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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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