Localities in which Pellagra is Prevalent. 9 



other cases examined showed the usual summer cessation of 

 the disease and an improvement in general health. The 

 affected regions on the two arms were surrounded by a deep 

 red border, as if something had got access to the blood in 

 the center of the area and was spreading outward into the 

 healthy skin, much as one sees in plants a fungus pushing 

 outward from a point of inoculation by a growth of its 

 mycelium. The area on the two arms and forearms seemed 

 to be of about equal extent. This affected region was such 

 as might at some time have teen exposed to the air when 

 the patient was busy about 1 er domestic affairs. A more 

 interesting and puzzling feature of this case was the presence 

 of two isolated round spots of diseased skin, one on the 

 point of each shoulder. If there had been one only, I should 

 have thought a hole in a gown might at some time have 

 exposed the part to infection, but the chances seem against 

 the presence of two such holes exactly alike, one on each 

 shoulder. I am giving this fact as an illustration of what 

 some physicians claim to be an invariable feature of the 

 ailment, no matter where the skin trouble appears, namely, 

 a symmetry in the skin affection, which they regard as 

 evidence that the seat of the disease is within and the skin 

 lesions only incidental and dependent. The case appears 

 to support this view, yet it may prove when we know more 

 of the conditions attending the contraction of the disease 

 that such cases are still explainable on the theory of insect 

 agency. 



THE STREAMS. 



In general character the streams examined are much 

 alike. A gap in the Pine Mountain range lets the Cumber- 

 land through from the south. It makes a bend after clear- 

 ing the gap, and partially encircling Pineville, located at the 

 base of the mountain, flows off to the westward. In its 

 course it receives numerous small creeks and rills from 

 springs, and farther west and north is joined by Laurel 

 River. Its water was rather warm at the time of my first 

 visit, and did not seem to me particularly well suited to the 



