PELLA'GRA is a disease chiefly affecting the skin, and particularly prevalent amongst the peasantry of the north of Italy. According to Dr. Holland (whose description in the Sth volume of the ' London 3Icalico-Chirurgica1 Transactions,' is by far the best that has been pub lished in this country), the disease affects the poor almost exclusively, and among them chiefly those who are occupied in the culture of the irrigated rice-grounds, and in other branches of agricultural labour. It usually appears first as a disease of the skin, breaking out early in the spring, with slightly elevated shining dark-red blotches on the hands and feet, and sometimes on other parts of the body, accompanied by a slight pricking sensation. Soon after, small tubercles arise upon the inflamed blotches, and the skin becomes dry and scaly, and often deeply cracked. Desquaznation gradually takes place, and, towards the close of the summer, or even earlier, the skin usually appears quite recovered. This, at least, is the usual progress of the first attack ; and there is seldom any greater general disturbance of the health than debility, irregular pains of the body, loss of appetite, and emaciation.
In the next spring however the disease usually recurs, with a great aggravation of both the local and the general symptoms, and especially with an increase of the nervous affection, and great anxiety and de spondency. In succeeding years it regularly returns with increased severity in every spring, though it does not, as at first, leave the patient nearly healthy in the autumn and winter. After the third attack, or sometimes later, the weakness of the patient commonly becomes ex treme, and he has many symptoms similar to those of scurvy, with constant diarrheas, dropsical swellings, and various nervous disorders. Its most marked character however is the total despair which fills the patients' minds, from which nothing can rouse them, and which, if the disease does not prove fatal by its effects in debilitating their bodies, generally leads to incurable idiotey or mania. In the lunatic hospital at Milan, Dr. Holland found, among 500 patients, more than one-third in whom the insanity had been the result of pellagra, and " even this statement gives little adequate idea of the nature of its ravages. The public hospitals are far from sufficient to receive the vast number of persons affected with the pellagra ; and the greater proportion perish in their own habitations, or linger wretched spectacles of fatuity and decay." The period during which the disease may continue is uncer tain ; but after the third or fourth year, there is usually little hope of benefit from any means that can be adopted. The diseases to which, in
its later stages, it may lead, or with which it may be complicated, are of the most varied kinds; and there are few which, in different cases, the Italian physicians do not ascribe to its influence.
The pellagra prevails chiefly in the provinces of Lombardy between the Alps and the Po, and especially in the district between the lsago Maggiore and the Lego di Como. Among the inhabitants of these parts it Las now been supposed to have existed for upwards of a cen tury : here it appears first to have become an object of attention to physicians, and hence to have spread slowly to the Venetian and other northern provinces. It is distinctly an hereditary (Escape ; but there in no sufficient evidence for believing it to be propagated by contagion. Its origin and prevalence are rather to be referred to the condition of poverty in which the peasantry, though the cultivators of one of the most fertile countries in Europe, are compelled to live. Their ordinary diet consists of vegetables, which are usually of inferior quality and ill-prepared : their bread, which is principally made of maize, is for the most part 111-fermented, and often deficient in salt. They rarely have any animal food, and their poverty almost entirely precludes the use of the wino( of their own country. Similar wretchedness is evi dent in their clothing, in their dwellings, and in the deficiency of all the commonest comforts of life. They are thus constantly predisposed to the attacks of diseases of all kinds, and espt•eially are unfit for ex posure to the influence of a burning sun during severe ngricultuml labour. Hence the disease usually makes its first appearance when the peasants are at their most active work, and when the heat of the days is increasing; and hence it is usually first characterised by a dis ease of the skin, which however is but a alight ludication of its future more serious and varied effects.
The treatment of pellagra offers little prospect of success, so long as the patient remains exposed to the same influences by which he was rendered subject to its attack. The course usually adopted by the Italian physicians for the patients who are admitted into the hospitals is a liberal allowance of wholesome food, and the ailminieration of wine and of tonics of various kinds. There seems little reason to doubt that if wholesome food could be constantly secured for the poor, the pelLagra would speedily disappear from all the districts in which it now so fatally prevails.