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Related post: the sun.
As to the infected alimentary tract. Dr. Lynch
has certainly brought out some good points with
Vol. X No. 5
DISCUSSION SYMPOSIUM ON PELLAGRA
389
reference to it. I have been following it, to some
extent, and have found parasites in the intestinal
tract of a good many pellagrins. I can not speak
with reference to the pathology of the alimentary
tract in this disease.
Dr. A. E. Confer, Chattahoochee, Fla. — I be-
lieve in the dietetic treatment of pellagra not be-
cause I desire to be an apologist for Dr. Gold-
berger, but because it has been my experience
that in the institution where I am working we
have had better results and a lower mortality Paroxetine High as
a result of that treatment than from anything
that we have heretofore tried. Notwithstanding
the wisdom that has emanated from Columbia,
Ala., I can not agree with all that has been said
from that quarter.
I think it is very unfortunate that one should
come here and read a paper as able as the one
presented by Dr. Goldberger and then have it re-
ceived in such a manner.
Dr. George C. Mizell, Atlanta, Ga. — Any one
who has seen a large number of cases of pellagra,
and studied them and followed them up, can not
get away from the effects of diet in the treat-
ment of pellagra. Since 1911 I have been keep-
ing up with all my cases of pellagra, about 200
in number, that I have been able to keep in touch
with and bring the condition of these patients
down to date. I have kept an accurate record
of all of these cases, and I can say to you that
those cases are not having recurrences and have
not had a recurrence in several years, and the
only change that was made was a change in diet.
The patients are living in the same locality and
in the same homes to a great extent. Further-
more, two orphanages (the one located in Atlanta
in 1911 had between 30 and 35 cases of pellagra)
have not had a new case of the disease develop
since 1911. There were two recurrences in 1912
and 1 in 1913. In Macon there is a hospital in
which they had a large number of cases of pel-
lagra in 1910 and 1911 and years before, but in
which there has not been a pellagra case since
then except among children who have been
brought into the institution and the disease be-
came apparent after they had been in the institu-
tion a month or two.
I am glad some one has mentioned the effects
of sunshine in pellagra. To me, the deleterious
effects of sunshine in pellagra should be recog-
nized because the improvement of the patient
goes along with the dietetic treatment. What-
ever the cause of pellagra may be, it is a sensi-
tive subject to many people, and in addition to
diet it appears to me that sunshine does exert a
very deleterious effect.
Dr. J. F. Yarbrouf/h, Columbia, Ala. — I rise to
a point of personal privilege. The very unpleas-
ant charge of having been discourteous to Dr.
Goldberger has been lodged against me. I chal-
lenge the gentleman to point to a single sentence
in my remarks that could, by the wildest stretch
of imagination, be construed into a personality.
The attack was made wholly on Dr. Goldberger's
diet theory in the treatment of pellagra, — )tot on
the man. In my remarks I stated that Dr. Gold-
berger had said that no drug or other remedy
other than diet was of benefit in the treatment
of pellagra.
In this symposium more than one gentleman
has charged me with misrepresenting Dr. Gold-
berger in the above statement. They say that
Dr. Goldberger is a man of too broad culture;
that his scientific attainments are of such high
order that he could not, and did not, make such
a statement. I wish to call the attention of these
gentlemen to a paragraph in an article published
by Dr. Goldberger in the .Journal of the American
Medical Association, February 12, 1916: "Here-
after the clinician who would attribute thera-
peutic value to any drug or other remedy in the
treatment of pellagra should be prepared to show,
what has not heretofore been done, that the cura-
tive effect claipied can not be attributed to the
diet."
If this does not exclude the transfusion of
blood, normal salt solution and all drugs in the
treatment of pellagra, tell me why.
Dr. Jos. Goldberger (closing). — The mere state-
ment of one's belief in this, that or the other
thing in connection with pellagra may be de-
scribed as a sort of confession of faith, and I
want to say that, in my judgment, a confession
of faith is not debatable. Therefore, if I dp not
refer to the remarks of some of the gentlemen
who have spoken, please understand that it is
because I do not propose to debate a confession
of faith. However, I feel obliged to make some
exceptions. One of these is my friend. Dr. HajTie,
who well represents those who delight in confess-
ing their faith with respect to one or another
aspect of this interesting, perplexing and impor-
tant problem. He persists in misunderstanding
the word "deficient." I feel certain that Dr.
Hayne knows, or should know, the meaning of
"deficient," but I have gained the impression that
for reasons best known to himself, probably as
an attempt at humor, he persists in speaking as
if it were synonymous with insufficient. As you
know, and as I don't doubt that he knows,
there is a vast deal of difference between an in-
sufficient diet and a "deficient" diet. The former
refers to a simple quantitative inadequacy in
bulk or calories, whereas the latter has in recent
years acquired a special technical restricted
meaning. Nor can the other of Dr. Hayne's re-
marks be taken any more seriously, for I am
certain that he very well knows that the Public
Health Service has at no time stated or claimed
that all cases of pellagra, without regard to the
stage of the disease, are curable.
As Dr. Yarbrough has correctly quoted, I want
to repeat that, when any one advocates a remedy
for the treatment or cure of pellagra, before ad-
mitting his claim he must show that it is not

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