March 3, 2025 • 39 mins
The pellagra epidemic of the early 20th century may have been the deadliest epidemic of a specific nutrient deficiency in U.S. history. Part one covers what it is, its appearance in 19th-century Italy, and the first reports of it in the U.S.
Research:
- Akst, Daniel. “Pellagra: The Forgotten Plague.” American Heritage. December 2000. https://www.americanheritage.com/pellagra-forgotten-plague
- Baird Rattini, Kristin. “A Deadly Diet.” Discover. Mar2018, Vol. 39 Issue 2, p70-72.
- Bridges, Kenneth. “Pellagra.” Encyclopedia of Arkansas. https://encyclopediaofarkansas.net/entries/pellagra-2230/
- Clay, Karen et al. “The Rise and Fall of Pellagra in the American South.” National Bureau of Economic Research Working Paper 23730. 2018. http://www.nber.org/papers/w23730
- Cleveland Clinic. “Pellagra.” 07/18/2022. https://my.clevelandclinic.org/health/diseases/23905-pellagra
- Crabb, Mary Katherine. “An Epidemic of Pride: Pellagra and the Culture of the American South.” Anthropologica , 1992, Vol. 34, No. 1 (1992), pp. 89-103. Via JSTOR. https://www.jstor.org/stable/25605634
- Flannery, Michael A. “’Frauds,’ ‘Filth Parties,’ ‘Yeast Fads,’ and ‘Black Boxes’: Pellagra and Southern Pride, 1906-2003.” The Southern Quarterly. Vol. 53, no.3/4 (Spring/Summer 2016).
- Gentilcore, David and Egidio Priani. “Pellagra and Pellagrous Insanity During the Long Nineteenth Century.” Mental Health in Historical Perspective. Palgrave Macmillan. 2023.
- Ginnaio, Monica. “Pellagra in Late Nineteenth Century Italy: Effects of a Deficiency Disease.” Population-E, 66 (3-4), 2011, 583-610.
- Hung, Putzer J. “Pellagra: A medical whodunit.” Hektoen International: A Journal of Medical Humanities. https://hekint.org/2018/09/18/pellagra-a-medical-whodunit/
- Jaworek, Andrzej K. et al. “The history of pellagra.” Dermatol Rev/Przegl Dermatol 2021, 108, 554–566 DOI: https://doi.org/10.5114/dr.2021.114610
- Kean, Sam. “Joseph Goldberger’s Filth Parties.” Science History Institute Museum and Library. https://www.sciencehistory.org/stories/magazine/joseph-goldbergers-filth-parties/
- Kiple, Kenneth F. and Virginia H. “Black Tongue and Black Men: Pellagra and Slavery in the Antebellum South.” The Journal of Southern History , Aug., 1977, Vol. 43, No. 3. https://www.jstor.org/stable/2207649
- Kraut, Alan. “Dr. Joseph Goldberger & the War on Pellagra.” National Institutes of Health Office of NIH History and Stetten Museum. https://history.nih.gov/pages/viewpage.action?pageId=8883184
- Marks, Harry M. “Epidemiologists Explain Pellagra: Gender, Race and Political Economy in the Work of Edgar Sydenstricker.” Journal of the History of Medicine and Allied Sciences , JANUARY 2003. https://www.jstor.org/stable/24623836
- Morabia, Alfredo. “Joseph Goldberger’s research on the prevention of pellagra.” J R Soc Med 2008: 101: 566–568. DOI 10.1258/jrsm.2008.08k010.
- Park, Youngmee K. et al. “Effectiveness of Food Fortification in the United States: The Case of Pellagra.” American Journal of Public Health. May 2U(H). Vol. 90. No. 5.
- Peres, Tanya M. “Malnourished.” Gravy. Southern Foodways Alliance. Fall 2016. https://www.southernfoodways.org/malnourished-cultural-ignorance-paved-the-way-for-pellagra/
- Pinheiro, Hugo et al. “Hidden Hunger: A Pellagra Case Report.” Cureus vol. 13,4 e14682. 25 Apr. 2021, doi:10.7759/cureus.14682
- A. C. Wollenberg. “Pellagra in Italy.” Public Health Reports (1896-1970), vol. 24, no. 30, 1909, pp. 1051–54. JSTOR, https://doi.org/10.2307/4563397. Accessed 13 Feb. 2025.
- Rajakumar, Kumaravel. “Pellagra in the United States: A Historical Perspective.” SOUTHERN MEDICAL JOURNAL • Vol. 93, No. 3. March 2020.
- Savvidou, Savvoula. “Pellagra: a non-eradicated old disease.” Clinics and practice vol. 4,1 637. 28 Apr. 2014, doi:10.4081/cp.2014.637
- SEARCY GH. AN EPIDEMIC OF ACUTE PELLAGRA. JAMA. 1907;XLIX(1):37–38. doi:10.1001/jama.1907.25320010037002j
- Skelton, John. “Poverty or Privies? The Pellagra Controversy in America.” Fairmount Folio: Journal of History. Vol. 15 (2014). https://journals.wichita.edu/index.php/ff/article/view/151
- Tharian, Bindu. "Pellagra." New Georgia Encyclopedia, 20 September 2004, https://www.georgiaencyclopedia.org/articles/science-medicine/pellagra/.
- University Libraries, University of South Carolina. “A Gospel of Health: Hilla Sheriff's Crusade Against Malnutrition in South Carolina.” https://digital.library.sc.edu/
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Stuff You Missed in History Class, a production
of iHeartRadio.
Speaker 2 (00:11):
Hello, and welcome to the podcast. I'm Tracy B.
Speaker 1 (00:14):
Wilson, and I'm Holly Frye.
Speaker 2 (00:17):
Holly's episode on hydroponics from not that long ago made
just a casual reference to vitamin deficiency, and that reminded
me that I have been wanting to do an episode
on pelagra and kind of similar to our episode on
iodized salt from June of last year. If you don't
(00:38):
remember that episode, I knew the basics of why salt
was iodized, but not really the details of what a
problem goiter had been before they put the iodine in
the salt. I already had a general sense that pelagor
is a vitamin deficiency, and I also knew that it
was a widespread problem in the Southern UA other parts
(01:01):
of the US two, but especially the South in the
early twentieth century. That has also come up on the
show before, but that has never quite made sense to me,
because I knew pelagor had something to do with eating corn,
But people in the Americas have been eating corn for
at least ten thousand years, So why did it take
(01:22):
millennia for pellagra to become a problem, and also to
become a huge problem. The pelagra epidemic of the early
twentieth century may have been the deadliest epidemic of a
specific nutrient deficiency in US history. I could kind of
imagine various explanations for what would have caused us, but
(01:46):
I did not actually know the answer. And so now
we have this episode, and actually we have two of them,
because it turns out that while I had mostly heard
about pelagor in the United States, there's a whole hit
my history also in Southern Europe, especially in Italy, that
I was not aware of at all. So today we
(02:06):
will be talking about what pelagra is and why it
became a problem in Italy in the nineteenth century, and
also the first reports of its existence in the United States.
And then part two will have the rest of the
US story, which is gonna involve some pretty gross self
experimentation as well as the medical experiments that definitely would
(02:29):
not get the ok from ethics to review boards today.
As Tracy just said, pelagra is a vitamin deficiency, specifically
a deficiency in niosin, also called vitamin B three. The
word niosin is derived from another name for this nutrient
nicotinic acid, because it was first identified and synthesized in
(02:51):
experiments involving nicotine in eighteen seventy three. That makes it
the first major vitamin to be synthesized at that point,
though western medicine had no concept of essential nutrients as
we know them today and the word vitamin hadn't even
been coined yet. That wouldn't happen for almost forty more years.
So people knew nicotinic acid existed, but they had no
(03:13):
sense of what it did in the body or how
important it is to human life. Without getting too far
into the weeds of biochemistry, the body breaks niosin down
into important coenzymes, including one called nicotinamine adenine di nucleotide,
or NAD. You can think of a coenzyme as a
(03:36):
helper molecule, helping enzymes to start necessary chemical reactions in
the body. NAD is particularly important. There are more than
four hundred enzymes in the human body that require NAD
to work, and that is more than any other vitamin
derived coenzyme. A lot of those chemical reactions are involved
(04:00):
with providing energy to cells, and some of the others
are part of a range of just critical cellular functions.
