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`TREASURY DEPARTMENT
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`PUBLIC HEALTH '
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`REPORTS
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`ISSUED WEEKLY
`BY THE
`
`UNITED STATES PUBLIC HEALTH SERVICE
`
`CONTAINING INFORMATION OF THE CURRENT
`PREVALENCE OF DISEASE, THE OCCURRENCE
`OF EPIDEMICS, AND RELATED SUBJECTS
`
`VOLUME 39—PART 1 -
`NUMBERS 1—26
`
`JANUARY—JUNE, 1924
`
`
`
`WASHINGTON
`GOVERNMENT PRINTING OFFICE
`1924
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`Elysium Health Exhibit 1014
`Page 1 of 13
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`LIBRARY OF CONGRESS
`niQEWELfi
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`DOCUMfiNTb Diving"
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`Elysium Health Exhibit 1014
`Page 2 of 13
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`EALTH REPORTS
` Mimic ii
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`N0. 3
`JAN—UARY is, 1924'"
`WET—39
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`
`A STUDY OF THE TREATMENT AND PREVENTION OF
`PELLAGRA.
`
`Showing the Value of Fresh Meat and of Milk, the Therapeutic Failure
`' ents
`x,
`a
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`prujm
`he Preventive Failure of Butter and of Cod-Liver 011.
`of Gelatin, and t
`F.
`'I‘imxian, Surgeon, United Stutcs Public Health
`Sm'vivc.
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`-
`In Jusnru GULUBERHEII, Surgeon, and \V.
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`[L win he recalled that a preventive feeding nxpm‘imenl. lit-gun in
`1511.1 hy (_}nl¢llnyrgr-i~, “Turing! 11ml Willi-win, and curried out. umnng
`instiluliniml hummus, resulted in dwmnstmling the.
`filJJJlIllPl-l-l pre-
`‘.-(‘.]ll[Ll).l1il-_\' u'l pellugru lay manna [if diet (I). The test. was of such
`a.
`t'.lll‘l.l'fl.l‘.Ll:I'.
`l.um-'uvur_.
`l-hul-
`it did nut.
`in itself reveal what.
`luud ur
`funds worn. ln ln‘. credited with the. fuvm'uhln result. At; must- it sug~
`goslm'l
`that. the fresh incul- and milk ill the till-3L were concerned in
`bringing ulmut
`the. pmlmzl...ive ufiut't-. This indiraliun war. strength-
`cued llY Llu! results uf a. study 01' the relutiun of diet, to pullugru inci-
`lll'lICL‘ inn:ng Imusvlmlds n'l curl-11in South ("urnlilni cuttun mill vil-
`lager; (:3).
`In [his study it mu; fuund not. only that pellugm murnrrml
`less froqumtllr m- nul ut all in lmusvholds having a (hilly .ininimum
`:n'rrngu supply of uppi'uximulvly a pint of milk or {if 30 grams ul'
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`nun-a maul. nor udull- unit, hm; also that 1111 increasing supply of mull
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`u'l these funds indi-[n‘lnlunt-ljgr of
`the other was dolinitraly :‘issmiriatt-‘d
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`with :L
`(l(:(,-.I"u:1.'<iiij_r
`pull:v.j_j;ru
`lllt‘llll-‘llt'P.
`'l‘hose indicutinns of
`the
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`I])I_'13;‘.(_Ell(‘.(‘f in lmlh moat. und mill; ml the essential pollzigru preventive
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`‘l':,u_.u;)r or l'mtmrs guin udditinnul support from a further study of
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`these funds, the rumlts ul' \rhirh study, with certain incidental obser-
`\'lell!]lti, \w (l(‘?~'il‘t‘ tn repurt ut- illis tinic.
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`FRESH MEAT.
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`("nu- study ml
`the value of fresh 1n mt apart from milk or other
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`animal pi'Hlt'l]! l'tmd hu< hovn limited to its use as u thornpautin unfunt
`in tho trmrt melt ml" iu-ti've tunes; of the. diam“) at tho Georgia Smite
`fir‘riiihuriuiii. V‘i'u have, up to the presunt time, not attempted to test
`11$ \-’:l-ll.lt"- [mlplri'lzunirully.
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`Julqlit \wllmnirlu-d, thnugh not vary severe (mainly dermal), (‘zlSOS
`lJI‘LVt-r SH lair lmvn treated with fresh hoof as the onlv known thorn-
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`Elysium Health Exhibit 1014
`Page 3 of 13
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`i-IiiL‘E-BC Cases:
`(Liter: I: A lt'i-yi-‘er
`turium July
`There was 111.1
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`lam m 51'
`U1?“31‘14'3‘1 f0? 1111:.wide. of not less then about
`h If
`eivingwhen the utteehdeveluped
`Jummry 111. 11121;.
`88
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`MP of hwina
`}
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`and heked in its own juiee. wes efl'ered daily 115 e supplement in the
`two end-UPI“ 11 mflll’t IS- 1111 the mineral-1111d-vitemine-enriehed diet.
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`shown in Irl‘ehle IL
`1921. About Mereh 15, 1922, iimild pell11iii'hdiaagriiiiiiiifiitn 111111 Jlil'ly,
`white wumen 40 mini 01
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`tienl- had been reeill 111111111111. el meet} er. in the ruse
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`.d w
`diet which the 1111
`Case- 3: A
`t 11.1111rnxirneting
`the heguimng of e recurrence. made its efipeerenee.
