352 THE VITAMINES 



not impossible. In France, the disease is supposed to have been 

 recognized only since the time of Napoleon I, especially in the 

 swampy province of Landes, but it has been entirely eradicated by 

 Roussel (I.e. 1279). 



In Egypt, especially in Lower Egypt, we find an insignificant 

 number of pellagra cases. In Canada, cases were observed by 

 Pinault (1289) and Rolph (1290). In North America, till a few 

 years ago, pellagra had been steadily increasing, apparently since 

 1880; some investigators believe, on the contrary, that it appeared 

 only in 1900. The progress of the disease here is much more acute 

 than in Italy, and the mortality markedly greater. The endemia 

 is most severe in the southern states (especially Texas, Arkansas, 

 Louisiana, Mississippi, Kentucky, Tennessee, Alabama, Virginia, 

 North and South Carolina, Georgia) and in Mexico. Lavinder 

 (1291), between 1907 and 1921, counted 30,000 pellagra cases, 

 with 40 per cent mortality. Petersen (1292) reported recently that 

 in the United States, during 1915, there were 10,663 fatal cases; 

 in 1916, there were 6289. During this time, in the southern states, 

 the pellagra cases were supposed to represent about 0.5 per cent of 

 the population, which would make about 165,000 cases. In the 

 Canal Zone, cases were reported by Decks (1293), arising on a 

 carbohydrate-rich diet. Tuttle (1294) has described cases in South 

 America. McDonald (1295) observed pellagra in Antigua; Nicholls 

 (1296), on the Island of St. Lucia; de Kock and Bonne (1297), in 

 Surinam. 



PROGRESS OF PELLAGRA 



Pellagra spreads in rural districts, while the cities remain free 

 from the disease. In Italy and Egypt, the disease attacked the 

 poorer population; in North America, however, even well-to-do 

 farmers who follow the usual mode of country life are not immune. 

 According to Roberts (1298), the picture of pellagra has changed 

 in the United States in recent years; here, the acute form resembles 

 the Italian type, and some forms are so mild that they may be 

 easily overlooked. The disease occurs more in women than in men; 

 in fact, the ratio between both sexes is given variously as 2 : 1 or 3 : 1. 

 According to Siler and Garrison (1299) and Grimm (1300), pellagra 

 often appears after a birth and in 83 per cent of all cases, it breaks 

 out in families in straitened circumstances. 



