352 DISEASES OF UNCERTAIN ETIOLOGY 



SYMPTOMS. 



It begins soon after arrival on the hills from the plains. 



The onset is sudden with abdominal pain in the early morning and 

 the passage of stools followed by relief. This is repeated next 

 morning. 



The stomach feels to be much distended, there is gurgling. 



The patient is better on returning to the plains. In Ceylon, how- 

 ever, there are similar symptoms with patients when on the plains 

 (Castellani). 



The tongue and mouth are never involved. 



It has a very low mortality. 



TREATMENT. 



The patient must avoid hills over 6,000 feet high. 

 Rest in bed. Warm clothing. 



Liquor hydrarg. perchlor. i to i^ drachms, fifteen minutes before 

 each meal. Pepsin, 12 to 15 grains, two hours after meals. 

 Milk diet diluted as necessary. 



SPRUE (PSILOSIS). 

 DEFINITION. 



It is a chronic catarrhal inflammation of the alimentary canal ; 

 characterized by large, pale, frothy motions; ulceration of the tongue 

 and mouth with digestive disturbances. 



DISTRIBUTION. 



Asia, Burmah, India, China, Japan, Fiji; West Indies, South 

 America, rarely in West Africa and Europe. Probably world-wide in 

 tropical and sub-tropical countries. It is a regional as opposed to a 

 climatic disease. 



ETIOLOGY. 



The causation is unknown. 



Some of the suggested causes are : climate, food, helminths, 

 bacteria, fungi, protozoa and a symptom-complex. Fungi are often 

 found in the mouth and the intestines of patients, the commonest being 

 the genera Monilia and Saccharomyces. They are perhaps secondary 

 infections causing the frothy diarrhoea, because sodi-bicarb. will clear 

 out the fungi, when the frothy stools will cease, but the disease 

 continues. 



Many fungi grow badly in alkaline media. 



