DIETETIC TREATMENT.—This is of the utmost consequence; indeed, except, perhaps, in the case of diabetes. there is no affeetion in which the question of dietary is of such vital importance, and the young physician must recognise that there is no point in connection with this subject which he can afford to regard as too trivial for his consideration. Few men can be in practice long without being able to testify to the disastrous or fatal consequences which occur from the patient's indiscretion in this matter. A good rule to have ever before the mind is to forbid every form of food all through the attack, except such as would readily pass through the meshes of a fine sicve. Not that it will be necessary to sift any food, but to lay clearly before the patient and nurse that only substances in the liquid form or those containing impalpable powders are admissible.
Cow's milk meets all requirements for the majority of patients, and when they can take it, which is nearly always the case, there need be little trouble about the dietary in the early and acute stages of the disease. It is needless to say it should be pure and fresh.
For adults the quantity should he not less than three or lour pints in the twenty-four hours. Some patients will be found who can take and digest twice this amount, and when very large quantities arc taken it may be advisable to skim it occasionally.
The rate or method by which this liquid nourishment is to be adminis tered is of quite as great importance as is the quantity. It must be given in small amounts at short intervals, so as to prevent the patient filling his stomach by a large drink. A wineglassful every hour would represent three pints in the twenty-four hours; hut then, in ordinary cases. the patient should out he disturbed frequently during the night, and therefore double this amount may have to be given during the day and The nurse must, therefore, he permitted to use her discretion according to the individual peculiarities or tastes of the patient, the main idea being adhered to that. ie; tar as practicable, the total amount of nourishment
should be as evenly as possible divided over the time. In the early morning the patient generally needs his food most, and in typhoid and typhus fevers in their advanced stages the life of the patient may be depending upon the conscientious discharge of the nurse's duties at this particular time of the day.
Over-feeding must be guarded against: nothing but injury can follow the administration of quantities of milk beyond the digestive powers of the patient, aim the physician by inspecting the motions from time to time can gain valuable information upon this point. It is hard to hit off the requisite amount necessary, but upon the whole it will be better to err it filth' on the side of giving too much. milk may he given warm, cold, or iced to suit any strong inclination upon the part of the patient. It will he better to give it iced when possible.
Soda or plain carbonated water may he mixed with it in varying amounts according to the requirements of the case. It is desir able to an occasional draught of water or iced water when the patient craves for it the only objection to this is when water or ice is allowed to take the place of nourishment in patients who have little appetite, as may often be seen in the ease of children. One system of treating typhoid fever consists in the administration of large quantities of water with the view of promoting elimination. It should always be kept in mind that the patient requires water in some form, and hence the necessity for diluting his milk. :11.er stage, should vomiting threaten or diarrhoea be severe, Lime AlN ater may be used to dilute the milk. Veo recommends Semmola's glycerin drink as an occasional remedy for thirst and dryness of the throat; it is made by mixing r oz. glycerin and 3o grs. citric acid with i pint of water. It may he better to double the acid and water where there is much thirst, but where there is a tendency to rhage citrates must he avoided.