develop on the hands, fingers, and thighs, of white females, from twenty-four hours to two days before death. Their occurrence is indicative of profound infection, and is usually associated with moribund states. The temperature curve is void of typical features, more often it is normal or may be sub-normal or go as high as 105 degrees. The pulse appears to bear some relation to the degree of intoxication and extent of mental involvement. In my experience, there has been a striking absence of vaso-motor influence in relation to the skin and its eliminative function; the surface, even in the delirious forms, being dry and scaly. I have observed multiple abscess in two cases. poor, in some cases ravenous. The urine has shown nothing musculature in mild cases presents the picture of fatigue toxaemia. The reflexes may be exxagerated, diminished or absent. Sensation among the insane is quite variable -it is hard to determine whether there is any true alteration or not. In cases where the spinal-cord seemed to be involved, I have seen marked intention tremor simulating pseudo-convulsive attacks.

The appetite is usually Vomiting is infrequent. of clinical value. The

In considering the neuro-psychic phase of pellagra, it will be expedient to study, first, the two conditions together, without attention to their strict division into separate clinical entities. Indeed, I might say, seldom do we have in Georgia an organic disease of the nervous system, of pellagrous origin, without invasion of the psychic realm. On the contrary, so intimately associated are the two maladies in many of their clinical aspects, that we are often perplexed to know which, if either, merits the place of priority in occurrence. An illustration will more adequately explain the confusion which has arisen in the author's mind as to whether a primary neurosis, of a non-pellagrous etiology, might exhibit a secondary symptom complex, simulating the pellagrous syndrome. Take, for example, amyotrophic lateral sclerosis complicated with insanity-the two diseases

may progress with the preponderance of symptoms favoring a spinal cord lesion as the primary site of invasion. The mental state may vary from mild confusion to complete delirium; the reflexes may be exagerated with a variable Babinski and Gordon paradox; the patient gradually develops a sore mouth, with alternating diarrhoea and constipation; later the skin lesions appear with variable intensity. Have we pellagra with amyothrophic lateral sclerosis and insanity as complications, or have we insanity and organic cord disease with a pellagrous complex? The cord lesions are usually confined to the lateral columns; the posterior of sensory may also be invaded, especially in the tabetic forms. The cortical cell changes, in the insane, are probably dependent to some degree upon the type of psychosis and its duration.

In our American nomenclature, we have no distinctive classifications for pellagrous insanity; the different psychic alterations falling under such category as the symptom complex may indicate;-scientifically speaking, all psychoses of pellagrous etiology-excluding organic diseases of the brain and nervous system, should fall principally under the intoxication of infective exhaustive group. However, for the sake of clearness, I have divided the classifications, generally speaking, into four headings. The conclusions, as regard the separate mental reaction states, having been obtained by carefully isolating such symptom groups as are more of less peculiar and constant in the different insanity phases.

First-The case showing a profund intoxication, with early delirium, high temperature range, with symptoms pointing to acute organic changes in the cord or brain. Controlling phase: Complete or incomplete psychomotor suspension.

Classification: Acute intoxication psychosis.

Second-Those cases of an apparent mild infection with some mental anxiety, apprehensive hallucinosis, gradually increasing mental confusion.-finally delirium -temperature subnormal or slightly elevated,—this type

usually covering six weeks to two months or more, ending in a slow but progressive exhaustion.

Controlling phase: Psycho-motor Retardation-Excitation (active passive).

Classification: Infective Exhaustive Psychosis.

Third-Those cases showing symptoms of mild melancholia, chronic in character, with remissions and exacerbations, impending fear, suicidal tendency, due more to apprehension than self-reproach; temporary recovery. Controlling phase: Psycho-motor Retardation (inconstant, passive).

Classification: Symptomatic Melancholia.

Fourth-Those cases of mixed type showing at times symptoms of depression, exaltation, confusion, impulsive acts, apprehensive hallucinosis, exhaustion, slow mental reduction,-including the Dementia Praecox Class.

Controlling phase: Psycho-motor Retardation-Excitation. (Active, passive, negative).

Classification: Manic-depressive-allied states.

REFERENCES

1. Public Health and Marine Hospital Service Report, 1909.

2. State Board of Health, Georgia Report, 1908.

3. Journal Record Medicine (Atlanta 1909).

4. Clinical Feature of So-called Pellagra. (N. P. Walker, Georgia).

5. New York Medical Journal, (March 1909). 6. Edinburg Medical Journal, (September 1909). 7. Insanity and Tuberculosis in Southern Negro Since 1860, (T. O. Powell, Georgia).

8. Report Georgia State Sanitarium, (1897 to 1909).

DISCUSSION

Dr. L. G. Hardman.

I would like to call attention to one statement especially in Dr. Mobley's paper, and that is when he

says we have good corn in this section of the country. The great bulk of corn is shipped in. It is rather the exception than the rule to find any farmer that doesn't ship in corn almost every year, and that corn is oftentimes damaged corn. You may take the city of Athens, or any small town and you will possibly find corn being dried there, if we feed it to the stock, the stock dies, the people eat the meal that is made from it. If we take the corn that is ground and cured in Georgia it is safe to eat it. A great bulk of the corn, or I might say the larger portion is damaged. I have in mind one warehouse that I was in yesterday that had the whole floor covered with corn sold as good corn. The U. S. government has investigated and they find that 6 per cent of corn meal could be put in flour hardly without detection. Another thing which occured in an adjoining county in which I live. There is a gentleman there whose wife had a disease they hardly knew what. She was examined and they diagnosed pellagra. This gentleman said it was untrue his wife did not eat corn bread at all. He left his wife in an institution of this State. He went back home and investigated. He found one of his renters had planted the corn and had gathered it and he found the corn was blue and he had fed it to his hogs and they would not eat it. He had this corn ground brought it back and set it in the pantry. His wife got the meal out of the large sack and baked the bread and she ate it. None of the other family eat of the corn bread that was cooked from that meal. She was the only one that had the disease. He told me he wrote the doctor he was certainly correct.

MUNICIPAL CONTROL OF TUBERCULOSIS

R. P. Izlar, M. D., Waycross, Ga.

It is evident that a subject as wide as that indicated by the announced title of the present paper can only be sketched on the broadest lines. It may be possible, however, to summarize certain of the lessons to be derived from the complex experiences of the last few years. The basis of the campaign is the clinical discoveries of the past twenty years.

If tuberculosis is an infectious disease, the cause of which is known and can be isolated, it is necessarily preventable. The organized effort, therefore, of the present day is in the direction of this prevention. That one means of prevention is the destruction of the cause is obvious. That the ability of individuals to resist an attack is a matter of observation and experience. Our efforts, therefore must be directed along either or both. of these two lines, to eliminate the centers of infection and to increase the resisting power of individuals. The responsibility for action must be placed primarily and squarely upon the local public authorities. The private. measures, other than those of education initiated by voluntary associations or individuals are all to be regarded as temporary expedients only, justifiable so long as public authorities fail to make proper provision, or as means of educating those authorities to a sense of their responsibility. With our political organizations, such as they are, it seems impossible to attack the disease in its recognized stronghold on a national scale under direction of the National Government. The Tuberculosis Campaign must be regarded as one of education and stimulation.

Experience has shown that municipal control properly