The color index averages higher than normal and with the poikilocytosis resembles the blood picture of an atypical pernicious anaemia. Nucleated reds are rarely found. The eosinophiles are reduced in percentage. The polymorphonuclears often show a great number of nodes, as 7 or 8 instead of the ordinary three.
There is a mononuclear increase with polymorphonuclear reduction. The white count is somewhat below normal—4000 to 6000.
Other Features of the Disease.—The liver is notably diminished in size. The urine shows indicanuria. The patient has a dry earthy skin and may show oedema about ankles.
Mentally there is lack of concentration with marked irritability and moroseness. Tetany has been reported as occurring rarely in very severe cases. The abdomen is doughy and the temperature in the later stages tends to become subnormal.
Diagnosis
Thrush is characterized by the membranous coating which microscopically shows the fungus. It also is chiefly a disease of children and those who live under wretched hygienic conditions and with insufficient food. The characteristic stools are absent.
Pellagra.—The stomatitis, diarrhoea and mental irritability are very similar in the two diseases. There is, however, absence of the sprue stools in pellagra and the periodical recurrence and skin manifestations of pellagra are absent in sprue.
Wood thinks that in the absence of any evidences of organic nervous disease in sprue we have an important differentiation as he finds that pellagra has as great a tendency to invade the nervous system as has syphilis. Salivation is marked in pellagra, not in sprue. The two diseases, however, are best differentiated by the darker, more fluid, less copious stool of pellagra as contrasted with the copious, light colored stool of sprue. Stools containing great amounts of undigested fat are most characteristic of sprue; fat absorption in pellagra is about normal (95%) while in sprue it is only about 75%.
Syphilis with its buccal mucous patches or geographical tongue may be mistaken for tongue sprue.
Hill Diarrhoea.—Many authorities do not consider this as a disease distinct from sprue. The English, however, note the features of its occurrence only at high altitudes; thus persons going to Simla suffer from hill diarrhoea but upon their return to the sea level the disease disappears. The characteristic features of hill diarrhoea or Simla trot, as it is often called, are the passage of from 2 to 6 watery, whitish stools in the early morning hours. The patient is usually free from diarrhoea in the afternoon. The color may resemble that of freshly made whitewash, hence diarrhoea alba.