In typhoid fever, too, on account of the length of its course, see that the patient takes food say every two hours. Give him lemonade, grapefruit, good chicken soup, a little ice cream - that is very refreshing and good. The same principle will apply to diseases of any duration accompanied with fever.

Now we will take up the diet in chronic affections not accompanied with fever. The principle which prevails here is just the reverse of that adapted for diseases of an acute type and short duration. In those we said that we need pay no attention to the amount of nourishment taken. It does not matter that the patient takes no food for a short time; he will get over the disease quickly. In diseases of a chronic nature the first principle is to see that the patient takes enough nourishment; for unless he gets sufficient nutrition it does not matter what else you may do - the diet may agree, the medicine, etc., be just right - but the patient will go down. He is bound to lose. He grows weaker, and finally succumbs not so much to the disease as to subnu-trition. No matter what type of disease patients have, they will get tired of the diet. If you do not pay a great deal of attention to them, and especially if the diet is restricted too much - say milk and eggs, and chicken soup, and nothing else - in a week or two they get tired of it, and do not enjoy it, and the tongue gets coated, and they take less, and grow weaker. So you have to see that you give the patients enough nourishment. This principle comes first in the plan of treatment, no matter what the disease is.

If you have to deal, for instance, with tuberculosis patients, who form a large class of these chronic sufferers - if you are not attentive in seeing that they take nourishment, - they will take less and less; they have a little fever off and on, and may have some catarrhal condition of the stomach or some catarrh of the bowels and not feel like eating. They are in a state of starvation, and very often they succumb to that. I will tell you of a case to show what can be done with proper nutrition in these cases. I was once called to a patient, a lady with lung trouble, who had suffered with diarrhea. Almost anything she took caused the bowels to move right away. The treatment she had been having consisted in keeping from her all kinds of food. She had only a little warm broth and perhaps two eggs in 24 hours. She had lost a great deal of flesh and looked like a skeleton, and had high fever, and the question was what could be done for her. When I got there I saw that she would die in no time, two or three weeks, perhaps, unless the plan of diet was changed. So I said we must give her nourishment, diarrhea or no diarrhea. We must put in food. It is better to put in and lose something, than not to put in at all. So we began to feed her. We gave her six or eight eggs a day, farina with milk, rice with milk; and in a few days we started in with meat and mashed potatoes, and we fed her five or six times a day. She had a nurse to watch her and push the feeding, and make her take the food; and by and by she began to rally, and in a short while she lost her temperature, and her bowels were better, and she began to go out, and gained thirty or forty pounds, and it was three or four years before the lung trouble again asserted itself and she died.

If there is subnutrition existing, you have to step in and work against it. You may say that the bowels are weak and cannot stand anything. You must try. I do not mean to say that you should not give any remedies. That lady, besides the diet treatment, had some remedies to bridge over the symptoms. If there is diarrhea, we will give them some tannigen, bismuth, and a little codein, but they must eat at the same time.

It is very much the same in other chronic conditions - gout, chronic rheumatism, chronic Bright's disease - which is a very common complaint. Here the diet is often too onesided. A great many physicians give milk and milk alone in kidney troubles because, as you know, the kidneys are not able to keep back albumin and make use of it; and the principle is to keep away the proteid foods as much as possible in order to save the organ. But if the diet is too one-sided, if the patient takes too little and does not enjoy it, he suffers from inanition, which is worse than the disease.

In these chronic diseases you can pay attention in the plan of treatment to the work of the affected organ, to its function, to see that the diet should not be too heavy for the particular patient. In kidney trouble you will try to eliminate the protein to some extent; give only a little meat, but the principle should not be carried to the extreme; you must give in a little and adapt the diet in such a manner that there will be a variety in the food, and the patient will enjoy it. Give them all the cereals and bread and a little meat. Restrict the particular article that you do not want, but do not cut it out entirely. The same way with diabetes mellitus - or sugar disease. We know that sugar is not well-borne; the system cannot use it up, and eliminates it through the kidneys. So, as a rule, we put these patients on animal diet, and cut off starchy foods; but if you take these away entirely the patient gets tired of the animal food and grows weak and runs down. Most physicians to-day agree that it is well to give them a little starchy food; the system is better off with a mixed diet; but restrict the undesirable kind. Give them only two rolls a day.

A restricted diet can be carried out without harm for a short period of time. You may institute a milk diet for a week or two without harm, but to carry it on too far is always a mistake.

The system is apt to suffer from a one-sided diet, no matter what the disease is.

After these points on diet in chronic diseases, we will go on to the diet in diseases of the digestive tract. With these, on the whole, the same principles prevail as in the other diseases. Acute conditions require little attention to diet. The diet should consist of the finest foods in liquid form and in small quantities. We do not have to look out for large amounts to cover the loss, and we act on that principle.