As in malaria, the individual attack is of short duration, nevertheless during this brief period an extreme degree of anaemia is attained. The greatest danger is suppression of urine; consequently the main dietetic requirement is the maintenance of an abundant supply of fluid in order to flush the kidneys. Nutriment, though important even during the acute stage, is less so than water.
Vomiting is a marked symptom in most cases, and is often a precursor and concomitant of suppression of urine. Every care, therefore, must be taken that fluid and diet be so arranged and administered as not to provoke this symptom. Food in liquid form, such as milk and soda-water or cooled broth, may be given frequently in 1 or 2 oz. doses, whilst the patient is kept perfectly still and hot applications are made to the epigastrium. If vomiting supervene, food must be discontinued, although plain fluids may still possibly be given by the mouth. Rectal alimentation can be employed, but as frequent saline enemata must be given, the bowel may become irritated, in which event there is little chance of absorption taking place; recourse must then be had to frequent subcutaneous injection of normal saline fluid. Stimulants will be required to combat the tendency to cardiac failure; they should not be resorted to at first, although they may be required by the second day.
The obstinate hiccough that sometimes occurs is difficult to treat. In some cases it may be relieved by solid food, such as dry biscuits. Occasionally what is known as the "prairie oyster" has a good effect. It is made by turning out the unbroken yolk of an egg into a wineglass, into which a teaspoonful of Worcester sauce and half a teaspoonful of whisky have been poured. The unbroken yolk should be well covered with black pepper. The wineglass is then rotated so that the whole surface of the yolk is wet with the sauce. The yolk should then be swallowed whole.
If food be retained it is well digested. During convalescence a light ordinary diet can be adopted. No restrictions, beyond care as regards the amount, quality and digestibility of the food (so as not to cause any attacks of dyspepsia or gastric dilatation) need be enforced.