This report is concerned with clinical and pathologic observations in a group of 40 patients manifesting the sprue syndrome. These patients were observed at the Mount Sinai Hospital during the past fifteen years. The central point of this symptom complex is an impairment in the absorption of fat, fat-soluble vitamins and some carbohydrates. As a result, there then may appear steatorrhea; weight loss of considerable degree; an anemia, usually of a hyperchromic macrocytic variety, and painful lesions of the mouth and tongue. Hypocalcemia with tetany and osteoporosis, pigmentation of the skin, hypoproteinemia, polyvalent deficiencies in vitamins, minerals and amino a'cids, as well as signs of hepatic damage are not infrequently seen.1 Of the 40 patients studied, the disease of 36 is designated as "primary sprue," that is, there were no roentgenologic or other evidences of organic changes in the intestinal tract that could account for the syndrome on clinical