COMMUNICABLE DISEASES 389 



Acute pellagra runs a rapid course, but more generally it is chronic, the 

 suffering continuing for years in an ever increasing ratio. The sufferers 

 simply degenerate from year to year and die a slow terrible death. 



Lombrosa, Ceni and others recognized the fact that pellagrins are 

 mostly of the poorer class, whose principal diet is polenta, a mush made 

 from corn meal. This much is usually prepared in large potfuls, sufficient 

 for a week's eating, and set away, exposed to dust, dirt, flies, etc., so that 

 these ignorant peasants often eat polenta which is more or less moldy and 

 otherwise spoiled. Efforts were at once made to correct these conditions, 

 but proved only partially successful as far as checking the ravages of the 

 disease was concerned. The primary cause of pellagra is not yet dis- 

 covered. Dr. Louis W. Sambon of the London School for tropical medicine 

 asserts that maize, either sound or spoilt, is not the cause of the disease, 

 that it is decidedly endemic in its tendencies, that its stations are closely 

 associated with streams of running water, and suggests that a small 

 blood sucking fly belonging to the genus Simulium is the agent by which 

 pellegra is conveyed. Others suggest that it is a dietary disease indicated 

 by the fact that the disease does not develop in those who use a welJ mixed 

 and well balanced diet. 



L. Syphilis. The primary cause of syphilis is the Treponema pallidum 

 (Spirochaeta pallida), belonging to the group of protozoa known as the 

 Zoomastigophora (Flagellata) . The life history is still unknown. The 

 full life cycle appears to be far more complex than was originally supposed. 

 The male organism is the form usually recognized as the Treponema of 

 syphilis. The female cell is supposed to develop in certain body cells, 

 as the lymphocytes and the endothelial cells. The idea of the bisexual 

 nature of the organism is gaining more and more credence among bacterio- 

 logists. These matters cannot be entered into in a work of this kind. 



Syphilis as well as gonorrhea are filth diseases in the sense that with 

 absolute physical cleanliness, as well as moral cleanliness, these diseases 

 could not exist. Sanitarians have made the interesting observation that 

 cities and towns that were subjected to a thorough cleaning up as a safe- 

 guard against the spreading of some infectious disease, such as cholera or 

 typhoid fever, also showed a decrease in cases of the so-called social diseases. 

 It is known that in those establishments for prostitutes where physical 

 cleanliness is required and strictly enforced (primarily for business reasons 

 only), the case rate for the two diseases is much reduced. While it is 

 true that the great majority of cases are traceable to promiscuous inter- 

 course, this factor per se plays no part in the dissemination of the two 

 diseases, excepting in so far as this promiscuity increases the chances 

 for contact with physical uncleanliness on the part of both sexes, the 

 female in particular. A decrease or increase in promiscuity has no pri- 



