ble home to an American boy; a writer offers to share his "den" with an Ally; an artist, his studio; here a clerk in a shop says that "his children may help to make up for a humble lodging in making some lad feel at home over here." And, thus, offers flowed in from everywhere.

I but recently returned from my furlough, spent in Nice, on the Mediterranean, which has been created one of the greatest of the leave-areas, and there I found an organization of marvelous variety and efficiency.

Out in the ocean, bordering the Promenade des Anglais, stands the Jettée Promenade, a great palace built for the amusement of the people of Nice. This building has been taken over for the American Army. Two bands play daily in the two great halls forming the two wings and separated by the width of the main building, which contains a theatre, concert-hall, dance-hall, where an orchestra plays for dancing every afternoon and evening, and a great cafe with numerous tables where refreshments are served at cost, while a canteen supply-store sells all sorts of things including tobacco in every form, candies, and sweets. This building is reserved exclusively for the soldiers. Officers are not admitted.

On the Place Massina, there is a beautiful theater for officers offering a great variety of free nightly performances. Also the first floor of a beautiful building, consisting of a dozen rooms, fitted as a club, with an enormous hall for dancing that will accommodate 200 couples, where an orchestra plays from 3 to 6 and from 8 to midnight. This club is constantly crowded, and here there is demonstrated a working-agreement between the Army authorities and local residents that is productive of most excellent results.

No lady is admitted, except by a personal card, to secure which, she must furnish her name, address, and two city references. This application is turned over to the local Committee of French Homes, who investigate and pass upon the qualification of the applicant. By this means, all undesirable "ladies" are excluded and, as a result, the family of the prefect, the mayor of the city, and all the leading families frequent the club and join in helping to entertain visiting officers. As a result of these casual

acquaintances, many of these officers are invited to the leading homes of Nice.

Now many Americans will learn to know French women as they never knew them; not, the painted dolls they meet in places of amusements, but, the proud and wonderful women that helped to keep up the courage of absent husbands and sons, whose delicate hands knew how to tend dreadful wounds, whose fragile strength never grew weary of long days beside the sick and dying in the hospitals. They will learn to know girls as pure and sweet as their own, and, thanks to this social revolution, the timeworn prejudice about "frivolous French women," which the American traveler has related upon his return from a trip abroad, may be corrected.

Paris, France.

B. SHERWOOD-DUNN

"SUCCESSFUL COLLECTING"

In the November, 1910, number of CLINICAL MEDICINE, there appeared an article contributed by the late Dr. William J. Watson, entitled "System for the General Practitioner." In the closing paragraph of this article, on page 1205, the author referred to two little books, one titled "How to write Letters That Win," and the other, "Successful Collecting."

Some correspondents in India are anxious to secure both these booklets. It has been possible to locate the first-mentioned one, but, no one consulted could refer us to the publishers of the book on "Successful Collecting."

If any of the readers of CLINICAL MEDICINE can help us out in this respect, they will do us a great service.

PELLAGRA, AND ITS TREATMENT

Pellagra, or erythema endemicum, as it is also known, is a disease, which, during the past ten years, has been gaining ground in our country, previous to which time it prevailed, principally, in certain European countries. I encountered the first case of pellagra in my practice in the year 1907, but, since then, have had to treat a number of others.

In every instance at the time that the victims presented themselves for treatment, the skin manifestations were the first symptom to cause them to seek medical attention. At the close of winter and

we observe a tendency toward atrophic thinning. To be more specific, the first appearance is a dark-red, discoloration, this, later, changing to a dark-brown or bronze. It makes its appearance upon the uncovered portions of the body (hands, wrists, and up to the elbow, if short sleeves are worn; neck and face into the margin of the hair). The skin of the face at first is thin, but, gradually thickens. Many patients complain of an intense itch

pressed by some, a feeling as if needles were being pricked into the back of the hand. To this, there were added faulty digestion and nutrition, a feeling of lassitude, headache, great fatigue, vertigo, and pain in the epigastrium followed by diarrhea. A feeling of weakness and indisposition would continue throughout the summer and autumn until cold weather set in when all conditions would begin to improve and quite disappear, until about the middle of March, when they would reappear in a more aggravated form.

Observation has taught me that, in the majority of cases, the cutaneous manifestations are the last symptoms to appear. The skin-disorder seems to develop in three stages. First, your attention is directed to a congested condition of the skin, giving it a thick, spongy feeling; second,

ing and, later, of impairment or loss of sensation.

In a few cases there is an inflammation which seems to affect the superficial layers of the skin and, in others, to extend to the deeper strata. The epidermis desquamates, the amount greatly varying in different patients. The skin may, at some time, have a fissured appearance, some

what shriveled and senile. Sometimes vesicles, bullæ, and petechiæ may be associated with the other manifestations.

All of the foregoing features become more pronounced with each successive attack, and all these manifestations may be repeated year after year, while each succeeding year may add entirely new symptoms, until, at last, there becomes noticeable decided muscular weakness ac

companied by mental deficiency and a pronounced despondency or melancholia.

In the advanced stage, when the skin presents the dark-purplish red or brown appearance, there may be present extensive exfoliation, while the fingers assume a drawn, claw-like flexed position, and seem immobile. The patient gradually becomes debilitated and very greatly emaciated, brought about by the faulty digestion and the resulting diarrhea, in part,

however, probably owing to the involvement of the cerebrospinal system.

