Fig. 5.

This photograph, taken by Dr. Joseph Jenkins Watson of Columbia, SC, is perhaps the most frequently reproduced illustration of pellagra in English-language accounts. “Pellagrins,” wrote Harvey E. McConnell of Chester, SC, “almost always have a frown of their foreheads” and the “erythematous eruption of the hands … the most constant and diagnostic sign … needs to be seen only once to be recognized, and if you ever shake hands with one of these patients, you never forget the sensation.” Courtesy: Waring Historical Library, Medical University of South Carolina, Charleston, SC.