So when the body doesn't get enough niacin, it can't
make enough NAD, which means a lot of necessary chemical
reactions cannot get started in the way that they should. Often,
the first places to show obvious signs of a problem
(04:22):
are parts of the body where cellular turnover is really fast,
so like the skin and the lining of the digestive tract,
or which use a lot of energy, like the brain.
This means pelagra can cause a whole collection of symptoms.
For the skin, there's a characteristic red or darkened rash
(04:43):
that often occurs in the areas that get the most
sun exposure. This rash can scale and blister and peel.
For the digestive tract, there's diarrhea, and for the brain
there are problems with cognition and mental health. This collection
of symptoms is often summarized as the three d's, that's dermatitis, diarrhea,
(05:05):
and dementia. People don't always have all three d's at once, though,
and when they do, their condition is typically already very advanced.
And this can also be a vicious cycle because if
you have chronic diarrhea or dementia, that can dampen your
desire to eat, and then that makes it even harder
to get enough niasin. These symptoms can be resolved through
(05:29):
a nutritious diet that is high in niosin and today
niosin supplementation, but if it's left untreated, pelagra can progress
to a fourth d which is death. A lot of
foods are high in niasin, including fish like tunas, salmon
and anchovies, meats including beef, chicken, turkey, and pork, especially liver,
(05:52):
whole grains including brown rice, peanuts, various seeds, and potatoes,
and today a number of process foods are fortified with niosin.
We're going to talk more about that in Part two.
The body can also produce its own niosin from the
amino acid tryptofan, which is also found in a range
of foods, including poultry, various seeds, eggs, fish, cheese, and soybeans.
(06:17):
So people who have access to a variety of foods
and are able to acquire and eat and digest those
foods usually get enough niosin from their regular diet and
they aren't at a risk of developing polagra. That means,
in wealthier parts of the world today, the people who
are at the greatest risk of developing pelagra usually have
(06:38):
some other factor involved, like highly restrictive diets, whether they're
by choice or by necessity. Eating disorders, gastrointestinal disorders, and
various types of organ damage can also put people at
a greater risk for polagra, as can some illnesses and drugs.
(06:59):
Severe alcohol use disorder can lead to pelagra as well.
So today, pelagor is far more prevalent in poorer parts
of the world, where people don't have access to or
cannot afford a wide variety of foods, including places that
are receiving large amounts of food aid in the form
(07:19):
of donated corn.
Speaker 1 (07:21):
Which brings us to the connection between corn, also called maize,
and pelagra. The term maze likely comes from the Taino
word for this plant. Its first appearances in English are
in translations of sixteenth century Spanish accounts of these plants
and foods in the Caribbean. The English word corn, on
(07:41):
the other hand, goes back centuries before maize was introduced
to Europe. It was originally an Old English word that
referred to grains. More generally, Indigenous people domesticated maize from
a wild grass called Teosinti and what's now southwest Mexico
about ten thousand years ago. By about seven thousand years
(08:03):
ago it was being grown in what's now Panama, and
by about six thousand years ago it had been introduced
in northern South America. Then, but for.
Speaker 2 (08:13):
Roughly about four thousand years ago, a hybrid version of
this domesticated crop started to be introduced into areas farther away,
and before long, corn was a staple crop in much
of the Americas. As a plant, corn or maize had
lots of uses in the farming technique known as the
(08:33):
Three Sisters. Stalks of maize provided support for climbing bean vines.
Corn husks could be used to make mats or fill bedding,
or to make dolls. The stalks could be made into
baskets or braided into cords. Dried cobs could be burned
as fuel, and of course, the kernels of the corn
could be eaten.
Speaker 1 (08:55):
In the region where corn was first domesticated, the process
used to prepare the kernels for ea eating is now
known in English as niche timolization. This comes from the
Nuadal word niche tomol, which is the name for the
food at the end of this process. Combining the words
meaning ash and tamale. First, dried corn kernels are steeped
(09:15):
in alkaline water. Today this is often done with food
grade lime or calcium hydroxide, but historically it has also
involved things like ash, lye, limestone, and seashells. After steeping,
the kernels are drained and rinsed thoroughly.
Speaker 2 (09:31):
This process removes the outer shell of the kernel, making
it softer and easier to digest. It also deactivates the germ,
which keeps the kernels from sprouting while they are being stored.
The resulting kernels can also be ground into a flower
called massa. Massa can be formed into a dough that
(09:53):
can be used to make foods like tamales and tortillas.
Whole kernels can also be boiled and used in dishes
like bosole.
Speaker 1 (10:02):
All of that would have been apparent to the indigenous
peoples who cultivated corn and developed this process, But nichemalization
also had another benefit that was not chemically understood until
far more recently. Corn contains niosin, but that niosin is
chemically bound in a way that means the body can't
access or absorb it during digestion. That's not the case
(10:25):
with nichemalized corn. That process makes niosin and other essential
nutrients more available to the body. Those other essential nutrients
include calcium. There is thirteen times more calcium available in
nicheabilized corn than in corn that has not been through
that process. In general, indigenous peoples across the America's eate
(10:47):
and eat a variety of foods, but this meant that
if people were surviving mainly on corn because of some
kind of disaster or a hardship, they weren't likely to
develop pelagra.
Speaker 2 (10:59):
Other indigenous peoples from other parts of these continents have
other names for corn that has been prepared through a
similar process. The word samp, which is a maize porridge,
has possible roots in both Lenape and Algonquian languages. The
word hominy comes from the Virginia Algonquian language, also known
(11:20):
as Powatan. When European colonists started arriving in the Americas,
they had their first encounters with corn, and they wrote
about it. The word niche temol didn't show up in
English until the late nineteenth century, but English speakers were
writing about foods like possole, tamales, and tortillas by the
seventeenth century. The Oxford English Dictionary puts the first use
(11:43):
of the word hominy in English as coming from the
true travels, adventures, and observations of Captain John Smith into Europe, Asia, Africa,
and America. John Smith is mostly known today for the
highly romanticized versions of his encounter with Maduaca, also known
as Pocahontas. In a chapter covering the history of Virginia
(12:05):
from sixteen twenty four to sixteen twenty nine, Smith describes
the colonist's food and drink quote for drink some malt,
the Indian corn, others barley, of which they make good ale,
both strong and small, and such plenty thereof. Few of
the upper planters drink any water, but the better sort
are well furnished with sac aquavite and good English beer.
(12:30):
The servants commonly feed upon milk homily, which is bruised
Indian corn, pounded and boiled thick, and milk for the sauce,
but boiled with milk. The best of all will feed
off on it, and leave their flesh with milk, butter
and cheese with fish, bulls flesh, for they seldom kill
any other. Some of these foods made from nistimalized corn
(12:53):
made their way into the colonists' diets. Hamani became a
staple in parts of British colonial Ts Territory, where it
became associated with the poorer classes as a staple food.
Farther to the south than areas that were primarily colonized
by Spain, people were making and eating all kinds of
foods with nichealized corn, and these foods all still exist.
(13:16):
You can buy things like masaflour or masa arena and
hominy and foods made with them in stores or from
people who make them. And the Americas today, I will
note if it says hominy grits on the label and
it's like an instant gritz product that might not actually
be made with hominy, that might just be cornmeal, that
(13:38):
there's a bunch of grits manufacturers that are still using
the word hominy almost out of nostalgia, not out of
what the food actually contains.
Speaker 1 (13:47):
But when returning Europeans brought corn with them to Europe,
nichetionalization did not really go with them, and this caused problems.
We'll talk more about it after a sponsor break.
Speaker 2 (14:08):
A lot of foods that are eaten around the world today.
Were first cultivated by the indigenous peoples of the Americas
and the Caribbean. When Europeans returned from voyages across the Atlantic,
they brought plants like potatoes, tomatoes, peanuts, pumpkins, and of
course corn. Corn in particular had a massive impact on lives, ecology,
(14:33):
and agriculture in the places where it was introduced. It
had a high yield relative to the amount of work
that it took to grow it and the amount of
land that it required. It could be grown in relatively
poor soil, including soil that wasn't suitable.
