The Medical clinics of North America . ( Fig. 106.—Hands showing dactylitis-like swelling of fingers and character-istic expression. cases, complicated by a Streptococcus hemolyticus infection ofthe blood-stream with an osteomyelitis, the patient was affectedfor nearly two years. The stages of exacerbation are marked by an increase in theitching eruption, augmented pains in extremities, and greaterdiscomfort of hands and feet, together with an exaggeration of DERMATOPOLYNEURITIS, ACRODYNIA, ERYTHREDEMA 441 the digestive disturbances, while restlessness and insomnia be-come more marked. Of our
The Medical clinics of North America . ( Fig. 106.—Hands showing dactylitis-like swelling of fingers and character-istic expression. cases, complicated by a Streptococcus hemolyticus infection ofthe blood-stream with an osteomyelitis, the patient was affectedfor nearly two years. The stages of exacerbation are marked by an increase in theitching eruption, augmented pains in extremities, and greaterdiscomfort of hands and feet, together with an exaggeration of DERMATOPOLYNEURITIS, ACRODYNIA, ERYTHREDEMA 441 the digestive disturbances, while restlessness and insomnia be-come more marked. Of our 12 cases, 2 have died, 1 after an intercurrent attackof measles and 1 apparently from exhaustion as a result of thedisease. Autopsies revealed only a general adenopathy. Theglands were of moderate size except those of the retroperitonealregion. In this area the lymphatic glands were very large, vary-ing in size up to the mass of a pigeons egg. Unfortunately, in. Fig. 107.—Hands showing palmar desquamation. neither instance was examination of the central nervous systempermitted, so that we were unable to compare the findings withthose of Byfield, who found glial changes about the central canalof the cord and some staining peculiarities in certain of theanterior horn cells. The etiology of this condition is still in question. Brown,of Toronto, thinks it the result of an infection which entersprimarily through the nose and throat. Others have considered 442 LANGLEY PORTER it the result of a chronic intoxication following gastro-intestinaldisturbances. Our own constant findings of a predominant pro-teolytic intestinal flora tends to make us sympathetic towardthis view, though the evidence is by no means has contended that the nervous symptoms indicate pri-mary cerebral irritation. Goldberger has consistently classedthe affection as a form of pellagra. That this is a warrantedassumption seems improbable because pellagra is, for
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