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Chapter

11 Plagues without Germs.docx


Department
Health Studies
Course Code
HLTB21H3
Professor
Caroline Barakat

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Chapter 16 - Plagues without Germs
confidence in one germ, one disease led to the identification and control of many
infectious diseases, but this also fueled bias that hampered the uncovering of the causes of
deficiency diseases; plagues without germs
The red plague
Known as pellagra, unheard of today but killer in its time
First describes in Spain; 1735: “Mal de la Rosa” meaning the red disease
Appeared first as skin rash that covered hands, feet & sketched an ugly butterfly
pattern across the neck
Mark of butterfly became a Stigma
Early stages: reddening of skin resembling sunburn, when skin crusted or peeled
away showing smooth shiny skin under then a diagnosis of pellagra was certain
Skin of hand is rough and dead and harsh
Flaming of the skin was the signature of disease, also loss of balance, staggering gait,
and senseless muttering characterized the disease
Weak and melancholy, tongue became reddened, burning sensation in mouth &
diarrhea
CLINICAL SYMPTOMS: 4d’s –diarrhea, dermatitis, dementia, and death
Afflicted poor and wasn’t only confine to poor; the word “pellagra” derived from
Italian word pelle=skin and agra=rough
Associated with people who had diet mainly CORN
EARLY 1900S; struck American south
Spring fever that appeared before mid February, grew worse by may and June
1st recognized among insane patients in Alabama, farmers and mill workers
1909; epidemic report of pellagra from 26 states in US
fatality rate 40% in 1916
continuing rise made it a national concern, US public health service got involved
disease could not be developed in animals even if injected with pellagra tissue or
urine extracts from pellagrins
1730-1930; estimated half million deaths worldwide
1950; pellagra eradicated
Searching for the “Germ” Pellagra
Joseph Goldberger: 1899 joined US public health department
traveled around for a year throughout the pellagra belt of the American South
discovered a paradox that the nurses, orderlies or doctors who treated patients
slept in the same room and had DIRECT skin contact BUT none came down w/ it
pellagra wasn’t contagious disease spread by direct contact
suggested to physicians that it was a disease of the poor
o the difference b/w poor and not poor was their diet [food they ate]

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o noticed the docs/nurses/orderlies had food of meat, vegetables and milk
while patients DID NOT
experiment in 1915 in Rankin Prison Farm where pellagra was never occurred
food for the experimental group was a monotonous diet called 3M
o consisted of meat [salt pork], meal [cornmeal], and molasses
o contained no red meat, no fresh vegetables, and no milk
80 convicts were held in a similar clean environment
after month, the convicts on the unsupplemented diet had headaches, dizziness
and burning sensation in their mouths but no rash
it took 6 months before the telltale butterfly rash of pellagra appeared on the
necks and hands of 5 convicts
poorer classes were dependent on foods that did not include red meat b/c
depression of 1917 & price of animal protein food rose over 40%
lower the income higher the incidence of pellagra
1928; 120,000 people in US who suffered an attack of pellagra
o a “hidden hunger” even though no direct diet-deficiency
problem of pellagra is in the main problem of poverty
improvement of economic conditions can heal this “festing ulcer”
contagionists held to believe it was an infectious disease
Goldberger held a daring experiment: 20 friends and his wide and himself
swallowed a capsule that had scrapings of pellagra patient and none became ill
He state in 1918 hypothesis that pellagra is of dietary origin and NOT contagious
is greatly strengthened”
Preventing and Curing Pellagra
Today recognized that pellagra can be prevented by adding fresh meat, milk eggs
and vegetables to diet
Goldberger: these foods contained what he called the “P-P” pellagra preventive
factor
Red plague of pellagra was plague of corn: hominy grits, corn mush, corn bread all
lack the p-p factor
Diet called “diet 123” consisted of cornmeal, cow peas, sucrose, cottonseed oil, cod
liver oil, sodium chloride and carbonate
o Required only 60 days on this diet to produce pellagra in dogs
Yeast is preventive and cure to pellagra
Simply sprinkling yeast on the 123 Diet prevented black tongue and death in dogs
Red cross distributed yeast to pellagra victims after river floods
Goldberger died of cancer in 1929
o Conrad identified anti black tongue factor in liver extracts
o Added to basic diet 123 dogs didn’t suffer from severe weight loss and didn’t
develop black tongue
Nicotinic acid, amide renamed niacin
o Niacin; water soluble b vitamin was the preventive of blacktongue and
pellagra and was goldberger’s p-p factor
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Mexican practice of soaking corn meal in hot limewater before making tortillas
releases the bound NIACIN and prevents pellagra
Niacin constituent of NAD & NADP: needed for normal oxidative metabolism of
sugars
Responsible for activating catalysts or enzyme by binding to it
Without niacin in diet food cannot be utilized as a source of energy because sugars
are not metabolized
Cells in body die or don’t function properly and illness results
Research of red plague led to discovery of antimetabolites; drugs designed to
inhibit bacterial growth by interfering w/ their enzymes
o Sometimes called antibiotics erroneously
o Isoniazid and pyrazinamide drugs used in treatment of tuberculosis are both
structural analogs of niacin; inhibit growth of “Mycobacterium tuberculosis”
The White Rice Plague
1611; governor general in Indonesia described a neurological disorder
characterized by paralysis of the hands and feet
native name: beriberi meaning weakness b/c person is too sick to do anything
national disease of japan
manifested itself as a progressive loss of strength, loss of appetite, swelling of ankles
and thighs with great pain in leg joints and loss of the ability to speak, emaciation
and death from asphyxia and convulsions
loss of sensation in feet produced characteristic ankle drop , disease was called
“kakke” meaning leg disease
acupuncture, scorching and blistering of skin in order to draw out the toxic gases in
body, practice of bloodletting used in western medicine for centuries
common belief that disease was result of miasmas from damp soil
Takaki: naval physician: modify the diets of naval cadets to include more meat,
bread and vegetables and less rice
o The foot drop of beriberi did not occur
o Concluded that the disease was a result of a protein-deficient diet
High incidence in Chinese immigrants in Malaysia
Tamils and Chinese both had rice as main component in diet
Hamilton Wright and Leonard Braddon
o Dietary experiments and found differences in the manner which rice was
prepared
o Both ate white rice but Tamils ate parboiled and parboiling destroys the
toxin produced by fungus growing on rice
o No toxin was found
Eijkman’s chickens after 3-4 weeks, showed the polyneuritis characteristics of
beriberi
o Those chickens that developed beriberi has leftover cooked rice fed to them
Cooked white rice or table rice made chickens develop polyneuritis but brown did
not
1900, Dutch physician Gerrit Grijins: beriberi was a nutritional deficiency disease
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