Speaker 1 (14:49):
For other crops.
Speaker 2 (14:51):
In some regions, the growing season was long enough that
people could grow a crop of wheat and then a
crop of corn in the same field in the same year.
People could also raise corn to feed animals like pigs,
or they could feed parts of the corn plant to
their livestock while eating most of the kernels themselves. The
(15:12):
availability of maize as a food source has been credited
with helping to protect people from famine in parts of Europe, Asia,
and Africa, and with supporting population growth in areas where
it made it easier for people to get enough to eat.
It seems likely that the first people to bring maize
to Europe had at least some experience with indigenous methods
(15:35):
of growing and preparing it, even without the understanding of
how that related to its nutrient content, but that knowledge
wasn't maintained as maize continued to be introduced across the continent.
Corn spread rapidly as an easy and cheap source of food,
and in some regions it had completely supplanted other grains
within about two hundred years. Eating corn that hasn't been
(15:58):
nischemalized is it's not really a big nutritional problem as
long as you are eating other foods as well, and
some of those other foods contain niacin. But in places
where corn became the cheapest and most available thing, there
were inevitably people who wound up subsisting on it almost exclusively.
(16:19):
Especially in times of hardship, war, or famine, There were
scattered outbreaks of pellagra as a result. Usually these were
among the poorest people in a particular region. Sometimes these
were seasonal, starting in the late winter and spring, after
people had been living mostly off of stored corn over
(16:39):
the winter, and then resolving as people had access to
a wider variety of foods after the harvest. The first
known description of pelagra in writing was by Spanish physician
Gaspar Caazzali Julien in seventeen thirty five, who wrote about
a disease that was occurring among peasants in Asturias, on
(17:00):
the northern coast of Spain. He described it as the
region's most horrible and stubborn disease. He called this mal
de la rosa or rose disease, after the red rash
that appeared on patient's bodies. This often happened around the
spring equinox, but it could occur during other parts of
the year as well, and he talked about this rash
(17:22):
as frequently appearing on the hands and feet, but also
on the front part of the lower neck, extending down
across the clavicles like a collar. Today, this particular part
of the rash is known as the Kazal collar or
the Kazal necklace. At the time, this was thought of
primarily as a skin disease, and it was sometimes mistaken
(17:42):
for Hanson's disease, which is also known as leprosy. Although
there were pockets of pelagra reported all around parts of
southern Europe and the Mediterranean, it became a more widespread
problem in what's now northern Italy, where one of the
staple dishes we polenta. Polenta is often made with corn today,
(18:04):
but it predates the introduction of corn to Italy. It
had previously been made with various other grains or with
nut or bean meal. People across economic classes ate polenta,
but it was only the poorest people who needed to
survive only on polenta and not much else. So when
(18:25):
corn replaced other crops and became the prime ingredient in polenta,
pelagra started to spread. The first person known to have
described pelagra in Italy was physician Francesco Fropoli in seventeen
seventy one. He published his work in Milan, in the
Lombardi region of northern Italy, where he worked at the
(18:46):
Ospidale Maggiore. He was the person to coin the term
pelagra from Lombard words meaning rough skin. By seventeen seventy eight,
Italian physician Gaetano Strombio had established a hospital just for
pelagra patients in Lignano, Italy, and he also wrote a
three volume work on the disease. It had not taken
(19:09):
long to make a connection between the disease and the
consumption of corn, and Strombio thought that it was caused
by spoiled bread and polenta. In seventeen eighty nine, Francesco
Fanzago was a student doctor in Padua and described a
patient at the hospital where he worked. She seemed to
be in a daze and she had a dark, peeling
(19:30):
rash on her hands and arms. She lived in the country,
and her mother told Fanzago that for the past two years,
every spring she had become so weak that she could
not do her work. Fanzago realized that this sounded like
the peleegra that had been reported in Lombardi, and that
it was probably the same condition as the one doctor's
in Padua had been describing as pellerina or peeling off.
Speaker 1 (19:56):
So a lot of.
Speaker 2 (19:57):
What we have read so far has been focused on
the rat and on other kind of more general symptoms
like weakness. But in eighteen oh six, physicians Azzare Ruggieri
of Venice published an account of the case of Mattillo
lavat levatt had wanted to become a priest, but poor
economic circumstances had led to him working as a shoemaker instead,
(20:19):
and that really was not what he had wanted to do.
Levatt's symptoms initially included a flaking rash on his hands
and feet, but then in eighteen oh two, he developed
a serious mental illness which involved an intense fixation on religion. First,
he castrated himself, and then he repeatedly tried to publicly
(20:41):
crucify himself. One attempt involved nailing one of his hands
and both of his feet to a cross that was
tied to a beam inside of a building, and then
maneuvering the cross out the window. Bystanders came to his
aid and he survived this, but he died in an
asylum in eighteen oh When this account was translated into
(21:03):
English about a decade later, the translator didn't have a
word for dietesi pelagarossa, and was translated into leprosy because
at this point, pelagor had not really been introduced into
the English speaking world as a concept. By the early
nineteenth century, physicians in Italy had started to notice some
(21:24):
similarities between pelagra and another vitamin deficiency disease, scurvy, which
is caused by a lack of vitamin C. They didn't
yet know what vitamins were, but both diseases involved the skin,
and both of them progressed and worsened over time. By
the mid nineteenth century, physicians in Europe had started to
(21:45):
think of diseases as each having one distinct cause. While
there was general agreement in Italy that the cause of
pelagor was something related to coorn, a fierce disagreement developed
about exactly how corn was involved. Physician Filippo Desana and
pathologist Carlo Frua wrote a study in eighteen fifty six
(22:09):
that walked through a number of potential causes for pelagra,
but then argued that the primary cause was a diet
made up primarily of maize, which they argued did not
contain enough protein to support human health. Although vitamins still
had not been discovered, the first descriptions of proteins to
(22:30):
go back to the late eighteenth century, and the word
protein had been coined almost twenty years before this. The
term protein comes from Greek meaning the first quality, and
chemist Gerhard Johann Mulder had chosen this name because protein
was believed to be a key component of food that
was essential to human life. For a while, the idea
(22:54):
that corn had insufficient protein was the primary idea for
the cause of pelagra in Italy. Then, in eighteen sixty nine,
Cesare Lombroso theorized that pelagra was being caused not by
the protein content of maize, but by a toxin that
was produced as it decayed.
Speaker 1 (23:12):
He thought that people who ate fresh, wholesome maze would
not develop pelagra, but people who ate spoiled maize would.
This led to intense debate in Italy about whether this
was a disease of deficiency or of toxicity, and there
were ongoing arguments in support of one conclusion or the other.
There wasn't a sense that it might be contagious. Doctors
(23:34):
and nurses cared for patients who were not kept isolated
for the rest of the wards.
Speaker 2 (23:40):
By the late nineteenth century, pelagora had reached really epidemic
proportions in a lot of northern Italy, with patients overwhelming
hospitals and mental institutions. According to census records, there were
more than one hundred thousand polagra patients in Italy in
eighteen eighty one. Medical community still didn't entirely agree on
(24:03):
exactly what was going on. Lombroso's idea of contaminated or
decayed corn had gotten a lot of traction, so eventually,
on July twenty first of nineteen oh two, the Italian
parliament passed a law meant to try to curb pelagra.
This law included banning the sale of amateur musty or
(24:23):
spoiled maize. Sanitation officials had the right to inspect grain
processing and storage facilities. The law also included funds for
health authorities to monitor pelagor cases and for the care
of pelagora patients. Cases of pelagor had to be reported,
and food was required to be distributed to poor polagra
(24:44):
patients and their families. The law also required the building
of public maize drying ovens and the distribution of salt.
School lunches were also provided to children in areas that
had high rates of pelagra. Rates had already been declining
for at least a decade before this law was passed,
(25:05):
and they continued to drop afterward. According to the nineteen
oh five census, there were fifty five thousand polagrapations, so
that eighteen eighty one number had been cut roughly in half.
