The farmer and mechanic. [volume] (Raleigh, N.C.) 18??-19??, 1915-03-30

,By Joseph Goldberger. Surgeon in
Charge of Pellagra Investigations;
y H.. Waring, Assistant Surgeon,
and David G.. Willets, Technical AS
.istant, United States Public Health
Seryice).
since the publication Of the COM
,.uo;cation on the Cause and Preven-
t.no Of Pellagra (Goldberger, Public |
4ealth Reports, September IL, 1910 |
large number Of inquiries nave been
r.raiv.d asking for detailed directions
as 10 the treatment and prevention
nj the disease. AS it a been imprac-
tf,able to reply to these as fully as
,nuearS desirable, it was decided to
.rc1are and publish a brief summary
our conclusions as to the nature of
,,uagra, and with these as a basis
Il, outline the treatment and means OF
gTevention.
ON taking up the study of pellagra
n.e of the first and most inSistent
.l5.stions that confronted us was that
If It's communicating. Our studies,
me General tenor of which was briefly
tnd!cated in the letter published Sep
teuher II. 1914, and the details OF
which will be embodied in our COM
uiered reports. have led us to con-
tiude () that pellagra is not a COM
muuicable (neither infections nor
~rontagious) disease, but that is is es-
,entially of dietary origin; ca that it
is dependent on some yet undeterm-
incl fault IN a diet in which the ami
tral or legumiuous protein component
Il, dtsproportionately small and the
nouleguminous vegetable component
uisproportionately large; and CD that
no pcllagra develops in those who
consume a mixed, well-balanced, and
varied diet. such, for example, as that
H. -. IN Il
Unlisted men Of the army, navy, and
marine corps.
TREATMENT.
DlET.-The experience of reliable
observers has over and Over again
shown that we have no specific me-
ficinal treatment for pellagra. A,
thc same time, we find that eve the
earliest students Of the disease make
mention Of the value Of nutrition:
food. The early observers were led tt
iced their patients a they found
that, as u general thing the disease
occurred then, as il does now, mainl.
IN the poor and the badly nOuriShed
1t was not and is not a rare ObServa
lion, however, to I'M individuals Suf
iering from pellagra who. to all out
ward appearance, are perfectly wei
oourished. Such observations, natur
ally enough, gave rise to doubts an
~ ChCiNlClSIl - = Oily AoA
sative relation between u~ndernourish
ment and p~ellagra. Indeed, sue oh
servations justify the inference tina
~pellagra is not a disease of malnutri
tion. provided h a by undernourish
nent or malnutrition we mean II
more than is ordinarily understood. a
some degree Of starvation.
The comparatively recent studio
that have definitely established Der
hpri &c a .dafSpinnoup disco 60 q dis
ease Of "undernOurishment" or starvs
lion in a sense hardly dreamed of bt
tore, have given a new and added sie
niicance to the more recent studio
ot nutrition and have opened a pra'
fically virgin field to the student
"pidelniology and therapy.
Caused By UndernOnr!shmcnt.
II now we consider pellagra as
ault of nutrition C"undernourisl
ment" or "starvation") in this ne
and special sense (that is, as in son
way analogous to beriberi or scurv
We at once get a new and more SyI
pathetic tolerance for the reports
beneficial results not only from Z
use Of "nourishing" food alone b
also from those reports OF unusual
favorable results following the admi
lstration Of this, that, or the 9th
form Oh arsenic or other mediciI
For on closer inquiry it will be fOu
mat in hose instances where the
seems to be reaso for believing tf
the favorable results claimed for Il
Or that drug appear to have q 81
stantial basis in fact. the credit US
ally claimed for the medicine ale
must, to say the least. be shared
The modification in the diet that Is
Fariably found to have been made. T
currences in such instances are
rare n not hard to understand WI
me reflects that, having gotten w
The natural tendency is to go back
ones ordinary diet, and this usus
the winter diet, to some of the ch
1cters Of which we will again re-
ON the basis OF the foregoing c.
customs and in the light of the 6
eral considerations presented we Wo
recommend that as long as elm
evld-nces Of pellagra are manifest
patient should be given and urged