PELLAGEA 903 



lumberman, a veterinary inspector in the Federal service, examples re- 

 corded, by the Thompson Pellagra Commission. 



Relation to Food. According- to the older theories pellagra is due to 

 the toxic action of maize in the diet, but modern investigations have 

 disproved this conception. Stannus has reported pellagra in prisoners 

 who had eaten no maize for years, and Viswalingham has observed an out- 

 break of pellagra 1 in the Malay States among Chinese coolies, whose diet 

 consisted largely of rice and contained no maize. The Thompson-Mc- 

 Fadden Commission, in 1913, failed to discover any positive correlation 

 between the frequency of use of any single food and the frequency of 

 occurrence of pellagra. At present no student of pellagra appears seri- 

 ously to maintain that the disease is caused by any single food. There 

 remains, however, the possibility that the excessive use or too exclusive 

 use of certain foods, maize for example, may predispose to the develop- 

 ment of the disease or may render the attack more severe. 



A second possibility is. that the insufficiency of certain dietary ele- 

 ments, rather than the excess of a certain element, may bear an etiological 

 relation to pellagra. The pellagra-preventing value of animal foods, 

 especially milk, emphasized by the Illinois Commission in 1911, and 

 clearly demonstrated by the Thompson-McFadden Commission in 1913, 

 is now generally recognized. Recently even Goldberger and his colleagues 

 of the Public Health Service (1920) seem to have abandoned the advocacy 

 of beans and to have turned to milk, milk products and fresh meat as 

 preventive diet for pellagra. In my own opinion the pellagra-preventing 

 value of these foods is similar to their value in preventing tuberculosis ; 

 they improve nutrition and increase the resistance to the specific microbic 

 cause of the disease. Mere lack of animal foods is not the specific cause 

 of pellagra as is attested by the host of strict vegetarians who escape the 

 disease. On the other hand, a relatively brief survey of a. pellagrous 

 district reveals pellagrins who have taken milk daily throughout their 

 lives, especially young children, and occasionally one finds adult pellagrins 

 who have eaten meat every day for years. 



The third possibility, namely that general insufficiency of food may 

 be the specific cause of pellagra has already been discussed and rejected. 

 Those nations in which belts were shortened during the years from 1914 

 to 1919 did not suffer from pellagra. There can be no doubt, however, 

 that adequate nutrition is a most important insurance against pellagra in 

 pellagrous districts and a most important factor in bringing about re- 

 covery from this disease and that inadequate nutrition predisposes to the 

 development of pellagra in those who are exposed to the essential cause 

 by residence in pellagrous districts. 



Sewage as an Etiologic Factor. Many of the older authors have 

 mentioned the association of poor sanitation with pellagra prevalence. 

 The Thompson-McFadden Commission (1913) and the Thompson Com- 



