Asylum Doctor: James Woods Babcock and the Red Plague of Pellagra

Appendix 2: Parallels in the Histories of Beriberi and Pellagra

267 A p p e n d i x 2 Parallels in the Histories of Beriberi and Pellagra Beriberi Pellagra Cause Deficiency of thiamine (vitamin B1) Deficiency of niacin (vitamin B3) Origin of the term “Extreme weakness” (Sinhalese); others “Rough skin” (Italian) Principal manifestations Peripheral neuritis and wasting (dry beriberi); heart failure (wet beriberi) Dermatitis (symmetric, sunburn-like rash), diarrhea, dementia Original place(s) of appearance Asia Spain, France, Italy, and Eastern Europe Setting that led to eventual cure Dutch West Indies American Southeast Presumed racial differences in susceptibility Japanese were thought to be more susceptible than Russians during the Russo-Japanese War. Blacks were generally thought to be more susceptible than whites in the American South. Probable cause of epidemic form Polished rice Degerminated corn Early explanation Diet based mainly on rice Diet based mainly on corn Idea that toxins were the cause Bacteria produce a beribericausing toxin (1886); others Moldy corn contains a pellagra-causing toxin (earlynineteenth century) Impact of the germ theory of the disease An infectious agent exists in peripheral nerves and is transmitted from person to person by an agent, possibly an insect (1902) The likely cause is a parasite, transmitted by an unidentified insect, quite possibly a fly of the genus Simulium (Louis Sambon, 1905). Parallels in the Histories of Beriberi and Pellagra (continues) 268 Asylum Doctor Beriberi Pellagra Development of an animal model Polyneuritis in chickens (fowl polyneuritis) (Conrad Eijkman, 1895) Black tongue in dogs (Chittenden and Underhill, 1917) Hero figure Christiaan Eijkman, 1895 Joseph Goldberger The hero figure’s good fortune (or lucky break) Eijkman’s chickens were being fed leftover cooked rice without his knowledge. Goldberger was assigned to pellagra shortly after Casimir Funk’s “vitamine” hypothesis went public. Major problems with the hero-myth Eijkman did not appreciate the full significance of his experiments and returned to the germ theory, despite mounting evidence against it. Goldberger did not “invent” the dietary-deficiency hypothesis (nor did he claim to have invented it). Numerous observations pointed away from an infectious cause. Main contributions of the hero figure Discovery of the animal model (fowl polyneuritis) Design and execution of studies using dietary manipulation to establish the essential cause; relentless campaign to promote balanced diets; demonstration of the preventative and curative value of brewer’s yeast Identification of the deficient vitamin Robert Runnels Williams (1933) Conrad Elvehjem (1937) ...