The modern dietetics of typhoid may be conveniently considered under three plans of feeding as follows:

1. Starvation Treatment Of Typhoid

This ancient method of feeding or omitting to feed typhoid patients has recently been revived with alleged good results, but those who have tested the method are thus far few in number and it is very unlikely that the profession as a whole will ever adopt it, especially since we know what may be done with liberal feeding. Typhoid subjects are commonly young, vigorous and well nourished and can naturally subsist for a long time on their own stored-up nutriment; while by "starvation" they are protected from intestinal fermentation of undigested food. Hence such patients may seem to do well for a number of days on water alone given in unlimited quantities. But this represents but one aspect, and that a narrow one, in the problem of feeding typhoid patients, and is applicable only to particular cases and particular stages of such cases. Much would also depend, perhaps, on other methods of treatment in use. Thus if the fever were kept down by cold baths, the demand for nutriment would doubtless be less than were the fever allowed to pursue its course.

With advancing age the mortality rate increases greatly, and patients above thirty-five or forty doubtless require nutriment to a greater extent than the youthful.

2. Liquid Diet In Typhoid

This consists chiefly of milk, varied with broths and cereal decoctions. The milk which is the mainstay, is given in amounts up to two quarts in twenty-four hours, other articles being given only now and then to vary the monotony. Milk may itself be administered in various forms - peptonised milk, whey, malted milk and junket, kumyss and artificially-soured milk.* Water is also given freely. This mode of dieting has been for many years the prevailing one for the acutely dangerous period of the disease, having succeeded the earlier beef tea diet. Under liquid diet may also be mentioned the various predigested foods, which, by reason of their concentrated state, are of value when there is difficulty in ingesting enough milk to make up the proper fuel value for the day.

Of late years, it has been claimed that milk is unsuited for diet in typhoid because it forms an ideal culture medium for bacteria. A much older objection is the necessary formation of irritating curds from the cows' milk usually given. This last objection has been met to some extent by peptonisation of the milk, and by ingesting it very slowly, so that no-large clot can quickly form. Milk already curdled and emulsified, as in the form of kumyss and other fermented products escapes this objection, and is less favorable to putrefaction. But the most weighty objection to a fluid diet is probably found in the belief that it gives too few calories in proportion to the volume of food injected, and hence like the starvation treatment is not adapted for routine use but only for special cases and special periods.

* Ewald recommends Sanatosren in milk and broth.