. Alienist and neurologist. . worse. The gums, especiallythe lower one, becanoe much inflamed and ulcerated. The under surface of the tongue became inflamedand small, ulcerated spots were observed along the frenum. Soon an acute uvulitis and pharyngitisset in, the flow of saliva was increased, and as it drooled out along the angles of the mouth, pro-duced fissures and herpes. Proctitis, vulvitis and vaginitis soon developed, and her food (whichwas in liquid form and taken with difficulty) was noted to be passed in her stools in a much undigestedstate. The erythema of the hands soon changed to
. Alienist and neurologist. . worse. The gums, especiallythe lower one, becanoe much inflamed and ulcerated. The under surface of the tongue became inflamedand small, ulcerated spots were observed along the frenum. Soon an acute uvulitis and pharyngitisset in, the flow of saliva was increased, and as it drooled out along the angles of the mouth, pro-duced fissures and herpes. Proctitis, vulvitis and vaginitis soon developed, and her food (whichwas in liquid form and taken with difficulty) was noted to be passed in her stools in a much undigestedstate. The erythema of the hands soon changed to a brownish discoloration, the skin became palpablyand perceptibly roughened and dry, and the line of demarcation separating the normal from theabnormal skin was made more distinct, giving the whole area of pigmentation a g/ove-/i^e effec:.Dry, roughened patches formed on her elbows, knees and buttocks. The diagnosis of pellagra wasmade on the 14th of December, and though an intensive animal protein diet was administered, from. Page One Hundred EiKhty-Nine THE ALIENIST AND NEUROLOGIST then on her body became more and more emaciated, her diarrhea contmued to be profuse, herfood undigested, regardless of intestinal antiseptics, astringents and digestive aids until about themiddle of January, when an appreciable improvement was noted. Her conjunctivae became purulentand an ulcer formed on the margin of the cornea of the right eye. Her abdomen was sensitiveto pressure, she complained of a burning sensation especially in the epigastric region, there was amousy odor about her, and as the picture well depicts |Fig. 1), she had an anxious, glaring special diet she seemed to improve physically and mentally. Her face lost for a time itsanxious, frightened appearance, becoming brighter. Her stomatitis, proctitis, etc., responded verynicely to treatment. Her appetite increased and she very seldom, if ever, refused her the mouth and chin the skin became da
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