Simplest of all these cases for the dietitian is the care of the surgical case and the childbed case. As a rule, the patient has a good appetite and good digestion. The patient has been active and in a good state of health up to the time of confinement to the sick room. The only precaution to be observed and the only rule to be followed is to decrease the quantity of food taken to bring it within rational needs of the patient. If a robust laboring man is confined for weeks or even months because of a broken leg, the physician and nurse may have difficulty in convincing him that he should not eat as freely after his confinement as he did when employed at his usual work. If, however, his appetite is not curbed, he is certain within a few weeks to suffer from a seriously deranged nutrition. While he may have a general diet without any special restriction as to kinds of food, the quantity of food should be reduced to not more than half of his usual ration. No small ingenuity will be required on the part of the nurse and on the part of the attendants to convince the patient that he is getting enough. He will feel empty and hungry a good deal of the time, unless tact and good judgment are used.

Two devices may be employed which will go a long way toward satisfying the patient: First, introduce into his dietary during the first two weeks, particularly, a considerable amount of bulky food that possesses only a small amount of nourishment. An ample bowl of thin soup, hot and well seasoned, will fill an aching void and make the patient feel comfortable. Fruits prepared as sauces, stewed with a considerable admixture of water, serve a similar purpose, and the free use of various drinks, bouillons, beef teas, etc., will give the patient a feeling of comfortable satiety but will really introduce into his system a small amount of nourishment, and, furthermore, the introduction of a large amount of liquid will also facilitate freer bowel movements and freer and easier secretion from the kidneys.

The second device of great importance in these cases is for the nurse to urge upon the patient the great importance of spending as much time as possible at his meal; let him be encouraged to spend a whole hour on a small meal, sipping his soup very slowly and deliberately, and chewing all solid foods as long as it is possible to retain them in the mouth. If this can be satisfactorily accomplished, both patient and attendants will soon be surprised at the small amount of food which will cause complete satisfaction of the appetite and give a feeling of comfortable satiety.

In the case of the woman in childbed, her condition is also an acute one. The physician and nurse will remember that while she is to be confined to her bed without exercise for a period of two or three weeks, the function of lactation must be established, and once established, the nourishment for the baby must be provided. The mother should, therefore, not be put upon a particularly scanty diet; in fact, her diet may be quite as full a one as she had before her confinement, but especial care should be taken that considerable liquid and a sufficient amount of laxative food be used to insure free and regular passages of the bowels.

In the case of surgical operations for tumors and the like, if the patient has been in a fairly robust condition of general health, the same principles should be followed as govern the choice of foods in the case of a man with a fractured femur. If, however, the operation is for the purpose of making a gastro-enterostomy, or other operation on any part of the alimentary tract, it will be a matter of great importance to fit the diet especially to the needs and exigencies of the case. In such cases the nutrition is usually seriously interfered with because of previous weeks or months of progressive development of the condition. Complete fasting for three or four days is not to be favorably considered, and yet nutriment must be introduced into the system. Rectal feeding has to be resorted to in such cases; the technic of this manner of feeding will be described later.