62 REVIEW — TKOPICAL MEDICINE, ETC. 



Enteric In a properly dieted case constipation takes the place of diarrhosa, but this tendency 



Fever— can be corrected by the use of sanatogen. Young mentions a list of foods devised to satisfy 



coidimud the cravings of the enteric patients for an ampler dietary : — 



1. Benger's and Mellin's foods, made with or without milk and fortified with cream, are of temporary value. 

 So are Jellies, bread crumbs, isinglass or rusks in beef-tea, and light puddings. 



2. Bread jelly made by thoroughly soaking stale bread, pressing out the water and allowing the pulp to 

 simmer gently for one or two hours. Strain through muslin and allow filtrate to set. Two tablespoonfuls of the 

 jelly suffice for one feed. 



3. Baw meat pulp carefully prepared and given in the form of little balls to be eaten with a rusk. 



4. Junket made in the usual way and given if desired with cream or brandy. 



5. Suet puddings, given after the temperature has been normal for a few days. The suet must be shredded 

 in thin slices and all the fibre removed. Wheat flour with an equal quantity of maize should be used. The 

 latter contains little gluten. Cook well and serve with sweet sauce or gravy. 



6. Fish, best in the form of whiting. 



7. Modified milk diets. Swithinbank and Newman's rules for boiling milk to prevent alteration in flavour 

 and formation of scum are given. 



(i.) Use an ordinary double milk pan, or a smaller covered saucepan containing the milk placed inside a 

 larger one containing the water. 



(ii.) Let the water in the outer pan be cold when placed on the fire. 



(iii.) Bring the water iip to the boiling point, and maintain it at this for 3 or 4 minutes without removing 

 the lid of the inner milk pan. 



(iv.) Cool the milk down quickly by placing the inner pan in one or two changes of cold water without 

 removing the lid. 



(v.) When cooled down, aerate the milk by stirring well with a spoon. 



Young now uses boiled milk with sanatogen added to it (2 grammes, i.e. 31 grains to 

 the pint). He also permits the addition of cocoa, coffee and tea to the milk. Other points 

 he notes are that cream added to soup or beef-tea improves the flavour and adds to the 

 food value, that sound oysters are useful, that glucose added to beef tea (one teaspoonful 

 to about 10 oz.) is valuable, and, quoting Harbin, that gelatin adds relish, lessens the 

 nitrogenous waste and prevents haemorrhage. Its food value, however, is nil. 



Young also deals with the question of drinks, and describes the preparation of a very 

 cooling beverage made from apples. He notes that ulti-amarine is found in sugar, and mica 

 in barley, and therefore thinks that in preparing food and drinks it is wise to make a 

 solution of the sugar first, allow this to settle for 6 hours and decant all except the bottom 

 portion. The latter contains the ultramarine, which chiefly consists of silica, alumina and 

 soda. In making barley water the barley must be well and frequently washed beforehand. 



For the treatment of marasmus he speaks very highly of sanatogen, which is said to be a 

 combination of pure casein and glycerophosphate of sodium. The large quantity of organic 

 phosphorus is said to make it of value as a metabolic stimulant. 



I have known a case in the Sudan in which milk was not well tolerated and sanatogen 

 was used with success, but otherwise I do not know that typhoid cases require any special 

 treatment, dietetic or otherwise, in a hot country, beyond such as may lessen the tendency 

 to hyperpyrexia. Rogers believes this is best done by the cold pack treatment. 



Ewart,' quoted by Young, advocates the Empty Bowel Treatment, or " plenty of food 

 and no faeces." He gives peptonised milk, white of egg diffused in whey before peptonising, 

 yellow of one egg a day, saccharin, lactose or a non-fermentable form of glucose, clarified 

 honey, maltine, oil or cream, one ounce a day, common salt 10 to 15 grains to every half-pint 

 of whey, watery extracts of vegetables, the juice of various fruits. 



Young has modified this, giving the whey with cream and sanatogen. Of this 

 prepared whey he administers 2^ to 4 pints in the 24 hours. It is easily prepared, easily 

 digested, easily assimilated, and is declared to be a simple and perfect diet for the early 

 stages of enteric fever. 



Faeces. Nothing is more important in the diagnosis of disease in tropical countries 

 than the examination of the faeces. This is specially true of the Sudan, a country in close 

 proximity to and having much intercourse with Egypt, where, as is well known, metazoan 

 parasites play no small part in the pathological field. There can be little doubt that in the 



Ewart, W. (December 19th, 1905), "The Treatment of Typhoid Fever." British Medical Journal, p. 1720, 

 Vol. II. 



