i 7 o MEDICINE 



In the purely psj'chological study of mental disorders, much interest has lately been 

 roused by Freud's system of " psycho-analysis " that is, the slow and exhaustive track- 

 ing-out and uncovering of some forgotten or hidden experience which was the starting- 

 point of the present obsession of the patient's mind. The past is dissected back and 

 back and the process may go on for years till something is found which explains 

 everything and may itself be explained to the patient as the primal cause of his or her 

 perversion. This underlying or subconscious something which is at last reached and 

 detected it may be after a year or more is something sexual. " I can only repeat 

 afresh," says Freud, " the principle which I have never found otherwise than true, that 

 sexuality, in the main, is the key to the problems both of the psycho-neuroses and of the 

 neuroses. He who disdains to use this key will never be in a position to solve them." 



Freud's position has been hotly criticised: and, though his contention were true, yet 

 the fact remains that very few have either the skill or the desire to be inquisitors on this 

 grand scale: and the danger remains, that the inquisitor into " psycho-neuroses " may 

 put into the patient's mind what he subsequently finds there. 



Among those who suffer from obsessional habits or thoughts, many receive benefit 

 from treatment by suggestion. It is perhaps in cases of this kind that this treatment 

 which may or may not be with " hypnotism " gains some of its most signal and 

 valuable successes. 



Pellagra. To heighten the interest of the problems of pellagra, a few cases of the 

 disease have recently been found in the British Islands; see the paper by Dr. Sambon and 

 Dr. Chalmers, " Pellagra in the British Islands," Brit. Med. Journ., October 26, 1912. 

 It is but a very few cases, at present, which have been found: but we may be sure, 

 seeing the endemic nature of the disease, its insidious onset, and its resemblance, in the 

 final stage, to other forms of delusional insanity, that where a few cases have been 

 found, more are waiting to be found. In Italy, pellagra has been endemic for centuries. 

 It occurs, also, in Spain, southern France, Hungary, Rumania, and Algeria. So far 

 back as 1893, Dr. Sand with recognised its presence in Lower Egypt; and his paper on the 

 subject (Brit. Med. Assn., Edinburgh Meeting, 1898) is the earliest full account in Eng- 

 lish of pellagra. 



The story of the finding of pellagra in the United States is a remarkable chapter in 

 the history of diseases. Before 1907, its existence was not generally known. " It was 

 not until 1907, when Drs. J. W. Babcock and J. J. Watson raised the alarm, that pellagra 

 became a subject of inquiry in the United States." Now, we know that the disease 

 prevails in no less than thirty-three States, and that there are thousands of indubitable 

 cases on record. " Recent importation, and spontaneous origin, are quite out of the 

 question. Only centuries of the prevalence of the disease can explain the wide range of 

 pellagra in North America, extending from the Atlantic to the Pacific Ocean and from 

 the Gulf Coast to the Great Lakes; especially when we consider the peculiar topographic 

 distribution of the disease, which, in America as in every other affected country, is limit- 

 ed to the foreland or ' Piedmont Section ' of mountain ranges, and more particularly to 

 the valley tracts of swift-flowing streams." A full account of the disease in the United 

 States has been published by Dr. Niles, Pellagra, an American Problem (Saunders, 

 Philadelphia, 1912). 



The Transactions of the Society of Tropical Medicine and Hygiene, v, 3, 1912, contain 

 two important papers, (i) " Pellagra in Nyasaland," by Dr. Hugh Stannus, (2) " Pellagra 

 in Thirty-five States of America," by Dr. Sandwith. In the discussion on these papers, 

 Dr. Sambon referred to the researches which he and Dr. Chalmers had lately made in 

 Italy, Rumania, Plungary, and Spain. It is evident, as he says, that " this grave dis- 

 ease is much more widely distributed and far more prevalent than had been imagined." 



Sambon's theory founded on years of careful study of pellagra in many countries, 

 with special regard to its geographical conditions and its mode of incidence is that the 

 disease is an infection, probably protozoal, like malaria, and probably conveyed by 

 Simulium, a species of midge: and there is evidence that this view of the disease is gain- 

 ing more acceptance than the older view, that pellagra is due to the eating of infected 



