Tropical sprue was one of the illnesses contracted during the war. While tropical sprue is associated with tropical regions, non-tropical sprue (now known as celiac disease) is recognized elsewhere. In the 1970s the distinction between celiac disease and tropical sprue became clearer, with celiac disease being linked to gluten and tropical sprue being linked to infections and environmental factors.
Tropical sprue is a malabsorption disease marked by inflammation of the lining of the small intestine and characterized by chronic diarrhoea, nausea, malabsorption of nutrients, weight loss and fatigue. This inflammation makes it difficult to absorb nutrients from food, in particular folic acid and vitamin B12. To avoid the complications and morbidity associated with this condition, it must be promptly diagnosed and treated.
Sprue generally occurs in the tropical areas of the Caribbean, India, South Africa and Southeast Asia. It is similar to, but different from, giardiasis, Crohn’s disease, ulcerative colitis and irritable bowel syndrome. It is treated with tetracycline antibiotics to kill the bacteria and with treatment for the malabsorption, by replacing the vitamins, nutrients, and electrolytes that the body is lacking, ie iron, folic acid and vitamin B12. Recovery can be quick and dramatic after the first large dose of folic acid, and folic acid may be enough to improve symptoms on its own. Most people show good outcomes after three to six months of treatment. Non-tropical sprue responds to a gluten-free diet.
At the end of the war, missionary Mildred Dibden had been seriously ill with malaria and a bowel illness, and was repatriated for treatment and recovery, leaving her friend Charlotte Bird in charge of the Fanling Babies’ Home.
Back in England doctors could not tell Mildred what her bowel illness was apart from being ‘one of those tropical germs’ and they advised her to 'stay at home and rest', ie not to return to Hong Kong! However, true to her calling, she returned in 1946 to continue her work, but continued to have flare-ups of the illness, often triggered by stress.
In 1954 she was advised by the Emmanuel Clinic in Kowloon to see Professor Alexander Mcfadzean at Queen Mary's Hospital. He identified tropical sprue, and treated it with folic acid and vitamin B12 and she recovered. However, she was never to be completely clear of the illness because during the war she had missed out on prompt treatment in the early stages, and it was something she subsequently had to live with and manage.
Bishop Ronald Hall (1932-66) suffered from sprue, which he contracted in Hong Kong. "For many years he had a tendency towards ‘upset tummy’, particularly in times of stress and anxiety", with episodes of cramping pain and diarrhoea. During his retirement he was particularly ill over the winter of 1967/68 and spent 6 weeks in hospital in Oxford being treated for deficiency of vitamin B12 amongst other things.
Sources:
R.O. by David Paton (Biography)