PELLAGRA 901 



There was observed, however, an outbreak of pellagra among Turkish 

 prisoners in a British prison camp in- Egypt, Many of these prisoners 

 were pellagrins before capture, but the disease also actually spread to new 

 victims in the camp. A British Committee of Inquiry ascribed this out- 

 break to the deficient diet of the Turkish prisoners and contrasted this 

 diet with that of the German prisoners in an adjacent camp. The German 

 prisoners had subsisted upon a most excellent diet before capture, and as 

 prisoners were receiving a diet above reproach. ' Most unfortunately for 

 the conclusions of this Committee, an outbreak of pellagra appeared among 

 these German prisoners immediately after their diet had been found to be 

 above reproach, namely in December, 1918. Enright, who has reported 

 this outbreak, concludes, "Although I have been unable to advance any 

 satisfactory cause for this mysterious outbreak of pellagra, I do submit 

 that I have established a clear case against a 'food deficiency' as being the 

 only factor involved." 



More recently Enright, and after him Stannus, has suggested that 

 perhaps some toxic disturbance of the endocrin glands may explain 

 pellagra. Whether this suggestion will be followed with enthusiasm, 

 similar to that aroused by the deficiency hypothesis suggested by Sandwith 

 eight years previously, only the future can tell. 



In my own opinion the causation of pellagra depends upon two factors 

 analogous to those recognized by Roussel: (1) a living microorganism, 

 which is the specific causative factor, without which pellagra does not 

 occur; and (2) a group of factors, quite non-specific, which serve to reduce 

 the resistance of the victim. In this latter group are recognized mal- 

 nutrition, either from inadequate food or inability to utilize food 

 adequately, cachexia, overwork, depressing influence of hot weather, strain 

 of reproduction in women, involution of old age, alcoholism, and other 

 such influences. The specific causative factor remains unrecognized. 

 Most probably it is a microbe which resides in the gastro-intestinal tract, 

 from which its soluble products are absorbed to give rise to the distant 

 manifestation of pellagra. In regard to transmission of the infectious 

 agent, the weight of evidence indicates that it passes to new victims by 

 contamination of food and drink with intestinal excretions, that it is 

 disseminated only within short distances from cases of the disease, and 

 that it attacks successfully only a small proportion of the exposed 

 population. 



Geographical Distribution. Isolated cases of pellagra are occasionally 

 observed in various parts of the world. Because of the chronic and 

 recurrent character of the disease and the extent of modern travel, such 

 observations are to be expected. However, the relation between place and 

 origin of pellagra is one of the most striking and characteristic features 

 of the disease. Pellagra is contracted where there is a preexisting case 

 of the disease and its apparent sporadic origin is relatively so rare as to 



