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XXXII] theless, I have seen cases in which, after failure of the most carefully carried- out milk or meat diets, a mixed diet proved successful for a time. In such mixed diets, in fact in all diets in sprue, restriction in the amount is as important, perhaps, as the quality of the food consumed. Food should never be given unless the patient is hungry. It is a great mistake to try to make these patients fat rapidly, or to stimulate the desire for food by encouraging active exercise. The bowel is not in a condition to deal with large meals. When to send the patient to Europe.— When sprue develops in the tropics, if feasible the patient should be sent to Europe as soon as possible. It is a mistake, however, to ship an invalid with his disease active on him, or if his end is manifestly not very far off. Diarrhœa should not be active when the patient is put on board ship. In every case provision, such as a cow or an abundant supply of sterilized milk, should be made for carrying on treatment during the voyage.

The clothing and general management.— Sprue patients returning to Europe ought to be especially careful in their clothing, and they ought to get out their warm clothes before the ship leaves the tropics. If their return is during the winter, they should arrange to remain in the south of Europe till at least late spring. Next to an unsuitable dietary, perhaps cold is the most prejudicial influence to which a sprue case can be exposed. A sprue patient ought never to feel cold; he ought always to wear thick flannels, thick stockings, and, when up and about, thick boots. In winter a chamois-leather waistcoat, provided with sleeves, is of great service. His rooms ought to be warm. He ought to eat very sparingly. He ought never to be fatigued; he ought to go to bed early and rise late; in fact, he ought to do everything in his power to avoid irritating the bowel, to guard against chill, physiological depression, and the necessity for copious eating. During the summer England is suitable enough