`I'l‘hiia wiihxiii'g
`(whirh diet iiii'eeniy included it 51111
`of newly admitted pet-11:11.15, us 1111 edditien tn 11 die
`
`Gompenied by e slightst01n11t—1tle 111111 Was even {allowed by some linse-
`'
`' ed the}? had had hel'ure udinissiun 11nd 11f
`11,. type
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`'_-h intramural 011505 1111111 hren ehserved to
`that. which it is heher
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`fiess ef the barrels.
`011 1111111 7 treatment with e gehttin diet, (Tabb v) Was begun
`in assurie.
`11 sunnnery ef the signifleent rlinirul features of
`but this was take“ 5‘" lmm'ii’ that on April 13 11 chem-re, W119. 111111. e to
`dex'ehnp.
`the beef diet shown in Tehle VI. One week later t m “Nowmm of
`The inlluwing is
`he standard 200 grams by dieeontimfinfl‘ the
`'11s admitted Lu the seni-
`(1:111:11 ellowml by file-institution, leaving 1.110 diet as Shown in Tab-i6
`meet was reduced to 1.
`tliegimst-d August
`Peiiegre “'11s
`21, 102.2.
`21-11,
`11.1213.
`I. The appetite hi this petient continued poor to tho and of the
`histm'y vi :1 prex-inus uttulrk. Hhe 131111111 under our 11h-
`month, hut she relished the meet, of which .he am pI-Mtim‘uy an
`serVeliuu August .11], 11.12:}. at whwh time she presented ehe.1-:u-terist1e
`011 May 12
`flintofpredi Dut'ipgany 111111' eppetite improved
`heel; of the hands, :iit es of the neck. 11nd ever
`.1.
`.1
`11x111‘e11n1t1esu
`eme -'
`‘
`'
`-.
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`dieeuetmneduleevhig the diet
`shiniiiiiii’ml; WEI“;
`the i.1.1.11er melieelus ut' the left feet. The hewels tunded te siight ever—
`tantalum! to Improve so that by the beginning of June she ilvppflmia
`derlnei 11351111111; en the
`111glpreetieelly 111 the fund offered.
`.
`W's em”
`e I was 111-gun 011 Au gust
`urtit’ity. She Wes eenhised end delirimls.
`Treetn1enL with the beef diet shown in Tehl
`Within ten weeks i111-
`31)“ eheut the Initldle of May 11,11 evidence of the dermatit.
`1
`[mmwwmmmwrmwmm$$-
`1E1.
`tt-i‘i‘i. This she ate well from the first.
`eeiter eentinued progres-
`eptihle, and ther
`s ei the dermat-
`1
`.lti]111L(‘l_Y 1Iep1111ed. fi-Im weight, wluch hm. been
`sirely. 15yUntnhur3ti.0xceptit1rsnnie resulnel mark
`gustl-ogmmthm
`nit-rd n11 reengnmihle evulenee 11"1 pellegre. Between
`priwvmrnt hegnn tn he pere
`35101:.
`111111 Verr 1
`i,
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`l of
`tl'e11t111e11t—-
`l-M' the beef treatment W113 111-
`tending 11m1'11werd. hegen te go 1111 11
`1t increased from 35.2 tu 42.3
`Aug11st‘21 11.1111 Deeemher 31-—vthe end ei the permit
`stunted; hetWeen April 1]. 11nd July -1
`her weight inereesed from 34.5 to it kilns.
`_
`37 years nid. who Wes inimilted tn the
`kilns.
`t
`£11111]. 13. eensieting of 1111 inc-reuse in
`Thus the change in die
`seniterinm M11}?
`(5, 1922, with entire pellegre,
`111111111 under our ub-
`.
`1.111311111111111.
`'-
`I H
`I r '
`I
`I
`I
`Case :51: A white 11111111111,
`1
`I
`.11,- Imprevei'nent in her
`-
`1
`fiéfilhfiri 2‘11} pf
`11:. 511111 lesions, DI the stumefitis, endliif the
`the fresh meet, wile i'eil
`sel‘\‘1‘.-li011 {111 the seine dete.
`She presented :1 rather severe derma-
`[ the terminus,
`111111 1'.-1111si1.ler11hle
`11'
`e. gum in enetite
`l
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`1.111
`,
`..
`Worthv ef unte Llii‘it ti " 'i
`11 "I N am “might.
`“I H
`11:. 1111111'111-'11111ent. rentinu l " ‘ "
`'
`h
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`-.
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`The huWu-ls Were
`titis (11' the hands end lower pert (-1
`du
`‘ v '
`e: 111s.1te.ef
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`'4
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`j
`Horns: 1pl 1111111111111» 111111 11111111111103 resultmg [rum the ei‘uintre elihhlle
`keretusis of the inrrheed. 11nd hruige 111
`the 11115111.
`ked. 1111111su1.
`She was week end 111
`1(-lusél/ 111 aelt'ihewn 1n Tnble Ill in that shnwn in Tehh
`I
`fly
`slightly louse. There wes 11111.1'
`-
`;
`i:
`11‘ 1.1 e 1.1."
`I
`II
`I!
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`--
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`i L11111'111e-e11r'11-l111d ward diet
`and rcvurrwtw .
