The physicians of the Dutch East Indies described the disease under the designation “spruw” and Manson in a very complete description of the disease called it “sprue,” a corruption of the Dutch name.
It is interesting to note that Hillary in 1766, described a similar disease of Barbadoes, W. I., which he called aphthoides chronica.
Geographical Distribution.—It is particularly prevalent in South China and the East Indies. India and Ceylon are also regions of the disease. In the West Indies it has been carefully studied, in Porto Rico by Ashford, and of particular interest is the fact that Wood has recently insisted on the presence of sprue in the Southern States of the U. S. The Philippines and tropical Africa are also sections from which the disease is reported.
Etiology and Epidemiology
Etiology.—The cause is unknown. The disease makes its appearance chiefly in Europeans who have lived many years in the tropics and may not show itself until the patient has returned home. (In one case reported by Thin seventeen years after the return home.)
It seems to select those who are weakened by dysentery or other debilitating diseases, or who are compelled to subsist on indigestible food or to lead a life of exposure to hardships. Women in whom the menstrual flow is excessive or who are in the period of lactation seem to be especially susceptible. Some think alcoholics more susceptible. The idea has been advanced that the abuse of calomel has been a factor and this view is one to be given weight because it is well recognized that at the present there is much less sprue than formerly and with this there has been a more rational use of calomel. The excessive use of highly seasoned food, so common with Europeans in the tropics, may have an influence.
Some have thought that sprue was the manifestation of a tropical pancreas; at first congestion and later exhaustion of its function. The character of the stools lends support to this view.
At one time it was thought that Strongyloides stercoralis was the cause; this idea had its origin in the finding of these larvae in the stools of a patient with Cochin China diarrhoea.
Certain authors have considered bacteria giving a granulose staining reaction as the cause while others have thought cocci to be concerned.
Kohlbrugge found organisms resembling Oidium albicans in the intestines, oesophagus and tongue. He found similar organisms in the stools and tongue scrapings of cases of sprue. Beneke found bacilli in the tongue, oesophagus and intestines and considered these as causative, regarding the thrush-like membranous deposit as connected with the cachectic state and not causative.