HISTORY 



1701 



suffered, markedly resemble pellagra, as he had an eruption upon 

 his hands and feet, associated with an extraordinar}^ mental condi- 

 tion; but though these speculations are interesting, they are far too 

 uncertain to be of any use in determining the interesting point as to 

 whether pellagra existed in Europe before the introduction of maize 

 by Columbus. In 1578 the disease seems to have been known in 

 Milan as ' pellarella,' but was confounded with eczema, leprosy, 

 erysipelas, and scurvy, and 

 no real importance can be 

 attached to a simple name 

 unaccompanied by any de- 

 scription of the disease to 

 which it was applied. A 

 slightly more definite refer- 

 ence is found in 1713 in 

 Ramazzini's work, ' De 

 Morbis Artificium Diatriba,' 

 under the heading ' Agri- 

 colae,' where he says: ' Eas- 

 dem ob causas, iis persaepe 

 contingunt dolores colici et 

 a ff e c t o Hippocondriaca 

 quam ipsi appellant, il mal 

 del Padrone.' 



The recognition that the 

 cutaneous, gastro-intestinal, 

 and mental symptoms ex- 

 hibited by the sufferers 

 constituted a cHnical entity 

 was first made by Gaspar 

 Casal on March 26, 1735, 

 but, unfortunately, was not 

 published until 1762, when 

 his work, ' Historia Natural 

 y Medica del Principado de 

 Asturias Sequida de la 

 Descripcion de la Enfer- 

 medad conocida por el Vulgo 

 con il Nombre de Mal de la 

 Rosa,' appeared. Casal gave 

 arepresentationof the disease 



(Fig. 736), showing the eruption around the neck and down the front 

 of the chest (called Casal's necklace), and on the dorsa of the hands 

 and feet. With Sambon one of us has visited the Oviedo district 

 of the Asturias in North Spain, where Casal first recognized pellagra, 

 and find that, as regards the cases along the River Nero the disease 

 exists as it did in his days. On December 2, 1740, a learned monk 

 named Feijoo wrote to Casal stating that ' Mal de la Rosa ' existed 

 m his native country, Galicia. Before Casal's pubhcation appeared 



^f^lo deinan^t-k.ca 



Fig. 



736, — Mal de la Rosa. 

 (After Casal.) 



