The geographic distribution of pellagra has always been a remarkable feature of this disease and has frequently been discussed by various investigators since the earliest recognition of pellagra. Special significance has usually been ascribed to this peculiar geographic distribution. Thus, for example, it has been argued that people who live in the same region consume the same diet and so are subject to the same dietary deficiencies, or again, that people living in certain regions are exposed to the attacks of certain insects, which live there, and thus acquire a disease transmitted by these insects. The possibility of such discordant interpretations indicates that a mere superficial examination of the geographic distribution of pellagra will not suffice to solve its etiology. An examination of this striking feature of the disease is nevertheless of obvious importance and the possibility still remains that a more intimate and exact study of geographic distribution
SILER JF, GARRISON PE, MacNEAL WJ. RELATION OF PELLAGRA TO LOCATION OF DOMICILE IN SPARTAN MILLS, S. C., AND THE ADJACENT DISTRICT. Arch Intern Med (Chic). 1917;XX(2):198–315. doi:10.1001/archinte.1917.00090020043005
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