PELLAGRA 335 



There is often loss of memory. He may refuse food. Dementia 

 may develop. 



There may be ptosis, hemianopsia, diplopia, amblyopia and 

 mydriasis. 



In extreme cases the bladder is paralysed, there is profuse diarrhoea, 

 dropsy and death. This latter in five to fifteen years from onset. 



Very rarely there are acute cases lasting only a few months. 



Skin eruption shows congestion, inflammation, thickening and 

 pigmentation of a light sepia tint. Atrophic wasting. 



The tongue sheds its epithelium and is known as Sandwith's bald 

 tongue (also present in sprue and scurvy). 



Blood pressure is low. Pulse-rate increased, extremities cold, skin 

 often bluish. 



Sexual power is diminished. Saltish taste in mouth common. 



Temperature but little altered. Emaciation marked. 



Complications and terminal affections are naturally numerous. 



To sum up : — 



(i) Cutaneous signs are : a remitting erythema and dermatitis of 

 the exposed parts. The skin loses its elasticity. 



(2) Gastro-intestinal signs are : salivation, stomatitis, oesophagitis, 

 dyspepsia due to hyperchlorhvdria, nausea, vomiting, diarrhoea, 

 dysentery symptoms and constipation. Proctitis with anal excori- 

 ations. 



(3) INIental symptoms are : vertigo, melancholia, myasthenia, trem- 

 blings, curious delusions, irritability. 



(4) Genital symptoms are : intense vaginitis, a sero-sanguineous 

 discharge with excoriation of surrounding parts. Mucous membrane 

 a scarlet red like that of the mouth. 



(5) Nephritic symptoms are : acute or chronic nephritis in many 

 cases, albumin, and casts in varying proportions. 



DIAGNOSIS. 



From acute dermatitis as erythema solare, &c., by the gastro- 

 intestinal and nervous symptoms. 



Fro'm chronic dermatitis as eczema by pigmentation, peculiar 

 localization to the exposed parts chiefly. 



Ichthyosis is all over the body and congenital. 



Gastro-intestinal symptoms as sprue by their not having an 

 eruption. 



PROGNOSIS. 



Be always guarded. Early mild cases may recover if removed and 

 placed in good suitable surroundings. 



