Pellagra in The united states of america
First cases of pellagra in the united states
The first report of pellagra in the United States can be traced back to 1902 by H.F. Harris, a physician in Atlanta [1]. He reported a case of a poor Georgia farmer whose diet consisted mainly of corn and was sick for almost 15 years [2]. His symptoms seemed to get worse during the summer time and got better when the whether got cooler [3]. The patient was told to move to a cooler climate and to stop eating decomposed corn to improve his health [4].
Shortly after the first case reported, pellagra began to be recognized in epidemic proportions. In 1906 Dr. George H. Searcy, an Alabama physician, noticed an epidemic of pellagra happening at Mount Vernon Hospital for the coloured insane [5]. There were 88 cases of pellagra reported at the time, 80 of them were female and the average age was 34 years old [6]. The fatality rate among those with the disease at the hospital was 64% [7]. The patient's had a diet that was mainly corn-based and were the only one's who became ill with the disease [8]. The nurses that came in contact with the patients on a regular basis never developed pellagra [9]. The main difference among patients and staff were their meals since the nurses had a more nutritious diet that consisted of things other than corn [10]. Since Searcy was aware of the previous theories of pellagra being caused by toxins in corn in Europe he blamed the consumption of mouldy and spoiled corn as the cause for the disease among the patients [11].
Shortly after the first case reported, pellagra began to be recognized in epidemic proportions. In 1906 Dr. George H. Searcy, an Alabama physician, noticed an epidemic of pellagra happening at Mount Vernon Hospital for the coloured insane [5]. There were 88 cases of pellagra reported at the time, 80 of them were female and the average age was 34 years old [6]. The fatality rate among those with the disease at the hospital was 64% [7]. The patient's had a diet that was mainly corn-based and were the only one's who became ill with the disease [8]. The nurses that came in contact with the patients on a regular basis never developed pellagra [9]. The main difference among patients and staff were their meals since the nurses had a more nutritious diet that consisted of things other than corn [10]. Since Searcy was aware of the previous theories of pellagra being caused by toxins in corn in Europe he blamed the consumption of mouldy and spoiled corn as the cause for the disease among the patients [11].
beliefs on the etiology of pellagra
In the early 20th century the common belief was that diseases were either caused by an infection or a toxin so the investigation was directed toward proving these theories [12]. The idea that pellagra was caused by a toxin or the "mouldy meal" hypothesis was widely accepted and therefore attention was put towards sanitation [13]. The medical community supporting the theory that spoiled corn was the cause for pellagra created an economic repercussion on agriculturists and several laws were passed on corn inspection in southern states [14]. A warning was even issued by the Georgia State Board of Health to warn the public about the danger that consumption of western corn could have [15].
Since the origin of pellagra was such a mystery patients with the disease were often shunned and ostracized [16]. They were compared to those who had the disease called leprosy and even called "lepers" because of the similarity of skin ailments [17]. Those affected with pellagra had to deal with social isolation and often were refused admission in some hospitals [18]. In 1909 the first national conference of pellagra in Columbia was organized by James Wood Babcock [19]. This organization had strong views that the etiology of pellagra was spoiled corn [20].
By 1912 pellagra was at its peak with 25000 cases reported in only seven years [21]. The disease was common among women who were 22-24 years old, children who were 2-10 years old and the elderly [22]. Most of those with the disease lived in cotton mill villages and cases were seen in clusters [23]. Unfortunately the presence of these cases in clusters gave more support to the hypothesis that pellagra was an infectious disease and people believed that pellagra was due to some infectious agent that was transferred from person to person [24]. By 1914 the opinion that pellagra was an infectious disease was very common.
Since the origin of pellagra was such a mystery patients with the disease were often shunned and ostracized [16]. They were compared to those who had the disease called leprosy and even called "lepers" because of the similarity of skin ailments [17]. Those affected with pellagra had to deal with social isolation and often were refused admission in some hospitals [18]. In 1909 the first national conference of pellagra in Columbia was organized by James Wood Babcock [19]. This organization had strong views that the etiology of pellagra was spoiled corn [20].
