It has been shown by Price1 that of the missionaries sent into tropical countries, a large percentage have to be invalided home; from India 46 per cent., from China 51.5 per cent., from Africa 79 per cent. The rate invalided home for sprue is available only from Central and Southern China, being 2.5 per cent, of those sent home from the former region and 4.5 per cent. from the latter. Harford,2 a former physician to the Church Missionary Society (England), states that he regards bowel disorders as the most important cause of invaliding, and specifically mentions sprue as a common and serious cause.
To come nearer home, sprue is widely prevalent in Porto Rico,3 which is being invaded at present by Americans in large numbers.4 As people suffering with sprue are constantly returning to this country from the tropics, the profession will have to consider this
H. B. HIATT, W. ALLAN. NOTES ON CASES OF SPRUE INVALIDED FROM THE TROPICS; WILL IT BECOME ENDEMIC HERE?. JAMA. 1914;LXIII(5):395–397. doi:10.1001/jama.1914.02570050031009