PELLAGRA 363 



thema, although certain signs of the skin affection were visible 

 around the mouth. On the other hand, a pellagra-like erythema 

 was observed in beriberi by Schiiffner and Kuenen (1347). Night- 

 ingale (1348) saw 1210 pellagra-like cases, in South Rhodesia, which 

 he called "zeism." The disease developed on milled corn, was 

 mild and without exanthema, but with light dermatitis and mouth 

 symtoms. He stated that cod liver oil therapy was quite favorable. 

 Edwards (1349) designated as "peripheral neuritis" a disease met 

 with in Jamaica among the poor inhabitants who live on a nitrogen- 

 poor diet. The symptoms resemble pellagra more than beriberi. 

 Finally, we wish to comment upon the composition of the diet, which 

 Braddon (I.e. 866) regarded as productive of beriberi. It was 

 exceptionally poor in animal protein and must have lead to pellagra, 

 according to the newest conceptions. This short chapter was 

 introduced here, not so much to demonstrate the relationship between 

 pellagra and the avitaminoses, but to show that we may be dealing 

 with mixed forms under certain conditions, which indicates perhaps 

 that if the diet is lacking in one constituent, it is likely that others 

 may be lacking at the same time. 



MODE OF DEVELOPMENT OF PELLAGRA 



Although theoretically pellagra may also develop without any 

 corn consumption, it appears and disappears, in practice, with corn 

 cultivation. Thus, corn was introduced into Egypt in 1840, and in 

 1847, the first cases of pellagra were noted. In Spain, the disease 

 has been endemic for two centuries, having appeared there with the 

 beginning of corn cultivation; at present, considerable rye, wheat and 

 oats, but very little corn, are grown and the disease has almost been 

 stamped out there. Weiss (1350) noted that since 1905, after the 

 exclusion of corn from the diet, cases in the Tyrol appeared more 

 rarely. Alpago-Novello (1351), in an Italian province, partially sub- 

 stituted corn growing by turnips and potatoes, whereupon the number 

 of cases decreased. It is likewise not without significance whether 

 hand ground or machine milled corn is used. In the United States, 

 it has often been found that in the mountainous districts where only 

 the hand milled variety is used no cases of pellagra occur; the con- 

 trary is true in small industrial cities where the natives use prepared 

 cornmeal, as brought out by Wood (1352). Blosser (1353) observed 



