Pellagra by George Henry Heald

Review and Herald Publishing Association · Takoma Park, Washington, D. C. · Jul 24, 1913

Pellagra

By George Henry Heald

G. H. HEALD, M. D. Editor Life and Health

Pellagra is one of the most sinister diseases that the human family must face, for several reasons, among which are its rapidly increasing prevalence, its high mortality, and its mysterious nature. Thus far no one can say that he knows certainly the cause of pellagra, and up to the present there has been no treatment that is reliably curative.

As to its increase. Only a short time ago the disease was unknown by name to the ordinary person, and to most physicians it was only a name for a rare disease they never expected to see. Now the physician who does not have pellagra in mind as one of the possibilities will almost certainly make a blunder sooner or later; and in some States the disease seems to have attacked almost entire neighborhoods.

The characteristic symptoms are, (1) an inflammatory condition of the digestive tract, very persistent and not yielding to ordinary treatment; (2) a rash, especially on parts of the body exposed to the sunlight, worse in the spring; (3) there are apt to be during some stage of the disease mental symptoms more or less severe.

The purpose of writing this article is to call attention to the work of Dr. W. E. Deeks, of the Ancon Hospital, Canal Zone, who formulated a theory as to the causation of the disease, and inaugurated a course of treatment based upon the theory, which has been remarkably successful. The fact that a number of our own people have been victims of the disease gives point to the theory that Dr. Deeks has advanced.

Any one desiring to read the articles by Deeks may find them in the Medical Record, March 23 (William Wood & Company, New York City, 15 cents), and Southern Medical Journal for July (Southern Medical Association, Nashville, Tenn., 25 cents).

Of those treated by his method two thirds—eighteen out of twenty-seven—were cured, three more were improved, and of those who died the record is that some died so soon after entering the hospital that the treatment had no opportunity.

Deeks attributed pellagra to "the result of an autointoxication caused by the action of some ferment or organism on a carbohydrate diet to excess, to the exclusion of green vegetables and fruits during the warm weather, when metabolic activity is lessened."

The disease, he says, "seems to prevail among the poorer people or those accustomed to live upon the cheaper or less nutritious foods." He made careful inquiry as to the diet in these cases, and concluded that corn could not be considered the important factor in the causation of pellagra. In some cases no history of the use of corn in any form could be obtained. "All, however, were consumers largely of sweet and starchy foods to the practical exclusion of proteids, green vegetables, and fresh fruits." And an extensive experience in the tropics, he says, has shown that "health is best maintained and much suffering avoided when sweet and starchy foods are excluded from the dietary or reduced to a minimum."

Corresponding to the lack of energy in the warm climate, there is less muscular activity and hence less opportunity for the body to burn up the fuel foods; as a result there is not a proper digestion and assimilation of the starchy and sweet foods, and fermentation results. It may be that pellagra is an infection, but if it is, the indigestion caused by the overuse of starchy foods seems to give it a foothold: and the facts that a rigid dietary cures and that the only patient who after cure had a return of symptoms was one who had returned to his old dietary, and who was again cured by a strict diet, is additional evidence that the disease is favored by a faulty diet.

Deeks believes that pellagra has increased because of the increased use of cane-sugar and of cereals. "I believe that it is not corn alone, but any cereal or starchy food in conjunction with cane-sugar in a warm climate, where there is lessened metabolic activity, and consequent inadequate elaboration of digestive elements which initiates the intoxication."

His treatment consists, "(1) in limiting the nourishment absolutely to fresh fruit-juice, preferably of oranges, meat broths, and milk as long as there is nausea and vomiting; and the absolute avoidance of everything that contains sweet or starchy elements; (2) in the administration of from fifteen to thirty drops of dilute nitric acid in three fourths of a tumbler of water three times daily on an empty stomach." In three or four days a carbohydrate-free diet is ordered. This in his practise consists of eggs, meats, fish, green vegetables (such as lettuce, celery, onions, tomatoes, beets, carrots, spinach, peas, string-beans, etc.), and fresh fruit of all kinds. The nitric acid is continued three times daily before meals.

It is always well to be wary of first reports on a new remedy. But Deeks, it should be remembered, reported on twelve cases in the spring, and now he reports on eighteen new cases, fully convinced by his additional experience that he has discovered, to say the least, an important contributing cause of pellagra.

While we remain committed to the proposition that the human body is essentially a fuel-burning engine, it must be recognized that much less fuel is required in warm climates, and there are other essential foods that must not be neglected.

The writer believes that as good results might be obtained without the use of meats and fish, provided a proper amount of milk and eggs is supplied.