1720 



PELLAGRA 



nerve roots may be implicated, and the intervertebral foramina may be 

 narrowed by a firm cartilaginous-like deposit. 



The Complicatorv Lesions. — Very often in pellagra post-mortems the signs 

 of secondary septicaemia (bacillary or streptococcal), of ankylostomiasis, of 

 mialaria, of enteric fever, of bacillary dysentery, of amoebic dysentery, and 

 of tuberculosis, may be seen, and complicate the pathological picture. In 

 performing post-mortems, it is necessary to attempt to unravel the true 

 lesions from, those caused by complications. The so-called characteristic 

 intestinal lesions described above are met with in many post-mortems in 

 which there is no sign of pellagra. 



Histopathology. — With regard to the autonomic nervous system, the nerve 

 cells of the sympathetic ganglia of the neck and abdomen are described by 

 Brugia as becoming swollen, and showing chromatolysis, with changes in the 

 nucleus and nucleolus in acute cases. Associated with this there is infiltration 

 of the interstitial tissue and proliferation of the endothelial cells of the 

 capillaries and "circumscribed haemorrhages. 



Fig. 738. — Cells of Clarke's Column in a Case^of Acute Pellagra. 

 (X 250.) (After Sambon and Chalmers.) 



With regard to the chronic cases, there is atrophy and reduction in number 

 of the nerve cells and sclerosis of the ganglion. The atrophied cells may be 

 pigmented, but this is by no means constant. 



In the spinal cord our own observations, as well as those of others, show 

 that the posterior area is congested, and haemorrhages are often present. 

 Degeneration has been met with in the cells of the spinal ganglia, in those of the 

 posterior cornu, and in those of Clarke's column. In these cells the Nissl 

 bodies and the fibrils disappear, while the nucleus is placed excentrically, and 

 often peripherally. Degenerated nerve fibres have been found in the posterior 

 roots, in Lissauer's tract, in Burdach's column, and in Goll's column, and less 

 commonly in the lateral columns. Some of the cells of the anterior cornu also 

 degenerate. Degenerated nerve fibres may also be seen in the peripheral 

 nerves. 



In the brain the cortical cells have been found to be degenerated, swollen, 

 and even disintegrated; while Purkinje's cells in the cerebellum are also said 

 to degenerate. Mott has shown that while the fibrils surrounding these cells 