`“emanlgi 511.11.»; old who had ielhwre.
`in 1913
`hed.
`en the minerel‘enduv
`lgoe'hémm uL-SIICILI 111-i, 1J4), 1913!,
`111111 11123
`The reci'urrm 1 in
`heei diet is] 11.11111
`.erted with the
`A'i'ter three dew;
`-'-‘
`s
`1.‘
`-11r1:1 29with fl
`1
`’
`"
`I
`16‘
`I
`leme 11 ts
`5111111111
`in Table ll, treatment- was st
`11 11nd Vii-111111116 supp
`the hands “In 1 u) I ‘
`I
`. 11. appeeiiuleu 11f
`11.1.1 ervtlieme
`isumrwrtermrhrrrdmrrme ‘
`'“m
`hne‘n in "l‘ehie IV. Her 11p-
`'111
`'l‘ehle lll.
`()11 Me};
`1‘3.-
`the 111i11er1
`1111d she 11.1.11 mere end more
`were disenntinued, enticing her diet es s
`t111d1et shown in Table V"
`lLlihliiK‘Dle‘i’ I]; mlc'flbu 6’ mm ma gala-
`_-
`.
`111111‘”.u
`v'
`-'
`'
`litien showed :1. wel «
`' etite, 11.1. lirst only l'uir. seen improved,
`)
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`'I: 33 "r
`I
`:
`I"
`u
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`Wee good. she 11111
`this diet well
`L
`’ H13 1):“an b “imam;
`hi
`the. loud uttered lie-‘1'. By May .1? her 1111111
`i as 11111111 1.1:; when
`-
`‘ 1reugl1
`the nomml 0W1“ “I
`'1'
`‘
`lhe skin lemons pessed 1-
`1111?..1’lied eluuige [111' the better. 11111.: sin: (:(‘Illlil'lillfi
`the intuit-h, how-
`she reine under our c.d1srrw,tiei1. By the end ui
`ldmut April
`in. The
`s1}: thet they lied quite eieered 111 by
`..
`.
`we 1a..
`.anruV‘er. e1
`’7
`'
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`i
`I
`l]
`‘-
`ever, she Wes respunt‘l.i11§_r to simple questions end Wes up and 11i11.11.1t.
`ln unethur two Weeks her skin lesiuns heti entirely eleered uh, 11nd
`1h ‘3-llgllt H-lUuL'ttl-tih “21E: Uhh.{‘1 i‘. ll taU llilA' 0 '1le 1”iii.
`hy the end 111' June her mental um‘ulition slum‘ml runrhed "unpre‘re-
`ahl ill flu~
`II; Ll“ {I dili- fillet 111,," Uf "911.11" ‘1‘ 35‘! 1111 ll 31"“: [1
`lh‘.‘ {lth “I ItI‘Il e
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`During this period of eight weeks she geined eppreximetely
`‘
`“11 It
`I] '
`I
`ll
`‘I
`II
`“I
`iUt? Hlll'i
`“HI ‘1‘ Hedi. q”
`0(1
`d..( 0],
`[1.11.
`illil
`‘
`110
`ii.
`I
`-'
`_ i
`'
`i
`i.
`L
`'h‘tl -
`I
`‘
`-
`n
`‘5.
`l
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`13 kilos in weight. She left the institution 1.111 hu-ieugh hie
`1.11 31111 gt'nllls t1ii11-‘(-_, eitheuei the diets
`I:
`.1e11.mlrss. eheut 1t] dew. 1,1,.
`f
`I
`."
`‘ """mlllt'tl to cut
`'
`lhl p 111111. hie.
`(151.
`. hurl
`I
`f
`l
`i
`.1 1W1-
`we” m” “I!
`111111111 es siirmn 11'1'111l1ie \11]
`eh:
`_
`-
`" 's
`e'-'\.
`'
`'1.” 1
`11 1'1" .1 ver' eleer evidence of
`11‘11‘1111.
`"‘- Ule dieti -.-
`,
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`..
`_
`-
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`1.922.
`th t
`letwelr luv: his ene'ipared
`r95].- ‘101‘mni-Itis nppe-irbd
`'
`1' U—i' "‘i 19. “hunt Miw 21|Ea
`-
`'
`-
`.
`commuinu 1mm 1L
`I1111 the 1111111151 and. kernel-um 1101’. hm, ‘1‘
`.‘nn
`‘
`.
`..,
`L115 “ought. 1.11;“.
`‘11. might he am,
`It
`'
`“ h
`i1L.-ngeons t.”
`h
`-
`.
`'1‘} a
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`.lie-Va:1 1s done (111 Maj. 3.1: the.._.-_. -
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`1111 d 11111. rhed imprurei'ue uintherwise Were re
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`{ .
`8.)
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`Jenner: 13, 19:14.-
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`111.11111ed 11111311, and aJULIt.
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`—uld eelnt'ed girl whn \1
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`tit-is, she.
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`'[Jl'L‘St
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`Lnent.
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`ptemher 5,
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`Elysium Health Exhibit 1014
`Page 4 of 13
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`January 18, 1.921.
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`On June 0 a pellagrmie dermal patch appeared on the neck; on
`June 2!} an eryt-henla was found to have devehu‘ied about the knees;
`and on July 5 the skin on the heek ol' the feet was found. to be fillet-led.
