Pellagra : history, distribution, diagnosis, prognosis, treatment, etiology / by Stewart R. Roberts.

  • Roberts, Stewart Ralph, 1878-1941.
Date:
1913
Catalogue details

Licence: Public Domain Mark

Credit: Pellagra : history, distribution, diagnosis, prognosis, treatment, etiology / by Stewart R. Roberts. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    involvement of the deeper structures. After rupture, ordinary granular tissue with the small elevations are seen as healing takes place. Either here or in the more severe dry form, fissures may develop, with gaping and localized inflammation. Favorite seats are between the metacarpal bones, over the knuckles, and between the fingers. The pellagrous dermatosis is a part of the pellagrous process— it is pellagra of the skin. One asks why the skin is affected in pellagra. There is no more an answer to this question than to the other view—why should the skin not be affected in pellagra? Measles begin on the face and scarlet fever on the body; the reason is not clear, and one can only say that it is a characteristic of the disease in question. The rose-red spots of typhoid select the abdomen and the dermatitis of pellagra selects the hands, and the selective action of different diseases on different organs and in different locations is as inexplicable as is the specific action of different pathogenic bacteria. Even with the knowledge that the dermatosis is the skin ex- hibition of the disease, it is well to remember that the internal malady may continue to exist independently of the eruption or of its disappearance. When the dermatosis goes, it does not mean that the pellagra has gone. The eruption does not kill, but pel- lagra does kill. The dermatosis is the least of the dangers to the pellagrin, but the most important of the symptoms to the phy- sician in diagnosis. It is the passkey and the capstone to the correct diagnosis of the disease. In the language of Roussel, it is the element decisif dans le diagnostic. The existence of pel- lagra sine exanthemata is relatively infrequent, and in all ordinary cases of pellagra the decisive element is the dermatosis. It may be so slight as to hardly differ from a slight sunburn and last only a few dajrs in its entirety, though the dermotagra on the forearms and elbows usually lasts longer, but this skin involve- ment is the decisive and conclusive element in the diagnosis. In the language of Hyde, it is the local expression of a systemic disorder. Eruptions in systemic diseases are common, and, viewed in this broad light, there is nothing remarkable in the presence of the pella- grous dermatosis. Syphilis has an eruption, and in suspected cases the physician may postpone treatment and wait for the appearance of the rash, because it is confirmatory and diagnostic rather than