HI STOP A THOLOG Y—SYMPTOMA TOLOG Y 1 785 



coloured by Leishman's stain take up a reddish or purplish colour. 

 They are apparently structureless, but they may present one or 

 two small vacuoles. These inclusions stain beautifully by using 

 H. C. Ross's jelly method, but even with this method do not show 

 any structure. They are not fat drops, as they colour deeply with 

 Leishman's stain instead of becoming dissolved in the alcohol. 

 They do not appear to be of nuclear substance, as the masses are 

 structureless. They do not seem to be parasitic, as they are 

 structureless and homogeneous. The severer the inflammation of 

 the tongue, whatever the cause, the more numerous are these 

 bodies. The greatest probability is that they are merely masses 

 of keratohyalin. 



Type II. — -Occasionally instead of structureless homogeneous 

 masses, granular agglomerations somewhat resembling chlamydozoa 

 are seen. Whether these are a stage of the former inclusions is 

 not known, but they appear to be merely cell degenerations. 



Changes in the Cells of the Blood. — These have already been men- 

 tioned under the heading Pathology. 



Morbid Anatomy. — The body is emaciated, and the skin often 

 hangs loosely, and there may be oedema about the ankles. The 

 tongue shows small areas of infiltration into the connective tissue, 

 vesicles, and small ulcers. The filiform papillae atrophy, and the 

 fungiform papillae become swollen and prominent. The pillars 

 of the fauces and the tonsils may show subepithelial inflammation, 

 and even suppuration and ulceration. The oesophagus is inflamed, 

 and its mucosa is attenuated in places. The mucosa of the stomach 

 may be pale and atrophied, or rough and cirrhotic. The mucosa 

 of the small intestine may be slightly eroded, or may be so de- 

 stroyed that the whole bowel is diaphanous with vascular arboriza- 

 tions; or there may be effusion into the solitary and agminated 

 glands. The contents are bile-stained in the upper parts, and 

 whitish lower down. The large bowel may be ulcerated. The 

 liver is atrophied, but otherwise normal. The pancreas may be 

 normal, inflamed, or cirrhotic. The peritoneum may be thickened 

 and chronically inflamed, and in some cases show adhesions. The 

 other organs are normal as a rule, but sometimes they are atrophied. 



Symptomatology. — The incubation period of sprue is quite un- 

 known, and the onset is insidious, without marked symptoms, 

 which are usually merely failing strength and an undefined sense 

 of illness. The disease may begin with diarrhoea and intestinal 

 symptoms, or with mouth symptoms only. 



Usually it begins with slight attacks of sore mouth, indigestion, 

 and morning diarrhoea, often of a bihous nature; but as none of 

 these are severe, and all are evanescent, the patient thinks little or 

 nothing about them, and does not consult a medical man until 

 the disease is well established. Three symptoms now worry the 

 patient — viz., sore mouth, indigestion, and morning diarrhoea. 



On examining the mouth, the dorsum of the tongue will be seen 

 to have a whitish fur, through which the swollen fungiform papillae 



