Every hospital student can recall cases in which a promising typhoid case, recovering from an acute attack, has suffered a sudden relapse, with, perhaps, perforation and death. On inquiry it is often found that the bad symptoms set in after "visiting day," and that kind friends (sympathising with the patient's desire for solid food and his distaste for the rigid regime so long enforced) have surreptitiously brought him plum-cake, fruit, or bread and jam, etc.; these have been secretly eaten at the cost of a relapse, and perhaps even of life. It is only necessary to study the pathological conditions depicted in Fig. 12, and to appreciate the fact that the intestine is in typhoid ulcerated and raw, and its walls dangerously thinned at certain points, in order to recognise the importance of not giving the patient solid food or articles likely to set up irritation or to cause violent peristaltic action of the intestine.

The cardinal principles of dietetic treatment are as follows: (1) to maintain the strength of the patient; (2) to give the intestine the physiological rest necessary, in order to avoid the accident of perforation, and to favour repair and cicatrisation. In all acute fevers metabolism of the tissues is abnormally active, and the waste great. The products of combustion are consequently present in abundance in the blood. Appetite is abolished, and stomachal digestion is suspended. Our object must, therefore, be to give the patient foods (1) that are easily digested, or rather, quickly absorbed; (2) that will not increase the amount of urates in the blood; (3) that will diminish the abnormal waste of the tissues. Hence the reason for the use in acute fevers, of beef-teas, jellies, arrowroot, gruel, and milk. In typhoid it must, moreover, always be borne in mind that the food given should be in the form of bland fluids very easily digested.

Milk

This is the aliment that suggests itself as the most appropriate for typhoid patients. It is a complete food, and on it alone a patient can subsist for an indefinite time. As a rule it is well borne. In such cases it should be taken in small quantities at frequent intervals. It must, however, be borne in mind that though milk is a fluid out of the body, it is curdled at once in the stomach by the action of the gastric acid. It may therefore, if not digested, pass as a firm solid through the whole length of the intestine, and set up irritation, leading to injury. It is of the utmost importance that in typhoid the evacuations of the patient should be carefully watched. If the milk is excreted in the form of curds, this is an indication that the patient cannot digest pure milk. It must then be given diluted. Equal parts of milk and Vichy or Vals water, or one part of milk to two of Apollinaris or soda water, may be administered, or ten grains of bicarbonate of soda and the same quantity of common salt should be added to every pint of milk and water in equal parts. Milk thus diluted and mixed with alkali can often be absorbed when pure undiluted milk would be undigested (Yeo).

Ass's milk, which is precipitated in the stomach in an extremely fine curd, and which is consequently the more easily digested, may be substituted for cow's milk.

Whey may be usefully given where milk is ill digested. It is made by boiling a pint of milk with a teaspoonful or two of lemon juice or rennet, straining through muslin, and squeezing all the fluid from the curd. Care should be taken to break up the curd with the fingers while pressing, for then much of the fat and some of the finely divided casein of the milk will pass into the whey and make it more nutritious.

Eggs

These should not be cooked, but the yolks beaten up raw with boiling water or hot broth.

Beef-Tea

The usefulness of beef-tea is universally acknowledged in acute fevers. It is valuable in many different ways, inasmuch as it contains gelatine, which, as already described, prevents waste of the albuminous tissues; soluble salts, which compensate for the extravagant loss of these in fever; and certain stimulating substances dissolved out from the beef. Mutton and chicken broths and clear soups are useful, as well as beef-tea essence, which should not, however, be given in too concentrated a form. In preparing clear soups and broths, vegetable juices should be added in order to supply the body with the salts and acids contained in vegetables, which are particularly needed in fever. It is important, however, to exclude the indigestible vegetable fibres from the soup. The vegetables used should, together with the aromatic herbs, be cut up fine and placed in a muslin bag and boiled. The juices should then be pressed into the soup or broth.

Raw meat pulp may be given in prolonged cases of typhoid. Thin oatmeal or barley gruel, carefully strained from all gritty and irritating particles, and flavoured with sugar and lemon peel, is one of the best of the farinaceous foods. It can also be mixed with milk, beef-tea, or meat essences, and thus a useful composite food is produced.

Water is an absolute necessity of the fever patient to allay his consuming thirst. Barley water, toast water, pure iced water, soda and effervescing waters can be given, changing one for another as the patient tires of each.

Alcohol in any form is as a rule forbidden, and should only be given under medical advice.