Chronic dysentery is often best treated by an exclusive milk diet of from two and a half to three quarts a day, with rest in bed or on the lounge. In other cases rare steak or roast beef or chicken and egg albumen may be allowed, with dry toast, zwieback, or crackers. The milk and meat diet may be advantageously combined.

In Osier's opinion, if there is much ulceration of the colon meat is not well borne, and it is better to keep the patient upon a diet which will give but little residue, such as boiled or peptonised milk.

The stools must be examined every day or two to ascertain the presence of undigested fragments of milk curds or meat, oil globules, mucus, blood, etc. If improvement does not occur, the patient may be put upon a diet of egg albumen with beef juice, or some of the preparations of beef meal (p. 113) or peptonoids, with pancreati-nised milk. Return to solid diet must be very gradual, and may be conducted on the lines directed for convalescence from typhoid fever (p. 441).

Acute Intestinal Obstruction

Many of these cases demand immediate operation, but if for any reason this is not performed nothing should be given by the mouth. If any food be taken it decomposes, and even drink may excite severe vomiting. The patient may be nourished by the rectum, and thirst can be relieved by injection of a pint of lukewarm water with a teaspoonful of salt into the rectum. If the latter is irritable a smaller quantity should be employed, and more frequently given. Another method of relieving thirst is to inject a pint or two of warm, sterilised salt solution of the above strength into the cellular tissue beneath the skin, after the manner of the hypodermoclysis recommended in cholera (p. 455). If necessary half an ounce or more of whisky is to be given from time to time hypodermically, weakened by two or three times the quantity of salt solution. If all these injections are sterilised and inserted deeply they are much less painful than if inserted immediately beneath the skin.

If the obstruction is overcome without operation, the diet should be very slowly increased, giving only fluid nourishment by the mouth for two or three days, or until all symptoms have subsided.

The fluid food should consist of beef juice, broths, egg albumin, and simple farinaceous gruels. Milk, if not wholly absorbed, forms too bulky feces.

The symptoms of profound collapse, thready pulse, etc., depend not upon the local condition of obstruction, but upon sapraemic intoxication from toxins produced by decomposition of retained food. This statement is corroborated by the prompt relief which sometimes succeeds emptying the bowel after removal of the obstruction and the use of lavage and irrigation with warm water (106° F.).