Treatment of tropical sprue: the work of Dr. Bailey K. Ashford examined in retrospect.

Tropical sprue is a malabsorption syndrome that responds to treatment with folic acid and a broad-spectrum antibiotic. Eighty years ago, prior to the identification of the vitamins and the discovery of penicillin, clinical trials often consisted of best guess treatments based upon current knowledge and available technology. Dietary interventions were emerging as effective treatments for alleviation of diseases such as pellagra and beri beri. Representative of his generation of clinicians, Bailey K. Ashford, MD, one of the pivotal figures in academic medicine in Puerto Rico, carried out dietary studies in his patients with tropical sprue. This historical retrospective presents an examination of the diets used by Ashford in terms of nutrient content and comparison to current recommended dietary allowances. Results show the diets to be inadequate for sustained nutrient value and especially low in folic acid. In summary, Ashford recognized the basic causes of tropical sprue but was unable to effectively treat the syndrome due to lack of adequate resources.