he 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 nitroge