TREATMENT 



1791 



diarrhoea and vomiting abate, the milk must be gradually increased, 

 and, indeed, the starvation must not be long continued in any 

 case. Starvation diets are dangerous in severe cases, when the 

 patients are emaciated and weak; and hence, while they are being 

 employed, great care is required in nursing. 



If the milk is succeeding, the diarrhoea ceases, the mouth troubles 

 diminish, and the patient feels better. The fseces will at first be 

 pale and grey, but, as improvement continues, stercobilin will 

 appear, as evinced by the brown colour. This change in the colour 

 of the faeces is a most important sign. 



But even if milk is agreeing with the patient, there will be much 

 trouble, as there is often strong objection to milk only. Another 

 difficulty is constipation, and this must be relieved by enemata. 

 Sometimes the milk does not agree, causing vomiting and pain. 

 Usually this can be relieved by alkalinizing the milk with bi- 

 carbonate, I grain to the ounce, or the citrate of soda, 2 grains to 

 the ounce of milk (convenient tabloids of this salt are prepared by 

 Burroughs Wellcome and Co.), or by adding Apollinaris or Emfe 

 water in the proportion of equal parts, or lime-water, i to 6 of 

 milk. As soon as a definite improvement appears, and the weight 

 begins to increase, the patient should be allowed to sit up, but great 

 care must be taken to avoid chills. Milk diet should be persisted in 

 for a month or six weeks, but may be modified by the addition of fruit 

 — e.g., strawberries, bananas, or apples — as will be described later. 



Then eggs may be beaten up in the milk ; chicken-broth can be 

 tried; then Benger's food, or some other simple food- — Allen and 

 Hanbury's, Mellin's, Albany food, Carnrick's soluble food, Sana- 

 togen, or Plasmon. Then fish, chicken, or sweetbreads, with a 

 biscuit, and, later, potatoes; and finally, the patient is put on to 

 a diet of eggs, toast, dilute China tea, soups, white meats, custard- 

 puddings, milk. But he must avoid dark meats, most vegetables, 

 spiced foods, iced drinks, and all indigestible substances. Alcoholic 

 drinks in every form are bad, both during the illness and afterwards. 

 Nor is smoking to be encouraged; we, personally, are much against it. 



But, unfortunately, a case of sprue is not so easy to treat as indi- 

 cated above, for, while the food is being gradually and carefully 

 increased, relapses are not infrequent, and a return to milk may be 

 necessitated. The patient gets weary, and at times exceedingly 

 angry about this dieting, and, indeed, is apt surreptitiously to kick 

 over the traces, with disastrous results. The prohibition of alcohol 

 also leads to trouble, but our experience about this is quite clear.: 

 if alcohol is taken, the progress of the patient is seriously hindered. 



Before leaving the milk diet, two points ought to be mentioned, 

 concerning one of which we have had considerable experience; 

 concerning the other, none at all. First of all, there can be no 

 reasonable doubt as to the advantages of liver-soup — i.e., soup 

 prepared from calves' or sheep's livers- — in the milder cases of sprue, 

 or in the return to ordinary food of a severe case. The liver treat- 

 ment is really an old native remedy in Ceylon. We do not profess 



