FAMINE DIARRHCEA—CCELIAC DISEASE 1799 



Diagnosis. — This is based on the history of starvation and extreme fatigue, 

 with diarrhoea without blood, while the patient wastes horribly in a short 

 time, and there are no signs of tuberculosis. It may be differentiated from 

 dysentery by the stools not containing blood, and by the absence of dysenteric 

 germs ; from cholera by the longer course and absence of cholera and para- 

 cholera germs. 



Prognosis. — This is serious, many cases terminating fatally. 



Treatment. — This is very unsatisfactory. Astringents such as bismuth 

 subnitrate, etc., even when given in massive doses, may not stop the 

 diarrhoea; at times they may check it, but the patient continues to become 

 weaker and weaker, and often dies. 



CCELIAC DISEASE. 



Gee described in England, in 1888, an infantile affection characterized by its 

 long course, ansemia, great wasting, and pale greyish abundant stools. Cases 

 are not very rare in Great Britain, and have been reported also from other 

 countries. The aetiology is unknown, though various germs have been found. 

 In three cases Nabarro has carried out a very complete investigation, and 

 has isolated from the faeces a dysenteric bacillus of the Flexner type. This 

 result would suggest that the condition might perhaps be aetiologically related 

 to the so-called pseudo-sprue of the tropics, described by one of us. 



In coeliac disease the tongue apparently does not become affected, and this 

 and also the fact that it is found in children rather than in adults differentiates 

 the malady from tropical sprue. 



The treatment consists in very careful dieting. Fresh cow milk should be 

 prohibited, and dried milk given instead, using one of the preparations on the 

 market which contain only a very low proportion of fat. Condensed milk 

 may also be used, but is generally less successful than dried milk. A fruit 

 diet, in contrast to what one sees in true sprue, is badly tolerated, and should 

 never be ordered. As regards drugs, Still's mixture is often found useful: 



01. ricini . . 

 Salol 



Spir. chlorof. 

 Muc. acaciae 

 Aq. anethi 



Ter die. 



lT\v. 



nii. 

 n\xv. 



ad 3i. 



Occasionally silver nitrate is valuable when the diarrhoea is very marked, 

 and Still recommends it to be given thus : — 



Arg. nitratis 

 Glycerini 

 Aq. dest. 



Ter die. 



ntv. 



ad 3i. 



Bismuth preparations are practically useless, but tannalbin has at times a 

 favourable action. 



REFERENCES. 

 Sprue. 



The current literature may be found in the Bulletin for Tropical Diseases. 



AsHFORD {191 7). American Journal of Medical Science. 

 Bahr (191 4). Transactions Society of Tropical Medicine. 

 Begg (1907). Journal of Tropical Medicine, p. 293. 



Bertrand et Fontan (1887). De I'Entero-colite chronique Endemique des 



Pays chauds. Paris. 

 Brown (1916). Bull. Johns Hopkins Hospital. 



