Stages in the recognition of epidemic pellagra in the United States

Recognition of the U.S. pellagra ``epidemic'' in the early part of this century occurred in stages. The recognition process distorted impressions of magnitude, rate of spread, and virulence. Unrecognized cases: Endemic pellagra developed from dietary deficiencies after the Civil War. Initially, cases were misdiagnosed as other more traditional disorders. Tradition and authority inhibited recognition. Recognition of severe cases: Beginning in 1907, outbreaks were reported in asylums. Existing severe cases came rapidly to medical attention, inflating the apparent rate of spread. Recognized cases had a fulminant course and a high case fatality. Expanded spectrum: Milder cases were increasingly recognized, leading to an exaggerated rate of increase in number of cases and a decrease in case fatality and apparent virulence. Greater sensitivity resulted largely from a shift in diagnostic thresholds, with loss of specificity and increase in false positive diagnoses. Standardization of diagnosis: Although no suitable diagnostic marker test was developed, diagnosis was ultimately standardized by development of a workable case definition and by assessment of response to an effective therapy (nicotinic acid) applied to presumptive cases. NEUROLOGY 1996;47: 829-834

[1]  R. Kierland.  A Plaque of Corn: The Social History of Pellagra , 1973 .

[2]  J. H. Cassedy.  THE REGISTRATION AREA AND AMERICAN VITAL STATISTICS: DEVELOPMENT OF A HEALTH RESEARCH RESOURCE, 1885-1915. , 1965, Bulletin of the history of medicine.

[3]  V. P. Sydenstricker.  The history of pellagra, its recognition as a disorder of nutrition and its conquest. , 1958, The American journal of clinical nutrition.

[4]  H. L. Dunn,et al.  Vital statistics rates in the United States 1900-1940 , 1944 .

[5]  N. Jolliffe,et al.  PORPHYRINURIA IN PELLAGRA , 1940 .

[6]  C. P. Rhoads,et al.  The Quantitative Determination of Urinary Coproporphyrin , 1938 .

[7]  V. P. Sydenstricker,et al.  TREATMENT OF PELLAGRA WITH NICOTINIC ACID: OBSERVATIONS IN FORTY-FIVE CASES , 1938 .

[8]  R. E. Stone,et al.  THE TREATMENT OF SUBCLINICAL AND CLASSIC PELLAGRA: USE OF NICOTINIC ACID, NICOTINIC ACID AMIDE AND SODIUM NICOTINATE, WITH SPECIAL REFERENCE TO THE VASODILATOR ACTION AND THE EFFECT ON MENTAL SYMPTOMS , 1938 .

[9]  T. Spies,et al.  A NOTE ON THE RELATIONSHIP OF PORPHYRINURIA TO HUMAN PELLAGRA , 1938 .

[10]  W. Freeman,et al.  REFLEX GRASPING AND GROPING: ITS SIGNIFICANCE IN CEREBRAL LOCALIZATION , 1929 .

[11]  W. J. Macneal,et al.  STATISTICS OF PELLAGRA IN SPARTANBURG COUNTRY, S. C., INCLUDING GEOGRAPHICAL DISTRIBUTION OF THE DISEASE AND ITS RELATION TO RACE, AGE, SEX AND OCCUPATION , 1915 .

[12]  W. J. Macneal,et al.  INTRODUCTION TO THE SECOND PROGRESS REPORT OF THE THOMPSON-McFADDEN PELLAGRA COMMISSION , 1914 .

[13]  W. J. Macneal,et al.  Pellagra. A Summary of the First Progress Report of the Thompson-McFadden Pellagra Commission. , 1914 .

[14]  J. F. Siler,et al.  AN INTENSIVE STUDY OF THE EPIDEMIOLOGY OF PELLAGRA. REPORT OF PROGRESS , 1913 .

[15]  F. Robbins.  Report of a Case of Pellagra. , 1913 .

[16]  C. Lavinder.  The Prevalence and Geographic Distribution of Pellagra in the United States. , 1912 .

[17]  H. Harris.  THE DIAGNOSIS OF PELLAGRA , 1911 .

[18]  J. W. Babcock.  THE PREVALENCE AND PSYCHOLOGY OF PELLAGRA , 1911 .

[19]  C. Lavinder.  THE PROPHYLAXIS OF PELLAGRA , 1909 .

[20]  E. Wood.  THE APPEARANCE OF PELLAGRA IN THE UNITED STATES , 1909 .

[21]  C. Lavinder,et al.  The Prevalence of Pellagra in the United States. A Statistical and Geographical Note, with Bibliography , 1909 .

[22]  C. Lavinder.  Pellagra in the State Hospital for the Insane at Peoria, Ill. , 1909 .

[23]  George H. Searcy.  AN EPIDEMIC OF ACUTE PELLAGRA. , 1907 .

[24]  J. Gray.  CASE OF PELLAGRA OF THE INSANE , 1864 .

[25]  J. Hewitt.  PELLAGRA IN VIRGINIA , 1909 .