Hexamethylenamine and quinine have been recommended; also thyroid gland in some form has been used. Symptomatic remedies must be used as needed. For insomnia, the bromides, chloral, paraldehyde, sulfonal, trional, and veronal; for the diarrhea, some of the bismuth preparations, atoxyl, guaiacol carbonate, ergot; for the anemia, some bland preparation of iron; for the erythema, a calamine lotion or a bland ointment, or, if necessary when there is exfoliation and infected raw surfaces, a moist antiseptic dressing. Strychnine is of value in convalescence. Symptoms must be met as they arise. Complications, such as malaria, syphilis, and intestinal parasites, should be promptly treated with appropriate remedies. It is wise to examine the feces for the ova of parasites. Surgical. Cole1 has directed attention to the value of the direct transfusion of blood in the treatment of pellagra. Under some circumstances it is doubtless a valuable surgical resource. The operation, however, requires surgical skill and experience. In a few cases of pellagra in the United States appendicostomy, with subsequent flushing of the bowel, has been employed. Such treatment does not seem logical unless there be some complication such as amebiasis. In conclusion, the mental depression so often associated with pellagra sometimes results in suicide, and this should always be kept in mind. It must also be remembered that pellagra is a disease which is very chronic in its nature, and patients even when apparently recovered should nevertheless be kept for a long while under medical supervision. BIBLIOGRAPHY. The literature of pellagra is extensive. Most of it is in Italian, French, German, and Spanish, but since the advent of the disease in the United States the English literature has rapidly accumulated. For those who desire to go thoroughly into the subject the Index-Catalogue of the Surgeon General's Library at Washington, and the volumes of the Index Medicus will be found indispensable. Salveraglio (Bibliografia della pellagra, Gior. d. Soc. ital. d' Ig., Milano, 1887, IX, 1-156) has carefully compiled the literature up to 1887. In Marie's monograph on pellagra, as translated by Lavinder and Babcock, will be found an exhaustive compilation of the English literature up to 1910, as well as extensive references to foreign literature. In the files of many American journals since 1907 will be found numerous articles on various phases of the disease. Brief articles may also be found in the recent editions of many medical works in English-works on tropical medicine, practice, diagnosis, skin diseases, mental and nervous diseases, as well as encyclopedias, reference handbooks, annual reviews, etc. 1 Winthrop, G. J., and Cole, H. P. New Orleans Medical and Surgical Journal, LXIII, 90-97, 1910-11. For the benefit of those who may desire to go a little more deeply into the subject, yet lack the time and opportunity for very extensive reading, there is given below, with critical comments, a brief list of literature. All of this may be found in the Surgeon General's Library, and some of it may be found in smaller collections. SPANISH. CASAL, GASPAR. Obra póstuma del Dr. Casal, publicada en 1762. Del padecimiento que vulgarmente se llama en esta region (Austúrias) mal de la rosa. Corresp. Med., Madrid, 1870, V, 78, 85, 93, 101, 111, 125, etc. CALMARZA, J. B. Estudios sobre la pelagra. Siglo Med., Madrid, 1869 and 1870, XVI and XVII. HUERTAS, F. La pelagra en España. Archivos Latinos de Medicina y de Biología, Madrid, año 1, núm. 1, October 20, 1903. The Spanish literature of pellagra is not of great importance. Casal's paper is of much interest from an historical standpoint. The reference given above is to a very good Spanish translation of the original, which is in Latin. Calmarza's work is of interest. He has written a good deal on the subject. The reference given is to a prize essay, antizeist in tone. Huertas is one of the best modern writers, and appended to the reference given will be found a very good bibliography of the Spanish literature. GERMAN. NEUSSER, E. Die Pellagra in Oesterreich und Rumänien. 1887, 4, 146. Also reprint. Wien. med. Presse, Das Krankheitsbild der Pellagra. Verhandl. der Gesellsch. deutsch. Naturforsch. und Aerzte. Versamml. 