Conference on Pellagra : held under the auspices of the State Board of Health of South Carolina at the State Hospital for the Insane, October 29th, 1908.

Date:
1909
Catalogue details

Licence: In copyright

Credit: Conference on Pellagra : held under the auspices of the State Board of Health of South Carolina at the State Hospital for the Insane, October 29th, 1908. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    sleeping sickness a peculiar itchy eruption is an early manifestation, and appears as an ill-defined erythema in patches distinctly ringed, in some cases seven to eight inches in diameter. Again, it may appear as rubelloid spots of congestion, shading ofif gradually into normal skin, and finally it may present as measly patches with the skin appearing slightly thickened and swollen. The skin manifesta- tions of syphilis are, of course, legion, and the appearances of both sleeping sickness and pellagra may be simulated exactly. General Symptoms: In the three there is common to each that gradual tendency to weakness, emphasized especially in the lower limbs in pellagra and general paresis, accompanied by progressive anemia and emaciation. Nervous Symptoms: We come now to possibly the most remark- able of all the similarities; namely, that of the nervous symptoms in pellagra and general paresis. In that type of pellagra where the spinal and mental symptoms stand forth prominently we have the picture of general paresis so closely simulated in every respect that it is extremely difficult to differentiate the two with the nervous symptoms alone considered. The one point of difference that has been called attention to is the absence of motor speech derangements in pellagra, which is a constant symptom of general paresis. Tuczek, indeed, claims that the conditions undoubtedly do coalesce, beginning with pellagroid symptoms and finally becoming true general paresis. As a rule the nervous symptoms in pellagra are not progressive, while in general paresis they are essentially so. In sleeping sickness we have the same headache and mental hebetude, the patient appear- ing apathetic, with cerebration retarded; muscular spasm, epileptic seizures and tremors often appear, paretic symptoms in general gradually supervening. The deeper reflexes are primarily exagger- ated, followed by a total loss; later, contractions of the flexors of the arms and legs appear and rigidity of certain groups of muscles is usual. The mental state, according to Jackson, is not usually that of general paresis, mania and the delirum of exaltation rarely being observed, while on the contrary despondency and a consciousness of wretchedness is the rule. In other respects it resembles general paresis. Pathology: Here we have further verification of the relationship between syphilis and pellagra in the spinal cord changes. Lombroso states that in the most typical cases they suggest that in incipient tabes, with this difference: while in pellagra few changes are found below the dorsal region, in tabes the lumbar region is chiefly affected.
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