CHAPTER VII 



SPRUE 



This disease, also designated as aphthae tropicae, Ceylon sore 

 mouth, psilosis linguae et intestini, diarrhea alba, tropical diarrhea 

 and diarrhee de Cochinchine, has been described in detail by Van der 

 Sheer (1384), Thin (1385), W. C. Brown (1386), Begg (1387), Schilling 

 (I.e. 840 and 980) and CasteUani and Chalmers (I.e. 839). This non- 

 infectious disease, investigated since 1776, is endemic in Asia, espe- 

 cially in the Malay Archipelago, Siam, Annam, Sumatra, Java, but 

 also in India, Ceylon, China and Japan, also in Australia and occa- 

 sionally in Europe. In the United States, cases were reported by 

 Wood (1388), Boyd (1389) and Sturtevant (1390). These patients 

 were never in the tropics, but Hiat't and Allan (1391) also observed 

 cases, which came from the tropics. The symptoms of the disease 

 consist in painful stomatitis with vesicles and erosions and persistent 

 diarrhea, with grayish-white foamy stools. The disease is curable by 

 a dietary therapy. 



SYMPTOMATOLOGY 



The edge of the tongue and the point are reddened, eroded, with 

 small vesicles, and covered with ulcers. Similar erosions, vesicles 

 and ulcers are found on the gums, lips, soft palate, uvula, and 

 cheeks. The patients complain of marked pain on chewing and 

 swallowing. According to Bahr (1392), the disease occurs much 

 more frequently in women, and may be confused with pernicious 

 anemia. 



The abdomen is blown up, especially at the epigastrium, the 

 patient complains of pressure, fullness and burning in the region of 

 the stomach, particularly after meals; in addition, there is heart-burn, 

 flatulency and vomiting (without nausea). On investigation of the 

 stomach, hyperchlorhydria and achlorhydria are not infrequently 

 found. In the morning hours, without bodily pain and without 

 tenesmus, there is a copious, soft, foamy grayish evacuation. The fat 

 content of the feces is markedly increased, and the findings, according 

 to Halberkann (1393) are similar to those in a pancreas affection. 

 According to T. B. Brown (1393a), there is a complete lack of 



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