Malt extract is very rich in vitamines and liver seems to have a higher content than beef muscle. Fat soluble A vitamine is abundant in glandular organs but scarcely present in the beef of our markets—this is probably true of water soluble B. Heart muscle is about on a par with liver. Germinating wheat and beans seem to have special value in treatment as well as prophylaxis.
In the treatment of a case care must be had not to allow a patient with any cardiac involvement to sit up in bed as this may cause sudden death. Braddon considers atropine hypodermically as of value in cardiac types of cases.
Amyl nitrite inhalations or injections of 1% solution of nitroglycerine are indicated when there is evidence of extreme cardiac dilatation. Venesection is also to be kept in mind. Cardiac tonics are of less value than rest, diet and venesection.
In the feeding of such patients only small amounts should be given at a time to avoid epigastric distress. Again carbohydrates should be restricted as there is evidence that excess of carbohydrates as well as vitamine deficiency may be concerned in the disease. The bowels should be kept open with salines. Mineral oil tends to keep down intestinal putrefaction which is a factor of importance.
Strychnine is usually given as a routine treatment in the less acute cases. With muscular atrophy massage is of prime importance. Electrical stimulation is also usually employed. With the palsies there is great danger of contractures so that even the bed clothing should not rest upon the paralyzed feet. Even splints may be necessitated.
CHAPTER XIX
PELLAGRA
Definition and Synonyms
Definition.—For a time it seemed as if the old idea that pellagra was connected with a dietary defect, chiefly as regarded some factor in a preponderating diet of maize, had been replaced by one assigning as cause some infectious process, probably protozoal, possibly bacterial.
The important advances recently made in the study of beriberi have tended once more to swing the pendulum to the food deficiency etiology. The latest views assign to food deficiency the basic etiology, but regard some other factor, possibly an infectious one, as secondarily operative.