77, 1905. BABES, V. and SION V. Die Pellagra. In Nothnagel's Spec. Pathol. und Therapie, Wien., 1901, Bd. XXIV, Hft. II, Abt. II, III. GREGOR, A. Beiträge zur Kentniss der pellagrösen Geistesstörungen. Jahrb. f. Psychiat. u. Neurol., Leipz. u. Wien, 1907, XXVIII, 215-309. MERK, L. Die Hauterscheinungen der Pellagra. Innsbruck, 1909. TUCZEK, F. Klinische und anatomische Studien über die Pellagra. Berlin, 1893. The German literature is important. Neusser has had a rich opportunity for observation of the disease in Roumania, as well as in Italy. He is the creator of the autointoxication idea of the cause of the disease. His view is discussed in the first reference given. The second reference gives an excellent brief account of the clinical picture of the disease. The article by Babes and Sion is a very good one and contains a good bibliography. Gregor's work is among the best on the psychic side of the disease. Tuczek's studies on the pathology of the disease are well known. Merk's handsomely illustrated volume on the skin manifestations is a fine study. FRENCH. ROUSSEL, TH. Traité de la pellagra et des pseudo-pellagres. Paris, 1866. LANDOUZY, H. De la pellagre sporadique. Paris, 1860. PROCOPIU, G. La pellagre. Paris, 1903. TRILLER, B., La Pellagre, Paris, 1906. NICOLAS, J., and JAMBON, A. Contribution à l'étude de la pellagre et du syndrome pellagreux. Ann. de Dermat. et de Syph., Paris, 1908, 4, ., IX, 385-480. The French literature is extensive. Roussel's work is a classic. It is perhaps the best single book in existence, but has a strong zeist bias. Billod and tan douzy's work is important from the side of pseudo-pellagra. Procopiu's small monograph is a good account of the disease. Triller's thesis may be recommended, but it contains some errors. The contribution of Nicolas and Jambon is among the best of the many modern French articles which take the broad view that pellagra is really not a morbid entity. ITALIAN. STRAMBIO, G. Dissertazioni sulla pellagra. Vols. I and II, Milano, 1794. Also LUSSANA, F., and FRUA, C. Su la pellagra. Milano, 1856. Gosio, B. Sul problema etiologico della pellagra. Atti del Terzo Cong. Pel. ALESSANDRINI, G. Sulla pellagra in Italia. Annali d' Igiene Sper., n. s., XX, fasc. IV. Also reprint. Rivista Pellagrologica Italiana. (A bimonthly journal devoted exclusively to pellagra. Its files extend from 1901.) Atti del Congresso Pellagrologico Italiano, I-IV. (These congresses were held in 1901, 1902, 1907, and 1909. There is a volume of transactions for each congress.) There is such a wealth of Italian literature that selection is very difficult. The files of the Rivista Pellagrologica Italiana and the Transactions of the National Congresses will put the reader in touch with all of the modern literature. Of the references given above Strambio's Dissertations are interesting and instructive. This is the elder Strambio, one of the first great writers on the disease. This family for three generations have been students of pellagra. Lombroso's writings are voluminous; the reference given is to his last important work. The article by Belmondo is a discussion of typhoid pellagra. Antonini's manual is a small handbook and gives a good general account. He has written many other things. Gosio's article gives a good study of the etiology. He is the author of many other articles and may be classed as one of the sanest of the zeist writers on etiology. Alessandrini's article is an epidemiologic study made in support of his hypothesis. It contains many new facts. ENGLISH. SANDWITH, F. M. Pellagra. In his Medical Diseases of Egypt, London, 1905; and many other articles. ALLBUTT, T. C., and ROLLESTON, N. D. Pellagra. In their System of Medicine, London, 1906. MANSON, Sir P. Pellagra. In his Tropical Diseases, fourth edition, London and New York, 1907. SCHEUBE, B. Pellagra. In his Diseases of Warm Countries, edited by Cantlie, Philadelphia, 1902. SAMBON, L. W. Progress report on the investigation of pellagra. Journal of Tropical Medicine and Hygiene, XIII, 18, 19, 20, and 21, 1910. The British literature is not very extensive. Sandwith has written of pellagra in Egypt and has directed attention to the gravity of the disease in that country. The article in Allbutt's System is not long. The article in Manson's book is very good, but is not an unbiased treatment of the subject. The article |