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Consequences of Eugenics The Contested Etiology of Pellagra -- Niacin The Cure

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Early stages of a niacin deficiency include symptoms like muscle weakness, anorexia, indigestion, and skin eruptions. Pellagra is the name given to a more severe deficiency of niacin and was first described when corn was introduced as a major dietary component in the early 1700's. This was common in the southern US in the early 1900's. In 1937 at the University of Wisconsin, Elvehjem first demonstrated that nicotinic acid cures pellagra. This usually results from diets lacking enough protein or not enough niacin. Symptoms of a niacin deficiency initiate with weakness, indigestion, and lack of appetite. As the deficiency worsens symptoms progress to the 3 D's: diarrhea, dermatitis, dementia. Pellagra can also eventually lead to death if not treated.  (source)

 

Source

• described in 1753 by a Spanish physician asmal de la rosa, "a kind of leprosy," caused by humid air, foul wind, and faulty diet.
• identified in 1771 by a Milan physician as pellagra (angry skin) and thought to be caused by the action of sun on skin.
• affected the very poor in both countries.
• symptoms began with a pattern of skin eruptions followed by diarrhea, lassitude, dizziness, and a variety of mental disorders. 

Thesis: eugenic beliefs in the hereditary susceptibility of "weaker stock" to this disease unnecessarily prevented the development of effective treatment for pellagra for at least two decades (1915-1935), resulting in unnecessary debilitation and death.

Source: Chase, A.(1977). The Legacy of Malthus: The Social Costs of the New Scientific Racism. NY: Alfred Knopf.

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In the early years of the 1900's investigators began to discover cases of pellagra in insane asylums and started to explore the incidence of this malady in nonistitutionalized populations. The origins, causes, and effective treatments for this conditian were uncertain and subject to debate among physicians and medical researchers. Among the competing causal hypotheses were:

• eatingtoo much or uncured corn
• microorganism carried by flies
• corn fungus
• side effects of syphilis
• infectious agents found in unsanitary living environments

Evidence was slowly emerging, that led some investigators to suspect that a poor diet might be responsible. By 1912, however, Dr. Edward Jenner Wood, chairman of the Pellagra Commission of the North Carolina, concluded that "insufficient nourishment" was not a cause. Five facts were known:

1. Advances in diagnostic technology had led to the identification of tens of thousands of cases that had been misdiagnosed as malaria, syphilis, anemia, or scurvy.
2. Resistance to other illnesses was lowered when a person sufered from pellagra.
3. Pellagra occurred most freequently in border and Southern states.
4. Pellagra harmed the textile industry because mill workers were in chronic ill health and suffered from frequent absenteeism.
5. American corn was having difficulty securing European markets because of a widespread belief that corn caused the disease.

Because hookworm and roundworm infestations frequently accompanied outbreaks of pellagra, the prevailing belief was that the disease was a result of toxic or infectious agents and was highly communicable.

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The Goldberger Experiments

Joseph Goldberger Surgeon and Epidemiologist US. Public Health Service Discoverer of the Etiology of Pellagra

 

Among the many unsung heroes of modern times are Joseph Goldberger and his fellow medical researchers. In the early part of the twentieth century these epidemiologists investigated serious diseases whose origins were unknown. Many of them died from exposure to maladies such as typhus and malaria, and those who survived frequently were weakened by these illnesses. These early epidemiologists were willing to experiment on their own bodies in the name of public health.

In 1914 the Surgeon General of the United States directed Goldberger to "discover the causes and the cure of pellagra." This work began with a tour of asylums, mill towns, and slums. Two observations were critical in his laboratory investigations:

• no employees of asylums, prisons, or old age homes developed pellagra.
• pellagra never struck non-poor areas of mill towns even though it was rampant among mill workers and their families.

Goldberger concluded that pellagra was not a communicable disease. Instead, he set out to test the hypothesis that the disease was caused by nutritional deficits, particularly the absence of animal protein in the diets of the poor. He conducted a series of studies to test this hypothesis.

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Economic data

Workingwith a U.S. Public Health economist, he reached the following conclusions:

 

1900 to 1913	Wage rates increased less than 25%
1907 to 1908	Wages in the South increased less than 5%
1900 to 1913	Food prices increased by 60%

Transmissibility Experiments of 1916(Fifteen Men and a Housewife)

Goldberger, several other researchers, and his wife undertook the following research procedures:

• injecting the fresh blood of people sick with pellagra into their own bodies
• swallowing vials bearing "little dough balls impregnated with the urine and feces of sufferers
• swallowing vials of dough balls combined with the scaled-off skin of the afflicted.

Mississippi Convict Study

In 1915 Goldberger and 12 convict volunteers in Mississippi lived on a high-carbohydrate, high-fat, no-protein diet. All of the volunteers contracted pellagra. All were subsequently cured when their diets were changed.

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At a national conference on pellagra a few days after the Mississippi convict study was released, most researchers leaned towards a "sanitation" hypothesis, focusing on a study containing over 1,000 observations which found a negative correlation between the presence of indoor plumbing and sanitation and the occurrence of pellagra. The author of this study cited the statistical techniques of Karl Pearson and Charles Davenport to support this claim. Goldberger argued that the diets of those with indoor plumbing and sewers differed from those who lived in areas with outdoor plumbing and no sewers (i.e., the poor). Pearson, inventor of the correlation coefficient, lived in England and so did not attend the conference.. His fellow eugenicist Charles Davenport, however, offered a "hereditarian" theory of the etiology of pellagra.

Charles Davenport Biologist, Eugenics Record Office Cold Springs Harbor, New York

Davenport supported the theory that pellagra was a communicable disease. He claimed that variations in reactions to the infectious agent were caused by "constitutional" differences in people. "Colored persons," he contended (erroneously), " are less subject to the disease on the whole than white persons." Because the presence of mental disorders brought on by pellagra and the severity of the rash varied between families, he maintained that different "blood lines" varied in their susceptibility to pellagra.

Davenport was instrumental in the publication of the final report of the Pellagra Commission, Pellagra III. He dismissed Goldberger's convict study in a footnote, contending that young adult men were "insusceptible" to pellagra. Davenport's data consisted primarily of the so-called "pedigree charts" popular among eugenics researchers, which traced the incidence of the disease across generations within individual families. The eugenists argued that the co-occurrence of these diseases across generations provided evidence for hereditary factors in human failings. They also claimed that "feeble-mindedness" was a hereditary condition that could not be changed by alleviating social misery. further, the "mentally deficient" were less capable of understanding the importance of sanitation (and also more prone to poverty due to their "deficiencies.") Since susceptibility was hereditary, changing the diets of the "unfit" was not warranted. such measures would artificially prolong their existence and lead to their polific reproduction.

Controversy over the origins of pellagra continued until the mid-1930's. Ironically, a national catastrophe was necessary to settle the controversy and eradicate pellagra in the United States.

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Goldberger spent the rest of his life (he died of cancer in 1929) trying to identify the specific Pellagra Preventive nutritional elemnt. After the stock market crash of 1929, the Great Depression drove many people into unemployment and poverty. Eugenic beliefs in social success as an indicator of hereditary quality were undermined by the national economic catastrophe. Government food relief programs and the manufacture of enriched flour all but eradicated pellagra. The disease is now known to be caused by a deficiency in the Pellagra Preventive element, now known as niacin. As the following table demonstrates, however, deaths from pellagra continued to rise after 1915. It was the widespread poverty of the Depression that led to the policy changes that eradicated pellagra in the United States (and other developed countries).

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