Vol. 60, 1909 - University of North Carolina at Chapel Hill

72 THE CHARLOTTE MEDICAL JOURNAL
casesof "pellagra-sine-pellagra," I havenot case of acute pellagra in a child eleven
noticed the peculiar ulceration which forms years of age by the hypodermic injection
from time to time on the buccal mucous of four grains of atoxyl, repeated every j
membrane on the roof of the mouth and be- fourth day. The drug in no way altered
tvveen the last molar teeth on both lower the course of the disease. I doubt very,
and upper jaws. The stomatitis of pellagra much whether this arsenic treatment which
is usually a simple redness, w!th salivation was successful in the milder European
but without definite ulcerated patches. I form of the disease, would affect our very
am disposed to question the correctness of severe and rapidly fatal cases. It is interthe
diagnosis of these cases, or to cpiestion esting, however, to note in. this connection
the correctness of the diagnosis of our cases that the disease as we see it today is very
of "pellagra-sine-pellagra," because, in much more attenuated than our first cases
both conditions, the symptoms and course three years ago. Three years ago our
were practically identical. It is far more cases always died while at the present time
likely that the diagnosis of pellagra is cor- the disease is assuming tlie more characterrect,
and that the diagnosis of sprue was istic chronic form which is very much
made through an imperfect knowledge of milder. It is to be hoped that in these
pellagra. I think that if Dr. Harris should cases the arsenic treatment may give usjfsee
some of our cases of pellagra, and also some encouragement.
some of our cases of "pellagra-sine-pella- After all, we must look to serum therapy^
gra" that he would be disposed to accept for relief. As mentioned above, we hav<
our view. It is to be hoped that, with the every reason to expect the early preparatiou|
discovery- of a specific organism of pellagra, of a curative serum.
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we may be able to resort to a definite ag- In concluding this paper, Iwouldlike^'
glutination test similar to the Widal test in again to entreat the medical profession in
typhoid fever. We have some grounds for North Carolina for their support and co- I
thinking that this test will be perfected operation in the study of a disease that bids '
shortly. fair to be second only to tuberculosis in its I
The treatment of pellagra has been one of importance. We are already deeply inthe
most disappointing in medicine. There debted to many members of this Society for.
is no specific, and first one remedy after an- their assistance during the past year, and I
other has been extolled, only to be thrust take this opportunity to assure them that
aside after the demonstration of its useless- any information or report of cases, or ideas
ness. In our experience, from the begin- as to the etiological factors in this disease !
ning, we are able to predict with a fair de- will be highly appreciated. We are ready ,
gree of certainty, those cases that will re- to" give our time and our means, as far as i
cover and those that will succumi) after a we are able, to the study of pellagra, and '\
few weeks, or possibly a few months, of we feel that we will not plead in vain for
untold physical and mental suffering. In the assistance of our brother practitioners,
the Berliner Klinische Wochenschrift for who should be just as deeply concerned in i
February 8th, 1909, there is a notable arti- the outcome of our studies as we are our- :
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cle by Babes, \'asiliu and Gheorghus, in selves.
which they advocate the treatment of these . T
patients by
Introductory.
arsenic, ,
given in three wa.N's,
simultaneously. They inject 7 '2 gr. atoxyl Mr. President and Gentlemen:
hypodermically, and in addition to this, I desire to express ray high appreciation
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they have rubbed into the patients skin, 75 of the honor conferred upon me bv the in- /
gr. of an ointment composed of a 1 to ,50 vitation of the Tri-State Medical Associa- \
arsenious acid preparation, Finally, they tion, ccniveved through their secretarv, to I
have the patient take internally, one fiftieth read a paper at its 11th annual session. 1
of a grain of arsenious acid in pill form. This invitation has given me all the more I
three times a day. These observers have pleasure to accept, because the meeting was 1
treated sixty five cases of pellegra in this to be held in Charleston, vS. C. mv beloved !
manner with the loss of only six cases. In native city, where I have not lived for a
the article referred to above, they report a number of vears, but to which I always -
series of fourteen cases, all of which re- return with a sense of coming home,—and .a
sponded readily to from one to three treat- for this opportunity I wish to tender my j
ments as detailed above, :
and have gone for grateful acknowledgment.
a number of months with no sign of any I interpret the invitation, however, as a \
recurrence. In all of these ca.ses there was tribute to the work in which I have been ii
a marked gam in weight. At the present so long engaged, rather than as any per- \
time, 1 am giving this treatment a trial, but sonal compliment to myself, and I : have, i
am not yet prepared ;o report my experi- therefore, regarded it somewhat in the light . \
ence with it. Last summer I treated a of a command that I should select for the i
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