CL IMA TOLOG Y—MTIOLOG Y 



have appeared, notably Roux's ' Traite ' in 1888, Thin's ' Psilosis ' 

 in 1897, and Cantlie's papers, and the pubhcations by Brown, Begg, 

 Castellani, Low, Bahr, Ashford, Rogers, Nicholls and many others. 



Climatology. — The endemic home of sprue appears to be Asia, 

 especially Malaya, Sumatra, Java, Siam, and Annam; but it also 

 extends into Burma, India and Ceylon, China, Australia (East and 

 South), New Caledonia, the Fiji Islands, and Japan. Possibly it 

 exists in the West Indies, where Hillary originally described it, and 

 it may occur all through the tropics; but if so, it must be rare in 

 certain regions — as, for example, West Africa. Rare cases of sprue 

 occur in Europe. 



etiology. — The etiology of sprue has not yet been elucidated, 

 but of the many etiological theories brought forward, the one 

 which at the present time receives more acceptance is the monilia 

 or oidium theory, also known as Kohlbrugge's theory. Kohl- 

 brugge, in 190 1, found in cases of sprue in Java a fungus which he 

 identified with Monilia albicans Robin, at that time better known 

 under the name of Oidium albicans. He made a very complete 

 histological study of one of his cases which ended fatally, and 

 emphasized the fact that the fungus in sections of the tongue, etc., 

 had invaded the deep strata of the mucosa, the glands, and portions 

 of the submucosa. He concluded that the fungus was the cause 

 of the disease. Kohlbrugge's findings were speedily confirmed by 

 many observers, especially French and Dutch, and Le Dantec gave 

 to the malady the name of blastomycosis intestinalis. 



In 1905 and 1912 cases of sprue with presence of monilia fungi 

 were placed on record by Castellani, who, in 1912, described several 

 species, Monilia intestinalis, M. enterica, etc. This author's opinion 

 was that such fungi were the cause of some of the symptoms of 

 sprue, as, for instance, the frothy appearance of the stools, but 

 doubted their being the primary cause of the malady. He believed 

 them to be the cause of the frothy diarrhoea, because he had noted 

 that this symptom generally improved after large doses of bicar- 

 bonate of soda. He thought that sodium bicarbonate given in 

 large doses might decrease the acidity of the intestinal contents, 

 and in this way check the growth of fungi, which, as is well known, 

 grow better on acid than on alkaline media. In 1913 Castellani 

 and Low described a new monilia found in a case of sprue, M. deco- 

 lovans Castellani and Low, 1913. They came to the conclusion that 

 this and other monilias (M. intestinalis, etc.) were the cause of certain 

 important symptoms of the disease such as frothiness of the stools, 

 etc., but they were not inclined to consider them to be the primary 

 cause of the malady; they quoted in analogy the example of scabies, 

 in which the main part of the symptoms is due to the secondary in- 

 vasion by staphylococci, and not to the primary cause, the acarus. 



In 1914, Bahr, in a series of interesting publications, supported 

 Kohlbrugge's theory, believing that the cause of the malady was 

 probably Monilia albicans Robin. 



From 1915, Ashford, in several able papers, has supported the 



