TREATMENT 



1789 



Treatment. — The treatment is symptomatic. 



An attempt must be made to soothe the alimentary canal, and 

 to give it as little work to do as possible, so that it may repair itself. 

 This line of treatment will necessitate rest in bed and a careful diet, 

 after the bowels have been swept as clear as possible of decom- 

 posing material. 



While this is proceeding, care must be taken to avoid chills, as 

 they aggravate the disease. Lastly, an attempt should be made 

 to treat those symptoms which worry and annoy the patient. 



The treatment, therefore, may be classified into: — 



1. The co-operation of the patient. 



2. Rest in bed. 



3. Suitable clothing. 



4. Removal of fermenting bowel contents. 



5. Diet. 



6. Medical treatment. 



7. Change of climate. 



1. The Co-operation of the Patient.— The nature of the com- 

 plaint and the dangers which the patient runs must be carefully 

 explained to him, and the line of treatment sketched out. Further, 

 he must be told that its success or failure largely lies in his own 

 hands. If he has not the strength of will to persevere, even when 

 at first success seems far from certain, he might as well not begin. 



If he agrees to co-operate, then he must be carefully weighed, and 

 a chart kept of his weights. 



2. Rest in Bed. — The^second point is that the patient must 

 remain in bed for a little time, and use the bed-pan and the urine- 

 bottle, in order to give the bowels as much rest as possible, and 

 warm water must be used in sponging. 



3. Suitable Clothing. — ^The underclothes and pyjamas should 

 be of wool or flannel, in order to avoid chills. 



4. Removal of Fermenting Bowel Contents.- — The treatment 

 should begin with a dose of castor oil, to remove the fermenting 

 contents of the bowel. 



5 . Diet. — The various diets advised may be arranged as follows 



{a) The milk diet. 



ih) The milk and fruit diet. 



{c) The fruit diet. 



Id) The m^eat diet. 



[e] The meat and milk diet. 



(a) Milk Diet. — The real basis of the treatment of sprue at 

 present is the milk diet. 



In the tropics, this milk should be obtained from a cow kept for the purpose 

 or from some really reliable dairy, as the danger of contamination is great. 

 Even when the cow belongs to the patient, great care has to be taken that the 

 milk is not adulterated by the household servants. We can never forget 

 that once the milk 6'f a peculiarly careful household, collected, apparently, 

 under strict precautions, was found on analysis to be grossly adulterated. 



