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XXXII] as special to sprue been separated from the characteristic stools.

Formerly sprue was supposed to be peculiar to the European in the tropics; but Bahr has recently shown that it is by no means rare in the descendants of the early Dutch settlers in Ceylon, and in the native Cingalese and the immigrant Tamils. He has also brought forward evidence tending to show that it is an infective disease. In searching for the fundamental cause of this affection, the latency which the disease occasionally exhibits, and the fact that the first symptoms may not appear until months or even years have elapsed since the patient quitted the tropics, must be kept in view.

Symptoms. Variability.— There is infinite variety in the combination and in the severity of the various symptoms of sprue, as well as in the rate of progress of the disease. In some instances it may be almost a subacute process running its course in a year or two; in others, again, it may drag on intermittingly for ten or fifteen years. Much depends in this respect on the circumstances, the character, the care, the treatment, the age, and the intelligence of the patient.

General symptoms in a typical case.— In an ordinary fully developed case the patient— who is generally dark or muddy in complexion and much emaciated— complains of three principal symptoms: soreness of the mouth, dyspeptic distension of the abdomen, looseness of the bowels ; the last being particularly urgent during the early morning and part of the forenoon. The patient may also complain of feeling physically weak, of loss of memory, and of inability to take exercise or to apply his mind. His friends will probably volunteer the information that he is irritable and unreasonable.

Mouth lesions.— If the mouth is examined, the soreness will be found to depend on a variety of lesions of the mucous membrane, which, though painful, seem to be of a very superficial character. These lesions vary considerably in intensity from day to