SPRUE iPSlLOSlS) 353 



Any depressing influence, intestinal irritation, or an exhausting 

 malady will predispose to the disease. It is generally seen in old 

 tropical residents during or after being in the tropics. 



It may be a specific infection falling upon over-stimulated glands 

 owing to certain meteorological conditions (Manson). 



Intestinal fermentative changes, bacterial or parasitic in origin, may 

 cause it in those long resident in hot climates (Cantlie). 



It is a disease of the European in the tropics. 



Natives are very rarely attacked. 



Both sexes of all ages and classes are subject to it. 



There is some evidence of its being a direct infection. 



Inoculation of sprue tongues, scrapings and stools injected into 

 animals have failed (Bahr). 



Bahr, a recent worker, submits evidence of its being a blastomy- 

 cotic infection which may be summed up as follows : — 



(i) Yeast cells and m}'celial elements are found intracellularly in 

 tongue lesions earlv, but not later, when the inflammation has 

 subsided. 



(2) Yeasts are the only organisms found in the deep layers of the 

 tongue. 



(3) The desquamation of epithelial cells and subacute inflammation 

 of the tongue and ciesophagus are changes one could expect 

 from yeast infection. 



(4) Yeasts were found in intestinal mucus of sprue, but not in 

 other cases of chronic diarrhoea. 



(5) The stools are such as one would expect in yeasts. 



(6) Its relapsing nature is compatible with the life-history of the 

 Blastomyces. 



(7) The sprue yeast is apparently identical with the thrush fungus. 



(8) Wasting, anaemia, and degeneration of hepatic capillaries and 

 endothelium, the symptoms of sprue, are reproduced by intra- 

 venous injections of broth cultures of a pathological veast in 

 animals. 



(9) Similar sprue symptoms are found in infants, the subjects of 

 thrush infections. 



(10) The scattered portions of the digestive tract affected by this 

 fungus would best explain the varying clinical manifestations 

 of sprue. 



(11) The local tropical conditions favour a luxuriant growth of 

 fungi. 



Dold in examining sprue stools for yeast found that — 

 Normal stools yielded yeasts in 7*5 per cent, of cases. 

 Diarrhoea stools (not sprue) in 16 per cent, of cases. 



