CLIMATOLOGY 



1707 



of moving far from the place in which the first symptoms appeared, 

 and, again, the first symptoms often appear in early childhood and 

 reappear after some years' interval, when the patient may be 

 living in quite a different district from that in which he resided 

 during his younger years. It is therefore necessary to prepare 

 and study spot maps showing where the patients were first attacked 

 by the signs and symptoms of the disease, and this is being done 

 at the present time by Sambon, whose results will be awaited with 

 interest. In general it may be stated that inquiries of this nature 

 show that by far the larger number of cases occur in country dis- 

 tricts, and not in towns, and that the densest locpJization is in 

 houses near or alongside certain streams. In fact, study the locali- 



JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT. OCT. NOV DEC. 





































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Fig. 737. — Seasonal Variation in the Admissions for Six Years of 

 Pellagra Cases into the Kasr-el-Ainy Hospital, Cairo. 



(Specially prepared by Keatinge and Stiven.) 



zation in what country you will, as we have done in France, Spain, 

 Italy, Austria, Hungary, Roumania, and Egypt, it is impossible 

 not to be impressed with the relationship between pellagra and 

 water. Generally the water is moving, and often it is moving 

 rapidly, but this last does not appear to be absolutely necessary. 

 As a rule, the nearer t?ie dwellings are to such water, the greater 

 the number of cases. Cases do, however, occur at a distance 

 from water, but inquiry will often demonstrate that the affected 

 people work near or have been in some way connected with a 

 stream. - Cases do occur in towns, but they are relatively few, 

 and careful inquiry will usually elicit a perhaps almost forgotten 

 fact that the disease really began after some visit to the country. 

 Inquiries, however, must be made with care, otherwise wrong im- 

 pressions may be obtained. One of the most interesting cases 