The number of new cases was also dropping steadily, although
that progress seemed slower in central and southern Italy, where
pelagra had been less prevalent than in the North. The
(25:28):
number of deaths per year also dropped from almost four
thousand in eighteen ninety eight to only three hundred seventy
six in nineteen oh seven. I've already talked about how
pelagor was caused by a deficiency in nison, that it
was not about spoilage in the corn. But some aspects
of this law may really have helped with the pelagorates
(25:48):
in Italy, especially the ones that involved providing food and
financial support to the affected people. In the late nineteenth century,
there had also been a wave of emigration out of Italy,
including to the United States, and often those immigrants sent
money back home, and then that money made it possible
(26:08):
for people to afford a richer variety of foods, including
foods that contained nyasin. However, as pelagora was declining in Italy,
it was starting to escalate in the US, and we'll
get into that after a sponsor break. The first known
(26:35):
description of pellagra in US medical literature was in nineteen
oh two, the same year that Italy passed its law
to try to curb the rate of pellagor. There there
were certainly cases and outbreaks in the United States before
that point, but most nineteenth century medical textbooks in the
United States did not even mention this disease. Henry Fauntleroy Harris,
(26:59):
who was the person who wrote this nineteen oh two report,
published a whole book on pelagra seventeen years later, and
its preface comments on how English writers had paid little
attention to the disease while there was quote an enormous
foreign literature on the subject. That enormous foreign literature was,
(27:20):
of course, mostly in Italian, and it went back almost
two hundred years. It wasn't until pelagora was firmly recognized
as a serious problem in the US that researchers looked
back at earlier disease reports and just found evidence of
misdiagnosed Pelagora outbreaks going back to at least the eighteen thirties.
(27:41):
Harris was a doctor who lived in Atlanta who also
served as secretary of the Georgia State Board of Health,
although he may not have started in that role yet
when he reported on this case. The patient from his
nineteen oh two report was a farmer, and a staple
of his diet was corn. He had occurring debilitating illness
(28:01):
that developed every spring, which had been going on for
about fifteen years. Every year, his mental health declined and
he experienced blistering of the skin on his arms and legs.
This would start to get better over the summer and
then resolve when the weather cooled. This farmer also had hookworm,
which was treated, and he was given arsenic and iron
(28:24):
as a pelagra treatment. This was a common treatment for
pelagra at the time, but when that didn't work, he
was advised to move to a cooler climate. The cases
and outbreaks from the nineteenth century in the US likely
stemmed from social and economic factors. The Southern United States
had faced massive destruction and hardship during the Civil War
(28:47):
and as a consequence of the centuries of enslavement that
had led to the war. The post war reconstruction had
included efforts to rebuild the South and to offer aid
and assistance to the freed people. Toward the end of reconstruction,
Southern business and civic leaders started advocating for a new South,
(29:08):
one that would be modernized and industrialized and urbanized, with
the building of new mills and factories and mines, and
the construction of roads and railroads to connect these urban hubs.
Agriculture was still a big part of the Southern economy,
but the primary focus was cash crops like cotton and tobacco.
(29:28):
The people who were hyping up the idea of a
new South were framing it as something that would modernize
the region and bring prosperity while still retaining a strong
Southern identity and Southern traditions, but that did not happen
in practice. There was a wave of new mills and factories,
but wages for people who worked in them were dramatically
(29:49):
lower than what they would have been paid for the
same jobs in the North. Although the reconstruction era had
worked toward equal rights for black people, white politicians and
activists had intentionally rolled back most of those gains. These
new industrial jobs were segregated, with black workers generally making
the lowest pay for the least desirable work. A system
(30:13):
of sharecropping also kept farmers tied to the land that
they were working. In a lot of cases the land
they had been working while they were enslaved, and also
kept them in debt to the landowner. And all of this,
of course connected to the food that people were eating.
Sharecropping was innately exploitive and sharecroppers needed to earn as
(30:34):
much money as they could to pay off their debts
to landowners and to make ends meet, so a lot
of them planted as much of a cash crop as
possible that left little to no land to grow food
to live on. In some cases, some of their pay
for their crops was in the form of credit at
a plantation commissary. They could use this to buy provisions,
(30:58):
but only the provisions that the landowner chose to stock.
This was similar to the situation for mill workers, who
frequently lived in company towns and were paid in company
script that could only be used at the company store.
Sharecroppers and mill workers and other people facing similar economic
(31:18):
hardship and exploitation had a similar foundation to their diets.
It was often described as the three ms, meal, meat,
and molasses. The meal was often corn meals, since corn
was cheap by this point it was being grown in
vast quantities in the Midwest and shipped to the South
by train. The meat was usually fatback or salt pork,
(31:40):
in other words, some of the cheapest cuts of meat,
which are very fatty and don't contain much niasin. Molasses
also contains a little bit of niasin, but again not much.
In addition to being inexpensive, these were often what was
stocked at company stores and commissaries. Thanks to their cost
and their long shelf life. People who had the ability
(32:05):
to buy or grow other foods to supplement those three
ms might be able to avoid developing pelagra, But the
poorest people in the United States, especially in the South,
were living off of that and very little else. And
then in nineteen oh one, technological developments probably made this
(32:25):
situation worse. John Beal of Decatur, Illinois patented the beal
De Germinator. This machine mechanically removed the germ and outer
brand layers from corn kernels, making it possible to separate
all these parts and use them for different purposes. This
made it easier and more efficient to make corn products
(32:47):
without the germ, which meant that there was a way
to keep corn from sprouting during storage without niche themalizing it.
There were other mechanical processing tools and milling tools before this,
but the beald De Germinator was a big improvement over
those earlier tools. This also made it a lot more
(33:07):
possible to sell low quality meal that had been made
from the least nutritious parts of the corn. It's not
conclusively proven that this degerminator put people at greater risk
of developing pelagra, but within a few years of its introduction,
doctors were reporting outbreaks of pelagora in places like orphanages
(33:28):
and institutions, and by the nineteen teens the US government
was actively investigating. That is all what we will get
to next time.
Speaker 1 (33:39):
Do you have some listener mail to take us out
of this peppi top idea I do.
Speaker 2 (33:45):
This is from Julie and Mackenzie, and Julie wrote an
email titled Mary Bethune Turned Lincoln Around? So, Julie wrote,
Holly and Tracy. When I moved back to DC in
twenty nine, I found a park close to me while
walking my dog. It had a statue of Mary MacLeod Bethune,
(34:06):
and since I didn't know who she was, I checked
to see if the history podcast I've been enjoying for
more than ten years had ever done an episode on her.
You had not, so I was thrilled that you finally
did one. The statue is in Lincoln Park, so named
because a statue depicting Lincoln in a slave casting off
his chains is there. The Emancipation Group was commissioned by
(34:28):
recently freed slaves in eighteen seventy five. Lincoln originally faced
west toward the Capitol, but when the married Bethune statue
was added to the park in nineteen seventy four, Lincoln
was turned to the east so that he now faces her.
Bethune statue is the first African American of any sex
in the first honorable woman on DC public lands. As
(34:49):
an aside, the Lincoln statue has always made me uncomfortable
the way Lincoln looms over the kneeling black man in
a very white savior kind way. Apparently I'm not the
only one, because during the Black Lives Matter summer of
twenty twenty there were attempts to tear it down, along
with so many other statues. The National Park Service barricaded
(35:11):
it and it remains in Lincoln Park unmolested. Here's the links.
You can make up your own minds. I've attached a
couple of my own very early morning dog walk doc
greate photos of these two statues. One of them includes
my pet tax Mackenzie is my blonde brindle snaffy pit
mix with goth eyeliner who has very big feelings and
(35:32):
is far too excited to meet people, but is also
the world's best snuggler. The muzzle is to prevent vet
visits because given the opportunity, she will eat anything and everything,
food or not. The pic in the car is a
road trip where we were listening to stuffy miss in
history class. Thank you for all you do. As long
as you keep making them, I'll keep listening. Julie and Mackenzie.
Speaker 1 (35:54):
Uh Kudie.
Speaker 2 (35:57):
I am familiar with this, the statue of Lincoln. It's
come upon the show before when we have been talking
about a different statue of Lincoln. I needed to go
make sure it wasn't this one we were talking about,
because it does. It looks exactly like the email said.
