From the dietetic standpoint, it should be remembered:

1. That typhoid fever lasts three to five weeks or more, so that nutrition is a matter of life or death;

2. That, during the second week, there is a considerable degree of inflammation of the small - occasionally also the large have a febrile stage of more than 2 1/2 to 3 weeks, the temperature should not rise, except briefly, above 103; there should be no septic complications, including pneumonia; and there should not be an exemplification of what is known generally as the typhoid state.

The constant use of a single nutriment, such as milk, meat extracts etc., tends to produce virulence of special strains of bacteria, notably of the colon bacillus and bacillus lactis aerogenes.

One liter of milk daily (a little more than a quart), the old standard ration, furnishes approximately 40 grams each of protein, fat and carbohydrate and yields about 700 - 750 calories. To furnish the necessary number of calories, about 3 liters of milk are required, involving a relative excess of protein, water, and fat and a relative deficiency of carbohydrates, especially as there is likely to be a laevulosuria from failure to oxidize the inverted lactose.

One liter of expressed meat juice furnishes about 70 grams of protein and a negligible amount of other organic foods, and yields only about 350 calories. Beef teas made with heat above the coagulating point of albumin contain practically no nourishment, except a little gelatin and, while the extractives of an organic nature are stimulating, they are essentially urinary waste products and are not only toxic but tend still further to embarrass the emunctories. Such preparations, therefore, can not be relied upon for nutrition but may be allowed occasionally to secure variety and as stimulants.

A fair average diet in typhoid, consists of 1250 c.c. of milk and 400 - 500 grams of cereal, or approximately a pound. Shredded wheat, rice, farina, crackers and toasted or dry bread may be used to secure a variety of cereals.

The foregoing ration may conveniently be divided into five feedings, each consisting of about a cupful of milk and the equivalent of four good sized soda crackers. A shredded wheat biscuit weighs 30 grams and a standard roll 60 grams, a slice of bread about 25 - 50 grams.

In order to stimulate the appetite and gratify the patient, as great a variety of cereals should be given as possible milk should be given in different ways, for example hot ice cream, combined with enough weak tea, coffee or cocoa to flavor it, combined with eggs as raw, baked or boiled custard. Beef juice or extracts known to contain reasonable proportions of nouriah-mcnl, may be used once a day. Fruit juices, and jellies may be used in small quatities. Gelatin may also be employed, variously flavored and with whipped cream, custard sauce etc., especially if there is haemorrhage. Gruels may be used if agreeable to the patient.

Various proprietary milk foods, artificial preparations of pro-teid etc., may be used as substitutes for milk.

Diet In Convalescence

Serious symptoms, or even perforation and death in typhoid fever, have been ascribed to a bite of fruit, a small morsel of bread etc. Such occurrences are probably coincidences.

At the same time, it is unwise to allow a sudden change to an ordinary diet during eanvalescence from typhoid and, the more restricted the dirt has been during the course of the disease, the more gradually should it l>e increased.

As a general rule, the diet should not be changed until one week after complete defervescence, although an occasional - not daily-rise to 99 or 99.5, may be disregarded.

'if the patient has been on the old-fashioned milk and broth diet during the febrile stage, the convalescent diet .should, at the beginning, he about the same as that herein advised for the febrile period. Tints, the dietaries according to the respective plans of treatment will be about as follows:

Old Method

New Method

Light diet following the cereal-milk diet already described, is about as follows: For the first day or two, a poached egg on toast, for one meal a day; then a small portion of chicken breast, a broiled chop or equivalent in steak, roast beef or possibly boiled ham, for one meal a day; in the last two or three days of the week, baked apple, gelatin desserts, cereal puddings, fruit sauce, free from seeds, sponge cake, ginger or sugar cookies, baked or mashed Irish or sweet potato. More liberal use of eggs, discontinuance of milk which has probably become distasteful. Oyster stew may be allowed in the week of light diet.

It should be understood that "full diet" following the week or ten days of light diet does not mean that the patient is to plunge into all sorts of excesses either of quality or quantity. At the same time a genuine craving is not to be refused without good reason.

Any febrile or digestive disturbance occurring after the diet has been increased should lead to a return, for several days, to a pretty strict regimen.

The routine use of alcohol during typhoid is to be deprecated but 1 - 3% (teaspoonful to tablespoonful of whisky or brandy to the cupful of milk) acts as a gastric stimulant and may be used as necessary. While alcohol probably always acts as a circulatory depressant, except as it relaxes arterial tone before it does that of the heart, it is a fuel-food to the extent of furnishing 7.1 calories per gram and nearly 30 c.c. can be given daily, in small amounts, without passing the power of the body to oxidize it.

Entirely aside from its use as a food or drug, alcohol should be allowed in small amounts, quite regularly, in all patients in whom previous custom has produced tolerance and the danger of delirium tremens

Similarly, there is no objection to allowing small quantities of tea, coffee and chocolate, as drugs, to support the heart or on account of habituation. While acute sickness usually removes the taste for tobacco, if abstinence produces severe nervous symptoms, moderate indulgence is advisable. Ordinarily, however, even an inveterate smoker will not care to indulge until lescence has begun. Thus the return of the craving for generally, a favorable prognostic. The advisability of taking advantage of the opportunity to discontinue all similar bad habits, should be seriously considered.