Implementing a cure
By 1924 a dietary treatment was adopted by almost every hospital, however a well balanced diet was not practical to poor Southerners with the disease because of bad economic conditions and some stubborn eating habits [1]. Just in Georgia there were a total of 5804 reported deaths in 1920-1930 according to the Georgia State Bureau of Vital statistics [2]. There were still two different theories of the cause of pellagra, either that it was infectious disease or it was a deficiency disease that was caused by a lack of vitamin or an unbalanced diet [3]. In 1930 the vitamin theory was now accepted by most people and it was generally thought to be a nutrition disease as Joseph Goldberger had stated [4]. Unfortunately the disease was not soon eliminated and in 1933-1934 there were 3953 deaths reported in the United states, 93% of the deaths were reported in the Southern states and the rest were widely spread across the U.S. [5]. In 1940 there were more than 2000 reported deaths even though there was a lot of attention put towards the disease from the federal and state health organization as well as the red cross and local welfare [6]. The effort, education and therapy was still not successful in putting an end to pellagra due to poor food habits, economic stress and chronic malnutrition seen over the Southern States [7]. Since the diet of fresh meat, milk and vegetables seemed to be too expensive to cure the disease many alternatives were produce, showing effective in treatment but for some reason not adopted well by the ill [8]. Nicotinic acid amide or sodium nicotinate could be given intravenously and was much cheaper, however this also did not stop the deaths from occurring [9].
World war II can be given a lot of credit in ending pellagra due to the employment it brought with it [10]. Almost everyone had either a job now or a soldiers pay that provided an income to once poor workers [11]. Also rationing that was done over the war made people want to only buy high protein foods that they never had previously, which helps to stop the disease [12]. The enrichment of flour began to put things back into it such as B-vitamins [13].
Pellagra Today
Today pellagra is very rare upon developing countries due do nutritional diets as well as the enrichment of wheat flour with nicotinic acid [14]. It can still be a problem in developing countries where malnutrition is a problem and foods that are lacking niacin such as corn and rice are the primary sources of nutrition. Primary causes of pellagra that would result in someone getting disease are through a lack of intake of the vitamin niacin or the amino acid tryptophan [15]. Malabsorbtion, inflammatory bowel disease resulting in failure to process niacin or tryptophan, alcoholism, liver cinchosis, carcinoid syndrome and certain drug use can all be secondary causes of pellagra that could be seen today [16]. However, pellagra in the US and developed countries is a thing of the past thanks to the discovery of the cause of the disease.
footnotes
- V.P. Syndenstricker, “The history of Pellagra, Its Recognition as a Disorder of Nutrition and Its Conquest,” The American Journal of Clinical Nutrition 6, no. 4 (1958): 409-414.
- Vernon E. Powell, “Pellagra,” The American Journal of Nursing 31, no. 3 (1931): 267.
- Ibid.
- Ibid.
- W.H. Sebrell, “Endemic Pellagra,” The American
Journal of Nursing 34, no. 12 (1934): 1153-1156.
- Syndenstricker, “The history of Pellagra, Its Recognition as a Disorder of Nutrition and Its Conquest,”
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid
- Ibid.
- J.D. Stratigos and A. Katsambas, “Pellagra: A Still Existing Disease,” British Journal of Dermatology 96, no. 99 (1977).
- Martin A. Crook, “The importance of recognizing pellagra (niacin deficiency) as it still occurs,” Nutrition 3, no. 4 (2014).
- Ibid.