And you know, while Lincoln did sign the Emancipation Proclamation
(36:21):
and all that, the work that was done toward emancipation
was so profoundly led by enslaved people themselves putting the
pressure on to do that.
Speaker 1 (36:31):
And that's not what it looks like from right this
from the sculpture.
Speaker 2 (36:38):
We have a very adorable picture of Mackenzie at the
Mary McLeod Bethune statue. I love that statue so much,
and then off, what a cutie pie in the car and.
Speaker 1 (36:50):
Little Carnes if I ever meet Mackenzie. There's no such
thing as too friendly. It's fine.
Speaker 2 (36:54):
Yeah, yeah, I I definitely. I have said before folks
that are having their dogs out leashed in public. I
love this so much. I know so many folks who
have had really tragic encounters with off leash animals, And
so anytime I see somebody whose puppa dog is on
(37:16):
a leash, I'm like, I love you, We're friends. I'm
too anxious for any other option, you know what I mean, Like,
I can't imagine. Yeah, that poor dog would run away
from me out of like the sheer desire to get
away from my bad energy. They would be like, you
are a nervous wreck. I cannot deal with you right now,
roll out. I got stuff to do. Also totally understandable
(37:38):
about needing to keep your dog out in the world
from eating things that should not be eaten. I get
having cats who are our cats typically don't eat things,
except for the one who just perpetually wants to chew
on plastic.
Speaker 1 (37:57):
We have two plastic chewers. What is up with that?
I don't know it.
Speaker 2 (38:01):
It's it's a whole meme about it on TikTok or
there was a while back. But yeah, but I there
are a couple of things that I know can cause
big problems for cats if they are eaten that I'm
always on the watch for around our home to make
sure they get disposed of properly, like dryer sheets for one.
Speaker 1 (38:24):
Yeah.
Speaker 2 (38:25):
Anyway, so thank you so so much for this email
these adorable pictures. If you would like to send us
some notes about this or any other podcast where at
history podcasts at iHeartRadio dot com. You can subscribe to
our show on the iHeartRadio app and wherever else you
like to get your podcasts. We'll be back on Wednesday
with part two of this episode. Stuff You Missed in
(38:53):
History Class is a production of iHeartRadio. For more podcasts
from iHeartRadio, visit the iHeartRadio app, podcasts, or wherever you
listen to your favorite shows.
Welcome to Stuff You Missed in History Class, a production
of iHeartRadio.
Speaker 2 (00:11):
Hello, and welcome to the podcast. I'm Tracy B.
Speaker 1 (00:14):
Wilson, and I'm Holly Frye.
Speaker 2 (00:17):
Holly's episode on hydroponics from not that long ago made
just a casual reference to vitamin deficiency, and that reminded
me that I have been wanting to do an episode
on pelagra and kind of similar to our episode on
iodized salt from June of last year. If you don't
(00:38):
remember that episode, I knew the basics of why salt
was iodized, but not really the details of what a
problem goiter had been before they put the iodine in
the salt. I already had a general sense that pelagor
is a vitamin deficiency, and I also knew that it
was a widespread problem in the Southern UA other parts
(01:01):
of the US two, but especially the South in the
early twentieth century. That has also come up on the
show before, but that has never quite made sense to me,
because I knew pelagor had something to do with eating corn,
But people in the Americas have been eating corn for
at least ten thousand years, So why did it take
(01:22):
millennia for pellagra to become a problem, and also to
become a huge problem. The pelagra epidemic of the early
twentieth century may have been the deadliest epidemic of a
specific nutrient deficiency in US history. I could kind of
imagine various explanations for what would have caused us, but
(01:46):
I did not actually know the answer. And so now
we have this episode, and actually we have two of them,
because it turns out that while I had mostly heard
about pelagor in the United States, there's a whole hit
my history also in Southern Europe, especially in Italy, that
I was not aware of at all. So today we
(02:06):
will be talking about what pelagra is and why it
became a problem in Italy in the nineteenth century, and
also the first reports of its existence in the United States.
And then part two will have the rest of the
US story, which is gonna involve some pretty gross self
experimentation as well as the medical experiments that definitely would
(02:29):
not get the ok from ethics to review boards today.
As Tracy just said, pelagra is a vitamin deficiency, specifically
a deficiency in niosin, also called vitamin B three. The
word niosin is derived from another name for this nutrient
nicotinic acid, because it was first identified and synthesized in
(02:51):
experiments involving nicotine in eighteen seventy three. That makes it
the first major vitamin to be synthesized at that point,
though western medicine had no concept of essential nutrients as
we know them today and the word vitamin hadn't even
been coined yet. That wouldn't happen for almost forty more years.
So people knew nicotinic acid existed, but they had no
(03:13):
sense of what it did in the body or how
important it is to human life. Without getting too far
into the weeds of biochemistry, the body breaks niosin down
into important coenzymes, including one called nicotinamine adenine di nucleotide,
or NAD. You can think of a coenzyme as a
(03:36):
helper molecule, helping enzymes to start necessary chemical reactions in
the body. NAD is particularly important. There are more than
four hundred enzymes in the human body that require NAD
to work, and that is more than any other vitamin
derived coenzyme. A lot of those chemical reactions are involved
(04:00):
with providing energy to cells, and some of the others
are part of a range of just critical cellular functions.
So when the body doesn't get enough niacin, it can't
make enough NAD, which means a lot of necessary chemical
reactions cannot get started in the way that they should. Often,
the first places to show obvious signs of a problem
(04:22):
are parts of the body where cellular turnover is really fast,
so like the skin and the lining of the digestive tract,
or which use a lot of energy, like the brain.
This means pelagra can cause a whole collection of symptoms.
For the skin, there's a characteristic red or darkened rash
(04:43):
that often occurs in the areas that get the most
sun exposure. This rash can scale and blister and peel.
For the digestive tract, there's diarrhea, and for the brain
there are problems with cognition and mental health. This collection
of symptoms is often summarized as the three d's, that's dermatitis, diarrhea,
(05:05):
and dementia. People don't always have all three d's at once, though,
and when they do, their condition is typically already very advanced.
And this can also be a vicious cycle because if
you have chronic diarrhea or dementia, that can dampen your
desire to eat, and then that makes it even harder
to get enough niasin. These symptoms can be resolved through
(05:29):
a nutritious diet that is high in niosin and today
niosin supplementation, but if it's left untreated, pelagra can progress
to a fourth d which is death. A lot of
foods are high in niasin, including fish like tunas, salmon
and anchovies, meats including beef, chicken, turkey, and pork, especially liver,
(05:52):
whole grains including brown rice, peanuts, various seeds, and potatoes,
and today a number of process foods are fortified with niosin.
We're going to talk more about that in Part two.
The body can also produce its own niosin from the
amino acid tryptofan, which is also found in a range
of foods, including poultry, various seeds, eggs, fish, cheese, and soybeans.
(06:17):
So people who have access to a variety of foods
and are able to acquire and eat and digest those
foods usually get enough niosin from their regular diet and
they aren't at a risk of developing polagra. That means,
in wealthier parts of the world today, the people who
are at the greatest risk of developing pelagra usually have
(06:38):
some other factor involved, like highly restrictive diets, whether they're
by choice or by necessity. Eating disorders, gastrointestinal disorders, and
various types of organ damage can also put people at
a greater risk for polagra, as can some illnesses and drugs.
(06:59):
Severe alcohol use disorder can lead to pelagra as well.
So today, pelagor is far more prevalent in poorer parts
of the world, where people don't have access to or
cannot afford a wide variety of foods, including places that
are receiving large amounts of food aid in the form
(07:19):
of donated corn.
Speaker 1 (07:21):
Which brings us to the connection between corn, also called maize,
and pelagra. The term maze likely comes from the Taino
word for this plant. Its first appearances in English are
in translations of sixteenth century Spanish accounts of these plants
and foods in the Caribbean. The English word corn, on
(07:41):
the other hand, goes back centuries before maize was introduced
to Europe. It was originally an Old English word that
referred to grains. More generally, Indigenous people domesticated maize from
a wild grass called Teosinti and what's now southwest Mexico
about ten thousand years ago. By about seven thousand years
(08:03):
ago it was being grown in what's now Panama, and
by about six thousand years ago it had been introduced
in northern South America. Then, but for.
