The Thompson-McFadden Commission was unable to note any evidence that would distinctly point to corn, good or bad, as giving rise to pellagra outbreaks. They did note, however, a very limited use of fresh meats. PATHOLOGY AND MORBID ANATOMY There is nothing very constant or characteristic in the pathological changes of pellagra. In the second stage the urine shows an indicanuria and the faeces an abundance of skatol. The examination of the gastric contents gives findings of anacidity and deficiency in pepsin. The HCl deficiency probably causes disturbance of pancreatic efficiency leading to mal-assimilation of fats and proteins. The blood shows a moderate lymphocytosis but not an increase in the percentage of the large mononuclears as has been claimed by the adherents of the protozoon theory. At autopsy we find rather marked emaciation. The wasting of all organs seems to be greater than in any other wasting disease. The skin lesions show degenerative changes in the corium with slight cellular infiltration. In the epidermis there is superficial atrophy but still some thickening in the stratum granulosum. Warthin states that the lesions are those of a chronic intoxication. The spleen shows atrophy and in the follicles there is necrosis of germ cells as well as hyaline changes. The liver and kidneys often show fatty change. In general the changes are those of a senile character. There is atrophy of the mucosa of the small intestines and there may be small ulcers present. The mesenteric glands are enlarged. Roaf has noted the presence of involvement of the adrenals and the Committee investigating pellagra in Turkish prisoners found a marked supra-renal inadequacy. Macroscopically no changes are seen in the central nervous system but histologically we often note chromatolysis with bulging of borders, eccentric nucleus and disappearance of tigroid substance in various nerve cells, especially those of the anterior horn, posterior ganglia, Clark’s column and Betz cells of cortex. There is an absence of chronic meningo-encephalitis and meningo-myelitis which should be present in the general type of protozoal infective lesions. Degenerations in the posterior columns and crossed pyramidal tracts have been reported from certain autopsies. The cell count of the cerebro-spinal fluid is normal and there is usually an absence of globulin increase with a negative Wassermann. The blood chemistry findings in pellagra appear solely to be low nonprotein nitrogen and urea values. SYMPTOMATOLOGY There is probably no other disease which shows such a multiplicity of symptoms and such variations in these symptoms.