Pellagra

pel'la-gra, a dread disease. A systematic study has been made of the origin, the prevalence, the symptoms, and the fatal results of this disease, but, after a century of anxiety and thirty years of the closest investigation, medical science is baffled in the attempt to assign an exact cause or to suggest a remedy. The disease has been considered a European malady. Of late it has appeared in the United States and has created widespread alarm. Pellagra is connected with the use of Indian corn or maize as an article of diet. It is confined to corn-eating countries. Mexico and the United States have not been aware until of late that such a disease exists, but in southern Europe, where the climate is suitable and has led to the extensive cultivation of Indian corn, pellagra has become a plague. The poor people--the peasantry--in sections of Portugal, Spain, southern France, Sardinia, Egypt, Roumania, and Italy live largely on corn meal. It is in these districts, where methods of curing corn are defective, and where damaged corn and sour meal are the rule, that pellagra is prevalent. To make the matter worse, one of the Italian experts has discovered that the miller finds it profitable and practicable to separate the moldy part of the kernel, usually the germ, from the sound portion, thereby producing sound meal and an inferior, damaged grade of meal much sought by the poor because it is cheaper. The peasantry, far from tidy, aggravate their ills by allowing the porridge which they call polenta to stand around until it sours. These aggravating dietary conditions have spread the disease among the poor to such an extent that the pellagra is called mal de la miseria, the disease of poverty.

The disease attracted attention on the shores of Lake Maggiore in northern Italy about 1740; in 1750 it broke out near Milan and in many localities of Lombardy. In 1776 while our patriots were struggling with the question of independence, the fathers of Venice were passing laws forbidding the gathering of moldy corn from fields that had been overflowed, and prohibiting the sale of spoiled corn in the market. The progress of pellagra has been noted more carefully in Italy than elsewhere. In 1839 there were 20,000 cases in Lombardy alone, and within twenty years there were twice as many. In 1881 eight regions of northern Italy contained 104,067 registered cases with scattered cases everywhere. The total extent to which this disease, ever on the increase, has become prevalent among the poorly fed working people of the Mediterranean countries is a matter of conjecture.

The conditions under which the plague prevails have been investigated by Italian physicians. It comes and goes with a moldy corn diet. Pellagrins, as the afflicted are called, are not found in villages that do not consume corn. A village of Russian sectarians that eat no corn, situated in the midst of pellagrous villages in Roumania, is free from the disease. In India, also, villages subsisting on fish and rye are free from pellagra. Rainy seasons result in moldy corn and increased virulence of the disease. Successive years of heavy corn yield increase the number of peasants who go on a corn diet and increase the number of afflicted. Corn crop failures cause a dying down of pellagra. Importations of corn, coming in the damp holds of ships from the ports of the Black Sea and the Danube, cause an outbreak of pellagra. Rigid inspection of imported corn is a help.

To say that no headway has been made in controlling the disease would be incorrect. It has been found that a change to proper diet affects a cure in the young and in cases that have not gone too far. In 1907 there were in Italy twenty-two hospital-asylums for acute cases and 591 diet-kitchens or dietary restaurants for the poor. A nominal charge is made for food. The fare consists of soup, meat, vegetables, bread, wine, milk, and cheese, and patients are enjoined to eat no other. Lunches have been provided for school children with excellent results.

In spite of all that has been done the cause of pellagra is a medical mystery. Those countries are free in which the inhabitants have a custom of oven-drying their corn as soon as it is harvested. The Mexicans are free; they hull their corn with lye or lime water and moreover bake the dough in griddle cakes or tortillas. Rotten polenta is the diet which breeds pellagra, but why does it? An Italian scientist, by the name of Lombroso, a name worthy to stand with Koch and Pasteur, has been on the trail of pellagra since 1864, and has not (1909) solved the question. He has searched for a disease germ like that of yellow fever, diphtheria, or the bubonic plague, but cannot be sure that he has found it. He has followed up the theory that corn is a food on which some disease germs live, but cannot get satisfactory proof. He has separated a poisonous principle from moldy corn and has given it to animals. This poison makes hens dull and droopy, or makes them walk backward lifting the foot high at each step; it gives frogs the lockjaw; it paralyses guinea pigs; it throws mice into convulsions; it kills cats and dogs; it gives healthy persons symptoms of the disease, but in no case have this indefatigable man and his friends been able to produce pellagra by means of the poison pure and simple. Rotten polenta they have tried over and over on peasants, workmen, and convicts; its effects are certain, but the poison extracted from the same polenta and fed with other foods does not produce the effect. The effort of these investigations to connect the cause of pellagra with zea, which is the botanical name of Indian corn, has given them the name of zeists. Those who look for the cause of pellagra independent of zea mays are called anti-zeists.