After the patient has had several annual attacks, the pulse becomes weak and thready; there is continual muscular weakness and pain in the head and in the spinal column. Sometimes a very pronounced stupor is noted, which not infrequently eventuates in insanity, death ensuing sooner or later.

I have found this disease to occur most frequently among the poor classes, although the wealthy are, by no means, immune against its ravages. It has been found in nearly all European countries, Italy and Roumania leading. Pellagra was at first thought to be brought about by the incessant use of corn-meal bread, but, later and more thorough investigations have proven this idea untenable. This, also, has been my own experience. Some of my patients suffering from the disease have never been users of corn-bread.

I am inclined to the idea that insanitary conditions and surroundings have much to do with its etiology. Still, I must admit that among some of my patients the sanitary conditions and surroundings were excellent, they being among the well-to-do and even wealthy. In all of my cases, without exception, I have found the nutrition impaired. However, after all, I must confess that still I am at sea as to the real cause of this insidious scourge.

The deranged condition of the central sympathetic nervous system I believe to be very largely caused by overwhelming amount of toxins produced in the intestines and thrown into the general circulation. The cutaneous changes I attribute to the mild congestion and irritation and to the atrophy of the rete.

In mild attacks, a favorable prognosis may be safely given provided a carefully selected diet and sanitary surroundings are being ensured. Severe cases, as a rule, prove fatal, with a duration of from three to seven years; others may be prolonged to ten or fifteen years.

As for treatment, I do not claim to have any specific. The main, and chief, condition is, to provide the patient with the proper food and good hygienic surroundings, together with efforts to improve the general health.

Medicinally, I have accomplished the best results with arsenic, iron and sodium. The best results will be attained by admin

istering these agents intramuscularly, using them in the form of iron arsenate and sodium cacodylate, as put up commercially in ampules. I administer the two alter nately, giving the iron arsenate one day and the sodium cacodylate the next.

Let me describe two cases from practice.

Case 1. Woman, age 35, married, no children. Father dead, at 65, of asthma; mother living, age 60, health good; four brothers living, in good health; three sisters living, health good; no brothers or sisters dead. She had all the diseases of childhood; health was good up to the age of 30, when the present disease made its appearance. Had lived in Idaho for five years, was living there when the skin manifestations first appeared on hands and face, and up to the time of my examination had had three returns (each spring).

This particular case differed from my others, in that it was worse upon the face and neck than upon the hands and forearms. Her face was horrible to look upon, with no resemblance of her former self, to the extent that she was not recognizable to friends, who had been intimate with her. She stated that she felt in perfect health during the winter months, but, about the middle of March the trouble would make

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its appearance. I pronounced hers a typical mild case of pellagra; and put her upon the iron, arsenic, and sodium course. improved from the first and, by the following December, her trouble had entirely disappeared. However, before spring, she left the community and I lost sight of her, not knowing as to the permanency of my treatment.

Case 2. This patient who now is under treatment, is, and has been, the most interesting, for many reasons, of any that I have ever examined. With this case, I submit several photographs, presenting back and front views. They will show more than I can hope to express in words.

Man, age 57; height, 5 feet 11 inches; weight, 88 pounds. Father died, at 62, of pneumonia; mother living, age 75, in good health; two brothers living, aged 40 and 45, respectively; one sister living, aged 42, health good. One brother died of pneu monia; one sister died of cancer, at 45; one sister died in childbirth.

He has had all of the diseases of childhood, has had pneumonia, typhoid and scarlet-fevers. With those exceptions, his

Fort Worth, with but three doctors and nurses in attendance, 3,000 persons were vaccinated against typhoid fever in one day-a stupendous achievement! Clinics for maternity-cases and child-welfare were established. Hundreds of persons, many of whom could not otherwise have afforded it, were thus enabled to secure medical advice, gratis.

The majority of such persons were wofully ignorant of the proper care of themselves and of their children, and, to such persons, the nurses, in a kindly, helpful, impersonal way, taught the simple and sanitary methods of hygiene, food preparation, and so on. Not the prescribing of medicines, so much as the giving of medical advice, together with the distribution of educational propaganda and the securing of more sanitary living-conditions, was the principal work of these clinics in the United States. In Europe, the great needs of the population forced them a step forward.

When the Red Cross Commission arrived in Russia, in July, 1917, the then Premier

Kerensky was in power. He gave them a cordial welcome, and activities were immediately started up. Infant-mortality was high and to combat this evil a system of clinics was opened. These did most efficient work. During the month of October alone, the contents of 50,000 cases of con. densed milk were distributed through the clinics; for, undernourishment was found to be the principal cause of ill-health and disease. These clinics were in operation in all the larger Russian towns until the tumultuous arrival of the Red Guard forced the Red Cross from the country.

The especial sphere of activity in which the French clinics operated was among the tuberculous refugees and the children. At Évian, through which the repatriated people passed in droves, 13,708 children were examined, in two months, at the Red Cross clinic. Under Doctor Maynard Ladd of the Red Cross, clinics were opened in the factories, town-halls, and schools of France and, in these, 1,765 children were treated during a single month. In the snools in Nesle, 500 children were reached month