Fig. 157.—Microscopical constituents of faeces. (v. Jaksch.) a, Muscle fibres; b, connective tissue; c, epithelium; d, leucocytes; e, spiral cells; f, g, h, i, various vegetable cells; k, “triple phosphate” crystals; l, woody vegetable cells; the whole interspersed with innumerable microorganisms of various kinds.
The Alimentary Tract
The Mouth
In pellagra we have moist fissuring at the angles of the mouth with a large indented tongue with central coating and bare tip and sides. There is often a glairy mucus covering these red borders on the side. The fungiform papillae are prominent. Later on the tongue may become fissured and uniformly red. The buccal mucosa shows a carmine flush. The gums are tender but there is not the tendency to aphthous ulcers one sees in sprue. The flow of saliva is frequently increased.
In sprue there is at first great sensitiveness of the buccal mucosa so that articles of moderate pungency give rise to painful burning sensations. The tongue becomes quite sore with vesicle formation along borders and tip which soon turn into ulcers. Ulcerations also occur on the buccal mucosa, particularly at the site of the posterior upper and lower molar teeth (Crombie’s ulcer).
The congestion causes a great increase in mucus especially about the faucial pillars and pharynx. Ulcers are common about the fraenum of the tongue. While the tongue is coated at first with red ulcerated tip and sides it later becomes bare of any coating, red and finally even glazed as though varnished. It is at times fissured.
Onyalai.—A very peculiar disease of Portuguese West Africa and possibly the Soudan region, known as onyalai is characterized by the appearance of blood-distended vesicles of the mucosa of the cheeks and hard palate. The tongue is often swollen. The skin may show haemorrhages and haematuria is not infrequent. The mouth blebs vary in size from that of a split pea to a diameter of ½ inch or more. The cause is unknown.
Herpes labialis is not so common in tropical as in temperate climate malarias. It is absent in plague pneumonia.
In leprosy the nodules which form on the inside of the cheeks and fauces tend to show ulceration and thickenings. The discharges from the ulcerations in the nose, especially that on the vomer, reach the pharynx and such leprosy bacilli-containing discharges may be expectorated and cause one to consider the material as coming from the lungs.