SYMPTOM A TOLOGY-^DIAGNOSIS 



787 



The colour of the faeces was greyish-green to greyish-white, but gave a distinct 

 urobilin reaction, due to the leuco-urobilin. Schmidt's test for urobilin is 

 performed by adding a concentrated solution of perchloride of mercury to the 

 faeces, when a bright red colour is developed if urobilin is present. If there 

 is much urobilin, the colour appears within five minutes; if little, in five to 

 fifteen minutes ; if very little, in half an hour. The colour deepens for twenty- 

 four hours. More analyses on the above lines are required. Halberkann 

 in a case he studied found a large amount of indican in the urine and a reducing 

 Fehling substance, which was not glucose, undetermined. In the stools he 

 found presence of urobilinogen, and they contained a large amount of fat. 



The blood coagulates slowly, and there is always some reduction 

 of the red cells, which may fall as low as 3,000,000 to 1,000,000 per 

 cubic millimetre. The coiour-index is low, and the structure of the 

 cells is normal. The white cells are also reduced to about 6,000 to 

 2,800 per cubic milhmetre. The ratio of white to red is about i to 

 400 in bad cases. A differential count shows an increase in the mono- 

 nuclears and eosinopliiles. 



The urine requires more investigation, but as far as evidence goes 

 at present it is not abnormal, showing only an increase in indigo 

 blue and urobilin, and at times Cammidge's reaction for pancreatitis. 



Schmitter has often noted loss of sexual power. 



The buccal, intestinal, and other symptoms may markedly im- 

 prove, even without treatment, but only to get worse again; and 

 this is repeated time after time. 



In. due course the patient becomes very emaciated, weak 

 physicalty, and depressed and irritable mentally. The skin becomes 

 harsh; the mucosse anaemic; the tongue becomes smooth, glazed, 

 rMdish-yellow, and small, and is often furrowed by cracks; indiges- 

 tion is marked; and the diarrhoea is worse. The patient continues 

 to lose weight, and emaciates rapidly, the skin hanging in loose 

 folds, the abdomen blown out with gas, the liver small and atrophied, 

 the ankles oedematous, while the pulse becomes slow and feeble. 



After this has gone on for a long time, the emaciated, worn-out, 

 irritable person dies of an acute attack of diarrhv^a or cardiac 

 failure. Sprue is essentially a chronic disease, with remissions, 

 intermissions, and recurrences, but, unless taken seriously in hand, 

 goes Steadily from bad to worse. 



Some writers distinguish three stages — a first stage, with oral 

 and d^/spoptic symptoms; a second stage, with marked intestinal 

 symptoms; and a third stage, with toxaemia, emaciation, and 

 anaemia; while cases are sometimes seen which are atypical — that 

 is to say, where there are the mouth symptoms without the intes- 

 tinal symptoms, and vice versa. 



Complications.— The complications met with in the course of the 

 disease are: — Acute diarrhoea; dysenteric diarrhoea; haemorrhage; 

 meteorism; pancreatitis; myalgia; insomnia; helminthiasis, 

 especially ankylostomiasis; impacted faeces; chronic appendicitis; 

 jaundice; diabetes; and pernicious anaemia. 



Diagnosis.— The diagnosis of the disease is to be based upon the 

 irregular chronic diarrhoea occurring especially in the morning, and 

 associated with flatulent dyspepsia, causing distension of the 



