By most North American physicians sprue has always been considered as a specific tropical disease, endemic and rarely, if ever, encountered among natives of temperate climates. It was described first by Hillary,1 from the Barbadoes, in 1766, and the subsequent writings of many authors have served to establish the habitat of the disease in the tropics. The idea that sprue, or a condition closely resembling it, might occur in nontropical climates is of rather recent origin. From a historical standpoint it is interesting to note that Vincent Ketelaer published an account of a disease resembling sprue, under the title "De aphthis nostratibus, seu Belgarum Sprouw," in 1699, which antedated the description by Hillary. As may be inferred from the title, the cases described were apparently instances of an endemic disease and were encountered in Belgium. Gee2 (1888) was the first modern commentator on spruelike diseases in nontropical environments.