`Sinee the I‘ClI‘LIJS.lI.‘l§_f dermal leaionu seemed to indirate a. failure. of
`gelatin to l’ai-‘oi'ubly inlluenee the progress of the disease, a. eliollgo
`wae made on July 7 to the heet' diet shown in Table
`Within :1
`month after this rhunge the patient-’3 emnlition had tluli.liil‘.el_‘,'
`lin-
`proved.
`ll}— t-he end of the first week of August; eh:- no longer pre-
`sented rwitleilee ol’ th 2 altar-l; err-opt, poseibly, that. her bowel. eel-ions
`Were gotta. She continued to improve in general appenrnnee and
`strength during a, further period of observation ending January ‘2.
`11123, although her bowels rontinued to not.
`irregularly. A fecal
`exumination on (}¢::tol'ie1' lit revealed Astra-rte urn. will worni era. and
`.S'treuyytoide.~i embryos Wlitt'll, in part, at. least, probah v explained the
`loose and irregular lmwolfi. Up to ulmut-the middle iii (Jetolaer this
`pntientfri weight was mainlaima'l at a level of l'ietweeu all and ~12 kilos.
`Afterthie it. went- up, so that by Januar ' 2:}, 11123 (the end of the prudent
`of treatment), she had gained 4.5 kilos.
`In summary it. appears; that during the six months (July? '37, 192-2,
`to January 2, 1923} following: the. inmiguration of the treat-ment- with
`200 grains o'l beef (Faith: 1):),
`this patient’e condition underwent
`definite improvement in marked eonli-ast with the nneatiefaetory
`pl‘ogl‘esu on the. gelatin (and mineral-and-ritamii'ie~enrirhedl diet.
`t’l‘ahlee V, VII, and VIII) during the inmiediately preceding period
`of three months.
`Gore .5: A white. Woman 46 yearn old who had pella-gra in 1013 and
`recurrence in 19“, 1913, 1921, and 11112.
`The recurrence in 1922 began to develop ahout Miu'eh 2-9 with the
`op iearanee of an ei'ythenia on the hands and torennns.
`‘reattineut with a. gelatin diet (Table. V) was hegun April T, but
`this was taken so poorly that on. April 13 a. ehange was amide to the
`beef sup demented ward diet (Table VI).
`A Weelk later the beef was reduced to 201.) grains by omitting the
`institution portion (Table III], and on May 1:3 the. mineral mixture
`and supplement of rertain 'i’itainineariel'i foods were discontinued, so
`that l-lle'l‘t‘tl-lt-fll' the diet was as slum-'11 in Tnble IV.
`She took the meat quite well, but her up wilt-e for the remaining
`portion of her diet eontiu'ued poor throuth J
`)t'll and "it-lay. During
`June her food intake lJE‘l'il'Illt‘. min-h inipruvet'
`.
`tip to April til her
`weight bad tended downward; after this, this; trend \roe arreeted and,
`
`it ain‘t-thing,
`turm-d in an upward dirertiou. Between April 1:} end
`duly -'l her Weight showed but. slight- rliz'tnge
`:1 rise from 45.5 to lit»!
`kilos.
`'i he heel. the (lt'l‘l'ilg'tl'ltlE; heal eleared
`
`l-‘Vlthin a. month after beginnin
`
`
`up, and (illl‘l‘.
`1‘.
`'eniahnlei
`'
`(3 period ol' treatn'zelil', ending July
`t!
`(3, 11-122,
`tin:
`llz‘ttll‘ilt 1‘t‘lllall11iul
`free time l't‘l".ltglllzzlldt‘ eridenee of
`
`lu‘llnnrz‘t.
`.3. while '\‘-..‘oma.n :'>:..’ _\'('.n'r:'<. old who had peliagra in 1911 end
`(Test- (3‘:
`reenrrenee in 1018. 11.1131. and 1922.
`The I'eeurrenm- of H322 began bet-weenMareh 13'.) and April 5 with the
`
`91
`
`January 18, 19241.
`
`somewhat increased, the resulting diet. being that shown in 'l‘ahle. VII,
`She continued to eat well, actually eoneuming a daily average. of,
`approximately 8Q grams of_ gelatin during the period May 13—31,
`and 79 vrams durinv the period June 1—2ti.
`_
`The iermntitio wrieh hogan hetween March 2!} and April 5 and
`which, at its height, involved the. hands, forearms, and feet, passed
`through the ordinal"),r cycle of pigmentation, keratoeie, nnd destiiiiinia—
`tion, reaching by June 14 the stage Irwhere there remained but a residual
`keretotie fringe on the foot.
`two weeks later, however,
`there
`up toured a fresh erythemn on he heck of each forearm, and by July
`5 i. re knuckles and haek of the hands were fl-lSO‘ll'n‘OlVLKl. There was!
`resent no other reeognizahle disturlninee.
`'lhroughout the ieriod
`annary 3 to July 5 the weight oeeillated between 5.3.5 ant no.5
`'JS.
`.
`*
`Lll’l‘he gelatin diet having, as in case 4,
`roved niadequntete rerent
`a. relapse of the dermal-inn, a. eh’a nge to t in beef treatment tingle IX)
`WILS made on July 1’. She continued to out well, and by the middle of
`September was :I'ree of active. pellagra, and 50 remained to Deeeniher
`2n, the end of the period of treatment. Between nuguet 1 and De-
`cember ‘26 her weig it. rose from 53.5 kilos to {51.5 kilos.
