Various methods of dieting have been advocated, and are used either singly or in combination. These may be classified as follows: -

1. The milk diet.

2. The meat diet.

3. The fruit diet.

4. The mixed diet.

In all cases the bowels should in the first instance be cleaned out by a dose of castor oil. Should pyorrhoea alveolaris or other condition of oral sepsis be present, as is often the case in this disease, appropriate local treatment must be carried out. Complete rest in bed and warmth are of the utmost importance in treatment.

The Milk Diet

This regime is the most generally applicable and effective in this disease. Much attention to detail is essential for its successful application. Written directions are supplied to the patient as follows (Manson and Daniels): -

1. Fresh milk, slightly warmed, to be the only food and drink.

2. The milk to be taken at intervals of two or three hours, in divided quantities up to the aggregate amount of 3 pints in the twenty-four hours.

3. The milk must never be taken hurriedly, but slowly sipped with a spoon or sucked through a strand or fine glass tube, in imitation of the natural way of ingesting milk.

4. After each feed the mouth must be rinsed out with an alkaline or antiseptic wash, and the teeth lightly brushed.

5. Unless the patient- is very weak, sleep must not be disturbed for feeding purposes.

6. If at any time there is a feeling of nausea or a want of appetite, one or more feeds should be intermitted.

7. Throughout the treatment the patient's weight should be taken every three or four days, and accurately recorded.

If after a thorough trial of this treatment for a week there is no marked improvement, the diet must be modified. If, on the contrary, as is usually the case, improvement is marked, attempts to increase the amount of milk must not be made too soon; nor, indeed, till the patient clamours for more food and the motions are solid. In this case, increase to the extent of half a pint per diem may be allowed every two or three days. Not until six weeks after the stools are formed, and the soreness of the mouth and the abdominal distension have disappeared, may any attempt be made to add to the dietary. If things go well, the following may be carefully introduced: - Fruit, especially strawberries or bananas mashed up with a portion of the milk; raw or underdone eggs; well-boiled arrowroot, rice-water or barley-water; rusk, crisp thin toast; custard, malted artificial food, stewed apple, chicken broth in which rice has been boiled and strained out; pounded chicken, chicken cream or panada; boiled sole or turbot; boiled, mashed, and afterwards balled potato; and so gradually, after several months, reverting to regular meals and ordinary diet, not for a long time introducing anything but the simplest and most digestible of food, and avoiding alcohol and beef, and unnecessary fluid at meals.

The milk treatment as above described may fail; but before admitting failure, certain modifications of it should be tried, e.g., peptonising the milk, diluting with water or barley-water, the use of whey, skimmed milk, koumiss, or buttermilk; and occasionally benefit is derived from the addition of a little fruit, especially of strawberries.

The Meat Regime

This regime is commenced with tea-spoonful, gradually increased to tablespoonful, doses of carefully prepared meat juice. If this is well borne, scraped meat, and later minced and lightly cooked meat, may be gradually introduced. At first, an ounce or two of meat is given every three or four hours; if this agrees, the quantity is increased, and the intervals between the meals lengthened, until a pound or more is taken in the twenty-four hours, in three or four meals. Thin, crisp toast may be taken with the meat, and hot water in small quantities, taken slowly, from one and a half to two hours after the meal. The return to a normal diet after a course of meat treatment should be as gradual and tentative as after the milk treatment. Very great benefit sometimes accrues from alternating the milk and meat treatment, e.g. alternating the two every four days. This is a point of great practical importance.

The Fruit Treatment

A diet of milk and strawberries, the amounts of both being gradually raised to 5 pints of the former and 3 lbs. of the latter, sometimes tends to a rapid and permanent cure of sprue. When good strawberries are not available, bananas form a fair, though inferior substitute. The fruit, which must be ripe, must be reduced to a pulp and thoroughly incorporated with the milk. Other fruit treatments have been advocated.

The mixed diet treatment has already been referred to. Special mention may again be made of the value of the system of alternating the diets in the manner described.