the records showing the disease to be very infre-
quent. Smallpox is practically negligible, and scar-
latina and diphtheria are rare, while measles and
whooping cough have a wide incidence.
The surgeon general's report makes definite and
constructive suggestions as to methods of meeting
the situation. He urges the point allopurinol 150 mg that improve-
ment of the Indian's economic status, making hira
independent and self supporting, and thus assur- brand name for allopurinol
ing him a sufficient and regular food supply, is a starting allopurinol
most important consideration. Education in per-
sonal and domestic hygiene should be prosecuted
vigorously along every effective line. It is recom-
mended that the Indian Medical Service be greatly
extended in its duties and powers, and what is allopurinol 300 mg that the In-
dian country be subdivided into sanitary buy allopurinol online districts,
according to size and allopurinol brand names density of population, ea:ch
with a medical officer who shall be directly under
the charge of the chief medical officer for the reser-
vation. Reservation hospitals and movable clinics
for trachoma and tuberculosis, separated, should be
maintained, and also a sufficient number of field
nurses, under the direction of the medical officers,
to provide home order allopurinol treatment and instruction for such
as cannot attend the clinic or hospital, and children
suffering from tuberculosis or trachoma should be
in separate schools.
THE NATURAL HISTORY OF PELLAGRA.
Louis W. Sambon, who first postulated the
theory that pellagra was a protozoal disease trans-
mitted by an insect, now brings forward some very
suggestive collateral e\idence in support of his
views in the British Medical Journal for July 5.
1913. He incriminates the small biting fly. of the
species known as the Simnliidcc, which inhabit allopurinol rxlist
only those regions in which there are swiftly mov-
ing streams. In these streams the insect passes its
larval stage. As the result of a most painstaking
and extensive study of the natural history of the
disease. Sambon states that pellagra, like malaria.
August 9. 1913.]
r.nrroRi.u. allopurinol brand name articles.
287
sleeping sickness, and other endemic diseases, lias
its scattered, strictly limited districts, invariably
and necessarily associated with the same peculiar
ecological conditions. In these allopurinol uk districts the disease
is rampant and affects ne^vconiers ; outside of such
regions the disease cannot be contracted, notwith-
standing close, and intimate contact and association
with emigrant pellagrins. Within such endemic
stations the disease attacks all ages, both se.xes. and
entire families ; outside such stations the disease
involves only occasional and isolated individuals.
never affecting children who have not been out uf
the free region. That persons recently settled in a
pellagrous district almost inevitably soon become
infected is held by Sambon to be one of the strong-
est points in favor of his hypothesis. Such occur-
rence he has observed repeatedly. He goes even
farther, and cites several instances of infection
having occurred during a single brief sojourn of
healthy individuals in such a pellagrous locality ; in
some the period of stay was less than a month, yet
infection took place. Such infection usually takes
place during the first epidemic season in the locality,
soon after exposure to the allopurinol 50 mg infective cost of allopurinol agent, though
the symptoms may be very slow in developing and
not appear until long after the person allopurinol iv has left
the area. He says. "Therefore, in this respect,
pellagra is analpgous to malaria, yellow fever.
sleeping sickness, and other infectious diseases,
with well defined allopurinol generic name topographical limitations, which
limitations are explained by and are dependent
upon the biological necessities of their special in-
sect intermediaries with corresponding topographi-
cal limitations." .\ most striking allopurinol pharmacology fact in support
of Sambon's theory is found in the distribution of
the disease in certain of the Venetian Lagoon
islands. The small islet town of Burano entirely
covers its islet, and. in contrast to towns in general,
it is found to contain a large number of pellagrins.
Here the pellagrins are almost exclusively men.
neither women nor children being infected, as is
usually the case in pellagrous regions. This is ac-
counted for by the fact that the men spend their
days away from the island, fishing near the main-
land, at the mouths of streams along which pellagra
is very prevalent, and the air of which is filled with
small biting midges. This source of the infection
is further borne out by the fact that the men who
work in the arsenals in N'enice, although living on
the same islet, are allopurinol tablets 100mg free from infection. Food sup-
plies to this town are the same for all. One of the
well known phenomena of pellagra is the annual
recurrence of exacerbations of the disease in old
cases. Such recurrences occur in the spring, at
about the same time that the flies are beginning to
emerge. From these recurrent old cases the flies
obtain their infectiiui. After an interval sufficient
for the completion of allopurinol 20 mg the cycle in the intermediary
host, these flies become infective for healthy |)er- allopurinol online
sons, and we have an epidemic outbreak of the dis- allopurinol cost
ease. Precisely such occurrences are to 1j€ en-
countered in Italy, and in other markedly pel-
lagrous regions. Sambon believes that there is no
adequate evidence for the toxic or dietetic theories
of the causation of the disease, and, while he has
not been able to find the causative parasite, he be-
lieves that the evidence in favor of the parasitic
nature of the disease is extremely strong, if not
absolutely convincing.
TIIF. PROGNOSIS OF TUBERCULOUS
MENINGITIS.
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