Notes on the prognosis and treatment of pellagra / by C.H. Lavinder.

  • Lavinder, C. H. (Claude Hervey), 1872-1950.
Date:
1909
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Licence: In copyright

Credit: Notes on the prognosis and treatment of pellagra / by C.H. Lavinder. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    total of 55,029 cases of pellagra in Italy in 1905, with a total mor- tality of 2,359, which is a little over 4 per cent. Babes and Sion (Spec. Path, u Therap. Nothnagel, Band, XXIV), in dealing with nonasylum cases, state that writh proper treatment complete cure of psychic as wrell as motor changes may result. They also state that the disease can be strikingly improved or cured not only in early but in more advanced cases, though the prognosis is far better in early cases. It is piobably safe to assert that as a rule the earlier the diagnosis is made and treatment begun the better the prognosis. The diag- nostician then should learn to profit by a similar experience in tuber- culosis in wdiich the situation is in some respects analogous. Pellagra, like tuberculosis, is a very chronic condition with, in non- asylum cases, perhaps just as hopeful an outlook. We should profit by experience, learn to make diagnoses, and institute proper treat- ment in the early stages of the disease and hopefully counsel our pellagra patients as we do our tubercle cases. Pellagra is said in Italy to last as long as twenty-five years; and Babcock in South Carolina has seen cases of eight and twelve years’ standing who were still in very good physical condition and showed improvement under treatment, if not recovery. It is true, however, that pellagra is variable in its manifestations, and acute accidents and grave com- plications are frequent. The chronic type of the disease, without mental involvement, gives the most hopeful outlook. Acute manifestations must be viewed with the utmost gravity. Pellagra is a disease of little fever, and it is, I think, the general opinion that fever, particularly if high or constant, must be regarded as a danger signal. The state of the erythema is generally thought to bear no relation to the gravity of the constitutional disturbances. It has been my experience, however, that moist, extensive erythemas are frequently accompanied by grave constitutional changes. Mental involvement, as stated, adds to the seriousness of the case; and such nervous disturbances as subsultus, marked tremor, retraction of the head, can, as in other affections, be interpreted as an index of severe intoxication. In mental cases periods of excitement are not rare, and they do much to help exhaust the patient. Severe recru- descence of the acute phenomena sometimes occur during the same season after the patient seemed to be on the road to recovery. Stead- ily progressing emaciation, especially if accompanied by an inveterate diarrhea, which is usual, very often ends fatally. Certain complications are of great importance in prognosis, e. g., malaria, intestinal parasites, marked nephritis, acute bronchitis, pneumonia, decubitus gangrene (which is often difficult to avoid), possibly tubercle, and at times hyperpyexia, due probably to a sudden