Transcript Pellagra * Cause and prevention

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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.
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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.
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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).
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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.”
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HEADLINES
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(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.
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(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.
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(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
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(1913) Insect Carries Pellagra
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(1915) 100,000 Cases of Pellagra in U.S.
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(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.
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(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
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(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
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Get with your partner(s)and propose
what you think could be the cause of
pellagra. Write it down and we will
discuss.
What do you think Goldberger did to prove his hypothesis?
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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.
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He noted that nurses that ate a different diet from
residents did not get sick.
Pellagra was associated with the “3-M diet” – meat (fatback), cornmeal and molasses.
 Recommended fresh meats, eggs, and milk.
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What do you think Goldberger did to prove his hypothesis?
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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.
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The 12 inmates from Mississippi State
Penitentiary recruited for a study.
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He cured, prevented and induced pellagra by
dietary manipulation. He was still not
believed.
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Goldbergere exposed 16 volunteers,
including his wife, to blood, urine, feces, and
epidermal scales of pellagra lesions. No
pellagra developed.
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Goldberger concluded that pellagra was a
socioeconomic malady related to poverty.