MALDISMU8. 225 



neck and back. Dizziness, muscular weakness and unsteadiness of 

 gait are frequently observed. Mental activity becomes slow, and 

 some complain of a numbness in the brain. In the majority of in- 

 stances, not in all, there is a characteristic erythema which is most 

 marked on the unclothed parts of the body, as the hands and face, 

 though it may be much more widely distributed. It is to this affec- 

 tion of the skin that the disease owes its common name, pellagra 

 (from pelle, skin, and agra, rough). 



The appearance of certain cerebro-spinal symptoms characterizes 

 the second stage of the disease. Chilly sensations are complained 

 of and there is often constant ringing in the ears. The muscular 

 weakness is increased ; tremors and convulsive twitchings become 

 frequent, and cramps and light spasms occur. The tendon reflex is 

 more markedly exaggerated, sensibility is often diminished and the 

 patient falls into a state of melancholia. The skin becomes pale or 

 there is capillary injection over certain areas notably of the face, 

 and in some instances the skin becomes hard and scaly. 



Marked emaciation is one of the characteristic symptoms of the 

 third stage. The subcutaneous fat wholly disappears, locomotion 

 becomes impossible, incontinence of urine is persistent and uncon- 

 trollable diarrhoea makes the bed-ridden patient an object of pity. 

 Fortunately, after this stage has been reached the individual loses all 

 resistance to the infectious diseases, and tuberculosis or septicemia 

 frequently closes the history. A considerable number of pellagrous 

 individuals end their sufferings by suicide. 



The most characteristic post-mortem findings may be stated as 

 follows : The body is greatly emaciated, the intestinal walls are thin 

 on account of the wasting away of the muscular coat, ulceration in 

 the intestines is frequently found, the cells of the liver and of the 

 skin and the muscles of the heart are deeply pigmented. Atrophy 

 seems to be most marked in those organs connected with the vagus 

 nerve, the lungs, heart, kidneys, spleen and intestines. Although 

 marked alterations from the normal are frequently found in the 

 brain and cord, there seems to be no constant or characteristic lesion 

 in these organs. 



15 



