Tuesday, November 23, 2021

History and discovery of pellagra

Pellagra is a nutritional disorder that occurs as a result of niacin deficiency. The term pellagra is derived from the Italian words “pelle agra” meaning rough skin.

The term “pellagra” derives from the Lombard dialect of Northern Italy and clearly highlights the most readily evident clinical sign of the disease.

It was identified among the peasants, in the Asturia region of Spain by Don Gaspar Casal, Spanish physician. Casal described this nutritionally deficient disease in 1735 as “mal de la rosa” with classic symptoms of dermatitis, diarrhea, and dementia, with death as the eventual outcome.

In his posthumously published encyclopaedic treatise on the “Historia Natural y Medica de el Principado de Asturias” (1762), there is a chapter on “De affectione quae vulgo in hac regione mal de la rosa nuncupatur”, where Casal refers to pellagra using a Spanish designation that refl ected the characteristic sunburn-like skin erythema.

The first publication on the disease appeared in 1755 an 1762, which contained an exact description of the condition; at that time it was ascribed to spoiled maize.

Its appearance in Italy was probably 50-100 years later. The disease continued to be widespread in Italy throughout the nineteenth century, e.g. data from 1862 report 39 000 cases in Lombardy in a population of 2.5 million.

It was not until early in the 20th century that Serbia and Southern Russia could have been described as ‘suffering a heavy visitation’.

The first report in which the term “pellagra” was probably used for the first time, was from Milan, Italy in 1771 when pellagra was given its name, meaning "rough skin".

The name of pellagra attached of the disease was suggested by Frappoli in 1771. He referred to it as of ancient origin at that time and probably identical with the “pellarella” reported in Milan in 1578.

In the first half of the 19th century, the social basis of pellagra became a major focus of attention as shown in the studies of Liberali (1831) on the manic dementia of pellagrins.

Pellagra had disappeared from Southern France by about 1880. After 1900, pellagra decreased greatly in Italy for reasons that are unclear, and by 1916 the disease had almost disappeared in the country

In 1922, Goldberger and Tanner suggested that pellagra was an amino-acid deficiency. For his pellagra studies in the first quarter of this century, Joseph Goldberger an American physician and epidemiologist is considered a hero of American clinical epidemiology.

In 1937 it was discovered that pellagra was caused by a deficiency of the B vitamin niacin (nicotinic acid). The body's synthesis of this vitamin depends on the availability of the essential amino acid tryptophan, which is found in milk, cheese, fish, meat and eggs.
History and discovery of pellagra

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