BLOOD PRESSURE IN INFLUENZA.
1
312 BLOOD PRESSURE IN INFLUENZA. To the Editor of THE LANCET. SIR,—Referring to Dr. Shore’s letter on the s need for keeping convalescents from influenza in bed, and for the administration of tonics until the low c systolic blood pressure has risen, I should like to t point out that a condition of chronic low blood t pressure is far from uncommon, and occurs in people t in whom it would not be expected. I have a dozen f patients in my practice whose systolic blood pressure has to my knowledge never risen above t 105 mm. Hg for two years. If such a patient were to contract influenza he might be condemned to a e decidedly long convalescence. Very little seems to be t known about this condition of chronic hypopiesis. l’ It seems to be more common in males than females, d 10 males and 2 females in my cases, and their aged r range from 30 years to HO years. All of them are active and earn their own livings, including the man t of 80, who is in full work as a surveyor. Four of them t are farmers and walk many miles a day. They all r- live hygienic lives and six of them have always been non-smokers. s The symptoms most commonly complained of r are (1) giddiness when assuming the erect posture ; I (2) lassitude and a vague feeling of being out of ., sorts. They sweat a good deal during physical exertion. These cases are often slightly hypochon- driacal, they are quiet and reserved in temperament and not given to enthusiasm. They exhibit an I astonishing tolerance of belladonna, including the t patient of 80 years. I have not found any decided t benefit with the usual tonic-treatment and hygienic t measures, such as cold or tepid baths and liberal diet. Daily injections of pituitrin and adrenal extract were tried, but apart from the immediate rise of blood pressure for an hour or so no benefit resulted. 1 have recently treated eight of these cases with " coramine " (a 25 per cent. solution of py-ridine-/3- carbonic acid diethylamide). A dose of 25 minims was given twice a day by the mouth and continued x for 14 days. In every case there was a great improve- ment in the patients’ sense of well-being and energy- The giddiness disappeared. In all cases but one -. the systolic blood pressure rose and was never less -, than 120 mm. Hg, and in some cases the blood pressure rose to 130 and 140 mm. Hg. It was noted that very little or no improvement took place during f the first week of administration in most of the cases. In regard to the permanence of the raised blood c pressure after the " coramine " has been discontinued * these chronic cases of long standing appear gradually to revert to their previous state in the course of four 1 or five weeks. I have not yet used " coramine " for the hypopiesis c resulting from influenza. I am. Sir. yours faithfullv. P. D. H. CHAPMAN, M.B., B.Ch. Camb. Bridlington, Jan. 31st, 1927. NEW NAMES FOR OLD DISEASES. To the Editor of THE LANCET. SIR,—In the discussion following Sir Humphry Rolleston’s address on Changes in the Clinical Aspects of Diseases (THE LANCET, Jan. 15th) I alluded to a possible source of confusion arising from occasional change in name of diseases, and I hope you will allow me to mention here one or two other examples of such a change in names. The rare disease in children to which I alluded was named " erythrcedema " in 1914 by Dr. H. Swift, of Adelaide, Australia. An objection to the name was that there was no obvious oedema, though the extremities might appear turgid. Recently, however. the disease has been called by a still more unsuitable name, " acrodynia." 1 The latter name had been previously bestowed on the great epidemic disease 1 The heading of W. Weston’s article on the subject in Abt’s Pediatrics, ii., 986. (hardly likely to be identical) which attacked abost 40,000 persons in Paris during less than a single year (1827-28). The names of well-known disettat such as measles and scarlet fever can hardly be attend, but uncommon and relatively little-known disease can be altered by any author who writes on them A recent example is that of tuberous sclerosis of the brain, often associated with Pringle’s multiple telangiectatic type of adenoma sebaceum of the face. Whenever the latter was present in the subject of epilepsy or mental deficiency the presence of tuberous sclerosis of the brain was suspected, but could hardly be proved without a post-mortem examination. Dr. E. B. Sherlock, not contented with these names, coined a new one, " epiloia," which he regarded as suitable, being short, unmeaning, distinctive, and capable of forming an adjective." Thus, at recent meetings of the Royal Society of Medicine 3 cases have been shown under the heading, " epiloia." It seems inconvenient, to say the le that, when careful studies of the subject have b published in various countries under the headiag. Tuberous (or Tuberose) Sclerosis, the latter name should be arbitrarily displaced in favour of " epiloa," recommended by its introducer as being "meaningless." In 1920, when Sir Arthur Keith proposed the name " diaphysial aclasis " for the disorder of growth generally known as " multiple exostoses," there was at the back of his