[ Read before the Texas Homoeopathic Medical Association, Oct. 14 and 15, 1931. ].
Pellagra has probably been known and endured for centuries in Italy and other Mediterranean lands, in Africa and the hot parts of other countries, especially among the very poor and ill nourished population. It has been called the Morbus Pauperum the Disease of the Poor. Disease of the Poorly Fed is more correct for the richest may also suffer if improperly fed.
When some of us began practice we knew pellagra only as a word, referring to a far distant disease, like beri-beri, away in distant lands, of no interest to us. Those were the days of free grass and free range, the days of thousands of cattle on the hills and plains, the days of meat retailing at three, five, eight cents a pound. This adequate supply of meat continued until the nineties. Then cattle became scarce in proportion to the population and meat across the counter began to rise in price until it went beyond the reach of the poor.
Other changes came about also, for example the development of the cotton mills and a great increase of tenant farmers in the south. Mill hands and tenant farmers ceased raising swine and poultry and keeping milk cows. Meat, eggs and milk disappeared from their diet. They could not afford to buy the high priced beef. Due to these factors they lived almost wholly on carbohydrates and hydro-carbons. Later we will consider the dire results of such a steady diet. The map of pellagra distribution in America follows pretty closely the state lines of the southern states rather than the isothermic lines.
Pellagra, in the light of recent investigations, is defined as a systemic deficiency disease. On this basis, it is to be classed with beri-beri, scurvy and rickets, but is unlike all of them, for it is caused by a different deficiency, which became pronounced in this country about 1900 and has continued to the present time.
Warm blooded animals are divided dietetically, into three distinct classes:.
1. Vegetarian or graminivorous.
2. Carnivorous.
3. Omnivorous. The omnivorous must have both vegetable and animal (nitrogenous) food in order to thrive. Humans are omnivorous. Those human races living almost wholly on vegetable food are inferior, in several points, from those living on vegetable and animal food. This paragraph is but a premise for discussion to follow.
The etiology of pellagra has been, during the past thirty years, a topic of much discussion based on several theories. Among the earlier theories was that of a certain Italian fly, which was said to produce the disease by its bite. Briefly, that theory has been abandoned. Then came the corn-smut theory, probably because most of the corn grown in Italy was very poor in quality, on account of poor land, and was consequently smutty. The homoeopathic provings of corn-smut, otherwise Ustilago maidis, show a toxic effect on the female system, but practically no symptoms resembling pellagra. Rye-smut, Ergot, does show many symptoms of pellagra, but in my practice it has been a disappointment in the treatment of this disease.
The U.S. Pellagra Commission mentions Ergot in their report, but says that while its outward manifestations resemble pellagra, the micro- scopic, inward results are very different. We would be interested to receive information as to pellagra in the rye-eating lands. Suffice it to say that in the southern part of our own country millions have been brought up on corn-bread, and we never hear of this disease as long as the protein ration is adequate. This paper throws to corn theory into the discard.
A more plausible theory, and one which suggests itself to every modern physicians mind, is the microbe theory. Even the modern laity assume that cause, and are afraid to come in contact with pellagrins. That theory, also, is vanishing. Dr. Edward Francis, U.S. Health Service, took samples, including cerebral and spinal fluids, from all parts of seventeen pellagrins in the Georgia Insane Asylum. Some of these samples were from living cases, some from post-mortems. He tried to develop cultures therefrom. All in vain. Not one culture developed anything suggesting a pellagrous microbe.
They either remained sterile, or developed extraneous microbes from contamination. Dr. Francis then prepared extracts from all parts-brain, spine, skin and internal organs-of dead and living pellagrins and injected them into some 94 rhesus monkeys. These monkeys are very susceptible to pellagra. He also introduced the extracts in other ways, by mouth, by nose, by rectum, in food and drink. Results negative. Only one monkey showed any sign of pellagra and this was probably contracted accidentally. The monkey recovered spontaneously. Dr. Francis report ends thus: “The work here reported furnishes no support for the view that pellagra is an infectious disease”.