By 1912 pellagra was at its peak with 25000 cases reported in only seven years [21]. The disease was common among women who were 22-24 years old, children who were 2-10 years old and the elderly [22]. Most of those with the disease lived in cotton mill villages and cases were seen in clusters [23]. Unfortunately the presence of these cases in clusters gave more support to the hypothesis that pellagra was an infectious disease and people believed that pellagra was due to some infectious agent that was transferred from person to person [24]. By 1914 the opinion that pellagra was an infectious disease was very common.
Dr. Goldberger and the cause of pellagra
In 1914 Dr. Joseph Goldberger was asked to investigate pellagra by the US public health service [25]. To do this he inspected southern orphanages, mental hospitals and prisons [26]. During his inspections he made a very crucial observation that the inmates who lacked a nutritious meal developed the disease but the staff who had a well balanced meal did not [27]. Dr. Goldberger had experience dealing with infectious diseases and with his previous knowledge on the subject he knew that this disease did not arise from an infectious agent or a germ [28]. He had the theory instead that pellagra was due to a nutritional deficiency, which completely went against what was previously thought of the disease [29].
Dr. Goldberger did a number of experiments to prove his theory that germs did not cause pellagra, which contradicted commonly held medical opinions. He knew that infectious diseases would not have discriminated against inmates and staff and there was no evidence on spoiled corn causing the disease [30]. Diet seemed to be the biggest factor in all the cases of pellagra [31]. For his first experiment he introduced fresh meat, milk and vegetables into the diets of children at an orphanage and inmates of an asylum [32]. Those who had pellagra were cured after the diet was implemented and those who did not have the disease never contracted it [33].
Even though Dr. Goldberger cured people with pellagra just by changing their diets there were still critics who believed in the original germ theory. Determined to prove pellagra was a dietary disorder he wanted to show that removing something from the diet of healthy individuals would cause them to develop the disease [34]. In 1915 he conducted an experiment using 11 healthy inmates at a Mississippi prison as volunteers who were rewarded full pardon for participating [35]. He fed them a poor diet that consisted only of corn-based meals, which he believed caused pellagra, and within five months 6 out of the 11 showed signs of pellagra [36]. He then added meat, milk and vegetables to their diet which reversed the symptoms [37]. Even with the dramatic results from this experiment and some praise from his colleagues there were still people who doubted his findings and believed his experiments were freud [38].
Dr. Goldberger was so dedicated and determined in his work with pellagra he even held "filth parties" in 1916 that he took part in along with his colleagues and even his wife [39]. During these "filth parties" those participating would inject themselves with the blood from patients diagnosed with pellagra and ingest scabs, faeces and body fluids from patients in capsules [40]. None of the people that participated in these experiments developed pellagra, which proved it was not an infectious disease and supported Dr. Goldberger's theory [41]. With Dr. Goldberger's experiments and dedication he was able to cure the disease among orphanages and prisons, produce the disease among healthy inmates and prove that the disease was not contagious through his filth parties.
In the end Dr. Goldberger was able to prove that a persons diet caused pellagra and not the previous germ theory. This linked the poverty of southern sharecroppers, tenant farmers and mill workers to the poor diet which was the cause of the disease [42]. He warned people of the crucial link of a poor diet due to poverty and the onset of the disease [43]. This lead to both positive and negative responses. His findings and ultimate cure for pellagra gained attention from President Warren G. Harding who approved an increase of the budget for hospitalization and supplies [44]. It also gained attention from public health services who asked Southerners to provide local relief for the poor [45]. Unfortunately since the link was made between the poor southerners diet and the cause of pellagra this enraged some of the public. They were worried that these new findings would damage their pride and prosperity and discourage economic investments and tourism in their area [46]. This group of people who had negative responses were led by South Carolina congressmen Jimmy Brynes [47].
Unfortunately after all the hard work Dr. Goldberger put into the research of pellagra he never lived to see the true cause of pellagra, or what the key factor that was missing from the diseased diets. Pellagra found in dogs was called canine black tongue disease [48]. A decade after Dr. Goldberger's death Conrad A. Elevjhem discovered that this disease in dogs was caused by a deficiency of nicotinic acid (B vitamin niacin) [49]. (history) This discovery quickly made it's way to help human patients suffering from pellagra and it was found by Dr. Tom spies that they could be cured by nicotinic acid as well.
