PSEUDO-SPRUE—HILL DIARRHCEA 



1795 



The Flexner-like bacillus found in these cases is identical with the typical 

 Flexner, but for the fact that litmus milk was rendered permanently acid 

 instead of the medium becoming first acid and then alkaline. Minor differ- 

 ences with regard to some sugar broths may occasionally also be noted. 



HILL DIARRHCEA. 



Definition. — Hill diarrhoea is a gastro-intestinal catarrh of un- 

 known cause, occurring mostly at high altitudes in tropical regions, 

 and characterized by the passage of several liquid, frothy, light- 

 coloured motions in the early morning. 



History. — Hill diarrhoea was first described by Grant in 1854, in 

 the same paper as that in which he dealt with sprue and dysentery, 

 and later as a disease quite distinct from sprue by Crombie in 1892. 

 The latter writer held that it was liable to occur at an elevation of 

 6,000 or more feet in India, Europe, and elsewhere. In India he 

 believed the monsoon to be a potent factor, associated, probably, 

 with a diminished barometric pressure. We have seen cases in 

 Ceylon occurring at a much less elevation — for example, at about 

 3,000 to 4,000 feet. 



More recently Duncan has put forward the view that mica in 

 the water is the causative agent. This mica is found in the laterite 

 — i.e., v/eathered gneiss — which is a common geological formation 

 in the tropics. Singer considers that he has met this disease in 

 four out of six Europeans on an expedition to Abyssinia, when they 

 reached a height of about 5,000 feet. 



etiology. — ^The causation of the disease is quite unknown. The 

 theories are: — Diminished atmospheric pressure, the irritation of 

 mica, faecal contamination of the water, and exposure to cold. 



Pathology. — Very little can be said under this heading, except 

 to invite attention to what has already been written under the 

 heading of Sprue with regard to the formation of leuco-urobilin, 

 and to point out that it is obviously to the formation of this body, 

 and not to anything wrong with the liver, that the colour of the 

 motion is due. The morbid anatomy would appear to be totally 

 different from that of sprue, and to be a congestion of the mucosae 

 of the stomach and bowels, with a proliferation of the mucosal 

 lymph and fibrous tissue in chronic cases. On the surface of the 

 mucous membrane of the small and large bowels there is a thick 

 layer of mucus, but no ulceration. 



Symptomatology, — The disease generally begins soon after the 

 patient has arrived in the hills from the plains. 



The onset is sudden, beginning with abdominal pain in the early 

 hours of the morning, with the passage of large, frothy, greyish 

 or whitish motions, which produce a sense of relief. The patient 

 goes about his work, but in the early hours of the next morning 

 the symptoms are repeated, and he will complain that his stomach 

 feels blown out, and that he can hear gurgles, and this goes on 

 morning after morning. 



If now the patient leaves the hills and comes down to the plains 



