336 DISEASES OF UNCERTAIN ETIOLOGY 



Cases have relapsed after two to fifteen years. 



It is not easy to say when a person is free from the disease, once 

 they have been attacked b}' it. It is better to speak of recovery from 

 an attack than a cure of the disease. 



Recovery is more frequent and more permanent in children than 

 adults. 



The death-rate in the initial attack is i5;8 per cent. (i,i8o cases). 



The death-rate in the recurrent attack is i2'3 per cent. (i,i8o cases). 



It is higher in Black than White races (Siler, Garrison and 

 MacNeal). 



Low blood pressure may cause death after exertion. 



Typhoid complications have a high mortality. 



Complications such as ankylostomiasis are always unfavourable. 



TREATMENT. 



There is none specific. 



Protect from the sunlight. 



Use soothing ointments. 



Diet important, fresh fruit and fruit juice, meat broths, miik. 



Avoid starchy foods. 



Dilute nitric acid 15 to 30 minims in four ounces of water, thrice 

 daily, one hour before meals. 



A 10 per cent, solution of trisodic citrate, intramuscular or sub- 

 cutaneously. 



Atoxyl 3 grains daily, intramuscularly, are good. 



Liq. arsenicalis in small doses can be tried. 



Radio-active serum injections are on trial. 



Later one can give eggs, meats, fish, green vegetables and fresh 

 fruit with dilute nitric acid continuously. 



Remove the patient to a non-pellagrous area. 



The Italian Government prohibits the sale of bad maize. 



The line of treatment largely depends on the causative view held 

 by the practitioner. 



BERIBERI. 

 DEFINITION. 



An acute or chronic, endemic or sporadic disease of unknown 

 causation ; characterized by a degeneration of peripheral nerves asso- 

 ciated with gastric disturbances, oedema and cardiac failure. 



DISTRIBUTION. 



Eastern Asia, Japan, China, Philippines, Indo-China, Java, and 

 Malaya, also in other parts frequently where Chinese and Indian 



