DIET IN CAUSE AND TREATMENT OF PELLAGRA 913 



as that reported could have resulted from the administration of a hypo- 

 thetical "anti-pellagra vitamin" which the extracts may have furnished, 

 when the diet was otherwise so poorly constituted. If the studies reported 

 by Voegtlin should be confirmed, they will, however, effectively establish 

 pellagra as a deficiency disease in the same sense as are the other syn- 

 dromes which are included under that term. 



The view that pellagra is due to specific starvation for a vitamin or 

 vitamins was first suggested by Funk, who, however, was not able to offer 

 any evidence in support of his contention. It has been shown by McCol- 

 lum and Simmonds that diets of the type commonly employed in pel- 

 lagrous districts can be supplemented by the addition of certain mineral 

 salts, purified protein and one of the vitamins (fat-soluble A) so as to 

 render them complete for the nutrition of the rat. If one were justified 

 in accepting data of this kind obtained in animal studies, as applying 

 directly to the elucidation of the human problem, this would constitute 

 definite proof that pellagra is not a disease due to lack of a vitamin. We 

 have one proven case, however, of the immunity of one species of animal 

 to a typical deficiency disease due to its ability to synthesize the vitamin 

 which, when lacking in the diet, leads to the development of the specific 

 syndrome. The rat does not develop scurvy when confined to a diet which 

 produces this disease in the guinea pig within two to four weeks. Young 

 rats may grow to maturity on such a diet and show no appearance of 

 abnormality. Miss Parsons, working in the author's laboratory, showed 

 that the livers of such rats would induce a prompt cure of guinea pigs which 

 were suffering from acute scurvy. The rats had not obtained the anti- 

 scorbutic substance from their food, and must, therefore, have been able 

 to synthesize it from some other complex in their diet. It is possible that 

 a similar situation may exist in the case of the rat restricted to a diet 

 which would permit or cause the development of the symptoms of pellagra 

 in man. Such an experiment as the satisfactory nutrition of young rats 

 on a diet on which man has developed the disease, when the diet has been 

 enhanced by the addition of purified food substances, does not eliminate 

 the possibility that the pellagrous diet, supplemented so as to be complete 

 for the rat, would still be incomplete for man. 



The cause of pellagra has recently been attributed by Wilson to 

 inadequacy of the diet as respects quantity and quality of protein. His 

 experiments were in essential features comparable to earlier ones by Gold- 

 berger. We may profitably consider certain of these very briefly. 



Goldberger, Waring and Willets observed that the diet in two orphan- 

 ages in Mississippi were derived in great measure from bolted white flour, 

 degerminated cornmeal, molasses, fat pork, and a few vegetables. The 

 number of pellagrins in one of these institutions, M. J., between January 

 and September, 1914, was 70, and in the other, B. J., 130. They replaced 

 a part of the calories of these diets by oatmeal in place of corn grits, and 



