28 



Scientific Proceedings (78). 



18 (1196) 



An experimental test of the relation of sewage disposal to the 

 spread of pellagra. 



By J. F. Siler, P. E. Garrison and W. J. MacNeal. 



[From the Robert M. Thompson Pellagra Commission of the New 

 York Post-Graduate Medical School and Hospital.] 



After a thorough survey of the whole community of Spartan 

 Mills in the city of Spartanburg, S. C, an endemic center of 

 pellagra conspicuous for the number of cases of the disease which 

 had originated in it, the surface privies were replaced by a water- 

 carriage system of sewage disposal in the latter part of 191 3 and 

 the first half of 1914. Subsequent to this change there has been 

 observed a remarkable reduction in the incidence of pellagra in 

 this community, such that during the pellagra season of 1916 only 

 one new case has appeared among the, approximately, 2,000 

 residents upon the mill property and this one case originated in a 

 house situated at the very margin of this sewered district and 

 across the street from an unsewered house in which an old case of 

 pellagra resided. Houses situated in the partly unsewered district 

 adjacent to the mill property furnished several new cases of 

 pellagra in 1916. Furthermore, many of the preexisting pellagrins 

 living on the mill property have suffered recurrence of the disease 

 in 1916. The results of the experiment so far would seem to 

 indicate very clearly that the improvement in sanitation has 

 served to prevent the non-pellagrous population from contracting 

 the disease, but has had relatively little influence upon the course 

 of the disease in those who had previously contracted it. This 

 result is quite in accord with the hypothesis announced by us in 

 1913, 1 in order to test which this experiment was undertaken. 



The detailed discussion of this experiment may be expected 

 to appear in the Archives of Internal Medicine as one of the present 

 series of papers, constituting the third report of the Robert M. 

 Thompson pellagra commission. 



1 Siler, J. F., Garrison, P. E. and MacNeal, W. J., Pellagra, A summary of the 

 First Progress Report of the Thompson-McFadden Pellagra Commission. Pre- 

 sented at the Special Pellagra Conference at Spartanburg, S. C, Sept. 3, 1913; 

 Jonrn. A. M. A., Jan. 3, 1914, lxii, 8. Ibid., The relation of methods of sewage 

 disposal to the spread of pellagra. Arch. Int. Med., 1914, xiv, 453. 



