PELLAGKA 907 



women in the puerperium and some old people in the decline of life. The 

 maintenance of individual resistance therefore has its limitations. 



Among- measures of the second group the most effective is distance 

 from persons suffering from the disease. Where pellagra has prevailed 

 in the general population, there new cases may be expected to appear. 

 Sanitary disposal of human excreta would appear to be an important 

 means to prevent the origin of new cases of pellagra. Physical equipment, 

 such as sewers, piped water supply and screens are very important, but 

 sanitary instruction and particularly an adequate inspection service to 

 insure the proper use of the equipment must not be neglected. Lunatic 

 asylums with most modern sanitary equipment, still may have their 

 "untidy wards." 



General improvement in nutrition, especially the liberal consumption 

 of milk and of wholesome fresh meat, plays an important part in pre- 

 venting pellagra among those who have not yet contracted the disease and 

 also in preventing recurrences in those already affected by it. Such foods 

 probably act by enhancing the general vigor, but there may be a more 

 specific effect, possibly by altering the intestinal bacteria or by supplying a 

 deficiency of certain food elements or by furnishing an accessory food 

 factor essential to nutrition. 



Treatment 



In treatment one has to consider the period of the active attack and 

 the interval between attacks. Recovery from the attack occurs in about 85 

 per cent of the instances. In fact, more than half the attacks do not 

 cause the patient to go to bed, and the vast majority run their course to 

 recovery without any definite treatment. In those who do become bed- 

 ridden the death rate is fairly high. 



The indications are for supportive and symptomatic treatment. A 

 comfortable bed in a clean, pleasant and moderately cool room, with a 

 competent, interested and sympathetic nurse, almost insure recovery. The 

 lips, mouth, teeth and pharynx should be kept scrupulously clean. Irrita- 

 tion of the eruption is lessened by bandaging with an ointment of zinc 

 oxid, lanolin and vaseline. The diet should include milk as the principal 

 element. Every effort should be made to encourage the appetite, but over- 

 feeding to the point of distaste or nausea is dangerous. Food may be 

 refused for two or three days without a fatal outcome. Pellagrins are very 

 susceptible to suggestion, and the presence of recovered patients has a 

 real therapeutic value. Conversely, a pellagrin, surrounded by friends 

 or by nurses who regard ,the disease as horrible and necessarily fatal, 

 usually dies. 



Pustules, ulcers and sloughs of the skin require mild antiseptic wet 

 dressings. The diarrhea should not be interfered with, and it is not a 



