acerbations it is red and swollen, but during the remissions, and when not inflamed, it is small, pointed, and, owing to the anæmic condition of the patient, it may be yellowish like a piece of cartilage. Apparently the tongue condition may be the sole symptom and may persist for years before the characteristic diarrhœa supervenes.
Dyspepsia.— Dyspepsia is usually much complained of, the feelings of weight, oppression, and gaseous distension after eating being sometimes excessive. Very likely the abdomen swells out like a drum, and unpleasant borborygmi roll through the bowel. Occasionally, though not often, there may be vomiting, sometimes coming on suddenly and not always accompanied by feelings of nausea.
Diarrhœa.— The diarrhœa associated with sprue is of two kinds one chronic and habitual, the other more acute and, in the early stages, evanescent. The former is characterized by one or more daily discharges of a copious, pale, greyish, pasty, fermenting, acid, mawkish, evil-smelling material. The latter is of a watery character, also pale and fermenting, the dejecta containing undigested food and, usually, an abnormally large amount of oil and fatty acids. In these latter circumstances the diarrhœa usually brings with it considerable relief to the dyspeptic distension, at all events for a time. When the mouth is inflamed the diarrhœa is usually more active. The stools during periods of quiescence may be confined to one or two in the early morning or forenoon; during the later part of the day the patient is not disturbed. The stools, however, even in this quiescent phase, are always extraordinarily copious, the excessive bulk being attributable in great measure to the aforementioned excess of fat and the innumerable microscopic gas bubbles; patients remark their phenomenal abundance. They are passed almost, or altogether, without pain. Not infrequently during exacerbations there may be a tender, excoriated condition of the anus, and sometimes, in women, a similar condition of the vagina.
Types, history, course, and termination. Proto-
