1722 



PELLAGRA 



Fig. 739. — Acute Exacerbation of 

 Pellagra. 



Note the marked erythema on the hands 

 and feet, and the less evident ery- 

 thema on the neck and face. 

 (From a photograph by Terni.) 



may be found to be normal, or 

 may be found to be slightly 

 atrophic, and to appear whiter 

 than the surrounding pig- 

 mented area. 



The patient thinks no more 

 of his troubles, the autumn 

 comes, and he feels well, and 

 during the winter there is no 

 alteration in his good health. 

 Perhaps the next spring may 

 pass without a recurrence, 

 and perhaps even several 

 springs may elapse before the 

 patient, who all this time may 

 consider himself to be in ex- 

 cellent health, has a return 

 of his symptoms. But though 

 the interval may be long or 

 short, this relapse will surely 

 occur, and often it will be in 

 a severer form than it v/as at 

 first. It will usually recur in 

 the spring, but it may take 

 place in the autumn, or, much 

 more rarely in our experience, 

 in the summer. 



This time the symptoms 

 may be mild, as before, but, 

 on the other hand, they may 

 be severe ; the erythema 

 appears with severe burning 

 sensations, and a real derma- 

 titis; with bulla formation, 

 may develop. 



The tongue, lips, mucosa of 

 the mouth and palate, may 

 become inflamed, and show 

 the presence of vesicles and 

 ulcers. The parotid gland 

 may enlarge (this is common 

 in Egypt, but rare in other 

 countries), the saliva may be 

 so increased in amount that 

 it pours from the mouth. 

 There may be signs of dys- 

 pepsia, pains in the abdomen, 

 and diarrhoea, or even dys- 

 entery may develop. The 

 vertigo already mentioned 



