A Report on Researches on Sprue in Ceylon

1. Origin and objects of the expedition; 2. Acknowledgments; 3. A description of Ceylon, its inhabitants, vegetation, geology and prevalent diseases; 4. A definition of sprue and a description of its symptoms; 5. Hill diarrhoea; 6. Explanation of the term 'sprue'; 7. Summary of the past literature of sprue; 8. General geographical distribution of sprue; 9. Distribution of sprue in Europeans in Ceylon; 10. Certain factors in their bearing on the incidence of sprue; 11. Sprue regarded as an infectious disease; 12. Symptoms of sprue as met with in Ceylon; 13. Investigations on the clinical pathology of sprue; 14. The morbid anatomy and pathology of sprue; 15. The aetiology of sprue; 16. A study of the yeasts found in sprue lesions and attempts at their classification on a rational basis; 17. Evidence in favour of and against regarding sprue as a blastomycotic infection; 18. Treatment; 19. Differential diagnosis; 20. Conclusions; 21. Bibliography; Appendices: 1. The population of Ceylon in 1911; 2. The number of Europeans resident in the different provinces; 3. Temperature and rainfall in Ceylon; 4. Clinical account of cases of sprue in natives; 5. Details of various estate bungalows and their relation to sprue; 6. A list of Ceylon mosquitoes; 7. Incidence of sore sprue-like tongues in natives; 8. Details of Noguchi reactions; 9. Table showing the relationship between the amount of fluid and proteid ingested and the amount of urine and urea excreted in two cases of sprue; 10. Blood counts of sprue cases; 11. Detailed history of sprue cases with an account of post-mortem examination, morbid anatomy and microscopic pathology; 12. Weights of organs in sprue and a comparison with those of normal subjects and those of a case of pernicious anaemia; 13. Tables showing the presence of yeast cells in cultures and in smears made from sprue post-mortems, and a comparison with similar preparations made from other post-mortems, mostly cases of diarrhoea; 14a. Table showing sugar reactions of a yeast as obtained after varying periods of incubation; 14b. Provisional classification of the yeasts of the genus Monilia, together with the sources from which these organisms were obtained; 14c. Variations in the sugar reactions given by these yeasts at different periods and on different media; 15. Various details of five sprue cases under treatment; 16. Details of twelve cases of apparent recovery from sprue, all still resident in Ceylon.