A dietetic approach to the coeliac affection.

The coeLiac affection occurs among children of all financial grades of the population, making its appearance some time between the ninth month of life and the end of the second year. Its incidence has been on the increase since before 1939, partly, no doubt, due to a more frequent recognition of its features. The war cannot be entirely blamed as, both during hostilities and since, food rationing has provided a better balanced diet in many homes, and more intense propaganda on food values has been provided by child welfare clinics. The traditional method of treatment, concentrating on reduced fat intake, was unsatisfactory, leading by a lengthy and laborious progress to an often imperfect recovery. Some improvement in results followed the high vitamin B therapy of May, McCreary, and Blackfan (1942), but there was still a large residuum of complete or partial failures and of recurres. It was decided, therefore, during the war, to investigate the treatment advocated by Bircher-Benner (1935) who, in his Zurich clinic, had obtained good results with a fruit and vegetable diet. A case of coeliac disease, first diagnosed at 3 years of age, had been placed on this diet at the age of 6 years, and gained 14 lb. in eight months with an increase in height of three inches. Simila, though modified, treatment had been introduced by Feer (1929) at the Kinderklinik, Zurich, and later continued by his successor, Fanconi. Fanconi (1930) referred to favourable results in 50 typical cases of coeliac disease treated with the fruit and vegetable diet. The present report describes the treatment of 25 cases of coeliac disease. The first 19 of these were given the fruit .and vegetable diet advocated by Bircher-Benner (Bircher-Benner diet).* At first this diet was followed exactly, but with the passage of time disadvantages became evident and eventually only nine cases continued on the strict regime. The diet of four cases had to be modified by the addition of appreciable amounts of protein, and two cases relapsed and died. Gradually a new diet was evolved, being a modification of that used by