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554 pathic sprue.— There is a striking uniformity in the history of most cases of sprue. On inquiry, we shall probably learn that the patient has been suffering for months, or perhaps years, from irregularity of the bowels. This, we may be told, began soon after arrival in the tropics as a bilious morning diarrhœa. For a long time this morning diarrhœa went on, without interfering in any way with the general health. Later the mouth, now and again, became tender, little blisters or excoriations appearing for a day or two at a time about the tip of the tongue or inside the lips. These sore spots would come and go. Perhaps, from time to time, exacerbations of the mouth symptoms would be associated with a little increase of diarrhœa. Gradually the stools lost their bilious character and became pale and frothy; dyspeptic symptoms, particularly distension after meals, now appeared. As time went on, these symptoms would recur more frequently and in a more pronounced form, following, almost inevitably, any little imprudence as regards food or exposure. The general condition now began to deteriorate; emaciation, languor, lassitude, and inability to get through the day's work satisfactorily becoming more pronounced each summer until, finally, a condition of permanent invalidism was established. Should the disease continue to progress, the emaciation advances slowly but surely. Diarrhœa may be almost constant, and now no longer confined to the morning hours; the complexion becomes dark, sometimes very dark the appetite, sometimes in abeyance, is more frequently ravenous, unusual indulgence in food being followed by increased discomfort, temporarily relieved by smart diarrhœa. At length the patient is confined to the house, perhaps to bed. The feet become cedematous, and the integuments hang like an ill-fitting garment, the details of the bony anatomy showing distinctly through the dry, scurfy, earthy skin. Finally, the patient dies in a semi-choleraic attack; or from inanition; or from some intercurrent disease. Such is the history of an ordinary, mismanaged case of sprue.