CHAPTER XX
SPRUE
Definition and Synonyms
Definition.—Under the designation sprue we have a form of chronic diarrhoea characterized by periods of improvement alternating with a return to the previous condition. The disease is afebrile, of insidious onset and first manifests itself by soreness of the buccal mucosa and vague digestive disturbances.
The soreness of mouth and gullet is soon followed by erosions, especially at the site of the posterior molars, and a bare raw tongue. Exceedingly characteristic are the voluminous, frothy stools which are evacuated chiefly in the morning hours. The patient becomes weak, emaciated, irritable and of an earthy pallor.
The disease chiefly affects Europeans who have lived in Southern China, Cochin China and Java, and unless treated early tends to progress to a fatal termination.
Synonyms.—The word sprue is a corruption of the Dutch term “spruw” used to designate this tropical aphtha or aphthous stomatitis. The name psilosis, meaning bare, was suggested by Thin and is the term employed in many books instead of the better recognized designation, sprue.
Other designations are: Chronic diarrhoea of the tropics, Ceylon sore mouth and Cochin China diarrhoea.
History and Geographical Distribution
History.—The French (1868-1872) described this disease under the name of chronic or endemic diarrhoea of Cochin China and noted its resemblance to Moore’s “Hill Diarrhoea.” In 1876 Normand incorrectly associated Strongyloides with the disease.