362 THE VITAMINES 



METABOLISM 



The first exact metabolism experiments in pellagra were made by 

 Myers and Fine (1339). The milk-vegetable diet used was well 

 utilized. Nicolaidi (1340) observed large food losses in the stool. 

 Albertoni and Tullio (1341) obtained a negative nitrogen balance on 

 corn; the balance became positive on meat. Hunter, Givens and 

 Lewis (1342) found in seven cases of pellagra a positive nitrogen 

 balance on a pellagra-producing diet. Boyd (1343) found, in a 

 metabolism experiment on Turkish prisoners in Egypt, in confirma- 

 tion of earlier findings, a decrease of hydrochloric acid in the stomach, 

 diminished pancreatic secretion, protein and fat loss in the stool 

 (remarkable in a disease caused by a lack of protein) and a very poor 

 protein assimilation. The latter is especially emphasized in recent 

 publications (Sullivan, Stanton and Dawson, 1343a) . 



PROGNOSIS 



In Italy, 55,029 cases of pellagra were recorded in 1905, with 2359 

 deaths, equivalent to more than 4 per cent mortality. In America, 

 on the contrary, the prognosis is much more serious, namely, 50 per 

 cent death rate in the asylums and 20 to 25 per cent in private 

 practice. It is obvious that the picture of pellagra, because of the 

 dietetic factor, frequently varies with the well-being of the popula- 

 tion, assuming either a mild or more severe type. 



THE RELATIONSHIP OF PELLAGRA TO THE ACCEPTED AVITAMINOSES 



BERIBERI AND SCURVY 



In the short paragraph on the relation of beriberi to scurvy in 

 South Africa (p. 296), we have seen that scurvy develops on a diet 

 consisting of very little animal protein and corn, without a sign of 

 pellagra. This is true also of a widespread occurrence of scurvy, 

 which G. R. Hopkins (I.e. 939) described in a population which fed 

 itself almost exclusively on corn. Marie (I.e. 1280) and Viswallingam 

 (1344) looked upon scurvy as a predisposing cause of pellagra. 



As for the relation of pellagra to beriberi, Sheppard (1345) saw 

 pellagra in Singapore on an exclusive rice diet. Stannus (1346) 

 stated that he saw a number of cases in Nyasaland on rice (only 

 partially husked) ; vegetables, fish or meat were eaten only once in 

 14 days. The disease progressed without any characteristic exan- 



