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

Discovery and history of niacin

Recognition that niacin is a vitamin in the early 20th century resulted from efforts to understand and treat a widespread human disease – pellagra.

Pellagra was probably first observed in 1735 in Asturias, autonomous community in Kingdom of Spain.

It was identified among the peasants by Don Gaspar Casal in 1735, soon after the maize was introduced into Europe. A loathsome skin disease, it was called “mal de la rosa” and often mistaken for leprosy.

Pellagra was already an epidemic in Europe in the 18th century, and in the first half of the 20th century it also started its spread in the United States of America, particularly among the poorest social classes.

In 1915, American epidemiologist and US Public Health Service officer Joseph Goldberger conducted a series of experiments on 11 healthy volunteer prisoners in a Mississippi jail and found that he could induce pellagra by altering their diets. He concluded that the disease was caused by the absence of some factor that was lacking in corn. He named it the P-P (for pellagra-preventative) factor.

In 1937, American biochemist Conrad Arnold Elvehjem and his colleagues successfully isolated the vitamin and demonstrated that pure nicotinic acid and nicotinic acid amide would reverse the pellagra and black tongue in dogs by feeding them the Goldberger diet.

He also isolated the P-P factor from active liver extracts, showing that this factor is actually nicotinic acid (subsequently named niacin for nicotinic acid vitamin).

The discovery of niacin as the antipellagra vitamin was announced by C. A. Elvehjem, R. J. Madden, F. M. Strong, and D. W. Woolley in 1937 (J. Am. Chem. Xoc. 59, 1767 (1937)),

During the following year a number of clinical trials were made which established beyond doubt the value of niacin in the treatment of pellagra, and that the acid or its amide should be regarded as the P-P (pellagra-preventive) factor.
Discovery and history of niacin

History of Pellagra

Pellagra is a distinctive clinical entity characterized by symptoms of neurological dysfunction accompanied by lesions of the skin and alimentary.

In the late 1960s about half of the rural blacks in South Africa suffered from cutaneous pellagra often associated with riboflavin deficiency.

History of pellagra shows that tropical diseases are disease of poverty.

The association of pellagra with consumption of maize was clearly perceived from the time of its initial appearance.

Pellagra was probably first observed in 1735 in Asturias, autonomous community in Kingdom of Spain.

It was identified among the peasants by Don Gaspar Casal. A loathsome skin disease, it was called “mal de la rosa” and often mistaken for leprosy.

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 and 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” (meaning – rough skin) was probably used for the first time, was from Milan.

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.

Pellagra had disappeared from Southern France by about 1880 and from Italy by 1914.

In United States, pellagra has sometimes been called the disease of the four D’s – dermatitis, diarrhea, dementia and death.
History of Pellagra