Idiosyncrasies In The Matter Of Food are not uncommon and have to be taken into account. Mental peculiarities have also to be considered and care may have to be exercised by avoiding a too sedulous interest in every little article of diet, or by too particular an inspection of the stools, to avoid fostering, or creating even, hypochondriacal tendencies not at all uncommon in chronic dysenteries. Some patients attach little importance to a moderate degree of chronic dysentery and consequently may be foolishly careless; on the other hand, there are not a few who become morbidly sensitive about the slightest irregularity, whether it be in the colour, consistence or smell of their dejecta, and are thrown into a fever of alarm by the appearance of the slightest looseness or streak of slime. Such people are apt to become a nuisance to the physician and a burden to themselves. They are over-careful. They live by theory; ignoring the promptings of their natural appetite they not infrequently land themselves in a condition of physiological starvation far from conducive to recovery. Patients with this tendency should not be instructed to watch their stools; they should be instructed rather to attend to a reasonable extent to any healthy natural appetite they may develop.
Circumstances may compel some chronic dysenteries to work hard, whereas others may be under no such obligation; some may be naturally robust, others delicate; some, apart from the disease of the bowel, may be constitutionally sound, others may be the subjects of tuberculosis, syphilis, malaria and so forth. The possibility of the existence of hepatic abscess must also be borne in mind. In prescribing a dietary in chronic dysentery all these things have to be considered and allowed for.
There are certain drinks and foods which all chronic dysenteries should avoid. Chief of these is alcohol; this, under every form, unless in very exceptional circumstances, should be strictly forbidden. Partially fermented drinks, such as gingerbeer, and sweet effervescing drinks, as bottled lemonade, perry, and so forth are dangerous; strong tea and black coffee are in the same category. Iced drinks or large draughts of fluid, especially at meal times, should also be avoided.
The following articles of food are generally inadmissible : Rich soups, strong beef-tea; oily fish such as salmon, trout, eel, mackerel, herring, smelt; shell fish such as lobster, crab, shrimp, prawn; dried, salted or otherwise preserved fish such as Bombay duck, smoked salmon, red herring, dried haddock, salted cod, sardines; red meats as beef, mutton, pork, venison, hare; all birds of the duck tribe as duck, goose; rich sauces, curries, potted or otherwise preserved meats; coarse vegetables such as cabbage, Brussels sprouts; dense vegetables such as peas, beans, carrots; nuts of all kinds; raw vegetables and salads; dried, candied, or otherwise preserved fruits such as raisins, currants, orange peel, crystallized fruit, preserved ginger, jams and pickles.
Although interdicting certain foods, in prescribing a dietary in chronic dysentery, we must bear in mind that the disease may run a very long course, and that too monotonous or restricted a diet if persisted in for many weeks or months may induce scorbutic conditions, or, if not actual scurvy, at all events depraved conditions of nutrition not conducive to recovery. It will generally be found that these cases do best on a mixed diet with short courses of a more rigid dieting and more energetic medicinal treatment interpolated from time to time.
Thus in those cases of chronic or recurring tropical dysentery so frequent among our countrymen from India, if the general condition be fairly satisfactory, and if there be no evidence of liver abscess or of tuberculosis of an advanced character, we may prescribe with advantage a course of ipecacuanha in large doses. At the same time we insist on rest in bed and a diet of milk and barley-water only, to the amount of 3 pints in the twenty-four hours. This course of active treatment is to be continued for a week or ten days. Thereafter the diet should be gradually changed and eggs, rusks or thin toast, arrowroot, well boiled rice, chicken broth, boiled fish, pounded chicken, mashed potato, milky pudding, stewed apple and so forth gradually introduced, one article at a time. So soon as it is found that the patient on this increasing diet has begun to gain weight the further increase of food is suspended as being unnecessary, but care must be taken to vary as much as possible the kind of food and the way in which it is cooked. A rule of great importance should be insisted on, namely, that food must never be taken in the absence of appetite.
As effective mastication is indispensable the physician must see to the teeth and gums, and the services of the dentist be invoked if indicated. Oral sepsis must be corrected.
In time some such diet as the following may be gradually worked up to : Breakfast: One or more of the following : Hot milk and toast or bread, lightly cooked egg, boiled sole or other white fish, thin toast, rusk or pulled bread, a little fresh butter, small cup of weak China tea or of chocolate. Lunch: Slice of fowl with bread sauce, or a piece of boiled fish, mashed potato, cauliflower, milky pudding or stewed apples. Five o'clock: A glass of milk and a rusk. Dinner : The same as lunch. Bed time : A glass of hot water, or of hot milk, or a cup of some malted food. Small quantities of fresh fruit may be taken, in many instances with great advantage.
On such a diet the patient may thrive and gain weight. Should this prove to be the case there must be no undue haste to change the regimen; at the same time, when any particular article of food begins to pall a substitute should be found, a too rigid monotony being carefully avoided. In some very chronic and persistent cases with marked tendency to relapse a good plan is regularly, and as a matter of routine, to suspend the mixed diet for one day a week, give the patient some mild aperient and place him for twenty-four hours on milk and barley-water only. Relapse is anticipated in this way, and it may be averted.
Whenever a relapse is threatened the diet of milk and barley-water must be at once resumed, the patient being sent to bed and active medicinal treatment instituted. By prompt action of this description and by persistent care in the feeding and general hygiene, most chronic dysenteries can be got rid of, if not promptly, at all events in time.
Other methods of dieting will be alluded to in the section on sprue.
There is one fact, with important practical bearings, that is too generally overlooked in the management of the various forms of dysentery, namely, the capacity for prolonged latency possessed by the germs responsible for the specific lesion. Once established in the colon these germs may be difficult to uproot completely; especially is this the case with the amoeba. A well directed treatment may have brought about apparent recovery, but on slight provocation, i.e. anything tending to cause intestinal irritation or congestion, such as alcohol, strong coffee, bad food, inappropriate food, too much food, especially red meat, chill, etc., the parasite may find its opportunity in the irritated tissues or deranged secretions, and after perhaps months or even years of quiescence once more start into activity and produce dysenteric lesions and symptoms. In some cases there appears to be a rough periodicity about the recurring relapses, as if these were determined by definite periodical biological changes in the parasite. In time, as with the malaria parasite, the infection appears to die out, but as in many cases this may be a long time, several years, one cannot be too careful in pronouncing a chronic dysentery as cured, or in relaxing dietetic and other precautions.