DIET IN CAUSE AND TREATMENT OF PELLAGRA 915 



inorganic factors and vitamins as well. The sum of the enhancement of 

 all these factors rather than of any single one of them should be given 

 credit for the results observed. 



A further point should be emphasized in connection with the experi- 

 ments of Wilson. His basis for the estimation -of the biological value of 

 the proteins which entered into the diets of his patients were the data 

 furnished by Thomas, and which have been frequently employed in recent 

 years for strengthening conclusions which were draVn from faulty experi- 

 mental data. Thomas's figures represent nothing more than digestion co- 

 efficients of doubtful accuracy, and cannot be looked upon as representing 

 the biological values of the proteins in the sense that this term is now 

 used. Thomas designated his figures as representing the "utilization" 

 of the different proteins which he studied. No one would to-day think of 

 conducting experiments in the manner in which his were carried out. 



It has been held by some investigators, especially by the Thompson 

 Pellagra Commission of the. New York Post-Graduate School of Medicine, 

 that pellagra is a transmissible disease. They based their conclusion on 

 the remarkable incidence of the disease at the end of winter. They were 

 inclined to incriminate the fly as a carrier of the infection. This view has 

 not been generally accepted, and has little direct evidence in support of 

 it. The occurrence of new cases principally in the spring is equally well 

 accounted for by Goldberger on the basis of adherence of the subjects to 

 a faulty diet during three to four winter months. This period is, he 

 believes, necessary for the effects of the faulty nutrition to become mani- 

 fest. 



Goldberger attempted to settle the question of the etiology of pellagra 

 by an attempt to induce pellagra in man by the continued employment 

 of a faulty diet. He restricted eleven volunteers among the prisoners at 

 the Mississippi State Prison during six months to a diet composed essen- 

 tially of the following list of foods : Bolted wheat flour, degerminated corn- 

 meal, polished rice, starch, sugar, molasses, sweet potatoes, fat pork, 

 cabbage, collards, turnip greens and* coffee. I calculated from the data 

 furnished by Goldberger, that less than four per cent of the total calories 

 of the diet were derived from the sweet potatoes, cabbage, collards and 

 turnip greens altogether. The diet was, therefore, essentially derived 

 from milled cereal products, molasses and fat pork. Six of the eleven 

 men were diagnosed as having at the termination of the experiment in- 

 cipient symptoms of pellagra. McNeal and others have insisted that 

 the diagnosis was made on inadequate evidence. The question as to 

 whether faulty diet of the type described can induce pellagra still remains 

 to be fully established. 



There are excellent reasons for believing that the most important 

 lesion in pellagra is a degeneration of certain centers in the cord. This 

 has been especially emphasized by Vedder. The remarkable bilateral 



