Vol. 71, 1915 - The University of North Carolina at Chapel Hill

THE CHARLOTTK MEDICAL JOURNAL.
Etiology and Treatment of Pellagra. at a temperature of eighty (80) to ninety
By B. W. Page, M. D., Lumberton, N. C. (90) degrees.
For two and a half years I have made Animal inoculation experiments have
a careful study of intestinal bacteria associated
with pellagra but the intestinal rhoea and nervousness was produced by
not been very successful. A mild diar-
flora and fauna include so many species feeding a cat on food contaminated with
I have looked with doubt on the patho-
pure cultures and the bacilli were again
genicity of any of them until it is definitely
proven. In addition to the colon
group of bacteria which are found in feces
of pellagrins, I have observed with much
interest a bacillus which must be the
cause of the disease.
This bacillus is from four to ten microns
in length and is more sharpened at
the ends than others of the colon group.
It develops by spore formation and presents
itself in many forms. When spore
formation is about to occur a point of
cloudiness or an area of bright refraction
appears in the protoplasm and the cell
bacillus emerges through the opening. On
first appearance the young bacillus is very
active and for a few seconds it is spiral
or crock-screw shaped. It gradually
elongates and becomes less and less motile.
Later it may appear rod-shaped,
slightly curved or as a long undulating
thread, often suggesting the appearance
of a streptococcus before sporulation occurs.
In all its forms the bacillus is motile.
The diflferent sized cells as well as the bacillus
itself have the power of indepedent
motion, and so varied is the appearance
of the organism, the microscopist often
believes he is dealing with many varieties.
It is best studied in a fresh stool, in a
warm room, but it is motile in a specimen
two weeks old or as long as there is
moisture. Morphologic changes, however,
are seldom observed except in fresh
specimens. The bacillus is aerobic; anaerobic,
and is discolored by Gram's and
Gabbet's methods of staining. The spores
are little affected by these stains.
Daily specimens from a single case of
pellagra vary much in appearance. One
specimen may show an abundance of
spores and very few if any bacilli, while
another specimen may reveal a dozen or
more bacilli in one field with very few
cells. A thin stool placed in an incubator
often changes its appearance in fortyeight
hours. So numerous are these bacteria
in many specimens, they compose
five per cent, of the solid portion of the
excrement and more than seventy-five
per cent, of all the motile organisms present.
Sterile feces afford the best culture
medium.
They grow well in this medium
observed on microscopic examination. In
a man pellagra has been induced by accidental
transference of cultures of the
bacilli. Pharyngitis and bronchitis developed
within three days and was soon
followed by definite intestinal and nervous
symptoms of pellagra. The pharyngitis
and bronchitis subsided in about ten
days but the other symptoms remained
until successful treatment was administered.
The microscope revealed the organism
in its many forms for four weeks.
Of the sixty-four cases of pellagra examined,
the bacilli were seen in great
generally elongates. The spore enlarges, numbers. Twenty-one of these have been
the cell membrane bursts and the young examined many times and the organism
was present in every instance for many
months. The organism has not been seen
on examination of healthy individuals and
those suffering from other diseases.
The bacillus in culture has been tested
by many drugs. A one per cent, solution
of ichthyol seemed to have a most decided
effect. I have partially tested this drug
on twenty-two cases of pellagra within
the last ten weeks. One or two five grain
enteric coated pills three or four times a
day for three weeks seems to cure the
average case. Nearly all uncomplicated
cases consider themselves cured by the
tenth day and the bacilli as a rule, disappear
by this time but by stopping the
drug this early the bacilli and symptoms
return in one-fourth the cases three or
four weeks later. From the short experience
I have had with the drug I readily
conclude, however, that an eight day
treatment is of far greater value than a
four months' treatment with the arsenic
preparations. I have never found a case
entirely free of the bacilli after treatment
with the latter drug. In the very severe
cases suppositories or colonic irrigations
are of great value. In so short a time it
is impossible to have tested the drug thoroughly
but I regard it as a specific. Just
how long the spores will lie dormant in
the intestine, time only will prove.
The bacilli in all stages of the disease
are present in enormous numbers in the
contents of the large intestine. I believe
they are usually confined to this situation.
Their deleterious effects upon the body
appear to be largely due to the prodtiction
of toxic substances which in addition
to serious intestinal irritation or le-