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

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ORIGINAL COMMUNICATIONS. 369
Dr. Petit, in an official report, says of the of disposition from slight depression to
conditions of the peasantry in the pella- hypochondria, melancholy and suicidal
grous district of Gironde; "They are slov- tendency, self depreciation and delusions,
enly and sleep in their clothes. Maize refusing of food, mania, restlessness, apathy,
enters largely into the food of the people, or catalepsy. Disturbances of sight and
which includes a little rye bread, sour most hearing are common, mutism is frequent
of the time, a few sardines and rancid (see second case ), and terminal dementia.
lat'd." These latter terminations are found in about
We have pursued the disease symptoms 3 to 5 per cent, of the cases,
supposed to be due to the use of spoiled 4- The cutaneous symptoms are not found
maize for many years. Let us consider early in the trouble. Instead of being the
these due to rancid fats,and their derivitives, initial symptom, the erythema of the dorin
diets for a short time, and the disease sum of the ieet, forearms and hands
will appear to be an exception to the usual symmetrical—resembling sunburn, little or
methods of germ infection. It puts the dis- no swelling, a red blush becoming deeper
ease in a class.by itself, so far as I know,
in which "chemical"—to use an old term
in color, sharply defined, which appears
late in the disease. The affected surfaces
or germ decomposition of fat is the very be- soon become dry and scaly, leaving the skin
ginnins of the after troubles. To the lay- dry, sometimes cracked and fissured, or
man, it makes no difference beyond erapha- eczematous. Skin manifestations have been
sizing the necessity of being more particular found in chronic digestive disturbances
as to wliat is used for food. To the doctor, from time immemorial. Two forms are
it changes materially the "line of march." recognized: The acute or typhoidal, which
It gives him a l)ase of treatment which, I runs to a fatal end in a few weeks, with
hope to show, will reward his advice and fever, delirium, and uncontrollable diarprescriptions
with full and complete sue- rhoes, due to acute rancid fat intestinal
cess. If it will do this, the truth or error toxaemia, and the mild or chronic or reciirof
the theory is not of material importance, rent, which results in inflammation of the
although it will be more satisfactory, if both sheaths of the dorso-lumbar intervertebral
agree. nerves as they emerge from the spine: In
The diet of a hard working man or wo- disturbances of the auditory, optic and
man should consist daily of an intake of gustatory nerves and those of general sensabout
7 oz. of albuminates, 2 oz. of fats, ation, with skin involvement, shown in
and 21 oz. of starch or carbohydrates, with erythema, eczematous inflammations and
water and mineral salts. These should be gangrene, equally hopeless and helpless, as
moderately free from agents of decompo- are the final terminations in disturbances in
)n—prepared artificially for easy and the use of nitrogen and hydrocarbons. Thus
rapid digestion and placed in a stomach completing the cycle. I notice three subthat
is in fair working order, to avoid a divisions in this latter form: Pellagra
tremendous number of evil consequences, proper; pellagra sine erruptione, and pseudo
should these conditions not be met. pellagra. This second type runs for twenly-
The symptoms of pellagra are: five years or more. With each recurrence,
1. Gastro-int^stinal; nausea, acid dys- anemia, debility and emaciation increase,
pepsia, sour or bitter vomiting, constipation and the other symptoms advance. The reor
diarrhoea, stomatitis, with more or less currences do not occur at regular intervals,
red mucosa, apthous ulcers, distressing sali- and, excepting in the typhoidal form, the
lion (with thick pasty saliva) and patients have no elevation of temperature
pyrosis. unless it is due to some complication. We
2. Nervousmanifestations; vertigo, pains now try to locale the initial disturbance in
and "swimming in the head," roaring in the fat contents of the food.
the ears, symptoms from the upper, middle The first argument against other infective
and lower regions of the spinal cord, ten- sources is the admitted failures in treatment
dernessover the dor.solumbar intervertebral based upon them for nearly one hundred
spinal nerves, as they emerge from the spine, years. Let us abandon a trail that has aldecrease,
or loss, of' leg reflexes, increase of ways terminated in the grave, and explore
reflexes of the upper extremities, spastic new fields.
symptoms, disturbed sensations and sphinc- First, we note that these patients avoid
terparalyses, sclerosis of the lateral columns fat in their diet as a source of serious disof
the cord, lesions of the posterior columns, comfort. Some of them have learned to
and degeneration of the posterior roots, in avoid corn also for the same reason, allong
continued disease. though they do not know that a large per-
3. Mental symptoms; confusion, weak- centage of corn is fat, sometimes approxiness
of judgment and will, anxiety, dis- mately ten per cent. I suppose that vegeorientation
as to time and place, alteration table fat is exposed to the same laws of de-
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