Excerpt from Archives of Internal Medicine, 1916, Vol. 18

In certain parts Of our country, and above all in our southern states. There are occasionally seen persons whose hands, feet and even other parts Of the body Show chronic, symmetrically placed,1 eczema-like rough patches or a formation Of bullae and desquamation over larger or smaller areas. A condition Of dermatitis may be due to a number of causes; to tuberculosis, to a filamentous fungus, to poisoning from without or within. Particularly the poison that can be expressed from certain mucors will, when injected into the veins Of a rabbit, cause extensive desquamation Of a similar sort. But in certain of these per sons there is, in addition to the chronic desquamation, a persistent diarrhea or dysentery.2 In consequence Of a disturbing factor, prob ably a tissue poison. Of whose presence these are merely indications. The affected person is liable to die; or else he recovers as the cooler weather comes on, to relapse into the same condition the following spring; or perhaps he recovers permanently. Now, these two states. Skin inflammation and diarrhea, may occur independently Of each other but when they occur together the diagnosis Of pellagra is nowadays rendered. If in addition to these two symptoms an individual shows an unwonted nervous or mental state, whether unusually excited or unusually depressed or confused and demented, then the diagnosis Of pellagra is given with greater confidence.

Now, is this association Of traits a necessary one, due to a single cause, for example, the introduction Of a specific poison Of parasitic or other origin, or is it an accidental association; just as one will find blondness, hair curliness and Short stature combined in a certain proportion Of the population? If an anthropologist should describe this type and give it a name, then Observers would easily detect per sons belonging to this type and the type would then begin to exist.

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