I7I4 



PELLAGRA 



family Filariidse, he considers to be the cause of the disease. He 

 also states that he has found a filarial egg in the skin of pellagrins. 



According to Sambon, who has seen Alessandrini's specimens, 

 the thick-shelled egg belongs to one of the nematode worms infect- 

 ing pigs. Alessandrini's theory has not received much support up 

 to date. 



Long's Theory.— This tneory suggests that pellagra is merely a 

 phase of amoebic dysentery, but the lUinois Commission, as well as 

 the observations of Sambon and one of us, do not support this 

 theory. Dysenteric-like ulcers can be found in the intestine, but 

 they often do not contain amoebae. 



Perroncito's Theory.— Perroncito ha:^ found peculiar parasitic 

 bodies in the skin of pellagrins. This is an important statement, 

 and further investigation of these forms is awaited with interest. 



Bab£;s' Theory. — ^Babes states that he has found bodies re- 

 sembling a Chlamydozoon, in the skin. 



Sambon's Theory. — -This theory is double-barrelled- — i.e., it 

 brings forward the proposition that pellagra is a protozoan infec- 

 tion, and that it is spread by the agency of a biting fly. 



Parasite. — His reasons for believing that it is a parasitic disease 

 are almost entirely epidemiological. They are: — 



1. The Mononucleosis present in the blood. 



2. The Presence of Long Intervals of Quiescence, followed by a 

 Relapse. — ^Thus, a young pellagrin with marked symptoms who 

 comes to London, and receives most excellent food, without any 

 admixture of maize, suffers from a mild relapse every year in the 

 month of April. In this case there can be no question of maize 

 causing these relapses. Further, we may state that the young 

 person appears to be in the very best of health at the time of writing 

 (January). Similar, but not such convincing, cases have often been 

 reported in gaols and asylums, as mentioned above. 



Siler and Nichols in Peoria Asylum filled two cottages with 

 about sixty insane persons in each. One cottage was placed on 

 a generous maize diet and the other on a maize-free diet. At the 

 end of twelve months the maize-eaters had four certain cases and 

 one doubtful case of pellagra, while the maize-free group included 

 five certain and five doubtful cases of pellagra. Probably these 

 were merely relapses of the disease which had occurred long before, 

 but as we have only seen a summary of the Illinois Pellagra Com* 

 mission Report, we cannot give details. 



A point has been made that, while patients in asylums develop 

 acute symptoms, the attendants do not, and this is held to be an 

 argument against the parasitic cause of the disease. But this 

 is just where the experience of Sambon and one of us differs from 

 those of many authorities, because we have seen the disease begin 

 so often in early childhood. The youngest case seen was three 

 months of age, and we have obtained excellent histories of long 

 intervals occurring between one series of acute attacks and the next. 

 We look upon these asylum cases as probably relapses of earlier 



