914 E. V. McCOLLUM 



adding meat, milk, eggs and legume seeds. The result of this modification 

 of the diet was that during 1915 there were no new cases or recurrences 

 of the disease. In similar orphanages in which there were no comparable 

 changes in the diet there were recurrences to the extent of 58 to 75 per 

 cent. Goldberger and his associates likewise eradicated pellagra from 

 the State Insane Asylum of Georgia through similar dietetic treatment. 

 Judging from what we now know about the dietary properties of many of 

 our more important natural foodstuffs, one may safely assert that the 

 important modifications in the diets just described, which led to improve- 

 ment of the condition of the inmates of institutions with respect to pel- 

 lagra, were due to the addition of milk, meats and eggs, especially milk. 



Wilson reported similar results in his work with the inmates of the 

 Asassia Asylum for the Insane at Cairo. The diet contained 100 grams of 

 meat, 50 grams of milk, and 300 grams of fresh vegetables, the character 

 of which was not named. Otherwise it consisted essentially of cereal 

 products. Through the addition of 45 grams of meat and 50 grams of 

 milk to the diet of each inmate, the death rate from pellagra during the 

 following year was diminished by nearly 50 per cent. Wilson regarded 

 the modification of the institutional diet as of such a nature as not to 

 modify in an important way any factors other than the quality and amount 

 of protein. He drew the deduction that the protein factor is the most 

 significant one in the causation of pellagra. 



There is a criticism which one is justified in directing against all these 

 investigations. The improvement in the condition of pellagrins, or the 

 reduction of the rate of 'incidence of the disease in any group of persons 

 who are taking the milled cereal type of diet, on the addition of such 

 complex natural foods as milk, eggs or meat, cannot with safety be inter- 

 preted as meaning that improvement of the diet with respect to protein 

 has induced the benefit. It is entirely defensible in the light of the 

 experimental observations now available on animals to view these experi- 

 ments in an entirely different light. 



We must emphasize that all our progress in the study of nutrition in 

 recent years has pointed to the .importance of recognizing borderline 

 malnutrition as a condition difficult of detection, yet fraught with menace 

 to the individual. The animal body is remarkably sensitive to the quanti- 

 tative relations between certain of the mineral elements contained in the 

 diet, notably calcium and phosphorus, and also to lack of one or another 

 of the vitamins as well as to the quality and amount of protein which the 

 food supply contains. Two or more of these factors may operate simul- 

 taneously to disturb the metabolic equilibrium, and even such modifications 

 of the diet as the addition of 45 grams of meat and 50 grams of milk to a 

 diet of the type described by Wilson, may easily be regarded as sufficient 

 to make a pronounced difference in the well-being of a patient, not alone 

 because of improvement of the protein moiety of the diet, but of the 



