EEVIEW — TROPICAL MEDICINE, ETC. 195 



santonin morning and evening for three days. The effect of this treatment is that the stools Sprue— 



at once become "bilious" ; the bile, which seems to have been pent up, owing to previous coniinued 



" milk treatment," flows with great freedom when meat is given, and at first the stools are 



copious, loose, and as many as two or three daily. By the third day, in all probability, no 



stool is passed, and when on the fourth day the motion is seen, it is not infrequently fairly 



solid, fsecal and deeply bile-stained. 



The diet may now (the fourth day) be increased, a poached egg is added to the beef at 

 breakfast and dinner ; pounded chicken may be given at the mid-day meal, instead of the 

 beef. On the sixth day the moat or chicken may be finely minced — thrice passed through 

 the mincing machine — in place of being pounded. By the eighth day the patient may have 

 a cut off a joint, the undercut of a piece of roast beef being the best. 



As soon as the stools are solid, or fairly solid, add vegetables to the diet— stewed 

 celery, stewed sea-kale, or vegetable marrow ; pulled and baked bread — -thin slices of bread 

 kept in a hot oven for twenty minutes until dry and crisp. The patient's diet is now fairly 

 varied, and additional food can be tried — as judgment directs. 



Rice-tea is made by roasting some rice in the oven until brown ; tiien placing two tablespoonfuls of it in a 

 jug and pouring over it one pint of boiling water and allowing the decoction to stand for fifteen minutes, when 

 the rice is strained off and the " tea " used as a drink. China tea is made by taking the finest procurable, placing 

 half a teaspoonful in a strainer over a breakfast cup and pouring boiling water over the leaves. Either of these 

 teas, or each used alternately, may be given fifteen minutes after finishing food — never with the meat, of course. 



The meat treatment, Cantlie holds, will not fail if carried out early and systematically. 

 It goes well with the strawberry treatment. 



In a discussion, Galloway differed from Cantlie on the subject of milk, and advocated 

 the asepticisation of the bowel by means of calomel. This author has an exhaustive paper' 

 on the subject, distinguishing an acute gastric (native) type and a chronic enteric type of 

 sprue. Of intestinal antiseptics, apart from calomel, he recommends chinosol in sugar- 

 coated "tabloids" of 5 grains each, thrice daily at first, but reduced even to one a day 

 as the case improves. The remarks on dietetics appear to be sound and of value. In 

 another paper- he shows how infection may take place by prolonged and intimate 

 contiguity, proof of the organismal nature of the complaint. 



Begg advised the exhibition of crude santonin, and Hartigan^ prefers cyllin given in 

 the form of intestinal palatinoids — 3 m. cyllin in each. Younge'' states he has known 

 at least one case with thrush recover under treatment with pepsin, which, in the form 

 especially of malto-pepsin, he has seen produce much benefit. It is given after meals 

 in 5-grain doses. 



Recently Cantlie" has had surprisingly good results in all cases of sprue by giving 

 ipecacuanha in the same way as in dysentery. Its effects are most marked in advanced 

 cases in which (a) the tongue is ulcerated and may have been extremely tender for months ; 

 (fc) the stools are bulky and frothy ; and (c) an increase of temperature occurs towards 

 evening. The drug is given daily in 20-grain doses for two, three, or more days, and 

 stopped when the stools become thin, brownish in appearance and devoid of odour (an 

 ipecacuanha stool). Cantlie now advocates "fast-days" for patients on the meat 

 treatment, i.e. days when milk alone is given as an " alterative" for twenty-four hours. 



Begg" gives the complications found in chronic sprue, and which may prevent patients 

 deriving full benefit from his santonin treatment. These are : (1) Pancreatitis ; (2) Chronic 

 appendicitis ; (3) Involvement of liver and gall bladder with resulting jaundice ; 

 (4) Diabetes ; (5) Pernicious ansEmia. Mayo Robson'' draws attention to the frequency of 

 chronic pancreatitis in Europeans returning from tropical countries diagnosed as oases of 

 sprue. He thinks that diseases of the pancieas are frequently unrecognised in the tropics. 

 The same fact is recorded by Cammidge," who mentions the special "pancreatic" reaction 



1 Galloway, D. Q. (October 16th, 1905), " The Treatment of Sprue." Jounial of Tropical Medicine and Uyiiicnc. 

 Vol. VIII. 



^ Gtalloway, D. Q. (October 2nd, 1905), " Some Clinical Notes on the Etiology of Sprue." Journal of Tropical 

 Medicine and Hyijirne, Vol. VIII. 



" Hartigan, W. (March 1st, 1905), " The Use of CvUin in Sprue." .Towrnal of Tropical Medicine and Hvaiene. 

 Vol. VIII. ■ ■ 



■* Younge, Q. (December, 1905), " Pepsin in Sprue and Hill Diarrhoea." British Medical Journal, Vol. II. 

 ^ Cantlie, J. (September 2nd, 1907), " Ipecaouanlia in Sprue." Journal of Tropical Mrdiciiie and Hygiene, 



" Bcgg, C, ihiil., " Complications Pound in Chronic Cases of Sprue." Iliid. 



' Mayo Robson, A. W. (.luly 27th, 1907), "A Note on Interstitial Pancreatitis in its Rel.ations to Sprue." 

 British Medical Journal, Vol. II. 



" Oammidge, P. .1. (.Inly 2nd, 1907). Journal of Tropical Medirine and Hinjicne, p. 293, Vol. X. 



