694 Sprue 



4. Chronic intoxication supervenes after well-developed sprue and the liver 

 atrophies without cirrhotic changes, secondary anemia making its appearance. 



5. The intestinal lesions produce large, acid, frothy, white stools with excessive 

 gas accumulation. The character of these stools does not warrant the belief that 

 serious ulcerative changes take place. 



6. There is a tendency to chronicity and to periods of latency in which decided 

 betterment and apparent cure may take place. 



7. Drugs are of little avail save when used symptomatically for definite critical 

 crisis and no specific has yet been found. 



From the epidemological studies made, he comes to the following 



conclusions : 



1. Sprue is a disease of towns and cities where bread is a staple food. 



2. Sprue is rare in the country districts where bread is not at least a daily food 

 and where often it is not eaten at all or only at long intervals. 



3. Family endemics are noticeable. 



4. There seems to oe a racial predisposition to sprue in persons of northern 

 birth. 



In the light of these facts he recalled that Bahr* in his " Researches 

 on Sprue" had given the following account: 



"The whole of the intestinal canal was covered with a layer of ropy mucus, 

 the tongue with a film of thrush. The esophagus was coated with a yellowish 

 substance, resembling a diphtheritic membrane, composed almost entirely of 

 yeast fungi; microscopically complete desquamation of the epithelial covering of 

 the tongue and of the esophagus, and deep infiltration with yeast cells and 

 mycelial threads were found. In smears from the liver from one postmortem a 

 few yeast cells were seen and in preparations of the intestinal mucus, stained by 

 Gram's method, from every part of the intestinal tube great numbers of these 

 cells and branching mycelium were found; in fact, they were by far the most abun- 

 dant organisms. Yeasts were grown in glucose broth from every part of the 

 intestinal canal, also in one case from the liver and spleen and from the kidneys 

 in the other." 



Ashford, therefore, made cultures from the tongue, the stools or 

 both of 197 persons. Forty-nine were distinctly cases of sprue; and 

 in them he found Monilia psilosis (not Monilia (Oidium) albicans) of 

 an undescribed species in 100 per cent. Ninety-two were cases of 

 gastro-intestinal disturbances ranging from mere vagaries to serious 

 disease, chiefly accompanied by excessive gas production; 17 per cent, 

 were found to harbor the same organism. Sixty-six were apparently 

 normal as far as their intestinal tract was concerned, and but 3 

 per cent, harbored it. 



Investigation of the Monilia showed it to be pathogenic for ani- 

 mals. Feeding it to them caused diarrhea and excess of intestinal 

 gas. Complement fixation tests showed positive in a few sprue 

 cases and negative in normal cases. 



In his excellent studies of the " Yeast-like Fungi of the Human In- 

 testinal Tract" Andersonf describes the yeast-like organism isolated 

 by Ashford, giving it the name Parasaccharomyces ashfordi. It is 

 perhaps too soon to declare this organism to be specific, but it seems 

 to be sufficiently well incriminated in the pathology of the disease 

 to justify a brief mention. Anderson describes it thus: 



* "Transactions of the Society of Tropical Medicine and Hygiene," 1914, n, 

 No. s- 



t "Jour. Inf. Diseases," 1917, xxi, p. 380. 



