1706 



PELLAGRA 



he had seen cases in Iceland resembhng the pellagra which he had 

 observed in Italy. 



Africa. — Though first noticed in Egypt by Pruner in 1847 under 

 the term ' leproses/ its recognition therein is principally due to vSand- 

 with, who found it in 1893, and to Keatinge and Warnock, who have 

 not merely kept that knowledge alive, but have added considerably 

 to the study of the disease. There is, however, still a tendency to 

 consider pellagra a part of the syndrome of ankylostomiasis. 

 More recently pellagra has been recognized in other parts of Africa, 

 and it is possible that it will eventually be found to be widespread 

 in that continent. 



America. — Notwithstanding careful inquiries. Wood has failed to 

 discover any evidence of the existence of pellagra among the North 

 American Indians during the eighteenth century, but he has found 

 some evidence of cases in the early years of the nineteenth century. 

 In 1864 Gray and Tyler first definitely reported cases in them, but 

 though at times recognized, the disease was not generally admitted 

 to be present until 1907, when Searcy reported eighty-eight cases, 

 of which fifty-seven were fatal. From that date the works of Bab- 

 cock, Lavinder, Siler, Roberts, Niles, Wood, and many others, have 

 made the disease well known. In the meanwhile, pellagra has been 

 recognized in the West Indies, Mexico, and other parts of America. 



Asia and Oceania. — During recent years pellagra has been recog- 

 nized in India, the Straits Settlements, the Philippine Islands, and 

 the Sandwich Islands. 



Summary. — ^The above history of pellagra demonstrates the ease 

 with which the disease may be overlooked, even when abundantly 

 present, by well-trained and most competent observers. It also 

 impresses us with the fact that pellagra should be looked for in 

 every country, without any preconceived idea as to its aetiology. 



Climatology. — It appears probable that before many years have 

 passed, pellagra will be found to be prevalent all over the world. 

 At present it is known to exist in : — 



Europe. — Scotland, England, France, Spain, Portugal, Italy, 

 Austria (including the Tyrol, Bosnia, and Herzegovina), Hungary, 

 Roumania, Russia, Serbia, Macedonia, Bulgaria, Greece, and Turke3/. 

 Cases have been reported as far north as the Shetland Islands. 



Africa. — Algeria, Tunisia, Egypt, Central Africa, Rhodesia, and 

 South Africa. 



Asia. — Asia Minor, Persia, India, and the Straits Settlements. 

 Oceania. — Sandwich Islands. 



America. — United States, Mexico, West Indies, Brazil, Columbia, 

 and the Argentine. 



The feature of the last fev; years with regard to the chmatology 

 has been the recognition of pellagra as an endemic disease in Scot- 

 land, England, and the United States. Mere geographical distri- 

 bution per se is not so important as an epidemiological inquiry 

 into the actual localities in which the disease occurs. Pellagra 

 is essentially a disease of long duration, and patients are capable 



