Dyspepsia is most apt to be converted into this intoxication either by increase of the total amount of food or the increase of special forms of food (fats or sugar). This is very likely to occur owing to the insuffi cient attention given to dyspepsia. Disorders of balance are seldom the introduction of the intoxication. A proper diagnosis and early treat ment of these dyspeptic symptoms %till prevent the effects of this food intoxication.
An intoxication undoubtedly exists causing the fever as well as the other characteristic symptoms. If it is not too far advanced it can be removed by a reduction of the nourishment.
A closer study of the different foods shows that sugar holds first place as the cause of this alimentary intoxication. In children suffering with dyspepsia it has been noticed that sugar hastens the stage of intoxi cation. It has been observed in clinics where they have used sweetened tea or water because of fever and gastric disorders that high temperatures ete. speedily developed and were explained by the use of sugar. This has been observed in the use of buttermilk (Tugendreich's buttermilk fever).
Flour, on account of its soluble carbohydrates being converted into sugar, plays a part as a cause of this disorder. The ordinary flours and mucilaginous foods when cooked have no effect.
Overreaching the tolerance limit of fats may cause this intoxication, especially in children who have early given manifestations of this diffi culty, and is shown by soaps in the stools and by soft pulpy evacuations rich in fats. (Salge has described this as being due to specific positive bacilli which act on the fatty acids. These bacilli are not present in many cases and but little importance is attached to their existence.) Casein and albumin seem to have no influence on the development of this intoxication.
The small part which skim milk and whey play in the causation of this intoxication is attributed to their sugar and salt content.
The effects of salts, NI Lich will be spoken of later, under decomposi tion have been shown (L. F. Meyer) to be harmless when given in whey made from human milk but when given in the whey made from cow's milk they cause serious disorders. Nothing positively is known as to the nature of the poison. There would not be such an improvement when nourishment is withheld if it were due to bacterial toxins. There are no positive grounds for assuming it to be an acidosis. It is not a ura-mia, because of the appearance of the kidneys. The kidney involve ment is secondary and never reaches the high degree necessary for producing urzemia.
No matter how active the appearance of alimentary intoxication may be or how disastrously it affects the various organs, it must still be considered a mild affection from the prognostic point of view. If early recognized it is curable, and it resists a rational treatment only when it has existed for a long time or when it occurs in very young or very weak patients. In this respect it is important to observe the rapidity with which a lessening of the poison, as denoted by decreasing temperature, is brought about by the introduction of a different diet (tea, water, etc., mixed with saccharin). Should such a change produce this rapid improvement in twelve to twenty-four hours, then the result will be favorable. Should it require longer (over twenty-four hours), then
the food should be resumed with great caution. If it is not possible to reduce the fever, the chalices for recovery are very slight.
Treatment.—This must be directed toward ridding the system of its poison and preventing the formation of new poisons from the food and by stimulating the action of the bowels, kidneys, skin, and lungs by the administration of liquids. This is brought about best through the admin istration of sugar-free liquids (tea, water, physiological salt solution, etc.). tinder its influence the temperature will fall, free diuresis will be estab lished, and stools poor in substance poorly formed, and without odor will be produced.
During recent years, because of the greater water retention, we have used other fluid drinks. The one recommended by Mery and which I have used satisfactorily is his vegetable bouillon. (It is prepared as follows: 60 Gm. potatoes, 45 Gm. yellow turnips, 15 Gm. white turnips, and 6 Gm. dried peas or beans are mixed with a litre of water, cooked for four hours in a porcelain or earthen-ware dish, expressed through a sieve, and then enough boiled water is added to make 1 litre and 5 Gm. salt is added.) The soup must be made daily, and in hot weather kept on ice. It is usually well taken, but sometimes causes cedema. This is easily remedied by reducing the amount of salt. Camby's vegetable soup is somewhat, similar but has a somewhat higher albumin content. It is prepared by cooking a tablespoonful each of pearl barley, indian corn (mashed), tlry white beans, dry peas, and lentils together in 1 litre of w-ater for three hours. After this 20 Gin. of salt are added. Pehu and Variot have prepared similar soups. Moro uses a carrot soup pre pared by cooking 500 Gm. of carrots down to 375 Gm. and cooking again after adding 220 Gm. of water for one-half to three-quarters of an hour. This is then sifted through a fine sieve and 1 litre of beef broth (made from 500 Gm. of beef and soup stock and Gm. of salt) is added. This should be made daily and kept in a cool place. Outside of its heavy water retention, which may cause mdema, this soup is useful in helping to form better stools, to warm the intestines, and, as Moro expresses it, to keep substance in the intestines. This soup, in spite of its relative high percentage of sugar (2 per cent.), is of great benefit in alimentary intoxication. This is shown by the constant results which have followed its use by me. This diet must be continued until the fever has dis appeared, and there is an improvement in the general symptoms and in the local intestinal condition. Frequently this requires forty-eight hours. This diet may be instituted in the beginning instead of tea, water, etc., because of its great water content, and, as it satisfies hunger, it may be continued for some time. Later flour (rice, oatmeal, etc.) may be mixed with it. When this is done a coffeespoonful of the flour should be mixed with a few spoonfuls of the soup and then added to the whole portion and heated.