In 1759 William Hillary (1) described a chronic type of diarrhea associated with sore tongue, pallor and emaciation which he had observed in Barbadoes. A century later in 1864, Julien (2) stated that Cochin-China diarrhea was a specific condition different from ordinary dysenteries and diarrheas. In 1880 Manson (3) in Amoy, and Van der Burg (4) in Java described more fully the features of the disease that Hillary had observed. Since then sprue has been accepted as a peculiar tropical disease and described by many authors.
But although the clinical features of the disease are now so well known, there has never been any agreement as to its precise causation, and many of the earlier theories are completely discredited. The most prominent of these was moniliasis, but Ashford (5) the main protagonist of this theory, in later years regarded sprue as primarily caused by nutritional imbalance complicated by monilia infection.