SPRUE AND OTHER DIARRHCEAS 



to consult a doctor, he is astonished to find that he is quite well, 

 and perhaps goes back to the hills without having obtained the 

 medical advice which he desired. A relapse takes place, for which 

 he does not as a rule seek advice, as he considers it a trivial com- 

 plaint, until later he begins to feel dyspeptic, disinclined for his 

 food or work, and now he will seek treatment, notwithstanding the 

 fact that he feels better on returning to the plains. The disease 

 may become chronic, and rarely may lead to a fatal result. 



Sequela. — It is said that neglected hill diarrhoea may develop 

 into sprue. 



Diagnosis. — The history of the case and the absence of mouth 

 symptoms are sufficient to enable the diagnosis as a rule to be 

 made from sprue. 



Prognosis. — The prognosis is good, as recovery is generally quick 

 under suitable treatment, but in certain cases it is found necessary 

 to abandon residence at high elevations. 



Treatment. — The treatment is simple and effective. It consists 

 in rest in bed, warm clothing, and J to i drachm of liquor hydrargyri 

 perchloridi, given fifteen minuces before each meal, and 12 to 15 

 grains of pepsin, ingluvin, or lactopeptin two hours after the meal. 

 The diet is to be milk, which may be diluted as advised in the treat- 

 ment of sprue. 



Prophylaxis. — Persons liable to the disease should avoid the hills, 

 especially in the monsoon season, and if compelled to go to high 

 altitudes should do so by easy stages. 



LOW-COUNTRY MORNING DIARRHCEA. 



This affection, described by Castellani, is common in Ceylon, and 

 somewhat resembles hill diarrhoea, but is found in the plains. 



Symptomatology. — The patient wakes up about 3 to 4 a.m. with 

 an urgent call to evacuate the bowels, but there is no abdominal 

 pain or straining. After an interval of one to two hours the bowels 

 are again evacuated, and perhaps again two or three more times in 

 the course of the morning. The motions are liquid, generally 

 yellowish or brownish, and do not contain blood or mucus. The 

 condition lasts as a rule for months, but usually ceases on a change 

 of climate. 



Treatment. — A dose of tannalbin (gr. xv.-xxx.) or bismuth sub- 

 nitrate (gr. xv.-xxx.) may be given at bedtime as a palliative. 



FLAGELLATE DIARRHCEA. 



Definition. — Flagellate diarrhoea is an acute or chronic diarrhoea due to 

 infections of the intestine with Oicomonas hominis (Davaine, 1854), Chilo- 

 mastix mesnili {Weny on, igio) , Giardia intestinalis (Lambl, 1859), and 

 monas hominis da Fonseca, 1915, and other flagellates. 



History. — From the days of Davaine, observers have from time to time drawn 

 attention to cases of diarrhoea or enteritis thought to be caused by these 

 parasites — e.g., Roos, Epstein, Castellani, Nattan-Larrier, Brumpt, da Fonseca, 

 Chalmers and Pekkola, Escomel, Paranhos, etc. 



