~The Mouth~ requires much care, even in fevers of short duration. A simple antiseptic wash should be used several times each day. ~Nitrogen Equilibrium~ is not sufficiently disturbed in such cases to require taking into account. Should the disease, however, develop into one causing a material breaking down of the body tissues, measures must be instituted to prevent the upsetting of the nitrogen balance in the body. PROBLEMS (a) Outline the dietetic treatment for malarial fever. (b) Outline a diet order, using liquids only. Show method of reinforcing this diet. (c) Show how the solids are added as convalescence progresses. FOOTNOTE: [95] In scarlet fever and other conditions in which the kidneys may be involved the above diet is not given unless advised by physician in charge. CHAPTER XIV TYPHOID FEVER ~Definition.~--Typhoid fever is an acute infectious disease excited by specific bacteria (Eberth). The intestines become the seat of ulcerations (Peyer's patches), which at times perforate. The chief symptoms of the disease are fever, headache, abdominal distention and tenderness, more or less diarrhea and a rose-colored abdominal rash. The source of infection is found in the intestinal contents of a typhoid fever patient, which in some way come in contact with and infect drinking water, milk, etc. ~Energy Expenditure in Febrile Conditions.~--In febrile conditions the energy expenditures increase as much as twenty-five per cent. In some cases, and when bacterial activity is added to this, as is the case in typhoid fever, the tissue waste becomes correspondingly greater; hence the nutrition assumes the chief role in such cases, for in no other way can 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.