Of all the infectious fevers, this one presents the greatest difficulty to the dietitian. The responsibility of the dietitian is greatly increased because of the fact that about the only treatment that can be given in the average typhoid case is the dietetic one. A further complication in the dietetics of typhoid fever is the fact that from the first the patient has no craving for food whatsoever, and the dietitian lacks the help that usually comes from the craving on the part of the patient. Furthermore, in typhoid fever there is usually a period of a week or ten days, called the ambulatory stage of the disease, when the patient's appetite is precarious and the nutrition more or less seriously disturbed. Therefore, when he finally takes to his bed and comes first under the care of the physician and nurse, his nutrition has already been so far interfered with that it is necessary to introduce nutriment into his system almost from the first. No food among the numerous ones that have been tested in typhoid fever has proved so satisfactory as milk, and this has for decades been recognized throughout this country and Europe as the staple article of diet in all the earlier stages of typhoid fever. Recently, however, we have come to recognize that with all its advantages milk has some serious disadvantages, and these are most in evidence in unmodified whole milk. The fact that it curdles in the process of digestion makes it distinctly more difficult to digest than its various modifications. Furthermore, the modifications are more pleasing to the appetite than straight milk. The most satisfactory modification is probably to be found in thin gruels. In the case of idiosyncrasy against milk recourse must be had to other liquid diet. Egg lemonade, egg-nog, and various similar preparations may be used. Beef juice, prepared as described above, may also be freely used.

As typhoid fever is the result of infection of the intestinal canal, those foods should be used which are almost completely digested in the stomach and duodenum and very easily digestible and completely absorbable. One of the greatest dangers in typhoid fever is that of perforation of the wall of the intestine. Should perforation take place all ingestion of food by the mouth must be suspended for a time. Any nourishment introduced must be in the form of enemata and these are sometimes contraindicated. Liquid foods must be continued in typhoid fever until the danger of perforation has passed and the patient is distinctly on the mend and convalescence practically established. There has uniformly been a considerable loss of weight and general depletion of the physical powers of the body. Convalescence is always a more or less tedious and prolonged affair. There is no part of the course of typhoid more important from a dietetic standpoint than the convalescent period. Throughout all the earlier part of convalescence semi-solid foods must be adhered to. When the appetite of the patient has returned he is ready to eat anything. If he were allowed free rein to his appetite he would almost certainly, through wrong choice of food or through overeating, bring on a relapse and the last condition would be worse than the first. From the semi-solid foods given during the first seven or ten days of convalescence, a gradual transition can be made to such solid foods as cream toast, soft-boiled or poached eggs, baked potato, baked apple, boiled rice, etc. During the latter part of the second week of convalescence steaks and chops may be introduced into the diet, but the greatest care should be taken that all solid foods should be very thoroughly masticated before they are swallowed. After the second week of convalescence a little wider range may be allowed, but so long as the patient is under the care of a physician and nurse, and even for weeks afterwards, he should be abstemious in his diet.

Care Of The Mouth

The care of the mouth is a most important hygienic measure to observe in all fever cases, particularly so in typhoid fever. The tendency to the collection of sordes and heavy coating of the tongue tends to make the food tasteless and generally to disturb the comfort and well-being of the patient. Whenever the patient is able to do so without help, he should thoroughly cleanse the mouth, rinsing it in water or in half saturated boric-acid solution. This should be done not only just after meals with a view to removing all traces of food from the mouth, thus decreasing fermentation there, but also just before the meal the mouth should be rinsed. When the patient is not able to do this himself, and such will be the case during a considerable portion of severe cases of typhoid, this important function must be performed by the nurse or attendant, using either plain water, or better, boric-acid solution followed by plain water; the mouth may be thoroughly swabbed out with a gauze swab prepared by the nurse.