In 1900 an Italian expert advanced the theory that pellagra is due to a germ communicated by the sting of a gnat.

Whatever the cause of pellagra it is a nervous disease. It manifests itself in the most contradictory ways. It causes loss of appetite and excessive hunger. One patient is stupid; another cannot sleep. One person is even morosely silent--stupid; another chatters unceasingly. There is a saying in Venice to the effect that pellagra can give six ills. It drives one crazy, it draws one backward, it bends one over, it gives dizziness, it gives hunger, and it gives a rheum of the skin. The last named affliction is loathsome and painful beyond description. The rheum attacks the hands, the feet, the face, the neck, back, or breast,--any portion exposed to the sun. Peeling after peeling takes place until the skin is gone and the livid, red flesh is exposed. The tongue and throat are attacked in like manner. The patient screams and sinks in prolonged agony, unable to die and unable to obtain relief from the torture of "swallowing live coals." The following paragraph is taken from an able article by Marion Hamilton Carter in McClure's Magazine:

Through it all runs the black thread of misery--agony of body and mind. Leprosy is very nearly painless; smallpox at least gives one a living chance and leaves the mind if one survives; bubonic plague is soon over. Only acute pellagra is rapid. In its chronic form patients are a never-ending burden. For years and years they degenerate while they slowly die.

Nor is this all, for pellagra seems to pass on a horrible hereditary taint, even unto the third and fourth generation. The children of pellagrins are often born with asymmetrical heads, ears set on wrong and sticking out, harelips, and the appearance of idiocy. They are stupid and apathetic, feeble and shambling in their motions, always sad, and many are very early inclined to suicide. The taint is peculiarly acute if the mother has been pellagrous. Whole families have been seen where not a single member has escaped. In others it skips a generation and comes out in the grand-children. Lombroso mentions the case of a pellagrous boy who showed an inclination to bite and to beat his head against the wall; he fell down at the slightest noise. His parents were healthy, but his grandfather had been a pellagrin with precisely these peculiarities.

America, wont to regard pellagra as a far-off evil incident to conditions not prevalent in this country, has been astonished, not to say horrified, to find that it exists in a virulent form in this country, and that it bids fair to become an epidemic. In 1864 a case was reported by Dr. John Gray of Utica to a national convention of superintendents of insane asylums. Superintendent Tyler of Massachusetts spoke of a similar case that had come under his observation. In 1883 another case was reported, and in 1902 a case was reported from Georgia. It appeared about this time as an epidemic in the Mount Vernon, Alabama, asylum for negro insane, but attracted little attention at the time. In 1908 the dreadful truth burst upon the medical world. America had pellagra, and it was widespread. In that year the disease centered in Alabama, but sporadic cases were known in New York, Massachusetts, Illinois, South Carolina, and Georgia. In September, 1909, the plague was virulent in Illinois and in all the cotton states east of Texas, with cases in Arkansas, Kansas, Virginia, Maryland, Pennsylvania, New York, and Massachusetts. What the end may be no one can foretell, but the skill and courage with which smallpox, typhoid, yellow fever, and other dread diseases have been fought by the medical profession give hope that pellagra, too, may be stayed.

Very possibly this disease to which Americans have been indifferent is a New World disease. It is indeed probable that the disease and the corn were a gift of the Americans to Europe and that, in bestowing the blessing of a great food plant upon the Old World, a plague went with it. Significance has been given to passages in the accounts of early explorations. It is now believed that the Spanish writers chronicled pellagra among the Indians in 1600. It is quite possible that we have had cases from the first settlement to the present day. Blind staggers, a vertigo that attacks horses, especially those fed on moldy corn, is suspected of being a form of the malady.

In 1909 a national pellagra conference was held to compare notes and stimulate further investigation of the subject.