Dr. Goldberger did a number of experiments to prove his theory that germs did not cause pellagra, which contradicted commonly held medical opinions. He knew that infectious diseases would not have discriminated against inmates and staff and there was no evidence on spoiled corn causing the disease [30]. Diet seemed to be the biggest factor in all the cases of pellagra [31]. For his first experiment he introduced fresh meat, milk and vegetables into the diets of children at an orphanage and inmates of an asylum [32]. Those who had pellagra were cured after the diet was implemented and those who did not have the disease never contracted it [33].
Even though Dr. Goldberger cured people with pellagra just by changing their diets there were still critics who believed in the original germ theory. Determined to prove pellagra was a dietary disorder he wanted to show that removing something from the diet of healthy individuals would cause them to develop the disease [34]. In 1915 he conducted an experiment using 11 healthy inmates at a Mississippi prison as volunteers who were rewarded full pardon for participating [35]. He fed them a poor diet that consisted only of corn-based meals, which he believed caused pellagra, and within five months 6 out of the 11 showed signs of pellagra [36]. He then added meat, milk and vegetables to their diet which reversed the symptoms [37]. Even with the dramatic results from this experiment and some praise from his colleagues there were still people who doubted his findings and believed his experiments were freud [38].
Dr. Goldberger was so dedicated and determined in his work with pellagra he even held "filth parties" in 1916 that he took part in along with his colleagues and even his wife [39]. During these "filth parties" those participating would inject themselves with the blood from patients diagnosed with pellagra and ingest scabs, faeces and body fluids from patients in capsules [40]. None of the people that participated in these experiments developed pellagra, which proved it was not an infectious disease and supported Dr. Goldberger's theory [41]. With Dr. Goldberger's experiments and dedication he was able to cure the disease among orphanages and prisons, produce the disease among healthy inmates and prove that the disease was not contagious through his filth parties.
In the end Dr. Goldberger was able to prove that a persons diet caused pellagra and not the previous germ theory. This linked the poverty of southern sharecroppers, tenant farmers and mill workers to the poor diet which was the cause of the disease [42]. He warned people of the crucial link of a poor diet due to poverty and the onset of the disease [43]. This lead to both positive and negative responses. His findings and ultimate cure for pellagra gained attention from President Warren G. Harding who approved an increase of the budget for hospitalization and supplies [44]. It also gained attention from public health services who asked Southerners to provide local relief for the poor [45]. Unfortunately since the link was made between the poor southerners diet and the cause of pellagra this enraged some of the public. They were worried that these new findings would damage their pride and prosperity and discourage economic investments and tourism in their area [46]. This group of people who had negative responses were led by South Carolina congressmen Jimmy Brynes [47].
Unfortunately after all the hard work Dr. Goldberger put into the research of pellagra he never lived to see the true cause of pellagra, or what the key factor that was missing from the diseased diets. Pellagra found in dogs was called canine black tongue disease [48]. A decade after Dr. Goldberger's death Conrad A. Elevjhem discovered that this disease in dogs was caused by a deficiency of nicotinic acid (B vitamin niacin) [49]. (history) This discovery quickly made it's way to help human patients suffering from pellagra and it was found by Dr. Tom spies that they could be cured by nicotinic acid as well.
footnotes
- Kumaravel Rjakumar, “Pellagra in the United States: A Historical Perspective,” Southern Medical Journal 93, no. 3 (2000): 272-277.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- 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.
- Ibid.
- Ibid.
- Ibid.
- Rjakumar, “Pellagra in the United States: A Historical Perspective,”
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Alan Kraut, “Dr. Joseph Goldberger & the War on Pellagra,” Office of NIH History. 1996, http://history.nih.gov/exhibits/goldberger/docs/ackn_8.htm (March, 2014).
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Syndenstricker, “The history of Pellagra, Its Recognition as
a Disorder of Nutrition and Its Conquest,”
- Syndenstricker, “The history of Pellagra, Its Recognition as
a Disorder of Nutrition and Its Conquest,