78 Bulletin No. 159 



says, after describing different methods by which the 

 Indians prepare maize : 



"They have another way of eating Indian corn. To 

 prepare it they take ears of it and put them in the water 

 under the mud, leaving them two or three months in this 

 state until they think it decayed. Then they take it out 

 and boil it with meat or fish; then eat it. They also roast 

 it and it is better so than boiled. There is nothing that 

 smells so bad as this corn when it comes out of the water 

 all muddy." - - * 



In addition to the evidence collected by Dr. Sambon, 

 showing the presence of species of Simulium wherever 

 pellagra occurs, he gives several other reasons for believing 

 the disease to be insect borne. In the first place, the alter- 

 nate periods of latency and activity in pellagra correspond 

 in a way with malaria produced by the protozoan parasite, 

 Plasmodium vivax, a parasite known to be conveyed by 

 mosquitoes of the genus Anopheles. Its symptoms,' course, 

 duration and characteristic lesions are, he says, like those 

 of parasitic diseases. "It is insect borne because not 

 directly contagious; because neither food nor water account 

 for its peculiar epidemiology." It is limited to rural dis- 

 tricts only, he asserts, towns and villages almost invariably 

 escaping. 



In Kentucky, it must be said, the disease is rural in 

 general, but puzzling instances are known to me of well-to- 

 do people becoming affected while living in the heart of a 

 city. Cases believed to have originated in asylums also 

 appear to contradict the sand fly theory. Yet it should in 

 fairness be added that the circumstances under which these 

 cases have appeared are not fully known, and more complete 

 knowledge of the disease at its inception in each case might 

 bring all of the apparent exceptions into agreement with 

 the idea so well presented and supported by Dr. Sambon. 



ACKNOWLEDGMENTS. 



In concluding, it is appropriate that acknowledgment 

 be made of courtesies extended to me by physicians at 

 Corbin, Pineville and Gary. To Doctor M. H. Steele and 