suggestion at least an interesting scientific theory of causation. Moreover, it is possible that the developmental disorder in ques tion may occasionaly occur without the forma- tion of actual exostoses 4 But there is no excuse of the kind for " epiloia." i, I am, Sir, yours faithfully, London, W., Jan. 18th, 1927. F. PARKES WEBER. PELLAGRA IN NYASALAND. wo rne Editor OJ THE LANCET. SIR,—I beg your permission to reply to criticisms made by Dr. Hugh S. Stannus in reference to my article on Pellagra in Nyasaland which appeared in vour issue of Jan. 8th. I read the first communication Dr. Stannus made to the Royal Society of Tropical Medicine and Hygiene on Pellagra in Nyasaland with very great pleasure, and I have the fullest admiration :01’ the accurate description of the disease that he ;av e on that occasion. 1 did not read his second communication on the same subject until quite recently, and I was unaware that cases of the disease had been discovered in members of the general population previous to my own observations. However, my work confirms his original obervations n that point. Dr. Stannus seems to imply in his letter that 1 claim to be the first observer to formulate the theory that the pathological lesions in pellagra are due ta * toxin, whereas I merely try to prove by my observations that the toxin acts upon various systems in the body and so produces the characteristic features of the condition. I am convinced that one of the chief actions of the toxin is to interfere with the correct functioning of the thyroid gland, heJ1(’t my comparison between certain signs in pellagra and other signs in myxoedema. Further, the above theory has received substantial support from post mortem evidence, the source of which I stated in my article. My observations are the result of cMe** investigation, and whatever the pathological changes in the nervous system may be, there are signs of a peripheral neuritis in the early stages of the condition. to quote Dr. Stannus, " pins and needles, and burning pains in the soles of the feet, especially along the outer margin and in the pulps of the toes, pains The Feeble-Minded, London, 1911, p. 242. 3 Section for the Study of Disease in Children, Oct. 22nd. 1926, and Section of Psychiatry, Jan. 11th, 1927. 4 F. P. Weber : A Developmental Deformity of the Right Forearm, similar to that sometimes met with in cases of Multiple Exostoses (Diaphysial Aclasis. of Keith), Proc. Roy. Soc. Med., Clinical Section, 1925, xviii., 25.
Transcript of BLOOD PRESSURE IN INFLUENZA.
312
BLOOD PRESSURE IN INFLUENZA.To the Editor of THE LANCET.
SIR,—Referring to Dr. Shore’s letter on the sneed for keeping convalescents from influenza in bed, and for the administration of tonics until the low csystolic blood pressure has risen, I should like to tpoint out that a condition of chronic low blood tpressure is far from uncommon, and occurs in people tin whom it would not be expected. I have a dozen fpatients in my practice whose systolic blood pressure has to my knowledge never risen above t105 mm. Hg for two years. If such a patient were to contract influenza he might be condemned to a edecidedly long convalescence. Very little seems to be tknown about this condition of chronic hypopiesis. l’
It seems to be more common in males than females, d
10 males and 2 females in my cases, and their aged rrange from 30 years to HO years. All of them areactive and earn their own livings, including the man
tof 80, who is in full work as a surveyor. Four of them t
are farmers and walk many miles a day. They all r-live hygienic lives and six of them have always been non-smokers. s
The symptoms most commonly complained of rare (1) giddiness when assuming the erect posture ; I(2) lassitude and a vague feeling of being out of
.,
sorts. They sweat a good deal during physical exertion. These cases are often slightly hypochon- driacal, they are quiet and reserved in temperament and not given to enthusiasm. They exhibit an I
astonishing tolerance of belladonna, including the tpatient of 80 years. I have not found any decided tbenefit with the usual tonic-treatment and hygienic tmeasures, such as cold or tepid baths and liberaldiet. Daily injections of pituitrin and adrenal extractwere tried, but apart from the immediate rise ofblood pressure for an hour or so no benefit resulted.
1 have recently treated eight of these cases with" coramine " (a 25 per cent. solution of py-ridine-/3-carbonic acid diethylamide). A dose of 25 minimswas given twice a day by the mouth and continued xfor 14 days. In every case there was a great improve- ment in the patients’ sense of well-being and energy- The giddiness disappeared. In all cases but one -.the systolic blood pressure rose and was never less -,than 120 mm. Hg, and in some cases the bloodpressure rose to 130 and 140 mm. Hg. It was notedthat very little or no improvement took place during
f
the first week of administration in most of the cases. In regard to the permanence of the raised blood
c
pressure after the " coramine " has been discontinued *
these chronic cases of long standing appear graduallyto revert to their previous state in the course of four 1or five weeks.
