Page:Tropical Diseases.djvu/576

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532
DYSENTERY
[CHAP.

Repose must be as nearly complete as possible. In acute cases and during exacerbations in chronic cases the patient must not be allowed to get out of bed; when he has a call to stool he must use the bed-pan. To a certain extent this enforcement of rest is com parable to the placing of an inflamed leg in a splint and elevating it. It ensures some degree of mechanical rest, and relieves the blood-vessels of the inflamed part of a certain amount of hydrostatic pressure.

Food in acute, dysentery.— The indication of rest we further endeavour to meet by stopping all solid food. Were it possible, it would be well to stop all food. This, of course, is impossible, and so we make a compromise between the therapeutical indication and physiological necessity by reducing the diet to a minimum and selecting only such foods as, while possessing considerable nutritive value, yield but a small or non-irritating fæcal residue. The tongue is a fair index to the sort of food most likely to suit the case. When this organ is coated, indicating gastric catarrh, small quantities of thin chicken soup, egg albumin, thin barley- or rice-water, are better borne than milk; when the tongue is or has become clean, then milk, pure, diluted with barley- or rice-water, or peptonized, is the best diet. Alcohol is generally contraindicated, but in cases of collapse small feeds of white wine whey may be given with advantage. These foods should be taken in small quantities at a time, a little every hour or two. They must be given neither hot nor cold, as food when either too hot or too cold is apt to excite peristalsis and to cause colic and straining.

Malaria and scorbutus.— If upon inquiry it is found that there is reason to suspect either a malarial or a scorbutic element in the case, treatment must be modified accordingly. Careful practitioners never forget to ascertain if these important complicating elements are present or not. If malaria be suspected, or if temperature is markedly raised, it is well to make a careful microscopical examination of the blood for the parasite; if this be found, then quinine must be freely administered either by the mouth or, if the