Pellagra : history, distribution, diagnosis, prognosis, treatment, etiology / by Stewart R. Roberts.

  • Roberts, Stewart Ralph, 1878-1941.
Date:
1913
Catalogue details

Licence: Public Domain Mark

Credit: Pellagra : history, distribution, diagnosis, prognosis, treatment, etiology / by Stewart R. Roberts. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    RELATION OF PELLAGRA TO THE SEASONS. Pellagra is a disease which avoids the winter. It usually first appears in the spring and early summer; it may reappear in the same patient in the autumn months of September or October, but usually it omits the autumn advent, hibernates during the winter, and recurs the following spring. In Italy the majority of the spring attacks occur between the middle of March and the middle of May, with extremes of invasion as early as February and as late as June. The autumn invasion recurs during September and October, with extremes of an early limit in August and a late limit in November. The latitude of 40° cuts the pellagrous area of Italy into northern and southern halves. The pellagrous area of Egypt is cut by the latitude of 26° north, and therefore is about 1,000 miles south of the Italian area. The spring attack occurs from November to March; the majority of the cases make their advent and reach their acme during January and February. Few cases recur during the summer. The Egyptian climate is far more tropical than either the European or American, and January more nearly corresponds to spring in the latter two countries. In North America the pellagrous area is included be- tween 25° and 45 north latitude, though by far the greatest num- ber of pellagrins live in the belt on either side of the line 35° north latitude. In Florida the spring invasion may occur as early as December and January, as in the case reported by Randolph; coming north into south Georgia, the spring attack may begin in February, and the farther north the later the seasonal attack. These represent the early appearances of the malady, but as a rule the greater number of cases in the southern states occur in April, May, and June. What is most surprising and apparently different from the usual cases described in the Italian and French literature is that the onset in America varies from January in Florida to late October, and one case is reported as recurring in November. I have seen eases whose onset included every month in the year except November, December, and January. One reason for this is the mild climate in the South, with only two or three months that could be counted severe, and even then the severity is not continuous. Again, spring advances in this large country gradually, so that a 200-mile trip produces quite a change in climate and in the time