The Health bulletin [serial] - University of North Carolina at Chapel Hill

:
28 The Health Bulletin September, 1927
and was so impressed with his views
tliat I agreed to treat the next hundred
cases from his viewpoint. Since
that time many more than that hundred
cases have passed through my
hands, but I have never departed from
the general idea implanted by Dr.
Goldberger that pellagra was due to
a nutritional lack, a deficit in the nitrogenous
or proteid part of the
diet. I learned then to analyze the
diet of every individual, and I cannot
recall an instance since in which a
gross food fault was lacking. As a
rule the fault is so obvious that it requires
only a moment to detect it.
Sometimes the patient is not perfectly
frank, and I have been beguiled by
the bounteousness of the particular
table until I learned that it was necessary
to know not what was set before
the victim, but what was actually
eaten. Very soon the cases began to
fall in the following groups: (1) well
conditioned people who were "cranky"
about their food, eating only one or
two tilings, as a certain lady whose
whole diet was biscuit and coffee, and
whose wealth and gentility proved no
proof against the disease, (a) Well
conditioned aged people living alone,
unstimulated by a good appetite, eating
tbe foods requiring little preparation
as out of a can. (.3) People with
such conditions as high blood pressure
who have dieted themselves into pellagra.
(4) The ignorant who have
not learned the dangers of a onesided
diet of highly milled grain with
the use of alkaline chemical raising
agents and a lack of such food as milk
and eggs. (5) The very poor living on
a one-sided diet through necessity.
(6) People affected with such diseases
as hook-worm, tuberculosis, diabetes
and pregnant women whose diets
under normal conditions might have
carried them by the danger, but who
with a lowered resistance fall easy
victims. It was notable that pellagra,
tuberculosis and diabetes formed a
very congenial company, but made a
combination difficult to control. It is
likely that with insulin this problem
will be simplified.
One of the most important publications
I ever read was that of P. A.
Nightingale In Rhodesia, wbo was
physician to a British jail. The prisoners
were fed a small cereal of the
maize family called ropoko, which was
ground by hand in the jail and the
whole grain eaten. When the crop
failed and he was forced to see his
patients eat "mealie meal," which corresponds
to our highly milled commercial
corn meal there developed at
once a malignant type of pellagra.
With rare discrimination Nightingale
at once suspected the grain, and went
outside and bought more ropoko with
an instant cessation of the disease
which, in his own language, was "immediate
and magical." Profiting by
this lesson I sought out a modern
grist mill and learned at once that the
law permits the commercial miller to
"degerminate" the grains of corn before
grinding. This degermination
consists in the removal of the germ or
heart of the grain which lies at the
end attached to the cob and which is
about as hax-d as a raw peanut, while
the rest of the grain (the endosperm)
is as hard as soft stone if it is a good
quality. This part removed is sold in
this section as "corn chops," and has
a fine reputation as a milk-maker,
which is only natural. I then had
chemical studies made of the various
parts of the grain and the grain under
different types of milling. It had been
shown in the Philippines in the study
of beriberi that the cortex (outermost
layers) of rice contained that curious
substance called vitamine which could
not be chemically analyzed, but occurred
in the portions where phosphoric
acid was most abundant. The
feeding of the rice polish had cured
beriberi, and it occurred to me that
by an analogy we might get help in
the pellagra problem. The following
table published in the Transactions of
the Association of American Physicians
for 1916 will be helpful
Phosphoric Acid
Percentage
Corn Chops 1.15
Water-ground meal (N. C.) 0.78
Whole meal, steam milled (Va.)_ O.GO
Highly milled meal (Ohio) 0.29
Steam-mill meal (N. C.) 0.58
Wheat middlings (offal of mill)- 0.9S
Whole-wheat flour 0.50
Average wheat flour (bought in
Wilmington) 0.14