`_
`(has 1:": A white woman 39 years old who had pelliigra in 1917 and
`reem'renee in 1.918. 1921, and 1932.
`I
`" began about A ril 5 With the ni'ipearanee of
`The recurrent-e in 1212..
`an errtliema on the right
`form'irin.
`y Hey it)
`the pellagrous
`derinrititie had affected the. hands, loreamte, and forehead, and a mild
`etouiatilies was preeen‘t.
`_
`u
`v
`On Me}! 13 treatment woe begun With gelatin (Tal'ile '\ II). Her
`a. petite living exrellent. ehe consumed practically all. of the. food
`0 ‘ered. it being estimated that. during;r the period May 13 to June .ll]
`her eoiienmption of gelatin a proximate-ti an nrernge of 83 Irrnt
`(lull
`Notwithstanding thie,
`lU“’[-!Vt‘l', a fresh er_\_'t_hein'n dove oped
`durin June. eligl'it mental contusion heenme perceptible, and toward
`the e one of this month the bowels. developed a. elightly inrreaeed
`aotivitv. Autiril‘iljltgzlv, on. July 7 the treatment was (hanged to heel
`(Table le. Following this eliange,
`imiu‘or'elm'nl'a Stir
`511: 11ml
`*1”
`i'eeugnizahle cvidul'lllo of the altael; Lllrinppoarml by ubullt‘the oloee'of
`August. Up to about the middle of September her weight tended
`elightly downward, but after this time,
`to the end of the year, she
`nmint-aineil her weight. with but negligible oeeillntione.
`There woe in this (resin therefore, a. clearing up of the evidence of a
`reourn-nt- attark ol' pellagra following upon the inauguration of the
`beef lreu-lmenl, nltllmigh during the immediater pit-ending period of
`nlmut eight wet-lie. on a liberal gelatin diet, the Stine-l; had Shown a
`tt‘nt'leney to imrrea-a-d severity.
`It is. worth),r of note, also, that the
`improvement flSfir-ltlt'lzttfi'tl with the her-‘1' diet tools“ pint-1:, as in urine. 4,
`in Shite of the redneLion in the minerals and lrnmm i-itmuiiu-oi winn—
`dent with the ehange from the gelatin (Table VII) to the heel diet
`(initial. '{Z‘Kj‘
`Uri-w 5': A. white. wmnan ill years» old \i’lli) had ra‘llaagru in 191’:I and
`'i'oattirrenc-e in .t‘JlS. Jill-3t}. and .1922.
`A
`‘7
`I
`‘
`V
`I
`n
`w __ the 1
`'- rerurrentul. began some time hetWL'..en nhont. May 3 and
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`Elysium Health Exhibit 1014
`Page 5 of 13
`
`

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`Janitor-118, 1021.
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`the. month, but. the howela, which had been somewhat irregular even
`before the. appearance of the dermatitis, continued loo:~'.e.. Fecal
`examination made in May slum-rd Triehiiria ova, and, in June, some
`Aer-aria.
`She. maintained her Weight with, perhaps, a slight gain
`during tliia peril-d.
`ller condition having seemingly improved on
`illegela'lin diet, it was thought- that the indication in favor of gelatin
`would he. strengthenml if the, small allowance of l'wcf in the. haaic diet
`were eXeludt-d. This was accordingly done on July 7. at the same.
`time compensating for the eahn'ies by an ilhrl'l'nSe. in the allowance
`of butter {Table X).
`' Durng tlie'pericd July 7 to July 31 her food Consumption continued
`well nigh ctmiplete, an that it
`is (intimated that aha ingested an
`average of approximately 83 gl'étlflfi of gelatin daily. Notwith—
`standing this, however, a relapse of the dermatitia on her feet dove —
`oped between July 15 and July 19, which, after alibaiiling somewhat,
`flared up anew on August 2 and awain on August 0.
`'During this
`latter perital there was :iliiu some falling off in appetite.
`'lflua failure. to maintain the seemingly favorable. progress noted
`early in July led to a.
`ti! iange, on August 13, to the heel diet shown
`in Table IX. The change was follrm—‘ed by a return of appetite, a
`slight change. for the better in bowel activity, gain in weight. and
`clearing up of skin lesinna. Between August 2'3 and December 5
`her weight increased from 38.5 to 4-1.5 kiloa. On January 7, 1923,
`the close of the period of treatment, this patient— prewnteil no recog—
`nizable evidence of her recurrence, nnlesa a persistent t-hough reduced
`irrevularity of the bowels iii to he so regarded.
`’elatin
`ins, as in cases 4, G, and 7,
`a.
`liberal daily intake of
`failed to prevent a. relapse of the d erinal manileatatinne of the i. iseane,
`but definite. clinical
`iinn‘ovenient was noted lt_illt)1‘.7lllf§ the change
`to the treatment with met.
`It is;
`‘iin'ii'tliy' of note,
`too. that this
`improvement took place in Spite or"
`the. 1't‘(l11('l-ltl]1 in minerals and
`known vitainines associated with the change from the gelatin
`(Table X.) to the hut-f diet (Table 1X).
