SPRUE. Sprue is a disease of tropical and subtropical regions, and possibly cases arise in temperate climates also.
The symptoms usually begin with dyspepsia and irregularity of bowel action. In a fully declared case the chief signs are the passage of bulky, frothy, pale porridge-like, stools, much flatulence and acidity, a sore, ulcerated mouth, a red, smooth and tender tongue, often with exquisitely painful ulcers on the fraenum and at the sides. Loss of flesh is very rapid amounting perhaps to 401b. in two months. Cramps of the fingers and of the feet and calves are common in severe cases. Death occurs from exhaustion and intercurrent disease or, more usually, from intense anaemia, or rarely from perforation of an intestinal ulcer.
The treatment is rest in bed for a fortnight on a diet restricted to milk (increasing from 4 to 71 pints daily) to gether with calcium lactate (gr. 15 thrice daily) and extract of parathyroid (gr. i/ioth twice daily). The parathyroid must be free from admixture with thyroid (most preparations contain some of the latter) for if any of the latter be present, the symp toms become aggravated and palpitation and other indications of thyroid excess are superadded. With a pure preparation, however,
the sprue symptoms improve within a fortnight, the ionic calcium increases to about 8 mg. %, the stools are reduced to one a day and the soreness of the mouth disappears. At the end of f our weeks in favourable cases, the calcium lactate can be dropped and the parathyroid reduced to half doses. About this time the blood serum will show a normal calcium content, but the parathyroid extract should not be left off entirely for another three to four weeks. Should symptoms recur, a return for a few days to a simpler diet and to the parathyroid extract will restore health.
Many patients treated on these lines have returned to their duties abroad, many others have been treated in the tropics and have recovered. A few years ago the appearance of sprue meant immediate return to a temperate climate and prohibition of future residence in the tropics. (H. H. S.)