358 DISEASES OF UNCERTAIN ETIOLOGY 



The stools are pale because of — 

 (i) The farinaceous diet. 



(2) A colourless reduction-product of hydrobilirubin. 



(3) The abnormal percentage of cijnlained fat. 

 The stools are large owing to 



(i) The lack of absorption of carbohydrates, &c. 

 (2) The lack of digestion ,, ,, 



The acid reaction is due to lactic and butyric acids (not to HCl), 

 and the absence of pancreatic ferments. 



Cammidge's urinary reaction is negative (Bahr). 



DIAGNOSIS. 



An irregularly, chronic, pale, frothy, morning diarrhoea with 

 ulceration of the mouth and flatulent dyspepsia in a tropical resident 

 is in all probability sprue. 



In Stomatitis the characteristic stools of sprue are not present. 



In Thrush, look for the fungi Monilia in the wliite patches of the 

 tongue. This condition, however, may complicate sprue. 



In Hill Diarrhoea the mouth symptoms are i^ften absent. There is 

 a history of living at an high altitude. 



In Chronic D3^sentery the mouth symptoms and pale stools are 

 absent, while blood and mucus is passed. There is usually no griping 

 with sprue. Look for amcebje and the dysentery bacillus. 



In Chronic Pancreatitis the mouth is normal, there is much fat in 

 the stools, and there are Cammidge's crystals in the urine. 



Remember that the denuded epithelium of the tongue is only seen 

 in Sprue, Pellagra and Scurvy. 



TREATMENT. 



The patient must assist the practitioner. His co-operation is 

 essential. 



Absolute rest in bed. Avoid chills. Remove all sujDposed causes. 

 Clear the bowel contents with castor oil. 



The diet is all-important. 



Milk Diet. 



The milk must be free from contamination and adulteration. 



If it contains much fat dilute it with whey made ^itli the juice of 

 limes. Sterilize the milk. 



If the attack is severe begin with whey onl}-, ad libitum, 7 to 8 pints 

 daily. 



Milk, sipped, three to four pints daily as soon as possible. 



.A.S the symptoms improve increase the milk gradually bv half a 

 pint daily until seven pints are being taken. Let it be distributed over 

 tw^elve meals dailv. 



