3. Liberal Or Generous Diet

This in its widest sense is doubtless the only sound routine plan, for it permits the use of semi-solid food if the patient can take it and digest it. It allows considerable variety, for such dishes as custard, ice cream, arrowroot, calf's foot jelly and the like, usually reserved for convalescence, may often be taken safely at an early period in the disease. There is, in fact, hardly any line drawn as to how far a person may go, provided he does not go beyond the dietary proper for delicate stomachs. Baked potato, baked apple, rice pudding, water toast and similar articles are gradually added to the diet and even lamb chop and soft-boiled eggs are given while the temperature is still elevated. This, of course, is in direct violation of the older rule of giving liquid food until fever has completely subsided. The justification appears to lie in the fact that liberal diet often saves life, and in cases where the chances seem against recovery it is one of the reserve cards to play. Because if the patient is likely to die in any case, the solid diet, if it can be tolerated, cannot add to the risk and may be of incalculable value. This observation was made long ago in connection with such diseases as childbed fever, blood poisoning, erysipelas, meningitis, gangrene and similar maladies with a natural tendency to go from bad to worse; and the severest types of typhoid belong in the same category of diseases.

Note

"High Caloric Feeding" in typhoid which has been tested in recent years is known as the high caloric, in which it is aimed to give the patient far more eateries than he should utilize in health, even at the hardest labor and on the most liberal diet. This is the exact antithesis of the water or starvation diet, in which the patient subsists on his own tissues. In the high caloric plan the theory is to supply such an excess of nutriment that the least possible loss of tissue occurs; so that the period of convalescence and recuperation should be greatly shortened. Certain physicians have actually claimed a gain in weight during the fever under plans of this character. It is obviously very difficult to feed typhoid patients with food having the highest calorific value. Even the blandest fats are badly tolerated, as is also cane sugar. It is possible, however, to use glucose, dextrin, and especially lactose, along with brandy, more or less in connection with ordinary feeding, to such a degree that in individual cases the number of calories in the ordinary liberal diet may be practically doubled.

Whatever shortcomings exist in connection with caloric feeding are naturally increased with the amount of food. There is practically no limit to what can be ingested in twenty-four hours, but there may be a limit to utilization. The amount of calories actually used can only be determined by painstaking investigation of the excreta. There is also great individual variation in the oxidation of special foodstuffs, as is seen notably in alcohol. The greater the daily intake, the greater the difficulty in establishing common standards. For this and other reasons it is best to regard caloric feeding as merely a check on the older methods and on common experience. It is hardly likely, therefore, that high caloric feeding will ever come into vogue, although it may have a field in the individual case or at some special period in a case.