494 



WILLETS. 



tion, are often of a mushy consistency and, as a rule, vary in frequency 

 from 2 to 6 a day. When other symptoms are well marked and great 

 emaciation is present, the diarrhoea at times may give place to constipation, 

 a condition which the physicians at the Georgia State Sanitarium have 

 learned to regard with apprehension. 



The nervous symptoms are very variable, depending upon the stage 

 of the disease and the individual case. The earliest symptoms are 

 headache, restless irritability, insomnia (rarely drowsiness), vague 

 neuralgias and some depression of spirits. As the disease advances, these 

 symptoms become more marked and an alteration in the knee jerk oc- 

 curs. In some cases, with menial symptoms similar to those of acute 

 mania, all of the deep reflexes appear to be increased. Muscular weakness 

 is characteristic. Many other conditions of a miscellaneous nature are 

 reported, such as paraplegia, hemiplegia, contractures of the extremities, 

 tetanoid states, convulsions, tremor of the tongue, head and upper ex- 

 tremities, and paresthesias. Trophic changes also, such as oedema, sen- 

 sations of cold, and general paleness, are reported. 



Some eases show no mental involvement, while others vary from slow 

 cerebration, faulty memory and slight depression, to asylum cases where 

 almost any psychosis from dementia prsecox to senility may be simulated. 

 Some, with a history of long-continued illness, are diagnosed readily as an 

 infective-exhaustive type, but others may be confused with manic-depres- 

 sive insanity in the depressed stage, involutional melancholia, imbecility 

 or dementia pnecox. Negative symptoms, particularly with regard to 

 taking food, not infrequently are present, and also stereotyped move- 

 ments. Bizarre, fantastic, changeable delusions, often of the nature of 

 a phobia, are at times coupled with a profound depression. As in the 

 case of skin lesions, where a slight change is left in the affected parts 

 when one attack clears up, just so some depression, irritability, and lack 

 of interest in ordinary duties is left over, and as often as the disease 

 recurs this condition is increased. 



Many of the insane in Italy are pellagrins. There were 945 such cases in 

 1874. and 1,348 in 1877. Statistics for Saint Clement's Hospital of Venice give 

 the following data (King) (6) : 





Num- 

 ber of 



insane. 



Pella- 

 grous 

 insane. 



1874 



558 

 595 

 1168 

 802 

 859 

 924 



178 

 153 

 175 

 215 

 294 

 337 



1875 - - 



1876 - 



1S77 - 



1878 -- - - - - -. 



1879 





It is not stated whether these pellagrins were insane when admitted to the 

 hospital or became pellagrous after admission. 



