490 WILLETS. 



in 1771, under the name of pellagra (from pellis — skin, and agra — rough), and, 

 according to King,(6) Frapoli declared it to be an ancient disease known in 157S 

 as pellarella, as might be seen by reference to the regulations for admission to 

 the Hospital Major of Milan at that time. The ravages of the disease have been 

 most marked in Italy and Roumania, where it appeared in 1810. In Italy, in 1879 

 there were 97,835 cases; in 1881, 104,067 cases; in 1899, 72,603, and in 1902, 

 55,029 (Wollenberg).(26) In Roumania, in 1885 there were 10,626 cases: in 1886, 

 19,797; in 1898, 21,272; (6) and in 1906, 30,000 cases (Triller). 4 



The elder Hameau ° reported pellagra from the vicinity of Teste, France, in 

 1818 (Maladie de la Teste) and Pruner • found it in Africa in 1847. It appeared 

 in Corfu, in 1856, and Sandwith found it in Egypt in 1893. Ray' reported it 

 in 1892, from one of the provinces of North Bebar, India, and three physicians 

 from India recognized photographs of cases of pellagra shown them by Sandwith 

 in England as being typical of a condition they had seen in India, but had not 

 understood. Two sporadic cases were reported in the United States in 1863 and 

 1S64 by Doctor Gray, of Utica, New York, and Doctor Tyler, of Somerville, Mas- 

 sachusetts. Doctor Sherwell. of Chicago, found a case in a sailor on a ship in 

 New York in 1902 and, in the same year, Dr. H. F. Harris, (4) of Atlanta, Georgia, 

 reported a case of agchylostomiasis in a native of Georgia who had always resided 

 in the State, presenting the typical symptoms of pellagra. In 1907. Scare}' (17) de- 

 scribed an epidemic of 88 cases in the Mount Vernon Hospital for the colored 

 insane in Alabama. Since 1907 many articles relative to pellagra have appeared 

 in American medical literature and many cases, especially from the insane in- 

 stitutions of the South Atlantic States, have been reported. The condition has 

 become so serious in the United States that The National Association for the 

 Study of Pellagra has been formed and the Surgeon-General of the Public Health 

 and Marine-Hospital Service has appointed a commission to investigate the 

 disease. 



Since Marzari, 3 in 1S10, associated pellagra with the eating of Indian corn, 

 the majority of investigators of the disease have attributed it to the continued 

 use of maize as a foodstuff; persons holding this opinion are known as the 

 zeists, in contradistinction to the antizeists who consider the condition merely a 

 symptom-complex occurring in alcoholics, insane persons, and in persons with other 

 depressed symptoms (Lavinder) .(7) However, the zeists differ widely in their be- 

 liefs as to just how the disease is caused by a diet of maize. Thayer (20) divides 

 the opinions of this school into four classes, as follows : ( 1 ) Toxic substances are 

 produced by changes occurring in healthy maize in the process of digestion (Neus- 

 ser) ; (2) the poisons are chemical substances arising from the decomposition of 

 maize before ingestion (Lombrosso) ; (3) the disease is caused by the products 

 of changes produced [in maize] by various special micro-organisms and bacteria 

 (Majoechi and Cubofli) ; (4) it arises from changes produced [in maize] by 

 various molds ( Ballardini, Gossio and Ferrati, Ceni, Fossati ) . 



Lavinder summarizes as follows the reasons why the ideas of the zeist school 

 can not lightly be passed over: 



" ( 1 ) The disease is an endemic one confined largely at least, if not exclusively, 

 to populations which grow and eat corn and more especially to those who, 

 through force of circumstances, eat a poor grade of corn. (2) By far the great 

 majority of thinkers and students believe the disease to be in some definite, if 

 at present rather ill-defined, way connected with the use of corn as a foodstuff. 

 (3) Italian and other authorities, in their attempts to limit and eradicate pel- 



4 Quoted by King. ° Quoted by Sambon. 8 Quoted by Taylor. 



5 Quoted by Lavinder. 7 Quoted by King. 



