Pellagra – Cause and prevention

Symptoms In 1902, an Atlanta physician reported the first case of

pellagra in the U.S. Patient is a poor Georgia farmer, who has always eaten a diet

in which Indian corn was a staple and has had a recurrent, debilitating warm-weather sickness for nearly 15 years.

Each spring he loses weight. Typically, blisters erupted on his arms and legs, and he has

extreme melancholia with suicidal ideation. Symptoms worsen through the summer and abate with the

onset of cool weather. Despite adequate therapy of a coexisting hookworm

infestation and treatment of pellagra with arsenic and iron, there is no sustained improvement.

The patient is advised to move to a cooler climate and to avoid eating decomposed corn.

In 1906, an epidemic of pellagra among hospitalized patients of Mount Vernon Hospital for the Colored Insane (Alabama) was studied. Of 88 cases, 80 were female, the mean age was 34, and the fatality rate was 64%. Most of the patients had been in good physical health prior to hospitalization. Two thirds had been in the hospital for more than a year. None of the nurses attending the patients were affected. A sample of corn meal consumed at Mt Vernon was tested in a lab and found to be unfit for human consumption.

 

In 1909, Pellagra occurred in epidemic proportions in several other mental institutions in neighboring southern states. Epidemic was seen in orphanages, cotton mill villages, and urban and rural areas.

The exact cause was not known. It had existed in Europe for two centuries. The Europeans had noted an association with corn and the occurrence of pellagra (remember corn comes from the Americas originally).

How widespread?

Between 1907 and 1912, over 25,000 cases had been diagnosed, with a mortality rate of 40%.

Culture of “Pellagraphobia” existed and patients were shunned as “lepers.”

HEADLINES

From The New York Times:

(1909) South’s Crusade Against Pellagra Spread of Dread Malady of Mysterious

origin Causes Alarm▪ Case Found in New York▪ More than 500 Found in South Carolina Alone

– The Damaged Corn Theory▪ National Conference on Pellagra convened in

South Carolina. They strongly implicated corn, especially spoiled corn, in the etiology of pellagra.

From The New York Times:

(1909) More Causes of Pellagra Impure Water Found to be One – Disease

in New York Cottonseed oil and sugar cane also

implicated. Claims made that pellagra is infectious.

From The New York Times:

(1909) Pellagra Victim Shown to Doctors Georgia Mountaineer on View to

Illustrate a Lecture at Academy of Medicine

Disease Spreading Here▪ Already has a Foothold in Twenty-two States,

Southern Physician Say – Poor Corn Blamed

From The New York Times:

(1913) Insect Carries Pellagra

(1915) 100,000 Cases of Pellagra in U.S.

From The New York Times:

(1916) Find Pellagra Cure in Change of Diet Federal Health Service Experiments in

Orphan Asylums Remove Odium from Some Foods▪ Flour Makers Suffered▪ Consumption of Highly Milled Product Fell Off 25

Percent. Under Misconception of the Facts.

From The New York Times:

(1921) Plague Threatens 100,000 Victims in the Cotton belt Tenant Farmers, Half-Starved by Crop

Failure, Face Scourge of Pellagra▪ Washington Is Alarmed▪ Public health Service Fears 10,000 Deaths

This year and more next Year▪ Urges Immediate Relief

From The New York Times:

(1921) Orders Relief For Pellagra Victims Harding Asks Public health Service for

Full Report on Cotton Belt Conditions▪ Seeks Red Cross Action▪ President Pledges Every Aid in His Power in

Fighting Plague and Famine

Your task

Get with your partner(s)and propose what you think could be the cause of pellagra. Write it down and we will discuss.

Joseph Goldberger from the US Public Health Service studied pellagra, beginning in 1914. He hypothesized the epidemiology of pellagra within 3 months of beginning his investigation. He proposed that the poor diet of the pellagra victims was the cause of the disease.

He noted that nurses that ate a different diet from residents did not get sick.

Pellagra was associated with the “3-M diet” – meat (fat-back), cornmeal and molasses.

Recommended fresh meats, eggs, and milk.   What do you think Goldberger did to prove his hypothesis?

What do you think Goldberger did to prove his hypothesis?

Goldberger’s Efforts

In 1914, commonly held opinion was that pellagra is infectious and communicable.

By observation and literature review, Goldberger hypothesized that pellagra was dietary disease.

After dietary modification in a Georgia sanitarium, there was no recurrence, even though there was a 50% recurrence among the controls.

The 12 inmates from Mississippi State Penitentiary recruited for a study.

He cured, prevented and induced pellagra by dietary manipulation. He was still not believed.

Goldbergere exposed 16 volunteers, including his wife, to blood, urine, feces, and epidermal scales of pellagra lesions. No pellagra developed.

Goldberger concluded that pellagra was a socioeconomic malady related to poverty.