the tissue waste and energy expenditure be met and overcome.

~Energy Expenditures in Typhoid.~--In typhoid fever the problem of
meeting these expenditures, and at the same time protecting the heart
and kidneys from the abnormal strain placed upon them in handling the
toxic substances produced as the result of bacterial action in the
intestines, becomes very real. It requires eternal vigilance and
patience not only from the physician but especially from the nurse,
with whom so much responsibility rests. The dietetic treatment
necessarily is the principal point to which all efforts must be
directed. By this is understood not only the type and amount of food
given the patient, but the behavior of this food in the body as
manifested by the symptoms, namely, the appearance of the patient, the
condition of the mouth, the abdominal distention, tenderness,
diarrhea, nausea, and vomiting, the hemorrhage which at times occurs
in spite of all care, and perforation which sometimes results in
death, and acidosis or acetonuria. All of which makes this disease one
requiring the most efficient attention from a nutritional standpoint.

~Energy Requirements in Typhoid Fever.~--In a previous chapter the
energy expenditures of the normal individual were dealt with; it was
seen that a man at rest, that is, in bed, not rising for anything, had
a normal expenditure of energy requiring from 1900 to 2200 calories
per day. Now, if these expenditures were increased twenty-five per
cent. by the fever and still more by the bacterial activities, it is
clearly seen that the diet must be increased in proportion if the
tissue waste is to be prevented and the normal body weight of the
patient maintained.

~High Calorie Diet.~--Dr. Warren Coleman,[96] to whom we owe so much
for his pioneer work in feeding in typhoid fever, devised the
so-called "High Calorie Diet." This consists of foods of the most
digestible type prepared in the simplest way. The weight of the
patient is considered and the diet directed with the following points
in view: (1) to cover the energy requirements of the body; (2) to make
good the tissue waste which at times amounts to a loss of from 15 to
20 grams of nitrogen a day (or from 1/4 to 3/4 pound of muscle);[97]
(3) to check or prevent the development of serious complications,
kidney, heart, etc.

In the Metabolism Ward at Bellevue Hospital, New York,[98] the best
results are obtained by the giving of diets furnishing from 6