1915] Casimir Funk 327 



or vitamine-poor foods. In the latter case an increase in the quan- 

 tity of cereals may induce beriberi, for the quantity of vitamine is 

 insufficient. Small additions of meat, once a week, or vegetables, 

 are not sufficient to prevent beriberi, but since such additions usu- 

 ally are eaten, no scurvy results. In the case of beriberi the etiology 

 is clear — it occurs on starchy food with a negative or insufficient 

 supply of beriberi-vitamine. We must remember that in accord 

 with the results of my experiments on pigeons, beriberi does not 

 occur on a maize diet. 



The etiology of scurvy has also been entirely cleared up. The 

 disease breaks out v^hen dry food, in most cases such as has been 

 stored for a long time, is eaten or when sterilized food (canned foods) 

 is eaten. Beriberi does not occur in such cases because the beriberi- 

 vitamine is stable enough to resist storage for a long time; but the 

 beriberi-vitamine is incapable of preventing scurvy. 



The Pellagra cases of Stannus had pellagra and not beriberi be- 

 cause the rice was only partially decorticated. In my opinion these 

 cases are very important, for they give us a clue to the etiology of 

 Pellagra. These cases suffered from pellagra, and not from beriberi 

 and scurvy, because the food contained enough beriberi-vitamine to 

 prevent the outbreak of beriberi, and there were apparently enough 

 fresh vegetables and fruit to prevent an outbreak of acute scurvy. 



As a general conclusion, and at the same time as a working 

 hypothesis, I regard pellagra not as a separate disease but as a very 

 chronic disorder due to partial insufficiency of beriberi- and scurvy- 

 vitamines. 



V. PELLAGRA 



Pathology. The problem of pellagra, for this country and for 

 other maize-eating countries, is one of the utmost importance. 

 Lavinder (58) gives the number of pellagrins in the United States, 

 between 1907 and 1912, as 19,915 with a 40 percent mortality. Of 

 these cases, nearly 55 percent were reported in Oklahoma, Arkansas 

 and Texas. Devoto (59) made an excellent clinical study of pel- 

 lagra. He described the diet of Italian peasants in pellagra districts, 

 which in winter consisted only of maize. Acute erythema appeared 

 early in March. The first Symptoms of the disease are weariness, 

 lassitude, loss of weight, anorexia, paresis of the legs. In this stage 