The fact that in pellagra hospitals the physicians and nurses, always well-fed, never contract the disease, also contradicts the infection theory.
The theory of bad sanitation as a cause was easily disposed of by comparing sanitary and unsanitary villages. They showed no practical difference as to incidence of the disease.
The facts, above, reported, were deduced from long and meticulous experimentation, which fills many pages in the report, and proves what are not the causes of pellagra.
We will now consider another series of very carefully arranged experiments, in the dietetic line, made scientifically and cautiously, in the quest of the true cause of pellagra. These experiments were made in 1915, by Dr. Joseph Goldberger and Dr. G.A. Wheeler, of the U.S. Public Health Service, with the co- operation of Governor Brewer of Mississippi, and his penitentiary authorities. On one of the penal farms, the Rankin, a few miles from the capital city of Jackson, the doctors were permitted to select from volunteer convicts, a squad of perfectly healthy men, on whom to make the test.
Those subjected to the test were promised pardon and liberty on the following October 31. This date allowed too short a time for complete testing. But the promise was kept, and the members of the squad were all released on October 31, 1951. The Commission agreed in advance that no patient should be diagnosed as having pellagra unless the skin eruption appeared on him.
Twelve healthy men were selected, free from all constitutional disease, of good heredity, and unassociated with any pellagrous person. “One ran away, and then there were eleven.” All the other convicts on the farm, about 35, and all the free persons, officers, guards and their families, total of about 47, were controls, or standards of comparison. The sanitary environments of these controls, the working convicts were quite unsanitary, dirty, hot, infested with mosquitoes and bedbugs.
Their work hours were long, and the work hard. The test-volunteers were placed in a thoroughly disinfected, and well screened hospital at quite a distance from other buildings. Its sanitary arrangements were very good. Their bedding was clean, and their rooms well kept.
They were closely guarded, to obviate any claim that they were in any manner exposed to contagion, and to prevent the introduction of any forbidden diet. Each one, on transfer to the test house, was examined and found to have good appetite, normal sleep, good elimination and no skin eruption. In February, they were confined in the test house, and continued for two months on the usual regulation diet, to allow time for any incipient trouble to manifest itself. None appearing, all were placed on the monotonous, experimental diet on April 19, 1915. These men ranged in age from 24 to 55 years. They were worked moderately on the farm when in condition to work, and allowed ten minutes rest out of each hour. Not so the others. When they were sick, they stayed in the house.
From April 19, 1915 their diet was uniformly about as follows: White bread flour biscuits, corn bread, corn grits, polished rice, cane sugar, cane syrup, sweet potatoes, pork fat (not fat pork), cabbage, collards, turnips, turnip greens, coffee.
Up to July 28, the biscuits were made with buttermilk. Thereafter buttermilk was omitted, as a nitrogenous food. During the week ending June 27 each man received four ounces of beefsteak per day, thereafter none. The pork fat was simply lard, a hydro-carbon. Thus we see that the diet was practically wholly of a farinaceous nature, wholly carbo-hydrate and hydrocarbon, with no proteins of animal source whatever. And remember that humans are by nature omnivorous-they need nitrogenous food. There was no limit on such food as they had. They could and did eat to satisfaction. The food was of the best quality, and there was no corn-smut in any part.
Also observe that the cornmeal, the wheat flour and the rice were all highly finished, the envelopes of all being removed, and with them all the Silicea. Dr. Schussler would make a great point of that. On this diet, each man received from 2,500 to 3,500 calories. The working convicts, in the main building, received 3,500 to 4,500. The regular diet of the working convicts included all of the foregoing test menu, plus many kinds of vegetables, beef, mutton, pork and fish, one or another, sometimes two every day. Bear in mind also that they were worked harder than the test volunteers, and that they worked right through the hot summer in the sun, 10 or 12 hours daily. But they had the diet proper for the omnivorous class of animals.
