PELLAGRA, the name given to a chronic disease of com paratively modern recognition. For some time it was supposed to be practically confined to the peasantry in parts of Italy (partic ularly Lombardy), France, the Asturias, Rumania and Corfu. But it has been identified in various outlying parts of the British Em pire (Barbadoes, India) and in both Lower and Upper Egypt; also among the Zulus and Basutos. In the United States sporadic cases had been observed up to 1906, but since then numerous cases have been reported. Probably the disease is even more widely spread through the world. The indications usually begin in spring, decline towards autumn, and recur with increasing intensity and permanence in the spring seasons following. A peasant who is acquiring the malady feels unfit for work, suffers from headaches, giddiness, singing in the ears, a burning of the skin, especially in the hands and feet, and diarrhoea. An erysipelatoid rash appears on the skin, the red or livid spots being tense and painful, especially where directly exposed to the sun. About July or August of the first season these symptoms disappear, the spots on the skin re maining rough and dry. The spring attack of the year following will probably be more severe and more likely to leave traces behind it ; with each successive year the patient becomes more like a mummy, his skin shrivelled and sallow, or even black at certain spots, his angles protruding, muscles wasted, movements slow and languid, and sensibility diminished.
Meanwhile there are more special symptoms relating to the nervous system, including drooping of the eyelid, dilatation of the pupil, and other disorders of vision, together with symptoms re lating to the digestive system, such as a red and dry tongue, a burning feeling in the mouth, pain on swallowing, and diarrhoea. Ultimately there is profound disorganization of the nervous system with melancholy, imbecility, and a curious mummified condition of body. After death a general tissue degeneration is observed. The condition is believed to be diabetic in origin, possibly due to vitamin deficiency. It has been produced experimentally by withholding fresh meat, eggs and milk from the diet and has been observed to occur secondarily in disease of the stomach interfering with nutrition. Consequent on these experiences minor forms of the disease have been recognized, and it may well be that in these forms the disease is more common than was supposed.
See G. D. Head, Arch. Int. Med., 1924, 34, 93; W. L. Bender, Jn. Amer. Med. Assn. 1925, 84, 1250.