SPRUE AND OTHER DIARRHCEAS 



are projecting. The sides and tip of the tongue are red and in- 

 flamed, with often small vesicles, small ulcers, and bare patches, 

 which are very tender. Similar patches may be noted under the 

 tongue near the frenum, on the inside of the cheeks, on the palate, 

 and on the pillars of the fauces. A little ulcer, called Crombie's 

 molar ulcer, may be seen near the two last upper or lower molar 

 teeth. So tender is the mouth at times that deglutition, mastica- 

 tion, warm or spiced foods, acid or alcoholic liquors, cause much 

 pain. In addition, mucus may be noticed clinging to the pillars 

 of the fauces and to the back of the pharynx. This mucus is a 

 source of great distress to the patient, as it accumulates in con- 

 siderable quantities, especially if some warm fluid has been taken, 

 and the effort to get rid of it makes him alm^ost sick. On swallowing 

 food, a burning pain is felt along the course of the oesophagus and 

 over the sternum, as though there was something raw inside (as, 

 indeed, there is). The voice is said by Thin to be altered at times, 

 but we have not specially noted this. 



The neck, thorax, and arms may show signs of emaciation. The 

 abdomen is swollen, sometimes markedty so, especially in the 

 epigastric region, and the wall is soft and relaxed. The patient 

 complains of dyspeptic symptoms— viz., a sensation of discomfort 

 and distension after meals, with acid eructations and sometimes 

 vomiting. Early in the morning he feels symptoms of intestinal 

 discomfort, and passes a few copious, greyish, offensive, frothy 

 motions, and no more for the rest of the day. After these motions 

 he may feel much better, and have a good appetite. 



Examination of the faeces shows mucus, epithelial debris, and 

 many bacteria, and often ^^east-like fungi, and in some cases eggs of 

 various worms may be present. The quantity of faeces passed varies 

 with each motion, but is in excess of the normal, this being due to 

 solids rather than liquids. The excretion of nitrogen and fat is 

 increased. Fat constitutes over 20 per cent., often 40 to 50 

 per cent, of the stools, while in normal individuals on a mixed diet 

 it averages 6 to 8 per cent. Some observers believe that this is 

 not due to the fat-splitting enzymes non-acting, but to the absorp- 

 tive power of the upper parts of the intestine being interfered with. 



The analysis of gastric contents may show a decrease in hydro- 

 chloric acid and pepsin. The pancreatic juice may show absence 

 of diastase, trypsin, and lipase. 



The most complete analysis of urine and faeces has been carried out by V. 

 Harley and Goodbody. The patient, weighing 36-87 kilogrammes, was on a 

 milk diet, containing 12-99 grammes of nitrogen, 76-44 grammes of fat, 82-32 

 grammes of carbohydrates, and 1,960 c.c. of fluid. The urine passed measured 

 1,050 c.c; specific gravity, 1012; urea, 16-8 grammes; uric acid, o-8 gramme; 

 ammonia, 0-44 gramme; phosphates, 1-27 grammes; chlorides, 3-89 grammes. 

 Total sulphates, 1-47 grammes, of which 1-35 grammes were alkaline and 0-12 

 aromatic. The average daily quantity of the motions was 255 grammes, of 

 which 79-46 were water, 1-47 nitrogen, 35-92 fat. The nitrogen given in the 

 food was 12-99 grammes, and that in the faeces 1-47 grammes; therefore 88-86 

 per cent, had been absorbed. The fat in the food was 76-44 grammes, and 

 that in the faeces 35-92 grammes; therefore 53-01 per cent, had been absorbed. 



