GENERAL DISCUSSION OF PELLAGRA. 491 



lagra, base all prophylactic measures almost entirely upon this theory and, as an 

 outcome of such means, good results are claimed." 



Sambon, (13) in 1905, referred to the United States as a conspicuous example of 

 a maize-growing, maize-eating country which did not have pellagra, but, prior to 

 June, 1909, Williams. (11) of South Carolina, obtained records of about 1,000 

 cases in that country, most of which were from asylums. It is variously estimated 

 that at present there are from 5,000 to 10,000 pellagrins in the United States. 

 Furthermore, it has been established that the disease doubtless existed there for 

 at least fifteen or twenty years and probably for thirty-five or forty years before 

 it was recognized. Jt is interesting in this connection to note certain changes in 

 vogue in recent years regarding the harvesting and marketing of maize in the 

 United States, as pointed out by Nichols(12) : Shelled maize is marketed from 

 four to eight weeks earlier than formerly, the time of weathering and drying it 

 on the stalk also is cut short, and more trouble is experienced in handling the 

 maize and preventing it from spoiling. Sambon, (13) in 1905, after discussing 

 the various theories of the zeists as to the etiology of pellagra, concluded by saying 

 that if lie were asked to suggest a new theory of pellagra he would feel inclined 

 to draw attention to the many analogies between it and some of the protozoan 

 diseases. It has been claimed recently that the disease is caused by a proto- 

 zoan(14) parasite transmitted to man by a minute biting midge of the genus Sirmt- 

 lium. The protozoan theory is, at present, attracting much attention. Taylor (19) 

 draws a striking comparison between the points of similarity occurring in pellagra, 

 sleeping sickness and syphilis. However, tlie results secured by applying the Was- 

 sermann reaction to pellagrins are conflicting. Bassd) obtained 8 positive reac- 

 tions out of 12 cases, other conditions, such as syphilitic history, malaria, etc., 

 which might have had their influence, being excluded. Fox, (3) on the other hand, 

 obtained three or four weak reactions, but not a single strong positive one in 30 

 cases. However, lie used Noguchi's modification of the Wassermann test. 



The following conservative resolution was adopted at the closing session of the 

 conference on pellagra, held at Columbia, South Carolina, November 3 to 4, 1909. 



"Resolved, That while sound corn is in no way connected with pellagra, evidences 

 of the relation between the use of spoiled corn and the prevalence of pellagra seem 

 so apparent that we advise continued and systematic study of the subject and, in 

 the meantime, we commend to corn growers the great importance of fully matur- 

 ing corn on the stalk before cutting same." 



Although individuals of all ages are susceptible to pellagra, the majority of 

 eases occur in persons between 20 and 50 years of age. Locality predisposes only 

 in so far as the climate may be favorable for the growing and maturing of corn. 

 Other conditions have no predisposing influence except as the general state of 

 nutrition may be lowered thereby. Direct sunlight is not necessary for the pro- 

 duction of typical skin lesions of pellagra, though they may be influenced some- 

 what by it. Lombrosso, to some extent, controlled the location of lesions by the 

 use of fenestrated gloves, but it is shown that gipsy children of Roumania, who 

 go about naked, have skin lesions of pellagra confined to the usual sites (Neus- 

 ser),° and five of Walker's(23) cases had not been out of doors in eight months. 



The pathologic findings are neither constant nor characteristic, and Harris(5) 

 says that "there are few, if any, diseases characterized by perceptible organic 

 lesions the pathological anatomy of which is so difficult to arrive at as that of 

 pellagra." The evidences of cachexia are seen in the wasted muscular tissue and 

 in the atrophic and fatty changes in the heart, lungs, liver, kidneys, and spleen. 

 In the digestive tract, the tongue is more or less denuded of epithelium, the 



Quoted by Sambon. 



