By Robert S.; Thimann, Kenneth V.; Marrian, G. F. Harris
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Tennessee Williams was once some of the most renowned winning and so much severely lauded and vilified dramatists of the twentieth century. His most renowned performs are tested during this textual content, together with without notice final summer season, The Glass Menagerie, and A Streetcar Named hope. This sequence is edited by way of Harold Bloom, Sterling Professor of the arts, Yale collage; Henry W.
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Kagawa nevertheless concludes that the retrobulbar neuropathy is part of the beriberi picture. Denny-Brown critically reviews Kagawa’s evidence and observes that it is capable of reverse interpretation, namely, that retrobulbar neuropathy and beriberi are not part of the same syndrome. Signs of optic nerve damage have been observed in “pellagra” by a number of authors over the last hundred years. Pellagra, however, can no longer be regarded as a specific deficiency disease, and although niacin is an important therapeutic agent for some of the classical features, many elements of the syndrome remain unaltered with niacin therapy alone.
Signs a. General. There may be evidence of recent debilitating disease particularly dysentery, or chronic malaria. In well established cases, the face wears an expression of chronic distress with dark shadows under the eyes. They are often jumpy and are apprehensive a t the prospect of having their feet examined. Epithelial lesions of the scrotum and mouth of a deficiency type are present in nearly half the cases. Diarrhea is not a common associated feature although there is often a history of several attacks of dysentery.
The case is strengthened if edema, which responds dramatically t o thiamine therapy, is concomitantly present in the individual or the community. Deficiency of other food factors in the diet nearly always exists when beriberi neuropathy occurs. It is uncertain how much this may contribute t o the nerve damage, and there is some experimental work in animals t o suggest that pyridoxin or riboflavin deficiencies alone may produce nerve degeneration (Zimmerman, 1943; Wintrobe, 1942). ” It is not justified, however, to put under this heading other neurological conditions occurring in malnourished persons, such as retrobulbar neuropathy, spastic paraplegia, posterior column damage, eighth nerve deafness and the painful feet syndrome, as there is little evidence that thiamine deficiency plays much part in their production.