GENERAL DISCUSSION OF PELLAGRA. 497 



weighing 1 kilo; salt and meat were given for a period of from sixteen to forty 

 weeks; free pamphlets relating to the cause and prevention of the disease were 

 circulated, with the result that 86 per cent of the patients were benefited to such 

 an extent that they could attend to their ordinary duties even in cases where 

 the disease was of from four to eight years' duration. In 1909 there were recur- 

 rences in 126 of the cases treated during 1907 and 1908. (Vienna letters.) (21, 22) 



No drug has been found to counteract pellagra. The best results, as 

 just indicated, have been obtained by excluding corn from the diet, giving 

 a liberal allowance including meats, and treating the eases symptomat- 

 ieally. Tonics are often administered. The skin lesions do not respond 

 well to local treatment. The exhibition of common salt is thought to be 

 beneficial. Arsenic in the form of Fowler's solution, arsenic trioxide, 

 atoxyl and soamin has been used, but reports of the results are very 

 conflicting, some men apparently obtaining good results, while others 

 believe that no beneficial effects are secured from its use. However, the 

 balance of evidence tends to show that Fowler's solution is of importance, 

 especially in nonasylum cases. Eeports regarding the administration 

 of atoxyl and arsenic trioxide combined' have recently been made and 

 encouraging results claimed (Babes), 15 but these have not been verified. 



Bearing in mind that pellagra is a disease which characteristically 

 recurs, it is evident that the physician must be exceedingly careful in 

 interpreting apparently good results from the use of any drug. War- 

 nock, 16 in 1907, believed atoxyl had a favorable action, but, in the follow- 

 ing year, he lost faith in its beneficial effects (possibly because of 

 recurrences). 



There is evidence tending to show that specific antibodies are developed in the 

 blood, and the serum of cured cases has been used successfully in the treatment 

 of typhoid pellagra (Antonini and Mariani)." Cole and Winthrop(2) report suc- 

 cessful results in 6 out of 9 cases treated by transfusion. In some of the cases 

 the blood of a cured pellagrin was used, but in most of them the blood was 

 taken from a healthy individual. Special reasons existed why the operation 

 would probably be unsuccessful in the three which were fatal. 



PELLAGRA IN THE PHILIPPINE ISLANDS. 



Mariano Agustin, of Cabeceria No. 10, of San Antonio, a hacienda of 

 the Compaiiia Tabacalera, and a barrio of Ilagan, Province of Isabela, an 

 llocano, was born in Batac, Ilocos Norte. He moved to San Antonio 

 about fifteen years ago. He is about 30 years of age and the father of 

 three healthy children, the. youngest of whom is between 3 and 4 years old. 

 Since moving to San Antonio, he has continuously lived in that place and 

 been engaged in growing tobacco. His family history is negative except 

 that his father died suddenly two years ago at about 60 years of age. 

 No history of serious illness could be elicited until the present illness 



15 Quoted by Lavinder. lc Quoted by Lavinder. " Quoted by Lavinder. 



