MAIZE GRAIN AS FOOD 683 



protein may so alter the body that the infecting organism has CHAP, 

 a better chance to grow." XIV. 



The Commission closes its Report with the following con- 

 clusions and recommendations : — 



(1) According to the weight of evidence pellagra is a disease 

 due to infection with a living micro-organism of unknown 

 nature. 



(2) A possible location for this infection is the intestinal 

 tract. 



(3) Deficient animal protein in the diet may constitute a 

 predisposing factor in the contraction of the disease. 



(4) The number of cases of known pellagra renders this 

 disease a decided menace to the public health of this State. 



(5) Careful search for, and investigation of, suspected cases 

 outside the State hospitals for the insane, is extremely desirable 

 in view of experience elsewhere. 



We therefore beg respectfully to recommend : — 



(1) That a new Commission be appointed and funds pro- 

 vided for a continuance of this investigation with adequate 

 assistance. 



(2) That as a prophylactic measure the animal protein con- 

 tent of the State Hospital dietaries be increased. 



(3) That the State Board of Health be advised to require 

 notification of all cases of pellagra. 



Pellagra produces a skin eruption, most common on the 

 backs of the hands and lower parts of the forearms, often ex- 

 tending as a cuff around the wrist just above the palm ; the 

 elbows and areas on the inner sides of the arms and forearms ; 

 the forehead and cheeks ; the neck, and finally the dorsa of the 

 feet ; at times the eruption is widespread over the whole body. 

 Gastro-intestinal troubles are very frequent. There is a great 

 tendency to the development of mental disorder of delirious 

 type. The mortality may be very high ; pellagra was given as 

 the immediate cause of death in 40/61 per cent of the 258 cases 

 at the Peoria, Illinois, State Hospital. 



One of the latest (14 March, 19 1 3) reports published in the 

 United States concludes : " The great prevalence of pellagra 

 in certain districts and the important relation that exists be- 

 tween pellagra and the public health would seem to be ample 

 justification for undertaking on a large scale the herculean task 



