Nicotinic Acid 191
dren and adults of both sexes suffer from the disease, preg-
nant women and nursing mothers suffer most. In localities
which are only mildly afflicted the disease appears year after
year in the spring to disappear later, but each recurring
attack in an individual seems to leave a permanent lowering
of his resistance, both to this and to other diseases.
The disease begins with loss of weight and waning
strength, together with vague grumbling complaints, poor
appetite, and fretful disposition. Later burning sensations
appear in the mouth, in which the mucous membrane be-
comes fiery red, swollen, and fissured, so that swallowing
is an ordeal. The skin is marked by red, rough, scaly areas
which burn and itch, and ultimately acquires the parchment-
like texture of a mummy’s skin. These red areas have a
strange symmetry on the two sides of the body, and most
commonly appear on the parts exposed to light—ugly, painful
patches on the backs of the hands, on the tops of the feet, in
necklace formations, and as “butterfly wings” on the cheeks.
The digestive system is upset also; the mucous membrane,
especially of the colon, becomes red, thick, and congested,
and dyspepsia, diarrhea, nausea, and vomiting are common.
There are nervous symptoms too—muscular cramps, tre-
mors, and a characteristic mental condition of melancholia,
lethargy, and stupor; in severe cases hallucinations and de-
lirium make the sufferers quite irrational. The lesions of
the nervous system are similar to those of beri-beri, but
occur mainly in the central nervous system while those of
beri-beri are more marked in the peripheral parts. Un-
doubtedly, however, nearly every case of pellagra is com-
plicated by some degree of deficiency in vitamin B1 as well.
The majority of pellagrins have anemia to add to their
burden of discomforts.
Alcoholics very often suffer from pellagra as well as