Pink Disease

MUCH has been written in recent years about the cause and origin of Pink Disease (Erythrodema Polyneuritica). It is only within the last twenty years that the condition has been recognised. It was thought to be a nutritional disorder due to lack of vitamin B, a variation of this being that it was due to lack of absorption of vitamin B. Later it was thought to be due to a virus and to have a slight degree of infectivity about it. A brief outline of the pathology is that there is a demyelinisation of the peripheral nerves. Secondly, there is a small round-celled infiltration of the -spinal cord; and thirdly, the skin changes which are hyperaemia and hyperkeratosis. In this article I want to present six cases. The first two will be written in full, and illustrate the possibility of the infectivity of the disease. The other four cases will be used in a very brief form to illustrate special points, firstly about the danger of intercurrent infection, and secondly the most successful way to treat these cases. The first two cases were two cousins who, although living about thirty miles apart, were occasionally in contact with each other. The first child was a boy aged eleven months just beginning to creep around the floor. He was always perfectly healthy up to this, and was on the heavy rather than the light side. He was breast-fed until nine and a half months old, and then gradually weaned. In this case the first sign was the photophobia. He had a marked loss of appetite, and eventually when he refused everything he had to be force-fed for six weeks. His hands and feet were pale, puffy, and pink. He was restless, irritable, and very difficult to nurse. There was a red macular rash, which was followed by desquamation on the hands and feet. The child had profuse sweating, especially about the head, and the sweating seemed to make the rash itchy. His temperature occasionally rose to 101° or 102°. His pulse was fast. There was considerable hypotonia, with a very definite loss of weight. Insomnia was a prominent sign, and sedatives such as chloral and bromide were useless. When he slept it was usually on his face with his knees drawn up. He was always ,thirsty, and his facial expression was that of misery. The second child was aged seven months, and he d-iffered from Case I as follows: He had no photophobia whatsoever. His rash was more marked and seemed very itchy. His head was frequently retracted, and he had the characteristic arching of his back. There was a trace of albumen in his urine. The most important part of the treatment of these two cases was good nursing at home. They were treated with all the vitamins, but vitamin B was not given until the third month, when a marked improvement was noticed. It was about five months until these two children were back to normal. The recommended treatment will be mentioned in the last two cases. The question about these two