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

ORIGINAL COMMUNICATIONS.
!...v.ed Ihe case to Dr. Buchanan the next reflexes absent. Has lost forty pounds of
Arter examination, he said: If this flesh in six or eight weeks (which I think
n IS not sunburn, I think this is a required muchlongerthan that ). "Pyrosis,"
pellagra. Ihe lady had not been mouth always sore, cardialgia, pupils mvi
.o he sunlight at all. otic, good habits, soles of feet slightly more
next case. Miss W., was white, sensitive than in a case of locomotor ataxia
aged forty-five, house-keeper, all (at an apparently similar stage), which
e croupy She thought that three came into my mind and might have relomhs
previously, while eating chicken, a mained there but for that word "pvrosis "
one had lodged m her throat. This swell- etc. He has lived on cornbread and bacon
i so rapidly at once that breatliing became good, bad, and indifferent, all his life and
ibored. She had no cough, but pain in cannot remember when he did not 'have
er throat ,n swallowing solids. The at- "sour belching." This was his onlv visit
riiding physician could find no foreign to me, so I cannot report progress. Please
ody 111 the throat, but began treatment for notice how the word "pyrosis" occurs in
iberculosis of the larynx. She had diar- these records. The case of complete, sure
loea in May, June and July; has not men- pellagra determined my investigation of the
ruated for two or three years. No blad- records of cases in which this word occurred
it troubles, always nervous, "pyrosis," so frequently as to attract mv attention and
)ur stomach, cardialgia, voice a whisper, this is the result. In five years about 3u0
J cough or ex pectoral ion, no loss of weight, cases of "rancid fat" had presented
doubted the diagnosis of tuberculosis. I do not think that every case in which
lie showed evidence of past tubercular "pyrosis" is present is pellagra, or that they
oubles at apices of lungs, but they were will all become pellagrous, as the stomach
net now. The throat and mouth were in- disturbances will limit the diet of these pansely
red. Pulse 84, temperature 99.8. tients instinctively, reducing suffering and
le was treated as were the other pellagra, prolonging tlie early stages of the trouble,
rancid fat patients, and in three weeks even bringing about a convalescence, which!
;r pulse was 72 and temperature 9,S.C, at 7 however, does not confer immunity. But,'
m., while she was gaining rapidly in in such a case, u-Aai the clijiician detects inery
way. The treatment will l)e detailed vo/vement of nerve cells or nerve fibsrs, or
ter on, but to it was added the static nerve sheaths, then it is a case ofpellagra witholet
discharge, and the arc light to ex- one the eruption. When he detects involverior
of neck, which gave rapid and pleas- ment of the skin, then it is complete pellagra.
Lilt improvement. I could then find no The germ appears to be in the fat, not in
:ns of active tuberculosis. the patient primarily, and the treatment of
We turn now to the case of Mrs. O. B., tiie patient for original germ troubles will
10 consulted me June 29, 1906, white, age be at best only modifying. Remove the
r,married,oiie child six years ago. Nursed germ laden fat from the diet, care for the
|iild three years and lost flesh and strength acid condition developed in the patient,
larkedly. Her menstruation always regu- clean out and keep clean the body of the
|r from confinement. Each period seven patient inside and out, see that clean nourlys
in length, with i)rofuse losses and lit- ishmenl, such as the patient needs, is pro-
^ pain. For eight years, back ached vided. Help the case along with proper
Jieii she was overheated. In micturition medication and satisfaction will result.
IS delay in starting urine. Slight uterine This brings us to the treatment. I do not
pcorrhnea, bowels regular, color of pass- recommend any formula, or cut and dried
;es normal^ anorexia, "Pyrosis," nausea treatment, but a plan which any physician
id cardialgia. Pulse 100, every day head can carry out to suit the case. A review of
hes, frontal or right side. Uterus retro- the various treatments used in pellagra by
;xed and prolapsed. Intense tenderness those who have had the largest number of
er right dorsal and lumbar intervertebral cases to care for shows the universal ten-