1784 



SPRUE AND OTHER DIARRHCEAS 



alimentary canal must be easier. Indeed, there is evidence of this 

 in the increase of indigo blue in the urine, which is at times marked. 



These two conditions would lead to an atrophy of the liver, which 

 organ is one of the great safeguards against a toxaemia of intestinal 

 origin. When the liver is sufficiently damaged, a toxaemia is pos- 

 sible, and occurs; hence, possibly, the advantage of the treatment 

 by liver-soup or other preparations of liver. 



The damaged condition of the mucosa of the mouth and tongue 

 makes mastication difficult. The denuded condition of the 

 oesophagus causes the burning pain during swallowing; the con- 

 dition of gastric and intestinal mucosae causes the dyspepsia and 

 diarrhoea of the disease. The diarrhoea is characterized by pale, 

 frothy motions, the explanation of which is as follows: — 



On opening the bowels post mortem, the observer is struck by 

 the fact that, though there may be plenty of bile in the duodenum 

 and in the higher portions of the bowel, this gradually disappears 

 until, in the lower parts of the small intestine, the contents appear 

 white. In normal faeces bilirubin should be changed into sterco- 

 bilin (hydrobilirubin) , which is urobilin, and is identical with that 

 found in the urine. The white appearance of the intestinal contents 

 is probably partly due to certain bacteria, especially B. albofaciens. 



Vaughan Harley has shown that in the upper third of the small 

 intestine the normal faeces are of a yellowish colour, due to bili- 

 rubin. In the middle third they are of a whitish or greyish colour, 

 probably owing to the bile-pigments being converted into chromo- 

 gens, which become green in the lower third. After passing the 

 ileo-caecal valve, the bile-pigments are converted into urobilin by 

 the action of putrefactive bacteria, but a considerable quantity of 

 this is in the form of a chromogen. If the pancreatic juice is absent 

 a colourless form of urobilin is found, called leuco-urobilin; the 

 blood pictures in the last stage closely resemble that of pernicious 

 annsmia. A very common feature is the presence of true chromatin 

 granules in certain red cells. 



Histopathology. — The histopathology of the disease requires much 

 further study. The principal histopathological feature of the 

 malady is a severe process of desquamation of the mucosae of the 

 digestive tract, together with atrophic changes of the mucosae, glands, 

 pancreas, and liver. One of us, in association with E. H. Ross, 

 Low, and Cropper, has studied certain histological features of the 

 epithelial cells of the tongue and the condition of the blood. 



Changes in the Epithelial Cells of the Tongue. — These cells present 

 often a fatty degeneration, but an interesting feature is the great 

 increase in the presence of certain inclusions, which, as demon- 

 strated by one of us, may be found also in various kinds of stomatitis, 

 including the usual tobacco variety, and even in normal people. 

 These peculiar inclusions are of two types. 



Type I. — This is by far the commoner. The cell presents a 

 various number — one to twelve or fifteen — of roundish or oval form- 

 ations of variable size, 2 or 8 fi in diameter, which in preparations 



