908 WARD J. MAcNEAL 



centra-indication to a liberal milk diet. Peripheral neuritis and paresis 

 require massage and precautions to avoid deformity. Mental derangement 

 should be expected in all severe attacks. Physical restraint usually only 

 aggravates the difficulty. Of the hypnotics probably chloral is the most 

 effective. Morphin is not recommended. Mental cases require vigilance, 

 for there is occasionally a real suicidal tendency. The noisy delirium of 

 these patients renders their treatment in a general hospital rather 

 difficult. 



Complicating disorders are often of more importance than the pellagra 

 itself. Tuberculosis, chronic alcoholism, pelvic disease in women are 

 common complications. In institutional pellagra, undernourishment from 

 prolonged lack of adequate food is common, and it is one of the most 

 easily corrected complications. 



After recovery from the active attack, every effort should be made to 

 keep the general resistance of the patient at a high level. Alleviation of 

 debilitating disorders, relief from overwork, administration of tonic drugs 

 and especially removal to a cooler climate are to be recommended. The 

 particularly dangerous period is the spring and early summer next fol- 

 lowing. Public charity may improve the resistance of poverty stricken 

 pellagrins but sometimes the handicap of a particular patient cannot thus 

 be relieved and this is usually true of well-to-d > ppllagrins. Such patients 

 require regulation of their lives for several years. 