`It is seen, ill-"‘1
`that in all eight cases; well-marked and progressive
`
`
`clinical
`improvement folloveil
`the inauguration of
`the,
`treatment
`with l'reeh heel.
`’i‘liia is particularly significant
`in the four eases
`(Nos.
`4:1, 0, T, and 8)
`in each of which the treatment with beef had
`been preceded by a; considerable periml of treatment with gelatin
`which,
`though coupled with a mineral and 1ritaniino enriched basic
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`diet, had failed to ::_i'i'e:-:.t
`the. pro:
`in oi"
`the. attack. This (entrust
`
`
`tenth-i
`to (3111pl11155l22t‘. on the. one nand,
`the inadaqna r of
`""L‘litldH,
`and, on the. other, Lie therapeutic potency of fresh heel.
`Taken liy itself. no restricted a lllfi"l':!]_)(‘lllll‘- t
`tan hardly be. more,
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`live; but \=.-'hen (Ti')‘t1})li‘(l with the :‘1‘Cilll21lil0 evidmrcc oi"
`than saggy,
`
`.
`\‘zllltt‘,
`oi"
`l'resih inc"
`it st._i_'i.=n;gtheii.~=a
`the iiulications
`the.
`)1‘t‘\‘elil
` (Hill-5711114.
`that i‘i'efiu
`t-iie pellagra iiii'ci'eiitit'e factor or factors.
`BULK.
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`January 18, 1024.
`a
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`to pi'ei'cnt pellagra, nevertheless it seemed highly desirable to put
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`this inference to direct
`test. This was done at the Georgia State
`
`'Sanitarium during 1022.
`In the rural areas of the South, milk is most commonly consumed
`as buttermilk. We therefore chaise buttermilk as the form of milk
`to use in this study.
`It was fresh,
`locally produced, and of fair
`quality. Analysis of a sample in the division of chemistry of the
`Hygienic Laboratory showed it to contain 2.88 per cent of protein
`(Nx {3.33). A daily allowance of approximately 1,200 grams (40
`fluid trauma) of this milk was offered each one of a group of 2‘.) colored
`female inmates of the sanitarium.
`It was well taken as a beverage
`at each one of the. meals. The approximate composition of the diet
`so supplemented is shown in Table XI.
`01' the 2%) patient-s constituting the group, 19 were. pollagrins and
`10 nonpellagrins. 0f the pellagrins, 16 remained in the test for
`one; year, to its termination on January 2, 1923. Three dropped out
`and passed from observation after shorter periods (63;, S, and 10
`months, respectively) by reason of the development of int-orcurrent
`illness necessitating transfer to other wards. 0f the. 10 nonpellagrins,
`‘.) remained throughout, 1 passing from observation on July 2‘3, after
`a period of over ("i-.1; months, on account of pulmonary tuberculosis.
`None of the. group of 22) patients; developed any evidence of pellagra
`at any time. duringr the ('il.)Si-.‘-1'Vzlthll period which, for 10' of the pcllag—
`rins and 0 ol the. nonpellaii‘rins, lasted one. year.
`Since our rather extei‘isive experience with this class of patients
`has em'ivinced us that without the buttermilk (or equivalent supple-
`ment) upward of ~10 or :30 per Cent. of the. group would with certainty
`have. derr‘eh'rped pcllagra. within a period of from three.
`to seven or
`
`eight merit-ha,
`the. ei_mi.J')lete al'isenco of any indication of the disease
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`in any of the; group 1;,
`in our judgment, conclusive evidence of the
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`prevei'itivc action of the lultterniilk.
`-
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`.:.-‘
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`:l'e hax e. more, then, and for
`the. hrst time, a direct demonstratron
`
`ot what- liei'elolurc has been an inference from indirect eyidenco~
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`_l,1(l]i]._l_\r, that. milk coiita is tiu. essential pellagia pie\-ent1\*e factor or
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`lactoi‘s.
`Inat'iuisrox.
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`In
`The results; herein repmrted are. of interest in several respects.
`the. [ii-st. place they einpl'iasim anew the. importance of fresh 111 int and
`
`mill:
`in the treati'nent and prerentien of pellaara. This does not
`
`mean, as .llindhedo (it) has taken it to mean (in the. face of repeated
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`\‘l‘ill‘lll
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`to the. (.‘ontrary (53)) that these are the only foods possessing;
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`Elysium Health Exhibit 1014
`Page 6 of 13
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` v 0
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`January 18, 1021.
`9
` stunner than the maximum needed. for treatment would he adequ:‘de,
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`January 18, W21.
`
`Judging- by our observation of a very high. incidence of the d isease
`asso./.-iated with such diet as that which was aupphrnienttal hy the
`heef in 'l‘ahles 1'. ill, IV, VT, and IX, and hy the huttermilk in Tahlo
`XI, it would :-:eei.'u as it this hasie diet.- ineluded hut. insignificant,
`il’
`any,
`]_')1'(‘-'\'t‘llli\'t‘. elements.
`(lur
`results with the heel and mill;
`supplen’ients are also of interest, therefore, in that they all‘ord some
`idea of the ei'l‘eetix’o (llttlllllt-y of these. foods.
`'.l.‘l.i:.-z determimition ol the quantity of heeP to he used in our study
`was largely arhitrar)‘. We \Wi‘e'guided in a 1n.e.~1.-<ure hy the ohs :r‘x-‘a—
`tion that. at the sanitarium the. [tllt'flVilllttt‘ of meat Whieh, so la' as
`We are ahh- to judge, has in the past. been the. pi'ine.i]_)al if not the. sole.
