11 Plagues without Germs.docx

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Department
Health Studies
Course
HLTB21H3
Professor
Caroline Barakat
Semester
Fall

Description
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  1 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] 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  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 o affected peripheral nerves only not muscles  1911, Casmir Funk polish scientist o isolated antineuritis substance from rice bran o amine and active he coined the term vital amine or vitamine o BUT he actually isolated a antipellagra factor b/c nicotinic acid amine  1926; Dutch chemists B. Jansen and W. Donath isolated crystals of actual anti-neuritis factor  TEASPOON of the vitamin in a ton of rice bran remained it vitamin B o1 Thiamine Preventing and Curing Beriberi  Husk alone contained the substance that was the “antineuritis factor”  1929; Nobel Prize Eijkman for discovery of cause and means of prevention  retaining husk of rice has eliminated beriberi or adding vitamin supplements  main cause of death among prisoners of war of Japanese in ww2  seen mostly among alcoholics who lack solid food in diet and who require more thiamine to metabolize large amounts of alcohol o Thiamine;  Cofactor of three enzymes necessary for normal cell metabolism of sugars and alcohol  Deficiency lead
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