DISEASES OF UNKNOWN ETIOLOGY 441 



The present trend of thought in connection with pellagra is that it 

 is a food deficiency disease connected with a deficiency in vitamines 

 necessary for normal metabolism (see beriberi). 



In February, 1915, Goldberger started a "pellagra squad," consisting of n 

 prisoners on a diet of wheat flour (patent), cornmeal, corn grits, corn starch, polished 

 rice, granulated sugar, cane syrup, sweet potatoes, fat fried out of salt pork, cabbage, 

 collards, turnip greens and coffee. Baking powder was used for making biscuits 

 and corn bread. The food value of each man's diet averaged 2952 calories. 



A control was carried out with prisoners on a normal diet. The experiment was 

 continued until Oct. 31, 1915. Of the n volunteers on the excessive carbohy- 

 drate diet six developed symptoms. Loss of weight and strength and mild neuras- 

 thenia were early symptoms. Definite cutaneous manifestations appeared only 

 after five months. The skin lesions were first noted on the scrotum, later appearing 

 on backs of hands in two cases and back of neck in one case. 



Just as with rice so does excessive milling of wheat get rid of vitamines, therefore 

 bread made from highly milled flour is dietetically deficient. 



Again, as brought out by Voegtlin, alkalis tend to destroy any remaining vitamines 

 in such bread. The practice of using sodium bicarbonate in preparation of bread 

 is a further factor in the food deficiency problem. With the use of baking powder 

 or buttermilk the alkaline carbonate of soda is neutralized so that there is no de- 

 structive effect on vitamine content. 



Notwithstanding the above evidence as to food deficiency etiology it must be re- 

 membered that McNeal and his colleagues on the Thompson-McFadden pellagra 

 commission, as well as other authorities on this disease, insist upon a probable 

 infectious agent as cause. 



Rat-bite Disease. A disease caused by the bite of rats. Rather 

 common in Japan. Five weeks after bite when wound has healed, 

 high fever sets in, cicatrix becomes inflamed with lymphangitis and 

 swollen glands. The fever falls in a few days to be succeeded by other 

 febrile paroxysms. An erythematous eruption accompanies the second 

 paroxysm. 



Supposed by Ogata to be due to a protozoon, but recent work by Schotmuller, 

 in 1914, has shown that the cause is a Streptothrix, S. muris ratti. This finding has 

 been corroborated by Blake. The organism first invades the lymphatic structures 

 and then the blood, giving a septicaemia. Various organs are later involved. Blake's 

 case developed a powerful agglutinin for the specific Streptothrix. 



Sprue. A form of chronic diarrhoea characterized by diaphanous 

 thinning of gut and ulcerations of buccal cavity. 



Kohlbrugge found organisms resembling Oidium albicans in the intestines, 

 oesophagus and tongue. He found similar organisms in the stools and tongue 

 scrapings of cases of sprue. Beneke found bacilli in the tongue, oesophagus and 

 intestines and considered these as causative, regarding the thrush-like membranous 

 deposit as connected with the cachectic state and not causative. 



