Indications for the diet to be prescribed for those suffering from typhoid fever are afforded, first, by the existence of acute inflammation in the intestines. Such a lesion anywhere in the gastro-intestinal tract indicates a liquid diet. Second, by the enfeebled digestion, which makes it necessary to use only food that can be directly absorbed or easily digested. Third, by malassimilation, which is so considerable in all severe cases as to make it impossible during the period of pyrexia to restore strength and flesh. Food must be given, however, to lessen or retard this loss of strength and flesh.

In mild cases, during the first days of illness, appetite is diminished and capricious. At this time it is necessary often to vary foods so as to tempt the patient to eat. The variety must be chosen from liquids. Milk should form the main staple, but beef-juice, chicken broth, clam broth, oyster broth, custard, weak tea or coffee, and gruels may also be given. In severe cases, after the first few days, the mental sluggishness or indifference that the disease produces makes it possible to adopt a monotonous but nutritious regimen. Patients are more inclined to complain because they are disturbed too frequently by the offer of nourishment than because of the kind of nourishment they are given. As convalescence approaches and is finally established, hunger demands quantity of food, and solid food, more than variety, although a varied diet is fully appreciated. During the febrile stage patients must be fed and given drink at specified times and in prescribed amounts, because they are mentally so indifferent or somnolent that they rarely ask for either food or drink. While not to be overcrowded with food, and, as a rule, not to be disturbed during sleep, their appetite must not be considered by nurses a guide as to the frequency with which food is to be given to them. On the other hand, when convalescence is first established, the extreme hunger of typhoid patients must not tempt physicians or nurses to give solid food too quickly or too plentifully. In uncomplicated cases a milk diet should be adhered to until a normal temperature has been maintained four or five days. During the next four or five days food should be liquid, but can be varied. When the temperature has been normal in the evening for a week, soft or semisolid food may be given. A few days later finely divided meats may be tried, and slowly the patient may be allowed to return to a mixed diet such as is usual in health.

Milk is the best food for those having typhoid fever, as it contains in liquid form the ingredients essential for the maintenance of bodily temperature, strength, and repair of waste. Milk-sugar and the fat of cream are easily prepared for absorption, and the protein of milk is, as a rule, readily digested. These ingredients do not commonly undergo fermentation in the gastro-intestinal tract which will produce toxic bodies. The salts of milk are almost identical with those of blood. Milk is an efficient diuretic and stimulates elimination by the kidneys, which is also important in lessening typhoid intoxication. All these qualities of milk make it a particularly good food for typhoid fever patients. From two to three pints of it should be given one daily. It is best to give a glass or half glass at a time. It is also well, when possible, to give it ten or twenty minutes after a Brand bath.

Occasionally milk is found to disagree with typhoid patients. This is sometimes due to giving too much of it. Friends will now and again crowd two quarts or more a day upon the sick. With impaired powers of digestion, this may be more than the stomach can tolerate, and it may be vomited as a soured and curdled mass. At other times it disagrees with them because it clots with abnormal rapidity. Excessively rapid curdling and consequent vomiting can frequently be prevented by adding lime-water or barley-water to the milk, or by thickening it with wheat flour. Better than any of these additions is a modification of milk, so that the proportion of protein in it will be 1.5 or 2 per cent, instead of 4. This can be accomplished by mixing one part of cream with three of boiled water, and three and one-half parts in 100 of milk-sugar. (See p. 186.) It is often helpful to 'pancreatize' the milk given to patients having typhoid fever. In the ordinary case, two grains of pancreatin and six grains of sodium bicarbonate dissolved in one ounce of cold water are stirred into four ounces of lukewarm milk, and this is at once given to the patient, who drinks it slowly and is usually unaware that anything has been added to the milk. This quantity is given every two hours. In rarer cases milk must be peptonized or partly digested before it is given. This, however, is necessary only in very exceptional cases. Patients who suffer from protein indigestion are often much helped by the administration of hydrochloric acid and pepsin.

Typhoid patients who are mentally dull rarely object to any food that is given to them, but a few of those who are not, have so intense a dislike for milk that enough nourishment cannot be administered to them if milk alone is used. In such cases it is necessary to find some substitute for it. Mellin's food, malted milk, and similar food-products maybe used, or gruels of wheat or barley. These last should be strained to remove solid particles. Patients will frequently take kumiss and buttermilk or whey when they refuse sweet milk. Many others will take custards, or milk with a raw egg beaten up in it, when they will take neither of the other preparations. Ice cream in moderation is also often unobjectionable.

It must not be forgotten that many persons who have a prejudice against milk can be taught to take it if it is fed to them from a spoon at first, in doses of two or three teaspoonfuls at a time.

Those who cannot tolerate milk in any form must depend upon bouillon. It is not sufficiently nutritious of itself. It can however, occasionally be fortified by adding an egg to it or by giving an egg lemonade in its stead. A little soft-boiled rice may sometimes be added to bouillon with benefit. The bouillon is absorbed directly, almost without digestion. The egg and rice require digestion. Bouillon, however, stimulates strongly the peptic glands and excites an increased flow of gastric juice. It restores the mineral salts of the blood, which are rapidly eliminated during the period of fever. So considerable is this elimination that a mineral inanition is sometimes threatened. In such cases bouillon must be given in quantities of from one to one and one-half pints daily. It is so useful as a stomachic and a restorer of mineral matter that it is well to give it in small amounts to all typhoid patients. From time to time gruels can be given instead of milk to increase the total calories which the patient receives, or, better, farinaceous foods can be added to the milk to slightly thicken it. Egg and milk mixtures can also be given for the same purpose. The fat of the egg and the sugar which goes into the mixture increases the caloric value of the food. Such substitutes can be made two or three times daily in many cases with advantage.