370 THE VITAMINES 



pancreatic ferments and the therapeutic administration of such is 

 recommended. The number of red blood corpuscles is considerably 

 decreased (1,000,000 to 3,000,000 per cubic millimeter); the hemo- 

 globin index is 60 to 70 per cent. In some cases, tetany belongs to 

 the clinical picture of sprue. In this connection, there are the newer 

 reports of Bassett-Smith (1394) and Barach and Murray (1395), who 

 investigated the parathyroids and found them normal. 



In severe cases, muscle weakness, loss of weight, depression, and 

 symptoms of cerebral irritation are observed. In the final and fatal 

 stage, continuous fever is often noted. The skin becomes gray and 

 scaly; the tongue appears smooth, rimous and atrophic; the ankles 

 become edematous; the liver becomes atrophic; the diarrhea, more 

 severe and the pulse, slow and weak. 



PATHOLOGICAL ANATOMY 



In the intestine, there is a primary congestion of the capillaries of 

 the sub-mucosa; later, hemoglobin exudation and round cell infiltra- 

 tion; finally, atrophy of the intestinal mucosa. This constant finding 

 of primary lesions in the sub-mucosa speaks against a local infectious 

 cause of the disease. The resophagus and the stomach are similarly 

 affected, but less intensively. In severe chronic cases, atrophy of 

 the intestinal wall, liver and pancreas is found. 



THEEAPY 



Substances like opium, bismuth, etc., are rather harmful. Emetin 

 was recommended by Schmitter (1396) although, according to 

 Miihlens (1397), this is indicated only in cases complicated by 

 dysentery. Simon (1398) used vaccine with good results, although 

 he stated that a change in diet must be made simultaneously. 

 Castellani (1398a) recommends sodium bicarbonate administration 

 in conjunction with the dietetic treatment. According to Wegele 

 (1399) the dietetic therapy is most productive of results. Among 

 the best substances to use are, according to Low (1400), milk; 

 according to Cantlie (1401), fruit, and according to Conran (1402), 

 meat. These are the same substances used in the treatment of 

 avitaminoses, but in sprue, special care must be exercised and only 

 frequent small doses should be administered. Especially to be 

 recommended, is milk, either raw or cooked for a short time, raw 



