General Principles

Regulation of the dietary plays an important, if not the most important, part in the management of the various morbid conditions to which the alimentary canal is so peculiarly prone in the tropics, and which constitute a principal feature in tropical pathology. Although in consequence of diversity in the circumstances of the individual cases, as well as of the diseases and in the degree of their severity, the details of dieting and management necessarily vary, there are certain general principles which serve as guides in elaborating these details. In proportion to the care and thoroughness with which these principles are applied will be the success of the practitioner.

In treating the diseases of the alimentary canal the condition and functions of the affected organs must ever be kept in view, and this more especially when the physician is directing the dietetic part of the treatment. He must not be influenced too much by the name of the disease; he must rather picture to himself the exact physical condition of the affected organs, recognizing that they are congested, inflamed, or ulcerated and, it may be, functionally perverted. At the same time he must not forget that their operation is necessary for the nutrition of the body; and, seeing that the diseased organs themselves are a part of the body, he must bear in mind that their recovery cannot be effected unless they themselves, as part of that whole, are also adequately nourished.

Such considerations suggest the leading indications for the dietetic as well as for the more strictly therapeutic management of the various forms of acute and chronic disease of the alimentary canal special to the tropics, and of which intestinal flux is usually a leading clinical feature. These indications may be summarized as follows -

1. The removal or suppression by drugs - quinine, ipecacuanha, calomel, purgatives, antiseptics, anthelmintics, etc. of such specific organisms as are either the primary and sole cause of the disease, or which may be contributory agents in the production of and continuance of secondary morbid conditions.

2. Rest of the affected organs so far as is consistent with:

3. Adequate local and general nutrition.

It is with the second and third alone of these indications that we are here concerned. They are best met, first, by the selection of the appropriate kind, quality and amount of food; and, second, by insisting on warmth and strict rest in bed in order to allow of reduction of the amount of that food to the lowest possible minimum compatible with the general and local physiological necessities. These are golden rules for the management of the grave tropical intestinal fluxes, whether acute or chronic; they can seldom be disregarded with impunity.