Pellagra

Pellagra (Ital. pelle agra, 'rough skin'), a disease, unknown prior to the first half of the 18th century, which is common among the peasantry of Northern Italy, and occurs also among the same class in Corfu, Roumania, the Landes and Gironde in France, and Oviedo and elsewhere in Spain. But the headquarters of the disease are in the northern and north central provinces of Italy; it is unknown to the south of Rome and in the islands. It is an error to describe pellagra as the result of poverty alone—to call it il delirio della miseria; it is clearly traceable to the use, as the staple diet, of damaged and unwholesome maize, gathered before it is ripe, and stored carelessly—often in cellars or pits—in its wet state. The disease makes its appearance in spring, in the form of a reddish-brown rash, which smarting painfully where exposed to the sun and air, as on the bare hands and feet; towards autumn this disappears, leaving, however, hard, dry spots on the skin, and returning with increased determination in the following spring, and again in each successive year, till the skin becomes shrivelled and yellow, or even black in certain spots, and the body is reduced to a mummified state. A burning feeling in the mouth and bowels is an accompanying symptom, and profuse diarrhoea, along with a rapid wasting, and dropsy, is a frequent cause of death. As the disease progresses disorders relating to the nervous system gradually develop, and culminate in melancholy, imbecility, or mania; death often ensues from delirium, or the wretched patients drag out their life within the walls of an asylum. In Roumania 1·22, and in Corfu 3·2 per 1000 of the population is affected; in Italy in 1887 there were 3688 deaths from pellagra, or 2·04 per 1000 of the estimated population; but in 1881 the proportion was 4·8, and since then it has steadily decreased, in part owing to the number of hospitals built within late years for the special treatment of this disease. See the official report, La Pellagra in Italia (Rome, 1880).