Speaker 2 (08:13):
Roughly about four thousand years ago, a hybrid version of
this domesticated crop started to be introduced into areas farther away,
and before long, corn was a staple crop in much
of the Americas. As a plant, corn or maize had
lots of uses in the farming technique known as the
(08:33):
Three Sisters. Stalks of maize provided support for climbing bean vines.
Corn husks could be used to make mats or fill bedding,
or to make dolls. The stalks could be made into
baskets or braided into cords. Dried cobs could be burned
as fuel, and of course, the kernels of the corn
could be eaten.
Speaker 1 (08:55):
In the region where corn was first domesticated, the process
used to prepare the kernels for ea eating is now
known in English as niche timolization. This comes from the
Nuadal word niche tomol, which is the name for the
food at the end of this process. Combining the words
meaning ash and tamale. First, dried corn kernels are steeped
(09:15):
in alkaline water. Today this is often done with food
grade lime or calcium hydroxide, but historically it has also
involved things like ash, lye, limestone, and seashells. After steeping,
the kernels are drained and rinsed thoroughly.
Speaker 2 (09:31):
This process removes the outer shell of the kernel, making
it softer and easier to digest. It also deactivates the germ,
which keeps the kernels from sprouting while they are being stored.
The resulting kernels can also be ground into a flower
called massa. Massa can be formed into a dough that
(09:53):
can be used to make foods like tamales and tortillas.
Whole kernels can also be boiled and used in dishes
like bosole.
Speaker 1 (10:02):
All of that would have been apparent to the indigenous
peoples who cultivated corn and developed this process, But nichemalization
also had another benefit that was not chemically understood until
far more recently. Corn contains niosin, but that niosin is
chemically bound in a way that means the body can't
access or absorb it during digestion. That's not the case
(10:25):
with nichemalized corn. That process makes niosin and other essential
nutrients more available to the body. Those other essential nutrients
include calcium. There is thirteen times more calcium available in
nicheabilized corn than in corn that has not been through
that process. In general, indigenous peoples across the America's eate
(10:47):
and eat a variety of foods, but this meant that
if people were surviving mainly on corn because of some
kind of disaster or a hardship, they weren't likely to
develop pelagra.
Speaker 2 (10:59):
Other indigenous peoples from other parts of these continents have
other names for corn that has been prepared through a
similar process. The word samp, which is a maize porridge,
has possible roots in both Lenape and Algonquian languages. The
word hominy comes from the Virginia Algonquian language, also known
(11:20):
as Powatan. When European colonists started arriving in the Americas,
they had their first encounters with corn, and they wrote
about it. The word niche temol didn't show up in
English until the late nineteenth century, but English speakers were
writing about foods like possole, tamales, and tortillas by the
seventeenth century. The Oxford English Dictionary puts the first use
(11:43):
of the word hominy in English as coming from the
true travels, adventures, and observations of Captain John Smith into Europe, Asia, Africa,
and America. John Smith is mostly known today for the
highly romanticized versions of his encounter with Maduaca, also known
as Pocahontas. In a chapter covering the history of Virginia
(12:05):
from sixteen twenty four to sixteen twenty nine, Smith describes
the colonist's food and drink quote for drink some malt,
the Indian corn, others barley, of which they make good ale,
both strong and small, and such plenty thereof. Few of
the upper planters drink any water, but the better sort
are well furnished with sac aquavite and good English beer.
(12:30):
The servants commonly feed upon milk homily, which is bruised
Indian corn, pounded and boiled thick, and milk for the sauce,
but boiled with milk. The best of all will feed
off on it, and leave their flesh with milk, butter
and cheese with fish, bulls flesh, for they seldom kill
any other. Some of these foods made from nistimalized corn
(12:53):
made their way into the colonists' diets. Hamani became a
staple in parts of British colonial Ts Territory, where it
became associated with the poorer classes as a staple food.
Farther to the south than areas that were primarily colonized
by Spain, people were making and eating all kinds of
foods with nichealized corn, and these foods all still exist.
(13:16):
You can buy things like masaflour or masa arena and
hominy and foods made with them in stores or from
people who make them. And the Americas today, I will
note if it says hominy grits on the label and
it's like an instant gritz product that might not actually
be made with hominy, that might just be cornmeal, that
(13:38):
there's a bunch of grits manufacturers that are still using
the word hominy almost out of nostalgia, not out of
what the food actually contains.
Speaker 1 (13:47):
But when returning Europeans brought corn with them to Europe,
nichetionalization did not really go with them, and this caused problems.
We'll talk more about it after a sponsor break.
Speaker 2 (14:08):
A lot of foods that are eaten around the world today.
Were first cultivated by the indigenous peoples of the Americas
and the Caribbean. When Europeans returned from voyages across the Atlantic,
they brought plants like potatoes, tomatoes, peanuts, pumpkins, and of
course corn. Corn in particular had a massive impact on lives, ecology,
(14:33):
and agriculture in the places where it was introduced. It
had a high yield relative to the amount of work
that it took to grow it and the amount of
land that it required. It could be grown in relatively
poor soil, including soil that wasn't suitable.
Speaker 1 (14:49):
For other crops.
Speaker 2 (14:51):
In some regions, the growing season was long enough that
people could grow a crop of wheat and then a
crop of corn in the same field in the same year.
People could also raise corn to feed animals like pigs,
or they could feed parts of the corn plant to
their livestock while eating most of the kernels themselves. The
(15:12):
availability of maize as a food source has been credited
with helping to protect people from famine in parts of Europe, Asia,
and Africa, and with supporting population growth in areas where
it made it easier for people to get enough to eat.
It seems likely that the first people to bring maize
to Europe had at least some experience with indigenous methods
(15:35):
of growing and preparing it, even without the understanding of
how that related to its nutrient content, but that knowledge
wasn't maintained as maize continued to be introduced across the continent.
Corn spread rapidly as an easy and cheap source of food,
and in some regions it had completely supplanted other grains
within about two hundred years. Eating corn that hasn't been
(15:58):
nischemalized is it's not really a big nutritional problem as
long as you are eating other foods as well, and
some of those other foods contain niacin. But in places
where corn became the cheapest and most available thing, there
were inevitably people who wound up subsisting on it almost exclusively.
(16:19):
Especially in times of hardship, war, or famine, There were
scattered outbreaks of pellagra as a result. Usually these were
among the poorest people in a particular region. Sometimes these
were seasonal, starting in the late winter and spring, after
people had been living mostly off of stored corn over
(16:39):
the winter, and then resolving as people had access to
a wider variety of foods after the harvest. The first
known description of pelagra in writing was by Spanish physician
Gaspar Caazzali Julien in seventeen thirty five, who wrote about
a disease that was occurring among peasants in Asturias, on
(17:00):
the northern coast of Spain. He described it as the
region's most horrible and stubborn disease. He called this mal
de la rosa or rose disease, after the red rash
that appeared on patient's bodies. This often happened around the
spring equinox, but it could occur during other parts of
the year as well, and he talked about this rash
(17:22):
as frequently appearing on the hands and feet, but also
on the front part of the lower neck, extending down
across the clavicles like a collar. Today, this particular part
of the rash is known as the Kazal collar or
the Kazal necklace. At the time, this was thought of
primarily as a skin disease, and it was sometimes mistaken
(17:42):
for Hanson's disease, which is also known as leprosy. Although
there were pockets of pelagra reported all around parts of
southern Europe and the Mediterranean, it became a more widespread
problem in what's now northern Italy, where one of the
staple dishes we polenta. Polenta is often made with corn today,
(18:04):
but it predates the introduction of corn to Italy. It
had previously been made with various other grains or with
nut or bean meal. People across economic classes ate polenta,
but it was only the poorest people who needed to
survive only on polenta and not much else. So when
(18:25):
corn replaced other crops and became the prime ingredient in polenta,
pelagra started to spread. The first person known to have
described pelagra in Italy was physician Francesco Fropoli in seventeen
seventy one. He published his work in Milan, in the
Lombardi region of northern Italy, where he worked at the
(18:46):
Ospidale Maggiore. He was the person to coin the term
pelagra from Lombard words meaning rough skin. By seventeen seventy eight,
Italian physician Gaetano Strombio had established a hospital just for
pelagra patients in Lignano, Italy, and he also wrote a
three volume work on the disease. It had not taken
(19:09):
long to make a connection between the disease and the
consumption of corn, and Strombio thought that it was caused
by spoiled bread and polenta. In seventeen eighty nine, Francesco
Fanzago was a student doctor in Padua and described a
patient at the hospital where he worked. She seemed to
be in a daze and she had a dark, peeling
(19:30):
rash on her hands and arms. She lived in the country,
and her mother told Fanzago that for the past two years,
every spring she had become so weak that she could
not do her work. Fanzago realized that this sounded like
the peleegra that had been reported in Lombardi, and that
it was probably the same condition as the one doctor's
in Padua had been describing as pellerina or peeling off.
