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Any thickening of the skfti, circumscribed, and of a coppery red 
tinge, should be suspected. 
Loss of feeling, even to sharp bodies, such as a pin, if it is found 
in a hardened patch of skin is very suspicious. Thickening of the 
nerves, for example an Enlargement and hardness of the nerve at the 
inside of the elbow — “the funny-bone” — should lead one to examine for 
anaesthetic patches elsewhere. 
Chronic ulcers of the feet particularly of the sole of the foot, are 
frequently leprous. 
The physiognomy of a leper is quite distinctive to the trained 
eye, and when the seared, leonine expression iis present, cannot be 
mistaken. 
Irregular and usually slight attacks of fever occur early in leprosy, 
the later signs, such as the loss of fingers and toes and repulsive 
ulcerations of the body, are, mercifully, seldom seen save in the 
asylums provided for these unfortunate beings. 
Abscess of the Liver. 
The fever, emaciation and general illness preceding the full 
development of this disease are so variable and progressive, that its 
diagnosis is hardly a subject for this pamphlet. 
Early operation is the secret of success, and all that I need mention 
about it will be a quotation from Sir Patrick Manson’s lectures at 
the London School of Tropical Medicine: “Whenever you find a 
progressive deterioration of health and vigour occurring, accompanied 
by some fever and sweats, always suspect liver abscess.” 
1 Sprue. 
I feel that a precis of sprue is a difficult task. Where tropical 
diarrhoea ends and sprue begins is not easy of definition, but if I were 
driven to a descriptive epigram, I would say, “sprue is a chronic 
deterioration of mucous membranes of unknown causation.” 
The symptoms may be represented by various combinations of or 
a conglomeration of the following : — 
Diarrhoea, sore tongue, ulceration of the mouth, abdominal 
pains, pain on swallowing, pale stools, gassy stools, loss of weight 
and energy, shrinkage of the liver. I cortsider sprue to be common 
amongst coolies in this country, but the difficulty of accurate diagnosis, 
causes the majority of the cases to be returned as diarrhoea. 
The treatment, which should be commenced very early, consists in 
baby-foods and milk, nourishing unseasoned dishes, such as 
freshly cooked minced chicken, fresh fish, eggs, rusks, and such 
like. I believe that if this treatment were adopted on the first appearance 
of symptoms of tropical diarrhoea or sore mouth, that many cases 
would not progress to the acute disease. 
