nuclear chromatolysis. There was marked chromatolysis of the cells of Clarke's columns. The Betz cells of the cortex and the cells of Purkinje showed similar changes, but in a less degree.
Diagnosis.— Of course, doubtful cases are occasionally encountered, but a localized erythema associated with nervous symptoms, particularly mental symptoms, great debility and seasonal recurrence, in a person in or coming from a pellagrous district, can hardly be confounded with any other disease.
Treatment.— Arsenic in large doses is now regarded as a drug of value in the treatment of pellagra. Fowler's solution by mouth 5 drops two or three times daily, increased by 1 drop daily until evidences of a toxic nature are induced or hypodermically in combination with carbonate of soda (3 to 5 gr.) two or three times a week, is said to be productive of good results if given early in the disease, and, of course, combined with good hygienic conditions and removal from the endemic area. Atoxyl, soamin, and salvarsan have also been commended. No case should be regarded as cured until the patient has been absolutely free from all symptoms for at least two years.
In its advanced stage the disease is practically incurable. In Italy the Government, basing its action on the maize theory of pellagra, has provided grain drying appliances for bakeries, and other hygienic advantages, including better house accommodation, also special asylums (pellagrosari) for the treatment of the disease in its earlier stages. It is stated that a decrease of the malady has followed these measures. Notwithstanding, pellagra seems to have increased of late years, especially round Perugia and in other districts of northern Italy in which these measures have been most strictly carried out.
As there has been no instance of a nurse or attendant in any of the lunatic asylums of the United States acquiring the disease, it is evident that pellagra is not a directly communicable disease, and that therefore any apprehension on this account is unwarranted.