`prewutire element in the general diet, has not. heen adequate to
`prerent all reeurreinws oi the disease.
`Vr'e. 1'(-\a.~:<uiei.t
`that.J since the
`Vast majority of the inmates seemed to he pi'<.>te<'.t.ed, that i:::. showed
`no evidence of the disease, this quantity ol' m at. is. presumably only
`a little short of hemp; lull)? adequate.
`It seenuu‘l 1'i.~a>'scaial.)h.s to assume,
`t.l'ier4.|l'ore,
`that. twice. this.
`:‘tll(.‘l\,\'il1'.‘-.(.'t'r~-rl'hz'!t is to say. an allmvanr'le 01"
`CIA
`an r-(piiralent or" about. 100 'rranis ot' round .T't-(‘illiiV‘L-‘(iiiltl sulliee to
`prevent all hut very exeeptional eases.
`llut. sine-e for the. treatment.
`of active easea, partieularly ]‘(-'(ftl]'1‘(.‘1lt‘t'5 in patients oi" the. dilapidatt-a'l
`my
`physile and mental type “with whieh We. ‘were de-aliirr
`a quantity
`in exre-i's. of that sullieient for prevention would prohahly he. th.‘5l1'ill)lt.=
`if not
`ilt‘ljtti-iszll'y, We. druihhrd the. quantity we judgrd might he ade-
`
`quate lor preventimi, thus arriving at 1300 grams as the quantity to
`he tried in treatment.
`
`treatment: eren larger
`is possihle that for purposes of
`While it.
`quantities may in exeeptional insta tees he. neeeasar)‘. it; seems highly
`prohahle, it not certain, that for prerent-ive purposes a smaller quan—
`tity will he. ample.
`Indeed, the ex_p<-_~riein.te at the saanitarium. already
`reterrml to, suggests that
`the small tpiantity allowed as part- ot' the
`general diet of that institution is ‘.\'(_Ell~lll_‘_{ll sultieient, and. as has been
`:nwnt-ieu‘aal, We. think it. prohahle that. nor. more than ahout twiee this
`allo‘.\'z'l‘:11_‘<.~.~—thut. is, about. ltltl to 13.3 grainswru'ould he found entirely
`adequate. in all hut- '\.'ery ext'eptiomil instances...
`lai deehlilif." uhozi
`the all:.~=.ra11ee ei' hutterinilk to use in our test
`o1” iidea hy our t.~.:\;perieuee 'e'ith it in the treat-
`1
`-:
`\
`:5
`'
`'t" (‘."v.:§t'>i.
`
`.e had found. that. .1"
`to it) lluid ounees as a.
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`
`suppleinem: to the
`f!-l‘\'\'.‘1.:\';"% seem adetpiate to :".1'1‘L‘:.§l?
`hasie diet did. not.
`«‘3
`in chants whieh cleared it) followin'r an increase to
`the pm {:31
`
`ounrxm.
`'zertzun that even this lat-3;; quantity \rill inva~
`
`
`. an attra‘k, for in a. reeent inst-ain'e, unique. in
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`this priwe-d to he
`we decided to try 4-0 emu-ea. As. has; been seen,
`adequate in the. group studied hy us. and it 13 not unprehahlo that
`a somewl'iat smaller quantity might have. served equally wall.
`(Jon-
`sidering the restricted hasie diet and the type. of individuid1 with
`V
`’
`r."
`whieh we were thrsziliiw.
`it. seems prohahle that. no more, than H.113
`(“Bonitv will .suil‘iee in all hut very e.‘<er-:pt1onal instauees.
`
`Flor-r does freL-rh whole mill:
`in this; eonneetion the. due. .-
`.
`ai‘ir.
`“'ipare with huttermid; in potency!
`‘ We have made no direct eom—
`ptu'isuai. But it is of interest to imte that our experience with hatter
`as the. therapeut.ii.: and pi't‘.\'l‘lll-l\"t‘. element 111 the dial. hazs. her-n very
`dis-2apraanting.
`1‘ lthoug‘h we have tried it. repeatedly and in inereaa-
`ins:
`i.liaiiit.-iLie:<,
`the. enusuunptinn in several recent instances having
`eciualed a. daily average of apprnxhnately 13-35 to l-h") grams of fresh,
`lei-ally lH'iHlLUI‘L‘Jl hatter (ii-stiinntaal as representing ml)
`to lit) grams
`o!"
`tart-halal?)
`from cows largely pasture led,
`for periods of from
`thrmi‘.
`to umvards ot' tire months (the patients Weighing hetween 5.1
`and 57.51 lil_l(.lt.§)l,
`it. has 1)1".1(.‘.l.‘il':1ll:~," inrariahly failed to prevent reeur~
`renee oi'
`the. disease. And in paéwine; it may he remarked that the
`\ results of similar trials with mat—liver oil have. been erpially disap—
`‘
`.
`point-ng. Consumed in duz‘rntities of 128 grams (that is, in propor—
`tion ol' o\"('1'
`7-? grams per 1i lo ol' hodfir' Weight) daily for perior'ls as hing
`as: three, four, and il\'(.51111)11tl1.\', no preventive elteet. on the recurrence
`of the diseasar. was :1])])l'ti!('ltll)lt.‘.
