Except, perhaps, ulcer of the stomach, there is no complaint in which the question of life or death is so imminently associated with diet and regimen as in Typhoid fever. A little solid food on the wrong day may easily mean death to the patient - a scrupulous adhesion to a fluid diet for the proper term may as easily mean life. Rest and quiet may determine the favourable course of a fever which without it would have been fatal.

The results of my own experience coincide with the statements contained in the following quotations from Sir William Jenner, to whose careful and intelligent observations in the early part of his career, we owe nearly all that is of vital importance in our knowledge of typhoid fever.

(A.) Extracts from an Address on the Treatment of Typhoid Fever

Delivered before the Midland Medical Society at Birmingham, Nov. 4th, 1879, by Sir Wm. Jenner, Bart., M.D., k.C.B., F.R.S., etc., etc. (The Lancet, November 15th, 1879.)

Some of the worst cases of typhoid fever I have ever seen have appeared to me to owe their gravity to the patient having travelled, after the commencement of the sense of illness, in order to reach home. I very rarely advise a patient's removal to his home, if that be distant, so satisfied am I that the fatigue of travel, whether by rail or carriage, tends to make what would otherwise have proved a mild case severe, and to cause a bad case, which might after perhaps a struggle have ended favourably, to terminate in death. Not only is other tissue-destruction than that due to the fever process in a great degree prevented by rest in bed, but the nervous system is there less liable to disturbance, any tendency to moisture of skin is favoured, the elimination of the products of waste tissue is unchecked, and chances of error in diet diminished. The air of the room should be as pure as possible; the room in which the patient is placed be large enough to permit it being freely ventilated without draughts; if possible, the patient should occupy a different room at night from that used in the day.

From the first the patient should be restricted to liquid diet, with farinaceous food, and bread in some form if the appetite requires it. It is better to vary the broths, and to add to them some strong essence of vegetables. Sometimes a littled strained fruit juice is taken with advantage, but skins and seeds of fruits and particles of the pulp are frequent sources of irritation to the bowels. Grapes are always dangerous from the difficulty of preventing the seeds slipping down the throat. The value of milk as an article of diet in fever is generally admitted, but it requires to be given with caution. The indiscriminate employment of milk in almost unlimited quantities as diet in fever has led to serious troubles. Milk contains a large amount of solid animal food. The casein of the milk has to pass into a solid form before digestion can take place. Curds form in the stomach, and, the digestive powers being weakened in fever, these curds may remain unchanged in the stomach, and produce considerable disturbance of system.

I have seen the patient restless, sleepless or drowsy, his temperature raised several degrees above what it had previously been, vomit, eject a quantity of curd, and at once the restlessness cease, the temperature fall, the skin become moist, and the patient drop into a quiet sleep. All the threatening symptoms vanish with the ejection of the offending material. Or the undigested curds may accumulate in the bowel, inducing flatulent distension and pain in the abdomen, restlessness, and increased febrile disturbance. Under these circumstances, I have seen an enema of thin gruel bring away a large vesselful of offensive, sour, undigested curds. Or again, the undigested curds may themselves (and this has not been an uncommon consequence of milk diet in my experience) irritate the bowels, and produce, keep up, or greatly increase diarrhoea. A distinguished chemist once remarked to me, 'Do not forget that a pint of milk contains as much solid animal matter as a full-sized mutton chop'; and solid the casein of the milk must become before it can be digested; and yet I have known a patient drink two quarts and even more of milk in twenty-four hours - i.e., solid animal food equal to four mutton-chops. Can anything approaching to such an amount of solid animal food be digested, and if it could, is such an amount of animal food good for a patient suffering from typhoid fever? He is weak because of the presence of the fever, and not from lack of food.

Patients suffering from typhoid fever should be allowed an unlimited supply of pure water. When pure water is freely absorbed, it passes away by the kidneys, skin, lungs, etc., and is of much service as a depurating agent. If it be possible, even, that the poison of the fever was conveyed into the patient by the drinking water or the milk of the district in which he is ill, then these fluids should be boiled till a different supply is obtained. All sources of foul air from drains or cesspools should be sought for, and the air the patient breathes be freed from all possibility of impurity; disinfectants should be placed in the close-stool, and the dejecta buried if possible. If the bowels are confined in the early stage of the disease a simple enema should be given. A hard stool retained in the bowel will produce irritation, and it may be catarrhal inflammation of the intestinal mucous membrane, and so induce troublesome diarrhoea. Small doses of mineral acid, well diluted, are grateful to the patient, and may perhaps be useful.

The fever is thus met by rest, quiet, fresh air, mixed liquid food and bland diluents, and the exclusion of fresh doses of poison; the intestinal lesion by the careful exclusion from the diet of all hard and irritating substances, and the removal from the bowel of any local irritant.

The chief causes of diarrhoea in excess of that due to the intestinal specific changes in typhoid fever are: - 1. Errors in diet - e.g., the use of solid food, - the presence of particles of undigested food in the bowel, the abuse of milk or of pure animal broths. My own experience has not satisfied me that one animal broth is more prone to produce diarrhoea than another. Excess of fluid, when there is inability to absorb the quantity drunk, passes through the bowel, and so simulates excessive secretion from the intestinal mucous membrane.