1798 SPRUE AND OTHEk DlAmitCEAS 



Symptomatology. — When in small numbers there may be no symptoms, or 

 the only symptoms are those of diarrhoea, with liquid brown motions, con- 

 taining yellow flakes, which are composed of epithelial cells and leucocytes, 

 around which the parasites are formed in large numbers. 



Treatment. — This is not very satisfactory. It is easy in most cases to stop 

 the diarrhoea by giving a small dose of castor oil followed after some hours by 

 the administration of astringents such as tannalbin and salol in large doses, 

 but it is most difficult to obtain a complete disappearance of the parasites. 

 Methylene blue acts fairly well on flagellates of the genera Cercomonas, Oico- 

 monas, Trichomonas and Chilomastix, but has practically no action on 

 Giardia (Lamblia). It is given in i or 2 grain doses twice daily in cachets 

 or gelatine capsules, and in addition enemata of 3 pints of i in 3,000 solution 

 of methylene blue may be given twice daily. The patient should be told that 

 the urine will become blue, otherwise he will be much alarmed. 



Another method of treatment is to administer calomel at night, a saline 

 purgative in the morning, and during the day powders or cachets of salol 

 combined with bicarbonate of soda. This is done for several days, while 

 the patients are kept on a restricted diet and the motions carefully examined 

 daily for the flagellate. Iodine solution (i : 1,000) by rectal injection has been 

 recommended by Escomel, but is painful. 



Thymol, turpentine, etc., have also been recommended, but these various 

 methods of treatment do not induce a complete disappearance of Lamblia 

 infections. 



Prophylaxis. — This consists in preventing flies and cockroaches from access 

 to food by keeping kitchens and outhouses, and all the immediate surroundings 



of a house, in a good sanitary condition. 

 Kitchens may be wire-netted and fly-traps 

 may be provided both inside the kitchen 

 and outside. Balfour says that ' chicken 

 entrails ' are the best baits for large fly- 

 traps situate in the open air. The flies 

 may be killed after being caught by means 

 of a daisy killer or any other smoke 

 apparatus. 



All fly-breeding places should be de- 

 stroyed by the removal of the dirt and 

 the digging up and disinfection of the 

 ground. 



FAMINE DIARRHCE^. 



Historical and Geographical.— This con- 

 dition has been observed in India during 

 periods of famine, and recently by us in 

 the Balkans, in Serbian and Montenegrin 

 troops after the retreat through Albania. 



iEtiology. — Bad, insufficient food and 

 extreme fatigue play a very important 

 role in the causation. No specific germ 

 has been found. 



Symptomatology. — The patient is ex- 

 tremely weak and terribly wasted, though 

 the abdomen may at times be prominent 

 and distended. He may feel famished, 

 but when given food can take very little of 

 it, and cannot digest it. He complains of 

 slight abdominal pains and has diarrhoea ; 

 the motions may not be very numerous; 

 they are liquid, of faecaloid or at times 

 greenish colour, with some mucus, but 

 no blood. The condition lasts usually between a couple of weeks and one to 

 two months, and often terminates fatally. 



Fig. 760. — Serbian Soldier 

 suffering from the effect 

 OF Famine Diarrhcea after 

 THE Albanian Retreat. 



