SPRUE 371 



meat juice, meat broth and meat jelly; of the fruits, especially straw- 

 berries (2 to 3 pounds daily), but also apples ; oranges, grapes, goose- 

 berries, and blackberries. Cantlie (1403) advised beginning carefully 

 with the meat diet (meat juice, meat jelly) and giving milk every 3 

 or 4 days. An exclusive milk diet does not suffice to bring about a 

 cure, so that in certain cases it must be combined with a fruit diet. 

 Later, light mixed food is gradually and carefully given. Bovaird 

 (1403a) suggests as therapy the replacing of fats and carbohydrates 

 by proteins and fruits. 



PATHOGENESIS 



Since sprue occurs less frequently than pellagra the number of 

 published communications on the subject is not very large. Al- 

 though some investigators like Cantlie (I.e. 1401) and Michael (1404) 

 believe in an infectious cause (a fungus, Monilia psilosis), neverthe- 

 less the following circumstances point to an avitaminosis : Ashf ord 

 found (1405) that in Porto Rico only the city dwellers, who eat 

 much bread, develop sprue, but not the farmers, who eat bananas. 

 According to W. C. Brown (I.e. 1386), the Chinese coolies in East 

 India develop beriberi, whereas the Europeans, on a practically similar 

 diet, develop sprue. Stewart (1406) is of the opinion that no real 

 basis exists for regarding pellagra and sprue as two different diseases. 

 Heaton (1406a) believes rather in the dietetic than in the infectious 

 origin of sprue. Werner (1407) observed scorbutic symptoms 

 (petechiae on the calves of the legs) in sprue. In the early stage of 

 sprue, there is often an aversion for meat and this feeling, together 

 with the known fear of fruit in diarrhea, leads to the further develop- 

 ment of the disease. Still, the most important reason for considering 

 sprue here is the influence of dietary changes on the course of the 

 disease, and the therapeutic results following the administration of 

 vitamine-containing foodstuffs. In particular, the fact that emphasis 

 is placed upon the raw state of the foodstuffs in the treatment gives 

 further support to our conception. Especially in the use of straw- 

 berries, does Leede (1408) emphatically state that preserved straw- 

 berries are far less effective than fresh berries, and that the active 

 substance contained therein is destroyed on heating. Whether we 

 have, in sprue, a disease similar to pellagra or scurvy, cannot be 

 stated with certainty at present; we must await further work on 

 the subject. 



