appertaining to digestion, a hyperactivity which also ends in a corresponding exhaustion. Chemical changes in the ingested food would then follow on the establishment of these apeptic conditions, and ultimately, from the formation of acrid chemical bodies, lead to the chronic catarrhal changes found post mortem.
Analyses of the stools in sprue by Wynter Blyth, Hunter, v. der Scheer, Harley, and others resulted in ascertaining the presence of the ordinary elements of bile, notwithstanding their apparent absence so far as lack of colour would indicate. Bile is secreted, but the colouring matter, bilirubin, is not formed, or is changed in the intestine into a colourless substance, leuco-urobilin (Nencki). The excess of fat in the stools would indicate pancreatic disease or destruction of the lacteal capillaries.
Of course, micro-organisms, and especially yeast fungi, abound in the fermenting stools; but hitherto no bacterium or protozoon which could be regarded as specific has been found in association with the disease.
Personally, I incline to regard sprue as the result of a specific infection falling upon structures subserving digestion, exhausted from over-stimulation by certain meteorological conditions. The remarkable effect of physiological rest, as supplied by "the milk treatment," in curing sprue, the relative rarity of the disease in the natives of the endemic area, the occasional latency of the disease, and the tendency to relapse seem to support this hypothesis.
Diagnosis.— The condition of the tongue, the character of the stools, and the history are sufficiently distinctive, one would suppose, to render diagnosis an easy matter. Nevertheless, I have known of cases in which the disease has been diagnosed and treated as syphilis, the condition of the mouth being attributed to this disease, the character of the stools and other symptoms being ignored. Care must be exercised in interpreting the significance of the small area of liver dullness usually found in well -marked
