THE BACTERIAL THEORY -PATHOLOGY 1783 



were of the viridans type, as found also in normal mouths. 

 Complement fixation tests carried out by Nicholls would seem to 

 support the streptococcal theory. Nicholls beUeves the etiology 

 to be in reahty twofold, there being an infection factor and a 

 dietary factor. 



Attention must be called to certain cases of pseudo-sprue, 

 described by one of us, and due to a bacillus of the Flexner group. 

 These cases are not true sprue, as they get well either spontaneously 

 without leaving the tropics or by a course of vaccine treatment 

 prepared with the l^lexner-like bacilli isolated from the stools. 



The Protozoan Theory. — Various protozoan organisms have been 

 found in cases of sprue, amo^b^, spirochsetes, flagellates, etc., but 

 none have been demonstrated to be the cause of the malad}^ 



The Climatic Theory. — This does not need to be discussed, though 

 a hot damp climate is an important predisposing cause. 



The Food Theory.— This also does not need to be discussed, 

 though spicy foods and alcohol may be predisposing causes, and 

 dietary errors, as emphasized by Nicholls, may lower the resistance 

 of the alimentary mucosa to germ infection. 



The Deflcieney Theory. — This theory has been ably brought 

 forward by Cantlie, who noticed in certain cases signs of scurvy. 



Syndrome Theory. — Finally, the theory must l3e mentioned 

 accordingto which sprue is not a separate disease, but is a syndrome 

 met with in various pathological conditions, such as chronic dysen- 

 tery and pernicious anaemia. This theory is not supported by any 

 medical man of long tropical experience. The disease presents 

 typical symptoms and a typical course, but, as in dysentery, so in 

 sprue, it is in our opinion probable that the clinical term covers 

 several closely allied conditions — 3.g., it is possible that there may 

 be a sprue of hyphomycetic origin, a sprue of bacterial origin, and 

 a sprue of protozoan origin. 



Pathology. — With an unknown causation, it is not easy to write 

 an account of the pathology. It would appear as though the 

 primary lesions are beneath the epithelium in both the tongue and 

 the intestine, and cause the superficial desquamation and catarrh. 

 In the intestine the disease begins with submucous congestion, after 

 which follows thrombosis of the vessels, and exudation of haemo- 

 globin, and a round-celled infiltration. The mucosa suffers because 

 its blood supply is damaged, and therefore necrosis takes place, 

 the glands and villi being affected. The oesophagus and stomach 

 also suffer. The liver is at first enlarged and congested, but later 

 becomes atrophied and small. The fact that the tongue, oesophagus, 

 stomach, and intestines are affected would indicate that something 

 deleterious is being carried bv the blood stream to these organs, 

 rather than that something is acting from the surface. The irrita- 

 tion of the liver may be due to the same cause. 



When once the mucosae are damaged, the chemical processes of 

 digestion and the absorption of their products must be interfered 

 with; while at the same time the absorption of poisons from the 



