been eaten. In this case wasting is progressive, and the patient gradually dies of inanition.
Intestinal atrophy consequent on sprue.— In certain instances, under treatment the symptoms proper to sprue subside; but the patient's digestive and assimilative faculties are permanently impaired. Slight irregularities either in the quality or the amount of food, chill, fatigue, depressing emotions, and other trifling causes suffice to bring on dyspepsia accompanied by flatulence and diarrhœa. These cases may linger for years. Usually they improve during the summer in England, getting worse during the winter and spring, or during cold, damp weather. Ultimately they die from general atrophy, diarrhœa, or some intercurrent disease.
Morbid anatomy.— Post mortem the tissues in sprue are abnormally dry; fat is almost completely absent; the muscles and the thoracic and abdominal viscera are anæmic and wasted. With these exceptions and certain important changes in the alimentary tract, so far as known there are no special lesions which are invariably associated with this disease. According to Bertrand and Fontan, occasionally certain changes are present in the pancreas— namely, fatty or granular degeneration of the cells, with softening of isolated acini and slight inflammatory infiltration of the connective tissue. These, however, are not more constant than are certain other and similar changes occasionally found in the liver and kidneys. Sections of the tongue show desquamation of the epithelium, especially from the surface of the fungiform papillæ; an invasion of the epithelial cells by yeast fungi has been shown by Kohlbrügge to take place and is possibly a terminal infection.
Lesions of the alimentary tract.— The principal and characteristic lesions are found in the alimentary tract. The bowel is thinned to such an extent as to be almost diaphanous. The serous coat is generally healthy, the muscular coat atrophied. The submucosa in places has undergone hypertrophic fibrous changes; and the mucous membrane from mouth to
