SPRUE {P SILO SIS) y:,7 



Bowel wall ver}' thin, sometimes like tissue paper. Mucous coat 

 atrophied, submucous coat has fibrosed areas with dirty grey tenacious 

 mucus. The ^'illi and glands destroyed. Erosions are most marked 

 in the colon. 



In the swollen endothelial cells of the venules of the spleen are 

 certain hvaline bodies, probably of a degenerative nature not found in 

 other diseases, perhaps produced in response to the extensive yeast 

 infection found in sprue. These yeasts are small. Gram-positive, and 

 have no affinit)' for fuchsin. They are not Russell's bodies (Balir). 



SYMPTOMATOLOGY. 



Insidious onset. Sore mouth, dyspepsia, diarrhoea, tongue in- 

 flamed but clean with small vesicles, ulcers and bare patches, ditto 

 on palate, pillars of fauces, inside of cheeks, acid salivation. 



Warm and spiced foods, hot, acid, or alcoholic drinks cause pain. 



Mucus accumulates about the mouth. Though hungry the patient 

 eats little. 



There is a burning pain behind the sternum on swallowing; the 

 neck and thorax are emaciated, the abdomen is distended with gas, 

 and the ankles with oedema. 



There is discomfort and distension after meals, acid eructations, 

 and sometimes vomiting. 



In the earl\- morning there are several copious, painless, grey 

 offensive, frothy stools. 



The fasces contain mucus, epithelial debris, many bacteria and 

 fungi. 



The nitrogen and fat are increased (undigested food and fatty acids). 



Often the hydrochloric acid of the gastric juice is diminished or 

 absent (Manson). The same applies to the intestinal digestive juice. 



The blood coagulates slowly. There is anaemia, 1,000,000- 

 2,000,000 reds. 



The colour index is low. Leucopenia to 3,000. 



Depression and irritability; tongue glazed, small and fissured, is 

 more like cartilage. 



Pulse slow and feeble. Emaciation. 



An acute diarrhoea or cardiac failure may cause death. 



The symptoms are often intermittent, but steadilv growing from 

 bad to worse. The disease may be mild or virulent, liable to sudden 

 remissions and latent periods. 



A denuded tongue makes mastication difificult. 



,, cesophagus makes swallowing painful. 



,, stomach causes dyspepsia, 



,, intestine causes diarrhoea. 



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