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the result of trophic changes, for which Dr. Cheatle has suggested the name In certain cases it would be almost impossible of "biotripsis," or "life wear."

I have not seen to distinguish this condition from the vestiges of a spent pellagra eruption.

A terrible association or complication of pellagra is gangrene, it myself in the West Indies, but Dr. C. J. Manning has reported it as occurring in the Barbados Lunatic Asylum. In a paper read at the First American Confer- ence on Pellagra, Columbia, 1909, he describes it as actually pertaining to the pellagra syndrome. He says:-

"The patches on ankles, dorsum of feet, etc., if the patient is white, soon have a purple blotched appearance, and appear to have been steeped in claret. They are indeed a kind of purpura, they form blebs, break down, and the epithelium atrips off, and this is why I call the disease psilosis, from 'bare, stripped.' Gangrene invades the discoloured area, and the cutis vera is the next to separate and come away 'in strips.' The muscles follow suit, and even the tendons hang in shreds about the parts that break down so rapidly. The buttocks soon have discoloured areas, over the trochanters, sacrum, etc., and after a deep burrowing gangrene sets in over the glutei muscles, horribly offensive, sloughs separate, bit by bit, and the patient sinks exhausted, a miserable and pitiable object, and death is indeed a welcome visitor."

In pellagra, gangrene may either involve the injured skin areas, the mucous membranes of the inflamed mouth, and external genitals, or the extremities, just as in typhus, measles, scarlatina, diphtheria, diabetes, and syphilis. Probably it is more I am inclined to likely to occur in cases associated with syphilis and dysentery, believe that many cases of "St. Anthony's fire" occurring in Spain and other were neither erysipelas nor countries from the tenth to the eighteenth century ergotism, but gangrenous pellagra. At one time hospital gangrene used to be a very frequent complication of all kinds of infectious diseases, as well as of wounds and ulcerated surfaces; fortunately, nowadays, it has been wonderfully reduced by improved hygiene, trained nursing, and surgical cleanliness.

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practicable. I should also be interested to learn why it is that the Medical Officers at Richmond, Balaclava, and Christiana have treated no cases of yaws with salvarsan.

5. I observe that the District Medical Officer at Annotto Bay states that the method of administration adopted was intramuscular injection into the buttock, and it may be of advantage if attention is called to the success of intravenous injection. When this matter was referred in 1912 to the Advisory Committee of the Tropical Diseases Research Fund they pointed out that the intravenous mode of treatment was certainly much more effective, provided that great care was taken in the technique of the operation; but that it was essential that it should be administered by a Medical Officer who was competent to do so, and that a Medical Officer without experience might do great harm.

I have, &c.,

2931

(No. 23.) SIR,

No. 102.

BARBADOS.

L. HARCOURT.

THE GOVERNOR to THE SECRETARY OF STATE. (Received 23rd February, 1915.)

Government House, 29th January, 1915. WITH reference to your despatch No: 56, of 2nd May, 1914,* and previous correspondence relating to Dr. Sambon's visit to Barbados and his investigation into the disease of pellagra, I have the honour to forward herewith an extract from the quarterly report of the Public Health Inspector, Dr. Hutson, for July-September, 1914, and extracts from the sanitary reports of the Parochial Medical Officers for St. George and St. John, all dealing with the increase of pellagra.

2. Any information which throws light upon the utility of a central institution will be greatly valued.

PUBLIC RECORD OFFICE

Reference:-

muimmimC.O. 885

23 PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO

(No. 53.) SIR,

No. 101.

JAMAICA.

THE SECRETARY OF STATE to THE GOVERNOR. [Answered by No. 120.]

Downing Street, 22nd February, 1915.

I HAVE the honour to acknowledge the receipt of your despatch No. 24, of the 21st January, forwarding reports upon the progress made in the voluntary treat- ment of yaws by salvarsan.

2. I have read these reports with interest, noting with satisfaction the success which, in some medical districts, has attended efforts to cope with this disease. I agree with you that the evidence furnished by these reports does not justify an immediate recourse to compulsory methods, and I am of opinion that a fuller experience of the results of voluntary treatment is called for before any change in the present policy can be considered.

3. At the same time, I feel strongly that District Medical Officers should be encouraged to use every endeavour consistent with the maintenance of the voluntary system to induce persons suffering from yaws to submit to treatment by salvarsan and to persevere in such treatment. In some other Colonies as soon as the reports of cures had become generally known a great demand for the treatment arose: and pos- gibly a greater publicity would have the same effect in Jamaica. I should be inter- ested to receive another report in a year's time showing what further progress may by then have been attained.

4. Meanwhile, I should be glad to be informed whether the twelve districts in respect of which reports have been furnished are the only localities specially affected by this disease, or whether, although it has not yet been found possible to extend the treatment to the remaining districts, it is nevertheless intended to do so when

* No. 98.

Enclosure in No. 102.

I have, &c.,

L. PROBYN,

Governor.

Extract from a Quarterly Report of the PUBLIC HEALTH INSPECTOR, JULY-SEPTEMBER, 1914.

It is strongly held by some parochial authorities that a central institution for the treatment of this disease should be established by the Government, as in the case of insanity and leprosy. A central institution would be most desirable on account of the isolation of cases that would result, and also as affording opportunities for studying the disease in bulk.

This course can only be recommended, however, on the assumption that the parochial authorities would undertake part of the cost of upkeep of such an instita- tion, as, for example, the payment of sixpence per day for every inmate from each parish. Assuming that a pellagra hospital would cost one shilling per inmate per day, the parochial authorities would thus be paying half the cost of upkeep.

In Italy, where the disease is widely spread, there are such hospitals devoted

to its treatment.

It appears that the time is ripe for a conference between the Executive and the parochial authorities on this subject, in order that the facts of the case may be freely ventilated and public attention called to the situation that exists.

* 18558 not printed.