This is a disorder which has been specially described by Dr. Eustace Smith as consisting of "an attack of fever which comes on suddenly, is accompanied by signs, more or less pronounced, of digestive disturbance, lasts in its acute form for several days, and may linger on in a modified degree for some weeks." The subjects of this affection, according to Dr. Smith, are usually children of either sex between the ages of three and twelve years, of a neurotic temperament, and liable to chills and acute gastric catarrh. These accompanying conditions may be ignored here, as apparently the important element both in the preventive and the curative treatment lies in the diet. An attack begins with headache and is frequently characterized by vomiting or diarrhoea, always by some kind of digestive upset. The child shows a disinclination for play or exertion of any kind; the temperature is raised to 101°, or it may be much higher; the face is dull and pasty in appearance, and the tongue is dirty. Examination shows extension of the stomach resonance upwards, enlargement of the liver, and thick, very acid, or high-coloured urine. The children, as a rule, make no complaint of bodily discomfort, but are fretful and irritable in the day, and at night lie awake or sleep badly, groaning and tossing from side to side. Often they do not care about their food, and sometimes it is most difficult to make them eat anything at all.
Although the attack may be started primarily by acute gastric catarrh, Dr. Eustace Smith believes that the fever is maintained by reabsorption from the bowel of injurious products of decomposition. The appearance of the stools shows that fermentation has been taking place, and it is a natural inference that some of the products of this fermentation must be absorbed into the blood. Dr. H. Davy also concludes that the fever is due to an autointoxication from the products of fermentation of particular mixtures of starchy foods.
All are agreed that the diet is of the greatest importance, and the following are the lines of dietetic treatment recommended by Dr. Eustace Smith. Articles of food which are capable of undergoing an unwholesome fermentation in the bowels must be forbidden. Starches and sweets should be given with caution, and a combination of starch with milk, such as is found in the ordinary milk pudding of the nursery, rice, sago, tapioca, etc., should be strictly forbidden. Milk itself, except in very limited quantity, is harmful, because of its tendency to ferment, and in persistent cases milk should be excluded entirely from the diet. Acids, such as are found in baked apples, grapes, oranges, and lemonade, must be condemned, as they tend to promote fermentation. " The proper diet for these children consists of mutton, poultry, white fish, well-boiled green vegetables, and eggs. They may have plenty of butter, with stale bread, toast, and rusks. The salted foods are good, such as bacon, ham, and tongue; bloaters also and sardines, and the pastes made of anchovy, bloater, and shrimp may be allowed." Although these foods are not all in common use in the nursery, Dr. Smith finds that they are harmless, and that the pastes make good substitutes for marmalade and jam.
It is plain that such a diet cannot be continued permanently nor does it appear necessary that it should. Dr. H. Davy has found that after a time farinaceous and other starchy foods may be given in small amounts and gradually increased as toleration is established. He is inclined to trace the attacks of fever to the fact that the pancreatic digestion is not proportionate to the age of the child. As the child grows older the power of his pancreatic digestion increases, and so the cause of the fever gradually ceases. The special dietary required may be carried on for six or twelve months until the pancreatic secretion is properly established.