Speaker 1 (19:56):
So a lot of.
Speaker 2 (19:57):
What we have read so far has been focused on
the rat and on other kind of more general symptoms
like weakness. But in eighteen oh six, physicians Azzare Ruggieri
of Venice published an account of the case of Mattillo
lavat levatt had wanted to become a priest, but poor
economic circumstances had led to him working as a shoemaker instead,
(20:19):
and that really was not what he had wanted to do.
Levatt's symptoms initially included a flaking rash on his hands
and feet, but then in eighteen oh two, he developed
a serious mental illness which involved an intense fixation on religion. First,
he castrated himself, and then he repeatedly tried to publicly
(20:41):
crucify himself. One attempt involved nailing one of his hands
and both of his feet to a cross that was
tied to a beam inside of a building, and then
maneuvering the cross out the window. Bystanders came to his
aid and he survived this, but he died in an
asylum in eighteen oh When this account was translated into
(21:03):
English about a decade later, the translator didn't have a
word for dietesi pelagarossa, and was translated into leprosy because
at this point, pelagor had not really been introduced into
the English speaking world as a concept. By the early
nineteenth century, physicians in Italy had started to notice some
(21:24):
similarities between pelagra and another vitamin deficiency disease, scurvy, which
is caused by a lack of vitamin C. They didn't
yet know what vitamins were, but both diseases involved the skin,
and both of them progressed and worsened over time. By
the mid nineteenth century, physicians in Europe had started to
(21:45):
think of diseases as each having one distinct cause. While
there was general agreement in Italy that the cause of
pelagor was something related to coorn, a fierce disagreement developed
about exactly how corn was involved. Physician Filippo Desana and
pathologist Carlo Frua wrote a study in eighteen fifty six
(22:09):
that walked through a number of potential causes for pelagra,
but then argued that the primary cause was a diet
made up primarily of maize, which they argued did not
contain enough protein to support human health. Although vitamins still
had not been discovered, the first descriptions of proteins to
(22:30):
go back to the late eighteenth century, and the word
protein had been coined almost twenty years before this. The
term protein comes from Greek meaning the first quality, and
chemist Gerhard Johann Mulder had chosen this name because protein
was believed to be a key component of food that
was essential to human life. For a while, the idea
(22:54):
that corn had insufficient protein was the primary idea for
the cause of pelagra in Italy. Then, in eighteen sixty nine,
Cesare Lombroso theorized that pelagra was being caused not by
the protein content of maize, but by a toxin that
was produced as it decayed.
Speaker 1 (23:12):
He thought that people who ate fresh, wholesome maze would
not develop pelagra, but people who ate spoiled maize would.
This led to intense debate in Italy about whether this
was a disease of deficiency or of toxicity, and there
were ongoing arguments in support of one conclusion or the other.
There wasn't a sense that it might be contagious. Doctors
(23:34):
and nurses cared for patients who were not kept isolated
for the rest of the wards.
Speaker 2 (23:40):
By the late nineteenth century, pelagora had reached really epidemic
proportions in a lot of northern Italy, with patients overwhelming
hospitals and mental institutions. According to census records, there were
more than one hundred thousand polagra patients in Italy in
eighteen eighty one. Medical community still didn't entirely agree on
(24:03):
exactly what was going on. Lombroso's idea of contaminated or
decayed corn had gotten a lot of traction, so eventually,
on July twenty first of nineteen oh two, the Italian
parliament passed a law meant to try to curb pelagra.
This law included banning the sale of amateur musty or
(24:23):
spoiled maize. Sanitation officials had the right to inspect grain
processing and storage facilities. The law also included funds for
health authorities to monitor pelagor cases and for the care
of pelagora patients. Cases of pelagor had to be reported,
and food was required to be distributed to poor polagra
(24:44):
patients and their families. The law also required the building
of public maize drying ovens and the distribution of salt.
School lunches were also provided to children in areas that
had high rates of pelagra. Rates had already been declining
for at least a decade before this law was passed,
(25:05):
and they continued to drop afterward. According to the nineteen
oh five census, there were fifty five thousand polagrapations, so
that eighteen eighty one number had been cut roughly in half.
The number of new cases was also dropping steadily, although
that progress seemed slower in central and southern Italy, where
pelagra had been less prevalent than in the North. The
(25:28):
number of deaths per year also dropped from almost four
thousand in eighteen ninety eight to only three hundred seventy
six in nineteen oh seven. I've already talked about how
pelagor was caused by a deficiency in nison, that it
was not about spoilage in the corn. But some aspects
of this law may really have helped with the pelagorates
(25:48):
in Italy, especially the ones that involved providing food and
financial support to the affected people. In the late nineteenth century,
there had also been a wave of emigration out of Italy,
including to the United States, and often those immigrants sent
money back home, and then that money made it possible
(26:08):
for people to afford a richer variety of foods, including
foods that contained nyasin. However, as pelagora was declining in Italy,
it was starting to escalate in the US, and we'll
get into that after a sponsor break. The first known
(26:35):
description of pellagra in US medical literature was in nineteen
oh two, the same year that Italy passed its law
to try to curb the rate of pellagor. There there
were certainly cases and outbreaks in the United States before
that point, but most nineteenth century medical textbooks in the
United States did not even mention this disease. Henry Fauntleroy Harris,
(26:59):
who was the person who wrote this nineteen oh two report,
published a whole book on pelagra seventeen years later, and
its preface comments on how English writers had paid little
attention to the disease while there was quote an enormous
foreign literature on the subject. That enormous foreign literature was,
(27:20):
of course, mostly in Italian, and it went back almost
two hundred years. It wasn't until pelagora was firmly recognized
as a serious problem in the US that researchers looked
back at earlier disease reports and just found evidence of
misdiagnosed Pelagora outbreaks going back to at least the eighteen thirties.
(27:41):
Harris was a doctor who lived in Atlanta who also
served as secretary of the Georgia State Board of Health,
although he may not have started in that role yet
when he reported on this case. The patient from his
nineteen oh two report was a farmer, and a staple
of his diet was corn. He had occurring debilitating illness
(28:01):
that developed every spring, which had been going on for
about fifteen years. Every year, his mental health declined and
he experienced blistering of the skin on his arms and legs.
This would start to get better over the summer and
then resolve when the weather cooled. This farmer also had hookworm,
which was treated, and he was given arsenic and iron
(28:24):
as a pelagra treatment. This was a common treatment for
pelagra at the time, but when that didn't work, he
was advised to move to a cooler climate. The cases
and outbreaks from the nineteenth century in the US likely
stemmed from social and economic factors. The Southern United States
had faced massive destruction and hardship during the Civil War
(28:47):
and as a consequence of the centuries of enslavement that
had led to the war. The post war reconstruction had
included efforts to rebuild the South and to offer aid
and assistance to the freed people. Toward the end of reconstruction,
Southern business and civic leaders started advocating for a new South,
(29:08):
one that would be modernized and industrialized and urbanized, with
the building of new mills and factories and mines, and
the construction of roads and railroads to connect these urban hubs.
Agriculture was still a big part of the Southern economy,
but the primary focus was cash crops like cotton and tobacco.
