PELLAGRA 333 



The inp-estion of this latter causes a retenlion of salts in the tissues 

 resulting- in their excessive fixation which, when liberated in excess, 

 causes the pathological lesions of pellagra. 



They aftirm to have considerably improved, if not to have cured, 

 cases bv muscular or subcutaneous injections of neutral citrate of 

 sodium. 



Dailv injections of a lo per cent, solution of trisodic citrate were 

 given. The acidosis is said to be neutralized by it. 



PATHOLOGY. 



There is an infiltration of the true skin and oedema of the con- 

 nective tissue. The rete Malpighii is infiltrated with cells, the stratum 

 corneum is thickened and shows hyperkeratosis. 



A blood examination shows a reduction of the red cells. 



Fattv degeneration and characteristic deep pigmentation of all 

 viscera. Wasting of all muscles. Intestinal mucous membrane 

 hyperfemic, sometimes ulcerated. Liver and spleen atrophied. 



Brain and cord show chronic leptomeningitis with much thicken- 

 ing, a perivascular cellular infiltration with pigmentation and degenera- 

 tion of nerve filaments. Ventricles distended. Brain shrunken. 



Lateral columns and crossed pyramidal tracts affected, mid-dorsal 

 region most marked. The condition is not unlike G.P.L 



SYMPTOMATOLOGY. 



Incubation not known, but the disease has occurred in a child three 

 months old. There is no support for heredity. 



The skin eruption has occurred in a healthy person two months 

 after visiting a pellagrous area. 



Onset, insidious. A sunburn may appear on the back of hands 

 or feet, face and neck. It burns and may blister. Perhaps sore 

 mouth, giddiness, muscular weakness. In a few weeks the redness 

 fades and pigmentation occurs; the skin may be thickened. In a few 

 days there is desquamation of these areas, the underlying skin being- 

 apparently normal. 



Autumn comes and the patient gets better. The next spring, or 

 several seasons later, it recurs surely and more severely ; dermatitis and 

 bulk-E may appear; inflammation of the whole mouth, tongue pro- 

 truded with difficulty, edge may have a greyish membrane, there is 

 enlargement of the parotid gland, dyspepsia, abdominal pains, 

 diarrhoea, or even dysentery. Marked vertigo, the patient may fall, 

 weak, trembling in head, arms and legs, melancholic, highly emotional^ 

 patient may seek to drown himself. 



He has burning pains at night and may go to the river to relieve 

 them. Someone pulls him out of the water and reports that he was 



