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Howard K. Tuttle, M.D.
JAMA. 1917;LXIX(25):2105. doi:10.1001/jama.1917.25910520004011e.
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I believe that this case of pellagra is the first to appear in Chile.

History.  —A white girl, aged 11 years, was brought to our company dispensary for treatment. The other members of the family, including three sisters and two brothers, were in good health. The patient first noticed that the skin on the backs of the hands was becoming red, and that the redness was gradually extending up the forearm, being accompanied by considerable burning and itching. Later the disease appeared on the face, forehead and sides of the neck; the tongue was swollen and sore, and the mouth hot and dry. There were pain in the epigastrium, intense thirst and severe attacks of vomiting. Diarrhea accompanied by cramplike pains in the lower abdomen had been present for some time. Nervous symptoms, such as headache, dizziness, choking sensations, tenderness over the spine, or mild convulsions, also disturbed the patient.


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