The relation of meat-eating to the incidence and severity of sprue and the relation of sprue to diarrhoea in the United Kingdom.

SPRUE IS one of the most important diseases in the world. It probably disables thousands of adults each year, and it also occurs in children. With the recession of malaria, bowel diseases bulk bigger in tropical health. If money is available to pay for them, there are effective treatments for bacillary dysentery, amoebic dysentery, cholera, typhoid, and intestinal tuberculosis. Worm infestations were never more easily and safely treated. Sprue, however, remains the same difficult disease. The numbers are so great, and the treatment so tedious and imperfect, that the application of some general preventive principle is very desirable. This note is written with India sprue in mind, mainly in Indian soldiers. Caribbean sprue apparently is different in some respects, and, like Indian sprue in Europeans, may be more easily treated. The response to folic acid is better. Sprue is said not to occur in Africa, but Trowell (1960) speaks of protein malnutrition in adults causing loose stools, anorexia and oedema. This may be related, as we see later. We may provisionally define sprue as a disease manifested mainly in the small intestine, with a protracted course, little tendency to natural cure, and a strong tendency to get worse. There is intestinal malabsorption, more or less severe, with anorexia, wasting, loss of strength, anaemia, ankle oedema and glossitis. Apathy and lack of drive are notable. There is usually no fever. The disease is very disabling and may end in death. It is not solely or mainly a disease of Europeans in the tropics. It attacks Indians and Pakistanis too. It is a disease not only of adults, but also of children (Hurst, 1942; Mathew et al., 1964). It is not merely sporadic. ft occurs in epidemics. Since it can be epidemic, it must be environmental, and not due to an innate abnormality of the small intestine. The epidemic of sprue in the 14th Army during its campaigns on the IndoBurman frontier, particularly in 1944, was specially instructive. Thousands of Indian troops (young men recently healthy, be it remembered) were evacuated to hospitals because of disabling sprue. Europeans were attacked, but in a smaller number. These events established that sprue could be epidemic, and epidemic in Indians. Further light was thrown on the disease by the observation that the incidence was worse in troops deprived of meat. The difficulties of supply were great. British troops could be supplied with tinned beef and that was done. Indian troops, Musalman and Hindu, had to be supplied with living goats and sheep. These were killed in the unit just before being cooked and eaten. Those for Musalman use are killed by Musalmans by a method prescribed by their religion. Procurement in India, transport to the field and distribution to units of the number of live animals needed was impossible. The extra ration of milk authorised for issue to meat-eaters when the meat ration was deficient, or to non-meat-eaters regularly,