`Since it. would thus appear that. the
`
`‘|:w'l.la.e;ra-pre\'enti\'e tantra is not J'nresent
`(in appreniahle amount) in
`lJLILlafitl‘:
`it;
`is- 1')(;'t'l'l‘.l]'):$ perniissihle to infer that Yv‘llt'lif. mill:
`is not ma—
`1 Wall'yrl.
`it} at. all, more. potent than huttermilk.
`So far, then, as the
`
`
`t-l"1;-zl'l'.ll
`jet and pu.'e\'<.‘ut_.ion oi pell en'a.
`tin the. speeiiie senael
`is eon-
`.ld'ti‘fil]. milk and. huttasrmilk mar he assumed to he quantita-
`e.(-:::r.ne<'|.
`tively in ten:haI'igeafhh'z.
`Our e:\';_'verinee with meat; and with mil: has naturall‘j :‘sliggestetl a
`it. .
`eonipariarai ol'
`t.llOiL"\";‘ll110.
`tintea‘ruuz el\_-’ our data are not. of sue-h a.
`el'iz'o'aeter as to permit us to torn-i snort-hing; more. than an impression
`with rerun-rt to illlE; ourstion.
`(Jor i.~.:\;periei.iee with these. i‘oode‘. has not a't'i‘orded us entimrl‘.’ eom-
`.l.’“"”l3’-l'3" "_|Mantitat-ive data. of their value in trtartment. and, as ahread‘f
`. -:
`1
`mated. no | 1.1m}. not, made. a direet. study of the 1.)]‘e\'euti\'e value. of
` 3'11 :3;
`my itself. Nevertheless, this experieinse and the rough e:;t.inie:rtes
`which h::a‘~.'e alreain heen discussed may he taken as [Ll-'llit'H'tllllg at least
`
`Il‘stiou oi the. eranparati‘ve value. of meat and huttei'inilk. Thus
`we. have. naind 300 grams oi" lean round steal; (3-12 grains; prom-in) to
`1,.‘..\.,.p'.'.‘:.,
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`Elysium Health Exhibit 1014
`Page 7 of 13
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`

`

`January 18,10213
`
`
`
`January 18, 1934.
`
`97
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`of an attack. We have had similar though, we have thought, not
`quite so prompt effects from 48 ounces of buttermilk (~13 grams
`protein). And we have estimated the approximately 1‘25 grams of
`lean round
`ink (‘27 grams protein) would probably be as efficient in
`prevention as the 4f) ounch of buttermilk (36 g‘ams protein) were
`found to be. These considerations lead to the. suggestion that gram
`for gram, on the basis of protein content, fresh beef is somewhat more
`efficient than buttermilk.
`
`Notwithstanding the possibly greater potency of fresh beef, milk,
`for purposes of treatment at least, must be regarded as the more
`*aluable, since, among other reasons, it has the practical ad ’antage
`that it needs no mastication, and can therefore be readily taken by
`patients in whom the condition of the mouth may render 111asti(,'a.t-i<_)n
`painful or impossible and can be easily given by tube in cases refusing
`nourishment.
`
`of interest, finally, as it bears on the. problem of the
`Our study
`identity of the essential preventive dietary factor or factors. Here
`it may be wort-11 recallng that six of the cases tr-‘ated with fresh beef
`had developed their attacks under our observation in spite of havng
`sul‘.>sisted for periods of not less than about two and one—half months
`on the mineral—and—vitamine—cnriehcd sanitarium diet
`shown in
`
`Table II. These cases harmed the principal subject of a previous
`report (3). As was there. stated, it would seem as if this diet must
`have yielded an abundance of the known vitamines and minerals,
`thus exclut‘ling deficit-hey of these and leaving the protein (amino
`acid) mixture of the diet, some as yet unrecognized dietary complex
`(possibly
`vitamine), or some Combination of these, for consideration
`
`in relation to the development of the dis
`.
`This interln'etatiim is s11].)portei.l and strengthened so far as con—
`cerns the antiophthahnie and the anti'racl'iitic complexes by the
`failure of butter and of coil-liver oil as preventives, and as concerns
`the antim-iuritie and the antiscorbutic complexes by the therapeutic
`e’lli(':.ieney, particularly under the conditions of our study, of a food
`(muscle tissue of heel) known to be relatively quite poor in these
`factors (1.)).
`"fit-h respect to protein it may be observed that the fail-
`
`
`"s in which beef was subse-
`uro of .jz;clati1‘1 in the. treatment of the c;
`quenth tried with markmlly lmnel'icial effect, would. seem to indicate
`that. the nitter result. can not be attril'aited to protein per so. This
`
`is in harmony with the. indi
`ion ali'orded by the. study of the diet
`of rellasrrous and nonpcllaggrous households (3:) of Sinith Carolina
`
`what. modified form adopted by Jobling; and Arnold (7), that the pro-
`duction of 'i'n-‘llagra is dependent on the excessive ccmsnmption of car-
`b<.)hydrate.
`laihile neither Decks nor .h'iblinggg and Arnidd tell us
`just what they mean by an “excess” of carbohydral‘es, we.
`IlGE\':‘!‘l-l'l(!-
`less find it diti'ieult to believe that the. diet shim-n in