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PUBLIC RECORD OFFICE

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Reference :-

C.O. 885

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ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO

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The disease appears to be more or less prevalent throughout the West Indian Archipelago. In March, 1912, in the "Anales Medicos de Puerto Rico," Dr. Pedro Gutierrez Igaravidez described a typical case from the district of Caguas in the Island of Porto Rico, and mentioned two previous cases seen, one in the district of Utado, in 1904, by the first Hookworm Commission, the other in the district of Four other cases were reported by Dr. Mayaguez, by Dr. Gonzales Martinez. Guiellermo Curbbelo Waterton, Superintendent of the San Juan Insane Asylum, at the second triennial meeting of the American Association for the Study of Pellagra, At this same Conference Dr. J. A. Mackintosh held in Columbia in October, 1912. recorded a case from Abaco, one of the Bahama Islands. In August, 1912, in the "Journal of Tropical Medicine and Hygiene," Dr. Lucius Nicholls described nine consecutive oases seen by him in the Island of St. Lucia during a period of three months, and Dr. Alexander King tells me he has seen thirty or forty cases within the last five years. While travelling from Trinidad to Antigua, a fellow passenger, Dr. John Alex Foreman, told me he knew of a case in the Island of St. Kitts, and Mr. Jennings, who visited this island on his way back to the United States, writes I have also me that, according to Dr. Branch, the disease is known to occur. hearsay information of the occurrence of pellagra in the Island of Cuba. Finally, from the number of cases which have occurred on the Isthmus of Panama, in labourers from Guadeloupe and Martinique, and from vague accounts in the old medical literature of these islands, I would infer that the disease is also present in the two French Colonies.

Pellagra in the Panama Canal Zone.

The pellagra conditions met with in the Panama Canal Zone require a few passing remarks. The disease was first reported in 1909 by Dr. S. T. Darling, the capable chief of the Ancon Hospital Laboratory, who recognized it at the autopsy When this case of a Jamaican negress who had lived on the Isthmus twenty years.

was discussed at a meeting of the Canal Zone Medical Association no less than five members remembered having met with similar cases, but there are no records that might carry us farther back. Since 1909, numerous cases have been reported from all parts of the Canal Zone, but, with one exception-a white American from Indiana-they seem to have occurred solely in adult West Indian negroes from the islands of Jamaica, Nevis, Antigua, Montserrat, Guadeloupe, Martinique, St. Lucia, Barbados, and Trinidad, the patients' length of residence on the zone vary. ing from three months to twenty years. So far, the disease has not been observed in children, the youngest patient being twenty-one years of age, and women have The very uniform distribution of the been affected out of all proportion to men. disease throughout the zone, its remarkable absence in children, its extraordinary preponderance in females, its limitation to the immigrant West Indian negroes, and the lack of any kind of connexion between the different cases, gives one the impression that the disease is not indigenous but imported. On the other hand, there is the report of an indubitable case in a Panama-born negress of Jamaican parentage There are also cases with a who appears to have spent all her life in the zone. history of three, five, seven, and even twenty years residence on the zone which are looked upon by some as indigenous. To these I am not inclined to attach much importance, because, in my experience, the disease may continue for many years, its recurrence often alternating with the quiescent periods of several years' duration, but I see no reason why indigenous pellagra should not occur on the Isthmus of Panama. On the contrary I should expect it to be there, since it is known to exist in Mexico and in Venezuela. The reported absence of the disease in children and Panamanians may be more apparent than real. Until quite recently pellagra had been almost everywhere overlooked in children. However, whether pellagra is or is not indigenous on the Isthmus, there can be no doubt, I think, that the majority of cases observed by the surgeons of the United States Army serving on the zone were imported cases, the disease having been contracted, perhaps many years previously, in the West Indian islands from which they came.

Pellagra in British Guiana.

