900 WAKD J. MAcNEAL 



The Illinois State Pellagra Commission, in 1911, drew the following 

 conclusions : 



(1) According to the weight of evidence pellagra is a disease due to in- 

 fection with a living microorganism of unknown nature. 



(2) A possible location for this infection is in the intestinal tract. 



(3) Deficient animal protein in the diet may constitute a predisposing fac- 

 tor in the contraction of the disease. 



This commission recommended an increase in animal protein in the 

 dietaries of the State hospitals and also compulsory notification of all 

 cases of pellagra. The Robert M. Thompson Pellagra Commission, after 

 most extensive epidemiological study of pellagra in the general population 

 of certain pellagrous districts, has come to conclusions supporting the 

 Illinois Commission. Johling and Peterson (a) and their coworkers have 

 also arrived at similar conclusions. 



Theory of Etiologic Relationship Between Pellagra and Beriberi. 

 Sandwith, in 1912, recognized certain analogies between pellagra and 

 beriberi and he suggested that pellagra may be essentially due to a de- 

 ficiency of nutrition. This theory was taken up with enthusiasm by 

 Funk(c), by Goldberger and their followers. The elimination of pellagra 

 from lunatic asylums, prisons, orphanages and other institutional popula- 

 tions by radical improvement in the dietary, as recommended by the 

 Illinois Commission, has been a striking feature of the argument in favor 

 of this deficiency theory. That such results admit of another interpreta- 

 tion was, however, pointed out by the Illinois Commission itself in 1911. 

 In November, 1916, Goldberger and Wheeler claimed to have produced, 

 by the experimental use of a deficient and unbalanced diet, a "typical" 

 eruption justifying a diagnosis of pellagra in six of eleven human sub- 

 jects. A full report of this work, which appeared after a delay of more 

 than three years, has revealed that the eruption designated as "typical" 

 was actually a dermatitis on the scrotum and apparently on the apposed 

 surfaces of the thighs. Apparently the authors no longer wish to maintain 

 that this is a "typical" eruption justifying the diagnosis of pellagra, for 

 this expression is avoided in the full report. They here even express a 

 doubt as to whether their experimental diet was of the specific quality 

 necessary to cause the usual eruption of pellagra. McCollum(a), with his 

 collaborators, has carried out a large series of animal experiments upon 

 diets of the type used by Goldberger and Wheeler, and has finally ex- 

 pressed his conviction that pellagra is an infectious disease. 



Theories of Dietary Deficiency. The deficiency theory has been con- 

 fronted with a serious dilemma during the period of the World War 

 from 1914 to 191 8. Dietary deficiency became the rule in central Europe, 

 and the resulting increase in disease and in death rate has been given 

 wide publicity. Among the diseases increased in this part of Europe 

 during the period of deficient diet, pellagra has been conspicuously absent. 



