During the acute stage of cholera food is out of the question. If swallowed and retained it can only do harm, for in the condition of the stomach at this period of the disease digestion and absorption are in abeyance and all foods, whether liquid or solid, are no better than foreign bodies; their administration therefore can only do harm. Water is the only thing permissible. This may be drunk ad libitum. If absorbed, even in small amount, it will help to dilute the thickened blood and flush the kidneys; if vomited it will carry out with it myriads of cholera vibrios and their products and to that extent proportionately improve the chances of recovery. If the patient can be got to take the water he craves for slightly warmed so much the better.
At a later stage of the disease when vomiting and purging subside and the pulse is returning and when urine begins to be secreted the question of food and drink becomes important. The epithelial layer of stomach and intestine has been completely shed, the blood vessels are nearly empty, the patient is in a state of collapse or of great prostration. In such circumstances to give food or stimulant in large amounts would only tend to interfere with the process of repair necessary for re-establishment of the digestive and absorbing faculties, and would very likely precipitate a severe gastro-enteritis. Food and fluid, therefore, must be very cautiously introduced. Milk, peptonized if possible, and freely diluted, thin barley or rice water, egg-albumin water, and very weak chicken, mutton or beef-tea are indicated, beginning with teaspoonfuls every quarter of an hour and gradually increasing the amount and strength, the interval between the feeds being at the same time lengthened pari passu with the improvement in the condition of the patient. But there must be no attempt to force feeding or at returning to solid food, more especially if there be indications in the form of the slimy or bloody stools of enteritis. Until all such evidences of enteritis have completely disappeared, and appetite and digestion are thoroughly re-established, solid food must be withheld, and even then care must be exercised for a time, both as regards the quality and quantity of the meals.
Should the condition known as cholera typhoid supervene on the acute stage of the disease, fluid diet of as nutritious and concentrated a character as can be digested and at the same time not aggravate any existing enteritis, must be sedulously administered every two or three hours, or at shorter intervals, day and night. If the urine is scanty or suppressed, the patient should be encouraged to drink water freely but not in such quantity as to induce vomiting. If vomiting is present, the water should be given by enema of weak salt and water, a teaspoonful of the former to a pint of the latter; or, if this be rejected, by subcutaneous or intravenous injection of sterilized physiological salt solution. Wine or other alcoholic stimulants may have to be given; they should be well diluted and administered in small amounts at short intervals.
In all cases of recovery from cholera the return to ordinary diet should be gradually effected.
During an outbreak of cholera great care should be taken to avoid any articles of food that would cause dyspepsia or reduce the normal acidity of the stomach contents. For this reason, fruits should be taken in great moderation or not at all. Melons are by some believed to be particularly unsuitable and to predispose to an attack. As water passes through the stomach without exciting secretion of acid it should not be taken between meals, and not in large quantities with them. In all circumstances it should be thoroughly and recently boiled and not filtered afterwards.