Pellagra in the United States: A Historical Perspective

Kumaravel Rajakumar, MD, Department of Pediatrics, West Virginia University School of Medicine, Morgantown.

South Med J. 2000;93(3) 

In This Article

Abstract and Introduction

Pellagra was in existence for nearly two centuries in Europe before being recognized in the United States, where it was first reported in 1902. Over the next two decades, pellagra occurred in epidemic proportions in the American South. Poverty and consumption of corn were the most frequently observed risk factors. Since the exact cause and cure of pellagra was not known, a culture of "pellagraphobia" formed among the public. Patients were shunned and ostracized. The medical community implicated spoiled corn as the cause of pellagra, which had economic repercussions for agriculturists. Joseph Goldberger, MD, of the United States Public Health Service eventually solved the secret of the malady: faulty diet. Goldberger was able to prevent and induce pellagra by dietary modification, a landmark event in the annals of medicine, nutrition, and epidemiology. His work and the social history of that period are reviewed.

Pellagra, a systemic disease of niacin deficiency, was not recognized in the United States until the beginning of the 20th century. Don Gasper Casal, a Spanish court physician, first described pellagra in 1735.[1,2] Casal noted the malady among poor peasants of Asturias and called it "mal de la rosa," because all the affected patients had the typical reddish and glossy rash on the dorsum of the hands and feet. Francois Thiery, a French physician, published the first description of pellagra in 1755.[1,2] He had learned about mal de la rosa from Casal during his visit to the Asturias in 1750. Casal's description of pellagra was published 3 years after his death, in 1762.[2]

Francesco Frapoli, an Italian physician, first used the term "pellagra" in 1771.[1,2] Pellagra in the local Italian vernacular meant "rough skin," denoting the rough skin dermatitis of the pellagrins. Earlier, Casal had been puzzled as to the origin of pellagra and had asked, "Is the cause of this disease to be sought in the heavens, that is in the condition of the atmosphere, or in the constitutions, or in the diet of the patients?"[2] Casal had observed that pellagrins were all poor, subsisted mainly on maize, and rarely ate fresh meat.[2] Indian corn or maize was introduced to Europe from the New World after the 15th century.[3,4] As a crop, corn was easy to grow and soon became the staple cereal of the European poor. Pellagra remained endemic for nearly two centuries among the maize eaters of southern Europe.

The first case of pellagra in the United States was reported in 1902.[5] Soon pellagra began to occur in epidemic proportions in states south of the Potomac and Ohio rivers.[6] The pellagra epidemic lasted for nearly four decades. It was estimated that there were 3 million cases and 100,000 deaths due to pellagra during the epidemic.[4] The exact cause of pellagra was not known. The patients felt ostracized and were shunned. The social stigmatization was similar to that of the present day epidemic of acquired immunodeficiency syndrome.[4] Joseph Goldberger of the US Public Health Service solved the secret of the malady of pellagra. Goldberger's epic work and the social history of the pellagra epidemic in the United States are reviewed.


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