Diet List Used in High Calorie Diets for Typhoid Fever
Advantages of Newer Treatment.—A marked difference is noticed in the patients treated by the old starvation diets and those given the high calorie diet. Dr. Coleman states[102] that while the range of temperature is apparently unaffected, the total duration of the disease is shortened in some instances by months through the shortening of convalescence. He further states that certain symptoms which have hitherto been attributed to the specific action of the typhoid bacillus have been discovered to be due to faulty methods of treatment, particularly to an inadequate or improperly balanced diet. The various investigators who have made the study and treatment of this disease a lifework claim that the mortality from this disease has been tremendously reduced by the use of the high calorie diets which maintain the nutrition of the patient throughout the disease, thus eliminating the horrors of the long, tedious convalescence which tried the nerves and patience of the patient, the nurse, and the physician. There is no doubt that so far as the administering of this diet is concerned it requires more effort on the part of the nurse than the old treatment of a glass of milk every two or three hours. It is necessary for the nurse to be able to carry out the orders as expressed in the diet lists, to be able to compute the proteins (nitrogen), fats, and carbohydrates in a food or recipe. But this is readily done by studying the tables given in the first section of this text. She must likewise be able to recognize the symptoms as they arise. In hospitals, the urinalysis is made as a routine procedure. In private cases the physician will either have the analyses made or expect the nurse to be able to make the simple tests.[103]
One of the greatest difficulties attending the administering of the high calorie diet is persuading the patient to take sufficient food for his needs. The fluids are often more difficult to give in quantity than the more solid foods, and it requires much tact on the part of the nurse to prevent a refusal of the necessary fluids. However, if the patient is possessed of even ordinary intelligence, an explanation of the reasons for the large amount of food will as a rule be all that is necessary. Few individuals will willingly prolong an illness attended with the discomforts generally present in typhoid fever.
Hemorrhage occurs in a certain percentage of cases of typhoid regardless of the diet, whether it be a strictly milk diet or the high calorie diet just described. The measures to combat them are essentially the same. It is necessary to guard against excessive tympanites since the pressure therefrom against the ulcerated intestinal walls may cause perforation resulting in hemorrhage. Lactose at times causes an evolution of gas as do fats under certain circumstances. Hence it is necessary to follow symptoms and watch the stools in order to determine which food material is to blame for the tympanites and reduce the allowance of that food in the diet.
Idiosyncrasies against Milk.—Certain individuals manifest an inability to take milk. This may be real or imaginary. When it is a true idiosyncrasy, it may be found necessary to substitute some other food for the milk in the diet, but great care should be taken to determine the real character of the disagreement before eliminating so invaluable a food from the diet. When the disagreement proves merely a distaste for milk, some of the different methods used in disguising it, such as flavoring or coloring, may be practiced. Otherwise, it is well under the circumstances to use some of the pre-digestive methods in order to increase its utilization. It is well to emphasize the value of accurate data on this subject as it is exceedingly difficult to administer a high calorie diet without milk in some form.
Essential Points.—Thus the dietary in typhoid fever is seen to be the most important part of the treatment. A careful study of the tables will enable the nurse to do her part in nourishing the patient. It is necessary that she be able to compute the nitrogen, carbohydrates, and fats in a diet and arrange these constituents in such a way as to give the desired amount of each in the dietary and in a form acceptable to the patient.
SUMMARY
Rate of Metabolism is greatly increased in typhoid fever even over other febrile conditions, not only on account of the elevation and duration of the fever, but also on account of the activities of the specific bacteria in the intestinal tract which differentiate this disease from other febrile conditions.
Energy Expenditures and Requirements of the body in typhoid fever, on account of the character of the disease, are much greater than those of the normal individual and must be met by an increase in the diet if the body is to be saved from destruction.