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In analyzing the data collected in 1912 we were struck by the inequalities in the distribution of pellagra in the townships of the county in which our studies were undertaken. This rate ranged from no cases to 71 cases per ten thousand of population. A further analysis, based on the distribution of the population in rural, urban and mill-village communities showed that in rural communities the incidence rate was 16 per ten thousand of population ; in the city of Spartanburg, exclusive of the mill-village section, it was 29 per ten thousand, while in the mill-village communities it averaged 104 per ten thousand.One of the features of our epidemiological work in 1912 was the investigation of methods of disposal of human wastes. In certain sections of the city of Spartanburg a water-carriage system was in use. In the rural districts the white farmers usually had
SILER JF, GARRISON PE, MacNEAL WJ. THE RELATION OF METHODS OF DISPOSAL OF SEWAGE TO THE SPREAD OF PELLAGRA. Arch Intern Med (Chic). 1914;XIV(4):453–474. doi:10.1001/archinte.1914.00070160003001
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