I have not yet used " coramine " for the hypopiesis c
resulting from influenza.I am. Sir. yours faithfullv.
P. D. H. CHAPMAN, M.B., B.Ch. Camb.Bridlington, Jan. 31st, 1927.
NEW NAMES FOR OLD DISEASES.To the Editor of THE LANCET.
SIR,—In the discussion following Sir HumphryRolleston’s address on Changes in the ClinicalAspects of Diseases (THE LANCET, Jan. 15th) Ialluded to a possible source of confusion arising fromoccasional change in name of diseases, and I hopeyou will allow me to mention here one or twoother examples of such a change in names. Therare disease in children to which I alluded was
named " erythrcedema " in 1914 by Dr. H. Swift,of Adelaide, Australia. An objection to the namewas that there was no obvious oedema, though theextremities might appear turgid. Recently, however.the disease has been called by a still more unsuitablename,
" acrodynia." 1 The latter name had beenpreviously bestowed on the great epidemic disease
1 The heading of W. Weston’s article on the subject in Abt’sPediatrics, ii., 986.
(hardly likely to be identical) which attacked abost40,000 persons in Paris during less than a singleyear (1827-28). The names of well-known disettatsuch as measles and scarlet fever can hardly be attend,but uncommon and relatively little-known diseasecan be altered by any author who writes on themA recent example is that of tuberous sclerosis ofthe brain, often associated with Pringle’s multipletelangiectatic type of adenoma sebaceum of theface. Whenever the latter was present in the subjectof epilepsy or mental deficiency the presence oftuberous sclerosis of the brain was suspected, butcould hardly be proved without a post-mortemexamination. Dr. E. B. Sherlock, not contented withthese names, coined a new one,
" epiloia," which heregarded as suitable, being short, unmeaning,distinctive, and capable of forming an adjective."Thus, at recent meetings of the Royal Society ofMedicine 3 cases have been shown under the heading,"
epiloia." It seems inconvenient, to say the lethat, when careful studies of the subject have bpublished in various countries under the headiag.Tuberous (or Tuberose) Sclerosis, the latter name
should be arbitrarily displaced in favour of " epiloa,"recommended by its introducer as being "meaningless."In 1920, when Sir Arthur Keith proposed the name" diaphysial aclasis " for the disorder of growthgenerally known as " multiple exostoses," therewas at the back of his suggestion at least an interestingscientific theory of causation. Moreover, it ispossible that the developmental disorder in question may occasionaly occur without the forma-tion of actual exostoses 4 But there is no excuse of
the kind for " epiloia."i, I am, Sir, yours faithfully,
London, W., Jan. 18th, 1927. F. PARKES WEBER.
PELLAGRA IN NYASALAND.wo rne Editor OJ THE LANCET.
SIR,—I beg your permission to reply to criticismsmade by Dr. Hugh S. Stannus in reference to myarticle on Pellagra in Nyasaland which appeared invour issue of Jan. 8th. I read the first communicationDr. Stannus made to the Royal Society of TropicalMedicine and Hygiene on Pellagra in Nyasaland withvery great pleasure, and I have the fullest admiration:01’ the accurate description of the disease that he;av e on that occasion. 1 did not read his secondcommunication on the same subject until quiterecently, and I was unaware that cases of the diseasehad been discovered in members of the generalpopulation previous to my own observations.However, my work confirms his original obervationsn that point.
Dr. Stannus seems to imply in his letter that 1claim to be the first observer to formulate the theorythat the pathological lesions in pellagra are due ta *toxin, whereas I merely try to prove by myobservations that the toxin acts upon varioussystems in the body and so produces the characteristicfeatures of the condition. I am convinced that oneof the chief actions of the toxin is to interfere withthe correct functioning of the thyroid gland, heJ1(’tmy comparison between certain signs in pellagra andother signs in myxoedema. Further, the abovetheory has received substantial support from postmortem evidence, the source of which I stated in myarticle. My observations are the result of cMe**investigation, and whatever the pathological changesin the nervous system may be, there are signs of aperipheral neuritis in the early stages of the condition.to quote Dr. Stannus, " pins and needles, andburning pains in the soles of the feet, especially alongthe outer margin and in the pulps of the toes, pains
The Feeble-Minded, London, 1911, p. 242.3 Section for the Study of Disease in Children, Oct. 22nd.
1926, and Section of Psychiatry, Jan. 11th, 1927.4 F. P. Weber : A Developmental Deformity of the Right
Forearm, similar to that sometimes met with in cases of MultipleExostoses (Diaphysial Aclasis. of Keith), Proc. Roy. Soc. Med.,Clinical Section, 1925, xviii., 25.
