbler of ale may be drunk, but with meals only.