In the suddenly developed and urgent types of dysentery - usually bacillary in origin - it is advisable, unless the patient from some special cause, such as starvation, is in a very prostrate condition, to withhold all food with the exception of very thin barley-water or rice-water for the first twenty-four or thirty-six hours, and until the first burst of the disease has to some extent spent itself. Fluid, however, must be supplied and may be given as plain water, or egg-albumin water, or in the form of the highly diluted farinaceous drinks mentioned. It is important that the amount administered at a time be small and, also, that it be at an appropriate temperature. Large draughts of fluid, especially of very hot or very cold fluid, tend to provoke peristalsis and thereby irritate the inflamed colon and aggravate the tenesmus and tormina from which the patient is doubtless suffering. It is advisable, therefore, during the first day or two of acute dysentery to direct that the patient shall receive a wineglassful of slightly warmed fluid of the description named every two hours, that it be administered in teaspoonfuls, and that no other food or drink whatever should pass the lips.
By the second or third day of the disease provision will have to be made for the regular and adequate nutrition of the patient. In arranging for this the state of the colon - inflamed, possibly about to ulcerate or slough - must ever be present to the practitioner's mind. It must be kept at rest as far as possible, and irritated by the passage of faeces as little as possible. Usually at this early stage of acute dysentery the entire alimentary tract - apart from the colon - is in a state of catarrh, the tongue coated, the gastric digestion feeble. It is evident, therefore, that liquid diet has to be continued, and it becomes an urgent question as to what form of liquid diet is the best.
Experience has generally shown that so long as the tongue is thickly coated, milk unless highly diluted is not well digested, curd appearing in the stools and doubtless aggravating the griping and purging. As a rule, until the tongue cleans, barley water, rice water, egg-albumin water, very thin chicken or mutton broth, rice or barley water in which chicken has been boiled, or chicken jelly constitute the most appropriate foods, the precautions already mentioned as regards quantity and temperature being observed. When the tongue has cleaned and when it may be inferred that gastric digestion has improved, milk, at first well diluted and peptonized, or raw egg and milk may be gradually introduced, and along with rice or barley-water should constitute for many days the staple and only food. As an all round food in dysentery, whether acute or chronic, when it is desired to give the patient the maximum amount of nourishment with the minimum amount of irritation, there is no food better adapted or more readily procurable than milk and rice or barley-water, in the proportion of two of the former to one of the latter. If desired a little salt may be added, or the mixture may be peptonized. It should be given slightly warmed, sipped with a teaspoon, and in quantities of from 5 to 10 oz. every two or three hours. If the monotony of this diet is complained of, one of the many malted foods on the market may be given occasionally as a substitute.
Later, as the stools improve and are free from blood, well boiled arrowroot, cornstarch, semolina, tapioca, revalenta and the like may be added. When the stools are formed hot milk and bread, chicken panada, rusk, boiled white fish, underdone egg, custard, light milky pudding, and well boiled rice will gradually pave the way to a slow return to ordinary diet. Fresh vegetables sooner or later are a necessary element in every dietary, but their introduction into that of the dysenteric patient must be cautiously effected. Coarse vegetables of the cabbage kind are injurious. Well boiled, mashed and then baked potato, stewed or roasted apple, well boiled Spanish onion, and fresh cauliflower appear to be the most suitable. They must not be given in large quantity, and their influence on the stools must be carefully watched.
For a long time after convalescence has been thoroughly established the diet must be attended to and carefully restricted as to quantity as well as to kind. Red meat and alcohol in every form must be sedulously avoided, as well as the coarser foods such as are mentioned under the section of chronic dysentery. On a threat - no matter how trifling - of relapse all solid food must be at once discontinued, and a milk and barley or rice-water diet resumed, together with rest and warmth and appropriate medicinal treatment.