SYMPTOM A TOLOGY 



1727 



frequency of nasal or facial seborrhoea, which is to be especially 

 noted in the nose where the sebaceous follicles are very prominent 

 and filled with plugs of sebaceous material. 



The Mouth. — The tongue is generally coated with a whitish fur 

 during the onset of an attack, but later it becomes abnormally 

 clean — ' Sandwith's bald tongue '—red, swollen, and sometimes 

 ulcerated near the tip. It may also become fissured, but in mild 

 cases it recovers as soon as the attack is over. 



During attacks the gums may become spongy, and may bleed, 

 and ulceration may appear, both here and on the palate, as well 

 as on the pillars of the fauces. There may be pharyngitis, and more 

 rarely oesophagitis. 



The Blood. — The red cells are usually reduced in number, and the 

 haemoglobin proportionally reduced. Usually the form of the red 

 cells is normal, but microcytes, and more rarely megalocytes, may 

 be found. There is usually only a slight leucocytosis in uncompli- 

 cated cases, but there is in our experience generally a distinct 

 mononucleosis. When the polymorphonuclear cells are increased, 

 it would appear to always indicate a comphcation. 



Circulatory Organs. — ^The blood-pressure is usually low, and the 

 heart-rate may be markedly increased. Vasomotor changes can 

 be observed in the coldness of the extremities, the bluish conges- 

 tion of the feet and hands, the goose skin, and the neuroparalytic 

 dilatation of the vessels of the face often giving rise to an appear- 

 ance seen in alcoholics. 



Respiratory Organs, etc. — ^The respiratory organs are not affected 

 in pellagra unless there is some complication, but there may be an 

 exudation of fluid into the pleural cavities in the late stages of 

 the disease, as well as oedema of the bases of the lungs. 



Urinary Organs. — Usually the urine is normal, or nearly so, 

 and any great change must be considered to be a complication. 



Sexual Organs. — Sexual power is usually diminished, especially 

 in the later stages. Amenorrhoea, metrorrhagia, and inflammatory 

 conditions of the vagina, uterus, ovaries, etc., are described, but 

 must be considered as complications. 



Special Senses. — ^The eyes suffer most in pellagra, but the changes 

 — e.g., weakness of vision, photophobia, etc. — are not dependent 

 upon the disease per se, but upon the weakness which it produces. 

 The patients often complain of a saltish taste in the mouth. 



Fever. — ^As arule the temperature is but little altered from normal 

 in pellagra, but it may be raised at intervals as high as 101° to 

 102° F. (Wood) for two to three days at a time, but it may also 

 be subnormal in other cases. 



Complications. — As may be imagined, in a disease of such lorjg 

 duration as pellagra, the complications are numerous, and include 

 malaria, tuberculosis, ankylostorniasis, bilharziosis, eye affections, 

 and many skin diseases, including itch. 



The most interesting complication is enteric fever , which may give 

 rise to the form often called ' typho-pellagra,' which is apparently 



