CHAPTER XXXII
SPRUE (PSILOSIS)
Definition.— By the term " sprue " is understood a peculiar and very dangerous form of chronic catarrhal inflammation of the whole or part of the mucous membrane of the alimentary canal, generally associated with disturbance of the chologenic function of the liver and, probably, of the functions of the other glandular organs subserving digestion. Although a disease of warm climates it may develop for the first time in temperate climates ; only, however, in individuals who have previously resided in the tropics or sub-tropics.
Sprue is characterized by irregularly alternating periods of exacerbation and of comparative quiescence; by an inflamed, bare, and eroded condition of the mucous membrane of the tongue and mouth; by flatulent dyspepsia; by pale, phenomenally copious, and generally loose, frothy, fermenting stools; by wasting and anæmia; and by a tendency to relapse. It may occur as a primary disease, or it may supervene on other affections of the bowels. It is very slow in its progress; and, unless properly treated, tends to terminate in atrophy of the intestinal mucosa, which usually, sooner or later, proves fatal.
Nomenclature.— Sprue has been more or less recognized by writers on tropical medicine for many years. It has been called " tropical diarrhœa," " diarrhœa alba," " aphthæ tropicæ," " Ceylon sore mouth," " psilosis linguæ " (Thin), besides a variety of other names. The term " sprue " is an adaptation from the Dutch word spruw in use in Java, where the disease is very common.
Geographical distribution.— It is probable that sprue, although more common in certain warm
