Attention has recently been called by Ewart to the advantages of a diet which leaves little or no residuum. The object here is to give plenty of food to the patients, but to dispense with the faeces so far as possible. It is obvious that there are many advantages in such a method. There should be an absence of any irritating residue which may increase the process of ulceration, and Ewart throws out the hope that just as we have learned that phagedenic chancre and hospital gangrene are no longer held to be normal developments in pathology, so we may yet learn that severe typhoid ulceration is a preventable condition. That it may be so is indeed very probable but, so far as regards hospital patients, the mischief will usually have commenced before they come under observation. Any diet, however, which claims to limit the severity of the process, demands careful consideration, and the dietary outlined by Ewart contains many most interesting and valuable suggestions.
The staple food is whey given in quantities from 2 1/2-4 pints in the twenty-four hours. This has, of course, been much used, especially in severe cases, by many practitioners, and is always worth trying when a patient cannot digest milk however carefully the latter is given. Ewart adds 10-15 grains of common salt to each half pint, with a view of correcting the deficiency in mineral salts which the ordinary milk diet entails. He advises that the deficiency in phosphates should be made up by giving periodical doses of one of the medicinal syrups. Sugar is also added to the whey, being useful as a food and having no residuum. The organic acids and essences contained in fruit and vegetables may be given in the form of watery extracts, carefully strained. Fruit jellies, especially apple jelly, are well taken by the patient, and vegetable soups should be given daily. The meat preparations and extracts are not recommended. To secure sufficient nitrogenous material white of egg is added to the whey, which is then peptonized. The yolk of one egg daily is allowed in divided portions. Clarified honey may also be used and is a valuable addition to the carbo-hydrate supply. Maltine is also useful in this connexion. As regards the fats, cream is the most useful and acceptable, either taken alone or added to the whey. One ounce is a sufficient daily allowance.
It is to be understood, for the first few days that the patient is under observation, that whey alone should be given, salted but with no other addition. When any meteorism has subsided, sugar, albumin, and cream may be added to it successively, the state of the patient and the condition of the stool determining each addition. Thereafter the vegetable soups, the fruit juices and jellies, and the honey are brought into use. Such a diet is certainly likely to leave little or no residuum. Ewart employs it in conjunction with an antiseptic treatment consisting chiefly of the use of paraffin and powdered charcoal. This it does not come into our province to discuss.