cases of sprue. This is not due to cirrhosis of the liver, but to the wasting this organ undergoes in common with the rest of the soft tissues of the entire body. The absence of skin lesions and mental symptoms differentiates sprue from pellagra.
Prognosis is good for recent cases, provided proper treatment is carried out. It is bad for patients over 50, for long-standing cases, for careless and injudicious patients, and for those who cannot or will not take a purely milk diet.
Treatment.— Importance of early and thorough treatment. If treatment be undertaken sufficiently early in sprue, and be thoroughly and intelligently carried out, it is generally marvellously successful. Should, however, it be undertaken at too late a period, when the glands and the absorbing surface of the alimentary canal have been hopelessly destroyed, do what we will the case is sure to end fatally. When prescribing treatment, therefore, the first thing for the physician to do is to get his patient thoroughly convinced of the deadly nature of his complaint; for, unless he receives the hearty and complete co-operation of his patient, the physician must not expect to cure a well-established case. To be successful, treatment must be thorough, sustained, and prolonged. All predisposing causes, as uterine or other discharges, syphilis, scurvy, and the like, must of course be dealt with and, so far as possible, removed.
The milk cure.— By far the most successful treatment is what is known as the " milk cure." In carrying this out it is well to commence with a dose of some aperient— castor oil or pulvis rhei compositus. Pending the action of the drug, all food, including milk, should be withheld. The patient should be sent to bed in order to economize strength and maintain an equable warm temperature of the skin. He should also be directed to clothe warmly, to encircle the abdomen with a broad flannel binder, to cover his arms and shoulders with a warm jacket, and to live in a large, sunny, warmToom. When the purgative has acted the milk is begun. At first 60 oz.