(29:28):
The people who were hyping up the idea of a
new South were framing it as something that would modernize
the region and bring prosperity while still retaining a strong
Southern identity and Southern traditions, but that did not happen
in practice. There was a wave of new mills and factories,
but wages for people who worked in them were dramatically
(29:49):
lower than what they would have been paid for the
same jobs in the North. Although the reconstruction era had
worked toward equal rights for black people, white politicians and
activists had intentionally rolled back most of those gains. These
new industrial jobs were segregated, with black workers generally making
the lowest pay for the least desirable work. A system
(30:13):
of sharecropping also kept farmers tied to the land that
they were working. In a lot of cases the land
they had been working while they were enslaved, and also
kept them in debt to the landowner. And all of this,
of course connected to the food that people were eating.
Sharecropping was innately exploitive and sharecroppers needed to earn as
(30:34):
much money as they could to pay off their debts
to landowners and to make ends meet, so a lot
of them planted as much of a cash crop as
possible that left little to no land to grow food
to live on. In some cases, some of their pay
for their crops was in the form of credit at
a plantation commissary. They could use this to buy provisions,
(30:58):
but only the provisions that the landowner chose to stock.
This was similar to the situation for mill workers, who
frequently lived in company towns and were paid in company
script that could only be used at the company store.
Sharecroppers and mill workers and other people facing similar economic
(31:18):
hardship and exploitation had a similar foundation to their diets.
It was often described as the three ms, meal, meat,
and molasses. The meal was often corn meals, since corn
was cheap by this point it was being grown in
vast quantities in the Midwest and shipped to the South
by train. The meat was usually fatback or salt pork,
(31:40):
in other words, some of the cheapest cuts of meat,
which are very fatty and don't contain much niasin. Molasses
also contains a little bit of niasin, but again not much.
In addition to being inexpensive, these were often what was
stocked at company stores and commissaries. Thanks to their cost
and their long shelf life. People who had the ability
(32:05):
to buy or grow other foods to supplement those three
ms might be able to avoid developing pelagra, But the
poorest people in the United States, especially in the South,
were living off of that and very little else. And
then in nineteen oh one, technological developments probably made this
(32:25):
situation worse. John Beal of Decatur, Illinois patented the beal
De Germinator. This machine mechanically removed the germ and outer
brand layers from corn kernels, making it possible to separate
all these parts and use them for different purposes. This
made it easier and more efficient to make corn products
(32:47):
without the germ, which meant that there was a way
to keep corn from sprouting during storage without niche themalizing it.
There were other mechanical processing tools and milling tools before this,
but the beald De Germinator was a big improvement over
those earlier tools. This also made it a lot more
(33:07):
possible to sell low quality meal that had been made
from the least nutritious parts of the corn. It's not
conclusively proven that this degerminator put people at greater risk
of developing pelagra, but within a few years of its introduction,
doctors were reporting outbreaks of pelagora in places like orphanages
(33:28):
and institutions, and by the nineteen teens the US government
was actively investigating. That is all what we will get
to next time.
Speaker 1 (33:39):
Do you have some listener mail to take us out
of this peppi top idea I do.
Speaker 2 (33:45):
This is from Julie and Mackenzie, and Julie wrote an
email titled Mary Bethune Turned Lincoln Around? So, Julie wrote,
Holly and Tracy. When I moved back to DC in
twenty nine, I found a park close to me while
walking my dog. It had a statue of Mary MacLeod Bethune,
(34:06):
and since I didn't know who she was, I checked
to see if the history podcast I've been enjoying for
more than ten years had ever done an episode on her.
You had not, so I was thrilled that you finally
did one. The statue is in Lincoln Park, so named
because a statue depicting Lincoln in a slave casting off
his chains is there. The Emancipation Group was commissioned by
(34:28):
recently freed slaves in eighteen seventy five. Lincoln originally faced
west toward the Capitol, but when the married Bethune statue
was added to the park in nineteen seventy four, Lincoln
was turned to the east so that he now faces her.
Bethune statue is the first African American of any sex
in the first honorable woman on DC public lands. As
(34:49):
an aside, the Lincoln statue has always made me uncomfortable
the way Lincoln looms over the kneeling black man in
a very white savior kind way. Apparently I'm not the
only one, because during the Black Lives Matter summer of
twenty twenty there were attempts to tear it down, along
with so many other statues. The National Park Service barricaded
(35:11):
it and it remains in Lincoln Park unmolested. Here's the links.
You can make up your own minds. I've attached a
couple of my own very early morning dog walk doc
greate photos of these two statues. One of them includes
my pet tax Mackenzie is my blonde brindle snaffy pit
mix with goth eyeliner who has very big feelings and
(35:32):
is far too excited to meet people, but is also
the world's best snuggler. The muzzle is to prevent vet
visits because given the opportunity, she will eat anything and everything,
food or not. The pic in the car is a
road trip where we were listening to stuffy miss in
history class. Thank you for all you do. As long
as you keep making them, I'll keep listening. Julie and Mackenzie.
Speaker 1 (35:54):
Uh Kudie.
Speaker 2 (35:57):
I am familiar with this, the statue of Lincoln. It's
come upon the show before when we have been talking
about a different statue of Lincoln. I needed to go
make sure it wasn't this one we were talking about,
because it does. It looks exactly like the email said.
And you know, while Lincoln did sign the Emancipation Proclamation
(36:21):
and all that, the work that was done toward emancipation
was so profoundly led by enslaved people themselves putting the
pressure on to do that.
Speaker 1 (36:31):
And that's not what it looks like from right this
from the sculpture.
Speaker 2 (36:38):
We have a very adorable picture of Mackenzie at the
Mary McLeod Bethune statue. I love that statue so much,
and then off, what a cutie pie in the car and.
Speaker 1 (36:50):
Little Carnes if I ever meet Mackenzie. There's no such
thing as too friendly. It's fine.
Speaker 2 (36:54):
Yeah, yeah, I I definitely. I have said before folks
that are having their dogs out leashed in public. I
love this so much. I know so many folks who
have had really tragic encounters with off leash animals, And
so anytime I see somebody whose puppa dog is on
(37:16):
a leash, I'm like, I love you, We're friends. I'm
too anxious for any other option, you know what I mean, Like,
I can't imagine. Yeah, that poor dog would run away
from me out of like the sheer desire to get
away from my bad energy. They would be like, you
are a nervous wreck. I cannot deal with you right now,
roll out. I got stuff to do. Also totally understandable
(37:38):
about needing to keep your dog out in the world
from eating things that should not be eaten. I get
having cats who are our cats typically don't eat things,
except for the one who just perpetually wants to chew
on plastic.
Speaker 1 (37:57):
We have two plastic chewers. What is up with that?
I don't know it.
Speaker 2 (38:01):
It's it's a whole meme about it on TikTok or
there was a while back. But yeah, but I there
are a couple of things that I know can cause
big problems for cats if they are eaten that I'm
always on the watch for around our home to make
sure they get disposed of properly, like dryer sheets for one.
Speaker 1 (38:24):
Yeah.
Speaker 2 (38:25):
Anyway, so thank you so so much for this email
these adorable pictures. If you would like to send us
some notes about this or any other podcast where at
history podcasts at iHeartRadio dot com. You can subscribe to
our show on the iHeartRadio app and wherever else you
like to get your podcasts. We'll be back on Wednesday
with part two of this episode. Stuff You Missed in
(38:53):
History Class is a production of iHeartRadio. For more podcasts
from iHeartRadio, visit the iHeartRadio app, podcasts, or wherever you
listen to your favorite shows.
Stuff You Missed in History Class News
Hosts And Creators
Holly Frey
Tracy Wilson
Popular Podcasts
Math & Magic: Stories from the Frontiers of Marketing with Bob Pittman
How do the smartest marketers and business entrepreneurs cut through the noise? And how do they manage to do it again and again? It's a combination of math—the strategy and analytics—and magic, the creative spark. Join iHeartMedia Chairman and CEO Bob Pittman as he analyzes the Math and Magic of marketing—sitting down with today's most gifted disruptors and compelling storytellers.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
The Breakfast Club
The World's Most Dangerous Morning Show, The Breakfast Club, With DJ Envy And Charlamagne Tha God!