SYMPTOMATOLOGY 



1725 



elicit curious facts that tend to show that pellagra, though occurring 

 in the person in question in adult life, probably really began in 

 infancy, that we are inclined to believe that the cases in young 

 children are often overlooked, and we are supported in this belief 

 by the mildness of the symptoms which we have observed in some 

 children, which indicate merely a sunburn on the face, hands, 

 arms, feet, legs, and perhaps the neck, associated with a little 

 diarrhoea or constipation. The child recovers, the skin becomes 

 normal, the attack is forgotten, and does not return until adult 



Fig. 741. — Hand in Chronic Pellagra. 



Note the thickening of the epidermis and the line of demarcation. The 

 hands in both figures had been vigorously scrubbed by the patient to try 

 to remove the scabs . 



(From a photograph by Sambon and Chalmers.) 



life, when the patient may have grown up and been living for years 

 in a town, when a typical relapse appears — a new case (a town case 

 it would be classified by many authors), but a careful inquiry into 

 thehistory of thecasemay elicit the fact from intelhgent people that 

 the first attack began in childhood, when it may be explained by 

 the friends as being in reality a sequela of Jenner's vaccination. 



Inquiry may often elicit the fact that when this occurred the 

 patient, at that time a child, was living in the country, and often 

 in close proximity to a stream — a fact which may be confirmed by 

 a visit to the locality. 



Another curious point with regard to some of these early cases 



