3. That the toxins have origin in the action of various organisms, especially B. coli, on the ingested corn, while in the intestines.
4. Recently views have been brought forward that pellagra is an anaphylactic phenomenon connected with sensitization to the maize proteins.
5. Rabitschek has brought forward a photodynamic theory which is that pellagra is due to a preponderating maize or possibly other cereal dietary which results in certain photodynamic substances being introduced into the circulation. These substances become toxic under the influence of sunlight. Hirschfelder has failed to find any fluorescent body in the serum of five patients suffering with severe pellagra.
Among arguments in favor of the maize etiology of pellagra may be mentioned the following:
(a) Among the natives of Upper Egypt, where millet instead of maize is the staple cereal, pellagra is rare, while in Lower Egypt where much maize is eaten the disease is far more prevalent.
(b) While the natives of Corfu, prior to 1857, grew their own maize and ate only sound grains there was no pellagra but later, when the corn crop was less profitable, and the grain was imported from Roumania, much spoiled maize was brought in and pellagra made its appearance.
(c) Alsberg has shown that in recent years new methods of harvesting corn have become common in the Southern States of the United States. Instead of topping the corn it is cut and shocked with the result that conditions are more favorable for the spoiling of the corn. He also notes that varieties of corn are now planted which have a greater oil content, which means a larger embryo, and that it is this embryo which most easily spoils. Again he notes that much corn is now raised in Northern States where the season is shorter, so that there is a greater probability of immature corn being marketed. All of these facts might explain the recent appearance of pellagra in the U. S. and its previous nonexistence. Thomas has shown that where 30 grams of a superior protein, such as that of meat, would suffice, it would require 102 grams of corn protein, an inferior protein. This inferiority is due to a lack of assimilability of the amino-acids of corn protein. Protein deficiency is the outstanding feature of a pellagra-producing diet and in the corn protein we have one of inferior value.
The Antizeistic Views.—As a rule the advocates of nonimportance of maize in the production of pellagra hold that we are dealing with an infectious disease and that it can only come into existence by transmission from some other case.
1. The Thompson-McFadden Commission, while holding a very conservative attitude, feel that certain faecal bacteria may be the etiological factors.
2. Alessandrini believes that the causative factor may be present in certain waters.