The Relation of Diet to the Cause 

 and Treatment of Pellagra 



E. V. McCOLLUM 



BALTIMORE 



Casal of Oviedo in Spain, who first described pellagra, associated the 

 disease with poverty and bad nourishment. Many investigations have 

 been directed toward the study of its cause, but the exact nature of the 

 factors which enter into its etiology have not yet been established. The 

 people of Oviedo ate little meat. Their diet consisted of maize, beans, 

 peas, chestnuts, apples, pears, melons and cucumbers. All later observers- 

 agree with this early report that persons who suffer from pellagra derive 

 their diet in great measure from vegetable foods, and that chief among 

 these are cereal products of one kind or another. 



In 1866 Roussel stated that pellagra could be cured with good food, 

 and that without adequate dietetic measures all remedies were useless. 

 In the light of all the extensive researches which have been conducted by 

 many investigators, all are in agreement with Roussel's view. There is 

 considerable difference of opinion, however, concerning the dietary factor 

 or factors which contribute to the causation of the disease. 



The early observations on the etiology of pellagra were made with no 

 understanding of the chemical composition which is essential for the main- 

 tenance of normal physiological function, and consequently it was not to 

 be expected that a satisfactory control of the diet or satisfactory interpre- 

 tations were likely to be made. Since, however, pellagra has not been pro- 

 duced experimentally in animals, all our criteria as to its cause are based 

 on studies on human subjects. As is almost always the case under such 

 conditions, the control of the character of the diet, or observations regard- 

 ing the constitution of the diet prior to the attack or recurrence, have 

 rarely been exact and complete. In other words, the nature of the observa- 

 tions in all experimental studies of pellagra are not such as to constitute 

 a rigidly controlled experiment. They do not, therefore, yield conclusive 

 evidence or form safe basis for deductions. 



It may be stated at the outset that the view that pellagra is due to an 

 intoxication might be expected to be supported or refuted by studies of 

 the kinds which are recorded in the literature. Strambio first propounded 



911 



