In no disease is the question of diet of greater importance than in typhoid fever. The disease is a serious one, on account of its usually protracted nature, with its corresponding drain on the patient's general strength. It is, therefore, of paramount importance to maintain the strength of the patient, but in doing so due regard must be paid to the lesion in the intestine (ulceration) which is usually present, and also to the impaired digestive powers of the patient. At the same time we must recognise that it is perhaps more true of this disease than of any other that we must treat the patient and not the disease. The truth of this is shown by a reference to the different systems of diet that have proved undoubtedly successful in its treatment. Some recognised authorities find good results from the use of a fairly full diet containing much solid food, throughout the whole course of the illness; others adhere to the time-honoured system of a milk diet during the acute phases of the disease. Both systems appear to be equally successful, and from this we may conclude that the diet has to be judged more from the nature and amount of the residue which it leaves in the small intestines than from the form in which it is taken into the stomach. It is probable that in certain cases a residue of undigested solid curd from an exclusive milk regime produces much more local and general disturbances of an unfavourable nature than the residue from a fish, chicken, or meat diet In this connection it must also be borne in mind that in some cases the local lesion in the bowel is of a very slight character, there being little or no demonstrable ulceration. In the present state of our knowledge it may be said that the most judicious system of feeding is that which relies largely on a milk regime. We shall therefore first describe this system in detail, and thereafter consider the other dietetic regimes that are recommended.

Milk Regime

Milk should form the chief food, and much attention to detail is necessary in its administration. It is specially important to closely watch the stools. If the motions contain undigested curd, it is clear that the amount of milk given or the form in which it is administered are unsuitable, and an immediate change in the diet is called for on account of the risks to the patient from the mechanical presence of lumpy curds, and from the abdominal distension from the fermentative changes in the food. If attention be paid to the following points, milk will seldom fail as a diet in typhoid fever. It should be given well diluted, it should be administered at regular intervals only, the total amount should not exceed from 2 to 3 pints per day, and the motions should be inspected daily for the presence 0/ undigested curds.

The milk should be diluted with plain hot water in the proportion of one to three, or one to four. The warmth of the mixture assists digestion by not chilling the stomach, and the dilution prevents the curd being too hard. If the bowels are costive, fluid magnesia (Dinneford's) can be used as the diluent and added to the warmed milk; if the bowels have a tendency to be loose, lime-water is the best diluent. The amount of milk administered in twenty-four hours is important It must never be used as a quencher of thirst, but always as a food; it must be taken at regular intervals and in stated amounts. The prescribed quantity should be taken at the proper time, and no milk should be allowed to stand at the bedside; this precaution ensures the stomach having time to empty itself. The amount of milk given should be limited; 3 ounces every two hours, i.e. under 2 pints in the twenty-four hours, is enough at first; if this does not cause curd in the stools the quantity may be increased up to 3 or 4 ounces every two hours. No interval of longer than three to three and a half hours should be allowed during the night without food.

The presence of undigested curd, whether in large masses or flakes, shows that either sufficient attention to detail in the administration is not being observed, or that the patient is getting more milk than he can digest. A reduction of \ ounce from the two-hourly feeds will often be sufficient to stop the presence of curd, and the improved digestion will probably put an end to the slight diarrhoea that may be present. If this does not prove sufficient, malted milk may be used, or the milk may be partially or completely peptonised. These modifications in the manner of administration are helpful in patients troubled with meteorism. Whey is a good substitute for milk if the latter is not tolerated. During this period very special attention is necessary to the toilet of the mouth.

Milk diet is very monotonous, and if a patient is not suffering from diarrhoea or blood in the stools, there is no reason why this monotony should not be relieved after twenty-four hours by the administration of some of the meat broths. An allowance of chicken or beef-tea or clear consomme is much appreciated, and can be given well salted. Most enteric cases crave for salt, and there is no reason why it should not be supplied. The actual food value of these preparations is small, but they help digestion by acting as stimulants. A well-recognised method of administering the meat-tea juices is to give a daily allowance of a pint, divided into three portions. One portion should be given as the dinner meal, the second portion, given hot about 9 o'clock, helps the patient to go to sleep, and the third quantity may be given in the early hours of the morning.

If diarrhoea is persistent, the warm meat-broths tend only to aeeravate it; it is then better to use raw-meat juice, or one of the many meat extracts on the market. Meat juice may be prepared at home, and given in 2 teaspoonfuls, slightly salted. The meat extracts should be given cold, and mixed with a little water. Bovinine and Wyeth's meat juice are excellent, but the strong meaty flavour is much disliked by some patients. Brand's chicken jelly is very aerreeable, and so is home-made chicken essence.