FRIGHTFUL ITALIAN SCOURGE.
A correspondent of the Lancet writes : —Ninty-seven thousand Italians (so I gather from the report lately issued by the Minister of Commerce and Agriculture) are at this moment dying of pellagra. About one-half of the provinces of Italy are desolated by this scourge. The number of the victims represents 3.60 per--1000 of the total population of the Peninsula, or 0.21 per 1000 more than the worst cholera epidemic that ever swept over France. If we restrict our consideration to the infected region only, the proportion becomes still more terrible, arid oscillates between a miximum of 11.76 per 1000 in Lombardy, 11.80 per 1000 inYenetia,anda minimum of 0.09 per thousand in Latium. In France, in the cholera visitation of 1834-35, the proportion in the infected departments only was 10.42 per 1000 of the population for the sick, and 4.73 per 1000 for the dead. From the Mantuan Commission, appointed to inquire into the subject I gather that pellagra, considered per se, is so extended and so manifold in its symptoms as to appear, so far as external phenomena are concerned, a general malady of the organism. Its developments are principally found on the skin, the mucous membrane of the mouth and the entire alimentary canal, in the muocular system, and in the nervous system in its threefold sensory, motor and psychical relations. For the most part its victims betray the first inroads of the disease by stupefaction, giddiness with a sense of traction from behind, and a general enfeeblement of organism. On the approach of spring the parts of the skin most exposed to the sun, the backs of the hands and feet, the face, the neck, and the median part of the chest at the parting of the shirt, show an erythematous discoloration, with desquamation of the cuticle, and more rarely, in the severe cases, rough nodosities, vesicles and puckerings. Corresponding characteristic altrahons manifest themselves later in the mucous membrane of the lips, the mouth and the fauces, and then there supervenes profuse, obstinate, exhausting diarrhoea. The patient, becoming always feebler, is no longer fit for the slightest exertion; he totters rather than walks, with knees semi-flexed and curved, until finally he falls forward and lies with his mouth in the dust. The skin of the entire body becomes of an earthy colour, and hangs in loose folds, the muscles are attenuated, and the whole person becomes lean or emanciated, if indeed he docs not rather acquire a tumefaction, down-dragging and semi-trans-parent, from the infiltration of the subcutaneous tissue with scerosity. The pellagrosi complain for the most part of a pain as if from contusion on the head and spine, which often radiates in zones around the abdomen, and is prolonged to the thighs ; of a formiculation and sense of heat at the extremities, and of an internal tremor often visible in the hands and tongue. They have often a>burning sensation in the stomach/SscemU ing the oesophagus; while nojt unfrequently there is laboured breathiflg, which sometimes approaches absolute aphoea. The .sight becomes clouded, the hearing first troubled with rumbling noises, and then blunted. The heart’s impulse gets weaker and diminished in bulk as the organ sometimes shrinks along with the other muscles. The radial pulse is feebleand generally raid, with venous stasis indicated by the diffused leaden color, mottled with sporadic sanguineus blotches sometimes small, sometimes large, on the skin and mooous membrane. In many
cases of pellagra, sometimes from the beginning, occasionally later in the progress of the disease, there is mental alienation, which may break out in sudden paroxysms and assume every form, from laughing and loquacious maniacal exaltation to the gloomiest, fiercest, melancholy, with suian d homocidal tendencies. often, however, it begins with hebetJße or slowing of the intelligence, and a prostrate apathy of mind which becomes true lypemania with siupour, and betrays itself by delirious words and deeds, in fear of persecution and in hopeless despair. Pellagra runs, usually, a slow course, lasting for years, during which it betrays itself in attacks which may continue for months, and less frequently in winter, and still less in autumn, and which recur always at the same season in successive years, with graver and more extended virulence. Like every other malady, pellagra renders the system more liable than it otherwise be to obnoxious influences ; and so it frequently happens that in its progress other common maladies supervene, especially those of the respiratory organs. It is computed that in more than one-half of the cases of death among the pellagrous, intercurrent diseases of the lungs is the proximate cause. But, independently of that, there are cases of pellagra in which it assumes an acute form, either from its commencement or in a more or less advanced state of its chronic course. The malady then takes in some measures the aspect of typhoid (tifo pellagroso), and is generally fatal. In these cases, as in those of a persistently plow course, death most often happen from an intractable diarrhoea, which has exhausted the patient.
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