Mr. S., a freight conductor. A very .large and muscular man weighing 245 pounds and apparently a very well-nourished man. Eruption of pellagra pronounced, but no other symptoms except that he lost fifteen pounds weight just prior to the appearance of the erythema.

Breakfast: Gets a very early start and usually eats no breakfast. When he does it consists of coffee and a biscuit.

Dinner: Almost always eats Irish potatoes fried with onions, and eats more of these than anything else; cabbage often. Does not eat meat because he does not care for it. Says he does not eat a pound of meat in six months. Has eggs perhaps once a week; beans occasionally; bread; ice cream often.

Supper: Potatoes and onions again whenever he can get them; oysters or fish occasionally, otherwise sandwiches or pie.

8tated that he might drink a glass of milk a day, and never ate butter, but that he was very fond of fresh raw eggs, and when he found some fresh ones, he might eat half a dozen at one meal. Said this did not happen more than once or at most twice a month. His dietary habits were most erratic, as he had to pick up what he could get on the road a good deal of the time, but he almost always ordered potatoes and onions for which he had an especial predilection.

Vedder says that in practically every case there is some peculiarity of taste or a history of indigestion or some other circumstance, as a result of which the patient had lived on a very one-sided diet, in every case consisting chiefly of flour, or corn products or potatoes, often with the addition of salt pork in some form or canned vegetables. Similarly Roberts 35describes 25 cases from private practice, all of whom were amply able to provide an adequate diet for themselves, but all of whom for one reason or another ate unbalanced or insufficient food.

Goldberger experimented with two orphanages at Jackson, Miss., which had been pellagra centres for several years. Without altering the hygienic and sanitary conditions the diet in the two institutions was modified to as to include a much larger proportion of fresh animal and leguminous protein. Among the 340 inmates from the two institutions who were kept under observation for a year only one developed a recurrent attack and no new cases were seen. Precisely similar results were obtained at the Georgia State Sanitarium, where a modification of the diet on the same lines as those followed in the orphanages had equally good effect, no recurrence being observed among the 72 pellagrins under observation, whereas among the control cases kept on the accustomed diet, 47 per cent presented recurrences.36

35 Roberts, J. Am. Med. Ass. 75, 21, 1920.

36 Goldberger, Waring, and Willets, Pub. Health Repts. 30, Oct. 22, 1915.

A very interesting experiment was carried out at the farm of the Mississippi State Penitentiary, where eleven convicts were induced by the offer of a free pardon from the Governor to submit themselves to an experimental diet similar to that on which pellagra was known to develop. The remaining population of the farm were kept under observation as controls. The volunteers kept about the same hours and did about the same kind and the same amount of work as the other convicts. Such differences as existed were in favor of the volunteers, especially during the latter portion of the experimental period. The general sanitary environment was the same for volunteers and controls, but the hygienic environment - personal cleanliness, cleanliness of quarters, freedom from insects, particularly bedbugs - was decidedly in favor of the volunteers. The diet comprised patent wheat flour, corn meal, corn grits, corn starch, white polished rice, standard granulated sugar, cane syrup, sweet potatoes, pork fat (fried out of salt pork), cabbage, collards, turnip greens, and coffee.

By the end of five months on this diet six out of eleven volunteers had developed symptoms justifying a diagnosis of pellagra, including the typical eruption, nervous and gastro-intestinal symptoms.37 This seems to be well attested, although McNcal38 has denied that the observed symptoms were those of pellagra.

Three investigations have been reported in which symptoms closely resembling those of pellagra have been produced in animals by prolonged feeding on unsuitable rations. Chittenden and Underhill 39 fed dogs on a diet consisting of varying quantities of boiled peas, cracker meal and cottonseed oil or lard. The animals were kept under the best sanitary conditions, protected from any possible infection, and allowed a sufficient amount of exercise, so that the only abnormal condition was the diet. After periods varying from one to eight months a pathological condition strikingly similar to pellagra made its appearance. At times the animals could be restored to normal condition by the addition of meat to the diet. The same symptoms could be induced on a diet of meat, cracker meal and lard, provided the meat intake was sufficiently small, but less than 50 per cent of the dogs were susceptible to these conditions. The investigators state that the level of nitrogen intake as such plays little or no role in the development of this disease.

Clementi40 found that after a prolonged exclusive diet of maize, chickens develop disturbances of digestion and of nervous system very different from those produced by polished rice and analogous to those of pellagra in man or those produced in birds by injections of alcoholic extracts of rotten maize. On discontinuing this diet the symptoms slowly disappear.

37 Qoldberger and Wheeler, Pub. Health Repts. 30, Nov. 12, 1915. 38 McNeal, J. Am. Med. Ass. 66, 975, 1916. 39 Chittenden and Underbill, Am. J. Physiol. 44, 13, 1917. 40 Clementi, Ran. Clin, terapi. eci. affini. 16, 131, 1917.

Chick and Hume 41 state that monkeys fed on a low-protein diet made up of butter, banana or apple, sugar, orange juice, cornflour biscuit, and "marmite " (a commercial yeast preparation) lost weight slowly and gradually developed symptoms characteristic of pellagra.