Sprue secondary to dysentery.— When the disease has supervened on dysentery, we learn that the motions characteristic of the original dysenteric attack had gradually changed in character; from being scanty, mucoid, bloody, and accompanied with pain and tenesmus, they became diarrhœic, pale, frothy, their discharge being followed by a feeling of relief rather than of pain. The mouth at the same time became sore, exhibiting the characters already described. Gradually a condition of confirmed sprue was established, which ultimately, unless properly treated, will almost certainly prove fatal.
Sprue secondary to acute entero-colitis.— Another type of case commences as an acute entero-colitis with sudden and profuse colicky diarrhœa, vomiting perhaps, and a certain amount of fever. The acute symptoms do not subside completely, but gradually have the typical symptoms of sprue grafted on to those of an acute intestinal catarrh.
Incomplete sprue, (a) Gastric cases.— Occasionally we meet with cases of confirmed sprue in which, at first, the morbid process, judging from the existing clinical symptoms and subsequent history, is confined to a limited part of the alimentary canal. Thus we sometimes get sprue without diarrhœa, the principal symptoms being sore mouth, dyspeptic distension, pale copious but solid stools, and wasting.
(b) Intestinal cases.— On the other hand, we may get cases in which the mouth is not eroded, and in which there is little or no distension or dyspepsia, but in which the stools are liquid, copious, pale, and frothy. Sometimes a patient who may have suffered at an earlier period or on a former occasion from the first type of the disease, later acquires the diarrhœic form; and vice versa.
(c) Sprue without diarrhœa.— It sometimes happens that under treatment the sore mouth, the dyspepsia, and the diarrhœa completely subside; nevertheless the wasting continues, the stools remaining phenomenally copious— so much so that the patient may declare that more is passed than has