The general recognition of pellagra in British Guiana is a matter of quite recent date, although Dr. Q. B. de Freitas, Medical Superintendent of the Berbice. Lunatic Asylum, had already reported cases in 1907, and Dr. E. D. Rowland had identified the disease, both in adults and children, after seeing it in Barbados. Owing to the interest and to the great kindness and helpfulness of the Honourable J. E. Godfrey, Surgeon-General of the Colony, I was able to examine quite a

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number of cases. The most typical and grave were the ones I saw at the George. town Almshouse, under the care of Dr. J. A. Robertson, who very kindly presented Other very interesting me with a series of photographs taken of previous cases. pellagrins were shown to me by Dr. de Freitas at the Berbice Lunatic Asylum. Here I saw the disease not only in negroes, but also in a Hindu woman and in a Chinaman. The Chinaman, Li-a-Hoo, was an inveterate opium eater, fifty-six At Fort William, years of age, who had been in the asylum since July, 1894.

Dr. J. Reid told me that in the district of Courtentree he had seen pellagra in a In both cases the rash Syrian woman and in a French sailor from Cayenne. recurred each year.

History of the Recognition of Pellagra in the West Indies.

In most of the places visited the disease had been already recognized by the local physicians, but only within recent years, and this is not to be wondered at, because, prior to its recognition in the United States in 1908, pellagra was seldom mentioned in the medical literature of the English-speaking countries. Indeed, it is very interesting to us, and highly creditable to the West Indian physicians, to find that pellagra was known and correctly diagnosed in Jamaica and Barbados as early as 1898.

In going through the records of the Kingston Lunatic Asylum we find that, on the 17th of March, 1898, a patient, Eleanor Newland, was admitted from Halfway Tree, on the outskirts of Kingston. In the notes concerning this case taken by Dr. McCormack, a definite diagnosis of pellagra was made on admission, and photo- graphs of the skin lesions were taken. The patient died 29th August, 1898.

That very same year Dr. the Honourable J. R. Phillips was the first to record in Barbados a death as due to pellagra. Italian naval surgeons visiting the island had recognized the disease as genuine pellagra, a view confirmed in 1901 by Dr. G. C. Low, who at my request very kindly inquired into the matter.

Personally I have no doubt that pellagra is a very ancient disease in the West Indies, and certainly quite as ancient as in the adjoining United States, in Yucatan, in Venezuela, in the Guianas, and in other parts of the world, such as the British Isles, in which it has been only recently recognized. But, of course, in the absence of the necessary records, it may not be possible to trace it very far back. However, the Barbadian physicians know full well that the same disease was observed in their island as far back as they can remember, and that it was confounded with other diseases. Thus sprue and pellagra were long con- on account of the stomatitis which may founded under the name of "thrush occur in both of them. Later, the term "psilosis," introduced by Dr. Thin to denote Dr. Cuthbert Bowen, tropical sprue, replaced the older and more popular name.

Psilosis () Pig- physician to the Bridgetown General Hospital, in a paper on mentosa," read before the First Pan-American Medical Congress held in Washing- ton, 5th to 8th September, 1893, says :-

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During the past four years I have seen so many cases of chronic diarrhoea often ending fatally-in which a peculiar inflammation of the mucous membrane of the mouth is accompanied by a clearly defined symmetrical pigmentation of the dorsal aspects of the hands and feet, that I have been forced to the conclusion that this triple association is not an accidental one, but is pathognomic of an epithelial disease sui generis, possibly peculiar to Barbados, or else closely allied to a specific disease of the alimentary canal which has its habitat in the East Indies, and has been accurately described by Dr. Thin, of London, as ' psilosis linguæ et intestini.” Then, after explaining that he adopts the term psilosis only as a temporary heading to introduce the new disease, he adds :-

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It being distinctly understood that I do not believe that in Barbados we are dealing with the identical disease to which the term psilosis, in its technical adaptation by Dr. Thin, strictly speaking belongs, although clinically there is a strong resemblance between their respective alimentary manifesta- tions. The tongues differ and there appears to be no accompanying cutaneous pigmentation in Dr. Thin's psilosis. At any rate, the qualifying adjective pigmentosa' will prevent confusion of the condition which forms the sub- ject of this paper with the class of cases recognized as psilosis in the East Indies, and at the same time will call attention to one of the most prominent features of the former. The external manifestations of Psilosis pigmen- tosa, as we see it in Barbados, are a crimson, peeled condition of the mucous