1732 



PELLAGRA 



render the prognosis more unfavourable, as does continued residence 

 in a pellagrous area. 



Treatment. — There can be no doubt that the essential basis of 

 the treatment of pellagra is to remove the patient from the pel- 

 lagrous area in which he has been living to a non-pellagrous area; 

 and, secondly, to give a good and liberal diet, preferably without 

 any admixture of maize, although Devoto has shown that good 

 maize not merely does no harm to pellagrins, but is very suitable 

 for some of them, as it is their usual diet. If this is done, most early 

 cases quickly improve, and apparently are cured, but, unfortunately, 

 this is not so, because, even if they remain under these excellent 

 conditions, sooner or later a recrudescence occurs. These recru- 

 descences may be mild, but at any time they may become severe, 

 even when maize is excluded from the dietary. 



Arsenic. — This being so, it is obvious that some medicinal treat- 

 ment is nece".:sary, in addition to change of Iccality and diet, and 

 apparently the best lemedy is arsenic in some form. Of all forms 

 01 the drug, that most commonly in ute, and also much vaunted, 

 is ' aloxyl,' which is administered by intramuscular injection of 

 3 grains per diem. 



Other methods of giving arsenic are salvarsan, neosalvarsan, and 

 soamin. 



Other methods are the cacodylate of sodium, administered in 3-grain 

 doses by intramuscular injection every third day until three doses have been 

 given, and then every second day until three more closes have been adminis- 

 tered , and then increasing to 5-grain doses every second day until the symp- 

 toms have improved. 



Associated with these injections, it is as well io gi\e liquor 

 arsenicalis in small doses internally, and lO continue this inter- 

 ruptedly for some three months after the symptoms have dis- 

 appeared. In addition, it is as well to repeat the liquor arsenicahs 

 some weeks before the advent of spring, and to continue it inter- 

 mittently into the summer for a few years after an attack, in order 

 to attempt to guard against the almost inevitable relapse. 



Radio- Active Se^'MW.— Nicolaidi has devised an artificial organo-mineraUzed 

 radio-active serum from horse serum, together with all the organic and 

 mineral salts of the blood, in a solution saturated with carbon dioxide gas, 

 which was then rendered radio-active. This serum is administered by injec- 

 tions until twenty to twenty-five are given, when, according to the author, 

 supported by several eminent authorities, most remarkable improvement 

 in the cases resulted. 



Symptomatic Treatment. — The patients must be protected frcm 

 the sunlight by clothing, veils, hats, gloves, etc., and the deima- 

 titis must be treated by emollient lotions, such as calamine, scothirg 

 and dark ointments, such as ichthyol in lanohne. 



The indigestion should be treated by a mixture containing dilute 

 hydrochloric acid and infusion of gentian. 



The diarrhoea and dysentery should be treated as indicated on 

 p. 1854 for bacillary, or on p. 1834 for amoebic, dysentery. 



