1724 



PELLAGRA 



The facies of the pellagra patient is one of anxiety and mental 

 worry. He cannot sleep, and there is often great mental depression 

 and discontent ; but some [are excitable and irritable, while others 

 are stupid and morose. He loses his memory, and has vague 

 feelings of pressure, weight, or pulsation about his head. From 

 this he proceeds to refusal of food and suicidal tendencies, with 

 delusions of sorcery and persecution, and has a tendency to suicide 

 by drowning. Melancholia may now becom^e confirmed, and may 

 eventually pass into dementia. 



Fig. 740. — Hand in Chronic Pellagra. 

 (From a photograph by Sambon and Chalmers.) 



Various .paralyses develop, such as spastic paralysis, ptosis, 

 hemianopsia, diplopia, amblyopia, and mydriasis. The extremities 

 and bladder now become paralyzed, and the demented, paralyzed, 

 rapidly emaciating patient, suffering from bad sweats, profuse 

 diarrhoea, and sometimes dropsy, obtains a relief from his sufferings 

 in death, the disease hav ( iisually lasted from ten to fifteen years. 



Such is a general acco..nt of this rather protean disease, and we 

 note that there is an onset in the spring, or more rarely in the 

 autumn or summer, an intermission in the winter, and a relapse 

 in the next or some following spring or autumn. 



Very rarely a case of pellagra may be acute, lasting only a few 

 months. 



Children. — The disease is so common among young children in 

 bad pellagrous districts, and so often can one, by careful inquiry, 



