Malaria Epidemics at Exceptionally High Altitudes

A MORPHINE ADDICT MEDICALTIJOURNAL45 about their unsightliness. They did not irritate, and they showed the usual seasonal variation. Since taking morphine she had been very moody-easily excited, then depressed. She rarely went out, and often made scenes-screaming, etc.-when the morphine allow- ance was finished. Her son dreaded coming home. She was admitted to the observation unit, St. Alfege's Hospital, on Aug. 7, 1941. She was pale, and the typical brownish branny patches on her skin stood out in contrast. In general the exposed areas were pigmented. There were particularly well marked pigmented patches over the manubrium sterni and nape of the neck, disposed " neck- lace" fashion, also on the backs of the fingers, wrists, and insteps. Her tongue was pale and very smooth. There was no fur, despite the poor appetite and the fact that she had taken so little food before admission. Her blood pressure was 110/70. There was gross oedema of the ankles All tendon-jerks were absent. The patient said that they had been absent for years. She did not display the classical pellagrous dementia. Cerebration was quick and fairly accurate. She was hypochondriacal, and would resort to any device, from violence to wheedling, to get morphine. She was very self-centred. The blood Wassermann reaction and Kahn test were negative. A barium meal showed evidence of " gastritis " (thickening of rugae), with poor gastric tone and some initial delay followed by rapid emptying. No ulcer was demonstrated.