CHAPTER LXXVI 



SPRUE AND OTHER DIARRHCEAS 



Sprue — Pseudo-Sprue — Hill diarrhoea — Low-country morning diarrhoea — 

 Flagellate diarrhoea — Famine diarrhoea — ^Coeliac disease — References. 



SPRUE. 



Synonyms. — Ceylon sore mouth, Aphthoides Chronica, Tropical aphthae, 

 Impetigo Primarum Viarum, Diarrhoea Alba, Psilosis Linguae et Mucosae 

 Intestini, Phthisis Abdominalis, Blastomycosis Intestinalis, Endemic diarrhoea, 

 Cochin China diarrhoea. 



The term ' sprue ' (sprew, sprau, sprulf, spru, spre, spree, spro) is a phrase 

 used in Holland and Scotland for aphthous stomatitis in children. Aphthae 

 fropicalis der deutschen, and was applied to this disease by Manson and Van 

 der Burg, the latter calling the disease in Batavia ' Indische spruw.' 



Definition. — Sprue is a chronic catarrhal inflammation of the 

 alimentary canal, of unknown cause, characterized by a peculiar 

 ulcerative condition of the tongue and mouth, and by the passage 

 of large, pale, frothy motions, the symptoms waxing and waning 

 periodically. 



History. — According to Hiatt, sprue was first mentioned in the 

 writings of John Bicknell, in America, in 1737. Hillary, of Barba- 

 dos, in 1766, in a most remarkably able manner, describes the 

 disease for the first time under the name * aphthoides chronica.' 

 His account is well worth reading, and t?iere can be no possible doubt 

 that his description refers to the disease we now call sprue. The 

 Indian physicians Twining (1835), Grant (1854), Cunningham (1877), 

 mention symptoms indicating that they were acquainted with a 

 disease of this nature, while Elliott of Ceylon gave a very good 

 account of the malady, which he called ' phthisis abdominalis.' 



At the same time — i.e., 1864 to 1883 — French physicians noted 

 a peculiar form of diarrhoea, commonly met with in Cochin China, 

 which perplexed them considerably, a large number believing that 

 it was dysenteric in nature, while others considered that it was 

 probably a new disease. 



In 1880 Manson was the first after Hillary to clearly define the 

 disease, which he called ' sprue ' ; and in the same year, and inde- 

 pendently. Van der Burg described it under the term ' Indische 

 spruw ' in Batavia. In the next year (1881) Sir Joseph Fayrer 

 delivered the Lettsomian Lectures on chronic white tropical diar- 

 rhoea. These three authors permanently established the disease as 

 a clinical entity. Since then many important papers and articles 



1780 



