SYSTEMATIC TREATMENT— PROPHYLAXIS 1733 



With regard to the nervous symptoms, the irritation on retiring 

 to bed and the sleeplessness should be remembered, and combated 

 with cool bathing, and, when necessary, by doses of bromides, 

 which, however, are apt to increase the depression. 



The vertigo should be borne in mind, and precautions taken lo 

 prevent accidents being caused by it. 



The mental condition should be cheered by pleasant surroundings, 

 and in severe cases a watch taken to prevent the suicidal tendencies 

 taking action. 



Diet. — ^The diet must vary with the condition of the digestion 

 and the bowels, and during attacks of dysentery or diarrhoea that 

 laid down on p. 1858 should be adopted. 



Complicatians. — Search should be made for signs of ankylosto- 

 miasis, ascariasis, etc., tuberculosis, malaria, etc., and these should 

 receive their appropriate treatment. 



Typho Pellagra. — ^This serious complication, which is really only 

 an attack of enteric fever in a pellagrin , in whom the acute symptoms 

 at once become aggravated, must be treated by a combination of 

 the treatments laid down for enteric fever on p. 1399, and pellagra, 

 as above. 



Prophylaxis. — As the setiology of pellagra is unknown, it is 

 obvious that remarks as to prophylaxis must be more or less specu- 

 lative. It does not appear to be directly contagious, and therefore 

 isolation, quarantine, etc., appear to be useless. In accordance with 

 certain setiological views, it is advisable to attempt to avoid being 

 bitten by flies in the early morning or late evening in the endemic 

 areas by the use of protective veils, fiy-brushes, etc. Protection 

 against the sun, as described above, is also of great importance. 



It is obvious that the consumption of diseased or damaged maize 

 must be injurious, and the action taken by the Italian Government 

 to prevent the sale of bad maize is not merely highly commendable, 

 but must be most beneficial to the community at large. 



Further, the excellent attempt to find out every pellagrin by 

 means of local lists is good, as it enables the Government to know 

 exactly the condition of this dreadful malady, provided the lists 

 are carefully compiled; on the other hand, if these lists are in- 

 accurate, they may result in much misconception of the incidence 

 of the disease. The provision of one good meal a day to poor 

 pellagrins during the spring and autumn is, in our opinion, highly 

 to be praised. That these meals are good, we can certify from 

 personal experience. We fail, however, to see the utility of the 

 free distribution of salt, but it does no harm. 



The methods adopted by the ItaUan and other Governments may be 

 summarized as follows : — 



T. Laws and Regulations. 



a) Prohibiting the importation and sale of spoiled corn. 



b) Government inspection of all corn dried, stored, or consumed. This 

 includes the erection of public storehouses. 



(c) Provision of desiccating plants to dry corn. 



