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

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

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ORIGINAL COMMUNICATIONS.<br />

!...v.ed Ihe case to Dr. Buchanan the next reflexes absent. Has lost forty pounds <strong>of</strong><br />

Arter examin<strong>at</strong>ion, he said: If this flesh in six or eight weeks (which I think<br />

n IS not sunburn, I think this is a required muchlongerthan th<strong>at</strong> ). "Pyrosis,"<br />

pellagra. Ihe lady had not been mouth always sore, cardialgia, pupils mvi<br />

.o he sunlight <strong>at</strong> all. otic, good habits, soles <strong>of</strong> feet slightly more<br />

next case. Miss W., was white, sensitive than in a case <strong>of</strong> locomotor <strong>at</strong>axia<br />

aged forty-five, house-keeper, all (<strong>at</strong> an apparently similar stage), which<br />

e croupy She thought th<strong>at</strong> three came into my mind and might have relomhs<br />

previously, while e<strong>at</strong>ing chicken, a mained there but for th<strong>at</strong> word "pvrosis "<br />

one had lodged m her thro<strong>at</strong>. This swell- etc. He has lived on cornbread and bacon<br />

i so rapidly <strong>at</strong> once th<strong>at</strong> bre<strong>at</strong>liing became good, bad, and indifferent, all his life and<br />

ibored. She had no cough, but pain in cannot remember when he did not 'have<br />

er thro<strong>at</strong> ,n swallowing solids. The <strong>at</strong>- "sour belching." This was his onlv visit<br />

riiding physician could find no foreign to me, so I cannot report progress. Please<br />

ody 111 the thro<strong>at</strong>, but began tre<strong>at</strong>ment for notice how the word "pyrosis" occurs in<br />

iberculosis <strong>of</strong> the larynx. She had diar- these records. The case <strong>of</strong> complete, sure<br />

loea in May, June and July; has not men- pellagra determined my investig<strong>at</strong>ion <strong>of</strong> the<br />

ru<strong>at</strong>ed for two or three years. No blad- records <strong>of</strong> cases in which this word occurred<br />

it troubles, always nervous, "pyrosis," so frequently as to <strong>at</strong>tract mv <strong>at</strong>tention and<br />

)ur stomach, cardialgia, voice a whisper, this is the result. In five years about 3u0<br />

J cough or ex pectoral ion, no loss <strong>of</strong> weight, cases <strong>of</strong> "rancid f<strong>at</strong>" had presented<br />

doubted the diagnosis <strong>of</strong> tuberculosis. I do not think th<strong>at</strong> every case in which<br />

lie showed evidence <strong>of</strong> past tubercular "pyrosis" is present is pellagra, or th<strong>at</strong> they<br />

oubles <strong>at</strong> apices <strong>of</strong> lungs, but they were will all become pellagrous, as the stomach<br />

net now. The thro<strong>at</strong> and mouth were in- disturbances will limit the diet <strong>of</strong> these pansely<br />

red. Pulse 84, temper<strong>at</strong>ure 99.8. tients instinctively, reducing suffering and<br />

le was tre<strong>at</strong>ed as were the other pellagra, prolonging tlie early stages <strong>of</strong> the trouble,<br />

rancid f<strong>at</strong> p<strong>at</strong>ients, and in three weeks even bringing about a convalescence, which!<br />

;r pulse was 72 and temper<strong>at</strong>ure 9,S.C, <strong>at</strong> 7 however, does not confer immunity. But,'<br />

m., while she was gaining rapidly in in such a case, u-Aai the clijiician detects inery<br />

way. The tre<strong>at</strong>ment will l)e detailed vo/vement <strong>of</strong> nerve cells or nerve fibsrs, or<br />

ter on, but to it was added the st<strong>at</strong>ic nerve she<strong>at</strong>hs, then it is a case <strong>of</strong>pellagra witholet<br />

discharge, and the arc light to ex- one the eruption. When he detects involverior<br />

<strong>of</strong> neck, which gave rapid and pleas- ment <strong>of</strong> the skin, then it is complete pellagra.<br />

Lilt improvement. I could then find no The germ appears to be in the f<strong>at</strong>, not in<br />

:ns <strong>of</strong> active tuberculosis. the p<strong>at</strong>ient primarily, and the tre<strong>at</strong>ment <strong>of</strong><br />

We turn now to the case <strong>of</strong> Mrs. O. B., tiie p<strong>at</strong>ient for original germ troubles will<br />

10 consulted me June 29, 1906, white, age be <strong>at</strong> best only modifying. Remove the<br />

r,married,oiie child six years ago. Nursed germ laden f<strong>at</strong> from the diet, care for the<br />

|iild three years and lost flesh and strength acid condition developed in the p<strong>at</strong>ient,<br />

larkedly. Her menstru<strong>at</strong>ion always regu- clean out and keep clean the body <strong>of</strong> the<br />

|r from confinement. Each period seven p<strong>at</strong>ient inside and out, see th<strong>at</strong> clean nourlys<br />

in length, with i)r<strong>of</strong>use losses and lit- ishmenl, such as the p<strong>at</strong>ient needs, is pro-<br />

^ pain. For eight years, back ached vided. Help the case along with proper<br />

Jieii she was overhe<strong>at</strong>ed. In micturition medic<strong>at</strong>ion and s<strong>at</strong>isfaction will result.<br />

IS delay in starting urine. Slight uterine This brings us to the tre<strong>at</strong>ment. I do not<br />

pcorrhnea, bowels regular, color <strong>of</strong> pass- recommend any formula, or cut and dried<br />

;es normal^ anorexia, "Pyrosis," nausea tre<strong>at</strong>ment, but a plan which any physician<br />

id cardialgia. Pulse 100, every day head can carry out to suit the case. A review <strong>of</strong><br />

hes, frontal or right side. Uterus retro- the various tre<strong>at</strong>ments used in pellagra by<br />

;xed and prolapsed. Intense tenderness those who have had the largest number <strong>of</strong><br />

er right dorsal and lumbar intervertebral cases to care for shows the universal ten-<br />

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