Lavinder says that many people have pellagra because they have some other condition and when this is cured the pellagra is also cured.
In truth, pellagra is very rarely a primary condition. We must then give careful attention to the predisposing causes which may not only be ancylostomiasis, alcoholism, or malaria, but, as well, various gynaecological or alimentary tract disorders.
With the colloidal silica etiology in view Allesandrino has recommended sodium citrate in treatment.
Goldberger has cited the following as showing the influence of diet:
In an orphan asylum with 211 orphans, 68, or 32%, had pellagra. These children were divided into 3 groups and given different rations, those under six years of age receiving milk and eggs, while those over twelve years were given meat, as they assisted in the work of the institution. The children between six and twelve lived practically on a vegetarian diet in which corn products and syrup preponderated with deficiency of legumes. Of 25 young children only 2 showed pellagra, and there was but 1 case in the 66 children over twelve years of age while the 120 between six and twelve gave 65 cases or 52%.
As the result of increasing the milk supply, so that every child under twelve years got a pint daily, also at least one egg daily, together with an increase in the use of beans and peas, as well as fresh meat, the disease was entirely eradicated. The corn elements of the diet were reduced but not excluded. There was increase in proteins and a decrease of carbohydrates.
As to the diet in pellagra Niles recommends the exclusion of all maize articles of diet. He recommends meat, eggs, milk or buttermilk with peas and beans. When intestinal symptoms are severe he gives barley gruel, rice-water, thick broths and dry meat powders. As a drug treatment for diarrhoea he uses bismuth beta-naphthol.
Babcock, recognizing the importance of the treatment of the pellagrous neurasthenia, recommends the Weir-Mitchell plan of prolonged rest in bed, nutrition, hydrotherapy and hygienic measures. “Fat and blood” should be our aims and he notes the value of cacodylate of soda in increasing fat. He also refers to the susceptibility to suggestion of pellagrins and is an advocate of psychotherapy.
Having in mind the vitamine deficiency view Voegtlin has treated cases of pellagra with extracts of substances rich in vitamines. Extracts prepared from fresh ox liver and fresh hog thymus caused definite improvement in pellagrins so treated while extracts of yeast and rice polishings seemed to be without value. It will be remembered that the glands of animals are rich in fat soluble A. For the burning of the erythema Niles recommends a lotion of calamine (4 drams), powdered zinc oxide (3 drams), in 1 pint of lime water. As regards climatic treatment the same authority believes that a colder climate is indicated and that a patient with pellagra should avoid hot weather for a year after all symptoms have disappeared.