354 THE VITAMINES 



1. Acute, malignant form 



Duration is from two weeks to three months. It may appear as the 

 first attack or during the progress of the disease, or end in chronic 

 cases with prostration, convulsions, fever and diarrhea. Contin- 

 uous fever (38 to 40.5C.); pulse 120 to 130, small and arrythmic; 

 tongue, deep red, fissured and painful; painful stomatitis and 

 pharyngitis; nausea; typical dermatitis; skin petechiae. In addi- 

 tion there are frequently tremors, convulsions, tetanus, delirium and 

 incontinence. This type, is often called "typhoid pellagra." 



2. Light sub-chronic jorm 



Prevalent in young individuals; light cases with dermatosis and 

 dyspepsia, disappearing when cured. Duration, 1 to 2 years; no 

 fever. This form is very common in Italy and Roumania; less so 

 in America. The symptoms consist of a light dermatosis on the backs 

 of the hands and wrists, reddening of the mouth mucosa, consti- 

 pation or slight diarrhea. 



3. Severe, cachectic sub-chronic form 



Temperature at the beginning, 37.7C; pulse, 100. Very severe 

 symptoms along the digestive tract; the tongue, deep red, eroded; 

 mouth and pharynx mucosa, deep red and painful; gums, swollen 

 and bleeding; nausea, vomiting, gastralgia, persistent serous diarrhea, 

 loss of weight. Later, there are cerebral symptoms, mental weak- 

 ness and skeleton-like emaciation. 



4' Chronic form 



Duration, 1 to 20 years. In most cases, three periods are differ- 

 entiated. A) First period, with dermatosis and dyspepsia, as in 

 light sub-chronic cases. B) Second period, symptoms along the 

 digestive tract become more severe; gastralgia, tabes-like stomach 

 crises, vomiting, diarrhea and tenesmus appears. Pulse, 80 to 100, 

 with dyspepsia and light dropsy. Typical dermatosis; on recur- 

 rence the skin of the feet is brownish red and scaly; backs of the hands 

 are brownish red, wrinkled and aged. To this picture there are 

 added brain and spinal cord symptoms; uncertain walk, vertigo, 

 tremor, epileptic and tetanic attacks, contractures, accentuated 



