At the commencement of an attack of appendicitis, or at any rate when the patient first comes under observation, it may be impossible to say whether perforation or gangrene has occurred.

In the event of perforation or gangrene having taken place, it is very important that the stomach and intestines should be as motionless as possible, and this can only be attained by withholding food altogether for twenty-four hours or more, by which time the actual condition of affairs may have been determined. If laparotomy is performed, the subsequent dietetic treatment should be cautiously along the lines laid down for post-operative treatment after abdominal operation, which is given in detail on pp. 33S and 345.

If it be decided that no immediate operation is necessary, 4 ounces of fluid nourishment may be given every two hours, the food consisting of milk diluted one in three with plain water, egg albumin, weak beef or mutton tea. From eight to ten feeds should be given in the course of the twenty-four hours. After a day or so of this diet, when the pain and fever have largely subsided, and all fear of localised suppuration or general infection is over, the diet can be rapidly increased by the addition of gruels made from oatflour, or barley-meal, or prepared invalid food (Benger's or Allenbury); also some of the Plasmon preparations, lightly cooked egg, scraped beef, and fish.

If the attack subsides, and if the appendix is not removed, the question arises as to whether diet will prevent a recurrence of the attacks. A correct diet will certainly greatly diminish the risk of fresh attacks. The diet must be a simple one, not too rich or varied, and should contain little of the canned food preparations. It must be free from excess of foodstuffs that are prone to fermentation or putrefaction. Hence moderation in the amount both of the carbohydrates and proteins in the food is essential. Thorough mastication, attention to the bowels, and the use of various lactic acid bacilli preparations may be mentioned as adjuvant factors in the prophylaxis.