The Health bulletin [serial] - University of North Carolina at Chapel Hill

September, 1927 The Health Bulletin 25
THE PREVALENCE OF PELLAGRA
Prevention of the Disease Larg-ely a Problem in Domestic Economy
By EDWARD J. WOOD, M.D., D.T.M., (London)
WUmington, N. C.
In April of this year the Health
Bulletin called the attention of its
readers to the importance of the problem
of pellagra. Since that publication
the number of cases in North Carolina
has been found to be much greater than
in a number of years and from all
quarters physicians are asking for information
regarding the newer knowledge
not only of its treatment, but also
and much more important, of its
prevention.
The following simple table of the
number of deaths in this State from
pellagra speaks for itself.
Year
Number of deaths
from pellayra
1922 302
1923 224
1924 272
1925 398
1926 458
Indications point to the probability
of a much more decided increase for
the year 1927 than any increase in
recent years. Physicians who have not
encountered cases in five or more years
are seeing not an isolated case but
numerous cases. In my own practice
I have seen more cases in 1927 already
than in any three years since 1917.
These depressing facts would not now
be so bluntly stated were it not that
pellagra is one of the most certainly
and easily prevented diseases. From
1907 until 1915 the efforts of physicians
in its control were of small account
but with the new conception of the
part played by food as set forth by Dr.
•Joseph Goldberger of the United States
Public Health Service the whole problem
was changed. Prior to that time
pellagra was probably the most awful
scourge the physicians of the South
had ever encountered. One hears about
the jellovv' fever of the past and how
it wiped out hundreds e.specially in and
about Wilmington, but awful as it was
there was a better chance for recovery
from it than from pellagra to say nothing
of the protracted suffering and
loathsomeness the latter caused with a
large incidence of insanity following
in its wake. In those days prior to 1917
pellagra was an acute disease. Before
its appearance in this country pellagra
which was known chiefly in Italy and
Roumania was a chronic disease always.
Because it appeared among us
as a very acute disease running a
course ofttimes as short as typhoid
fever many conservative physicians
would not accept the diagnosis.
This very fact caused a delay of two
or three years in the general recognition
of the disease. It was unique in
medicine for acute pellagra to occur
and it was not surprising that some
of the most eminent of our great consultants
in the eastern medical centers
as Baltimore refused to make the
diagnosis. Gradually the disease became
transformed into first a subacute
process and finally into a chronic process
so that today it differs little from
the Italian type with only an occasional
acute malignant case.
With this decrease in the acuteness
of the process there has been a decrease
in the death rate. Ofttimes in
the past the death rate in some groups
of cases was well over fifty per cent,
while today I do not think it will exceed
five or ten per cent, and there
is no occasion for any deaths except in
that rare acute malignant form which
happily is becoming extinct.
It will be noted that during the past
two years there has been a notable
increase in the number of deaths, therefore
in the number of cases. The explanation
of this increase is a matter
of vast importance. Some observers
with good reason attribute the increase
to the cotton situation. The farmer has
made less and has eaten less variety of
food and the cotton mill operative also