PELLAGRA 357 



2. Skin 



The pellagrous dermatitis is one of the most important of the early 

 symptoms. In light forms, this dermatitis is maculo-papular; in 

 severe acute types, vesicular with intensive reddening, edema and 

 pain. The dermatitis appears in a typical manner symmetrically 

 on the backs of the hands, and wrists (the pellagrous glove), then 

 on the neck, less often on the face, and on the feet (the pellagrous 

 shoe). This dermatitis was likened by Gurd (1313) to X-ray 

 dermatitis. The pellagrous glove and shoe extends frequently 

 one-third of the way up the forearm and leg respectively. On the 

 face, the dermatitis appears on the nostrils, temples and behind the 

 ears; sometimes, ecchymoses appear on the eye-lids. On the elbows 

 and the forearm the skin remains rough and scaly for a long time; 

 this protracted scaling may appear on the face, shoulders and, in 

 fact, on the whole body. In chronic cases, the nails sometimes 

 become grayish white, thickened and brittle. On recovery, the skin 

 appears brownish red and dark brown on the affected places; in 

 rare cases, this extends to the entire body. 



It is of etiologic importance that in the production of human 

 experimental pellagra by Goldberger (1314), the first symptoms 

 appeared on the scrotum. This condition has inclined some investi- 

 gators to dou^t the validity of Goldberger's findings, pointing out 

 that it had nothing to do with real pellagra. Because of this, it is 

 important to state here that Deiaco (1315), Merk (1316), Decks 

 (I.e. 1293), Crosby (1317) and Wood (I.e. 1308) observed this 

 localization of the dermatitis as the first sign in their cases. 



This specific dermatitis appears to be of trophoneurotic central 

 origin, but the influence of the sun rays cannot be altogether denied. 

 The burning of the hands and feet, a very disagreeable occurrence 

 independent of the dermatitis, belongs to the nervous symptoms. 



3. The nervous system 



Pain in the back is one of the early symptoms of severe cases. The 

 reflexes are accentuated. The muscles become atrophic in half of 

 the chronic cases, with fatty degeneration; contractions in a flexed 

 position sometimes develop in the hands and feet. The degeneration 

 reaction is usually lacking. Among the later symptoms, are tremor, 

 especially of the hands, infrequently of the tongue and lips, and 



