1788 



SPRUE AND OTHER DIARRHCEAS 



abdomen, and the passage of fermenting, abundant, clay-colonred 

 motions. With these symptoms there will be progressive emacia- 

 tion and anaemia, and when to these the characteristic mouth- 

 lesions occurring in a person living in the tropics are added, it 

 is indeed difficult to imagine any disease with which it could be 

 confounded. Van der Scheer considers that the discovery of fat 

 in the motions is a diagnostic sign before the disease begins; but 

 this condition may also be found in pancreatitis. Low says that 

 the so-called psilosis pigmentosa of Barbados is pellagra. The 

 diseases from which sprue should be distinguished are stomatitis, 

 hill diarrh(]ea, chronic dysentery, and chronic pancreatitis. 



Stomatitis. — All forms of stomatitis are very common in the 

 tropics, and may be accompanied hy intestinal symptoms such as 

 diarrhoea. The stools, however, do not show the peculiar char- 

 acteristics of sprue — viz., the white colour, the frothy appearance, 

 and the copious amount passed in the twenty-four hours. 



Thrush. — 'This is easily diagnosed by examination of the white 

 patches, in which fungi of the genus Monilia will be found. It is, 

 however, to be noted that in long-standing cases of sprue, as in all 

 chronic complaints, thrush may develop. 



Hill Diarrhoea. — The patient generally gives a history of residence 

 at a high elevation, and the diarrhoea is as a rule present only in 

 the morning, while mouth symxptoms are absent. We have, how- 

 ever, seen several patients in whom sprue has developed after 

 repeated attacks of what to all appearance was simply hill diarrhoea. 



Chronic Dysentery. — In chronic dysentery there is an absence of 

 the mouth symptoms, while the motions are not whitish in colour, 

 and may contain blood and mucus during the exacerbations. The 

 diarrhoea of dysentery is generally accompanied by griping, while 

 that of sprue is not. In chronic dysentery pain is often felt on 

 pressure over the sigmoid and descending colons. In some cases 

 microscopical and bacteriological examination of the stools for 

 entamoebae and the Shiga-Kruse bacillus may be necessarj^ to clear 

 the diagnosis. 



Though personally we consider sprue and chronic dysentery to 

 be different diseases, still we have seen several cases of sprue develop- 

 ing in old-standing cases of chronic dysentery. 



Chronic Pancreatitis. — iVbsence of the mouth symptoms of sprue 

 and presence of tenderness in the region of the epigastrium and 

 the passage of large quantities of fat in the motions, together with 

 Cammidge's crystals in the urine, will enable the diagnosis of 

 chronic pancreatitis to be made. 



Prognosis. — The prognosis in any case of sprue is serious, because, 

 unless the patient will honestly co-operate with the doctor, he will 

 go from bad to worse. We are of the opinion that, no matter 

 how mild the case may be, the patient should be warned of the 

 danger. 



If treatment is properly carried out, the prognosis improves con- 

 siderably, but even then relapses are apt to occur. 



