A mental state resembling the acute delirium of paresis may be present. Such states are often terminal. The usual course of pellagra is afebrile. Such terms as pellagra sine pellagra are given to cases which may not show the skin lesions and the designation pseudopellagra has usually been used by those who insist upon limiting the name pellagra to those cases which fit in with their special etiological views so that cases clinically pellagra but in which the special etiological factor does not obtain are called pseudopellagra.
Symptoms in Detail
The cutaneous neurological and alimentary tract disturbances have each already been separately described in detail.
The Blood.—Hillman has made very careful blood examinations of a series of cases and found a variable degree of chloranaemia which however, was not a prominent feature. He notes the occasional occurrence of a leucocytosis in the course of the disease. As a rule there is a definite lymphocytosis, the average percentage of lymphocytes being 33.99. The average percentage for the large mononuclears was 2.59. The average percentage of eosinophiles was 2.73. The determinations of the coagulation time of the blood gave normal figures.
In Ridlon’s series the average red count was 4,720,000, the white count varied from 14,200 to 4200, average 8027. The polymorphonuclear percentage averaged 68.2, that of lymphocytes 21, of large mononuclears 8 and of eosinophiles 2.
Hb percentage averaged 77 and color index 0.81. The blood serum failed to give positive Wassermann reactions.
The Urine.—There is rarely any increase in albumin. The most important urinary finding is in connection with indicanuria, 96.4% of Ridlon’s cases showing this finding. As convalescence comes on indicanuria tends to lessen.
The Temperature Chart.—We expect a normal temperature in an uncomplicated case of pellagra but in typhoid pellagra and in the terminal stages of the disease a fever of from 101° to 103°F. is generally noted. Fever makes for a bad prognosis. There is nothing special about the circulatory system other than low blood pressure and a tendency to vasomotor disturbances. With the genito-urinary system other than the rather marked indicanuria, there is nothing of note.