PELLAGRA 353 



The first attacks and relapses appear in Italy mostly early in the 

 year March or April; in North America, beginning in February 

 and lasting throughout the summer into late autumn. Wellman and 

 Sparkes (1301) have reported some winter cases. 



Pellagra is no respecter of age, but it is seldom seen in infants. 

 Niles (I.e. 1283), for example, says that he has personally never seen 

 a case under 5 years and very few under 10 years of age. According 

 to Snyder (1302), the disease is often seen in older children; thus, 

 10 per cent of all cases appear before the age of 15. In one case of 

 a diseased mother who nursed her child for 6 weeks, pellagra 

 symptoms appeared in the child a few days later on an artificial 

 diet. Weston (1303) found in Columbia 15 cases among children, 

 one of which had a sick mother; the child developed pellagra 

 shortly after being weaned. Voegtlin and Harries (1304) reported 

 the very interesting case of a 5 months old breast-fed baby, whose 

 mother showed no symptoms. Byfield (1305) described a pellagra- 

 like disease in 17 children under 4 years of age, for which, however, 

 he assumed an infectious and not an alimentary cause. According 

 to Murphy (1306), the disease is much milder in children and is 

 without nervous symptoms. 



Pellagra is not hereditary, but frequently the children of pellagrans 

 show stunted growth, mental weakness and other signs of degener- 

 ation. It is not contagious ; never was there an infection in an orphan 

 asylum or among the guests of a health resort; according to Gold- 

 berger (1307), there was never any pellagra among physicans and 

 nurses of a pellagra hospital. 



The course of the disease varies; there are severe acute cases 

 terminating fatally in a few weeks, and chronic types, with recoveries 

 and relapses, of many years duration. In an examination of 100 

 cases, Wood (1308) noted the first symptoms, divided as follows: 

 skin, 100 per cent; gastro-intestinal disturbance, 77 per cent; 

 mouth symptoms appearing sometimes before the skin symptoms. 

 Of the latter, 97 per cent appeared on the hands and the forearms, 

 and in 39 cases, on the hands only. The uncovered parts of the body 

 are involved, for the most part, but in one case, the anus, and in 

 two cases, the back was affected. According to Roberts (I.e. 1281), 

 there are altogether four different types of the disease. 



