Alabama Physicians Debate the “Scourge of the South”
Shortly after Dr. Searcy’s 1906 discovery of the pellagra epidemic in Alabama, area physicians began to dialogue about the etiology and treatment of this “scourge of the South.” The venue for much of this discussion was the Medical Association of Alabama annual meeting, and various theories were published in the transactions of that body, as well as in other regional medical publications. From the descriptions of the articles below, it is apparent that opinions regarding pellagra were wide ranging. Some thought it contagious, other agreed with the traditional view of spoiled or toxic cornmeal, and some looked to diet and living conditions. Mosquito vectors and sun exposure were also mentioned. Suggested treatments ranged from blood transfusion to arsenic therapy and drug treatments. Despite their disagreement, what is apparent from these articles is that Alabama physicians were valiantly struggling to find a cure for this virulent disease.
Articles by Alabama Physicians (in chronological order)
Leach believed pellagra was “due to an intoxication from existing damaged maze, corn which has not matured, not been properly dried or meal which has not been kept dry after grinding.” Leach adds that poverty, hard labor and high exposure to the sun are “predisposing causes.” He suggests a “prophylactic” treatment with “tonics of iron and quinine,” and concludes with a case study and discussion.
Dr. Cole's article reports on the "successful" treatment by blood transfusion of a pellagra patient at the Mt. Vernon Hospital. In this case, blood from a recovered pellagra patient was given to one suffering the advanced stages of the disease. The article also discusses more generally the technique of blood transfusion and the theoretical basis for its use in fighting disease.
In this article, McCafferty gives an update on the pellagra cases at the Mt. Vernon Hospital since Searcy's 1907 article. Detailed incidence and mortality lists are provided. He describes the results of several experimental tests and postmortems conducted at that hospital. He also notes patient responses to various treatments, especially the "success" of blood transfusion (also reported in H. P. Cole's article).
This paper, read before the Southern Medical Association in 1908, gives an extensive overview of the current knowledge of pellagra up to that date. Discovered in epidemic proportions in the U. S. just two years prior, this article provided Southern physicians current information regarding pellagra's symptoms, historical distribution, etiology, pathology, diagnosis, prognosis, and treatment, as well as numerous case descriptions.
This paper was written at the request of Medical Association of Alabama President Wooten Moore Wilkerson. It presents 12 case studies.
This paper presents a history of the disease up to George H. Searcy’s report. Mason notes that its “etiology remains obscure,” and that Guido Tizzoni’s claim of a bacterial basis remains unconfirmed. The belief that it is contagious, Mason insists, is “without foundation.” It proceeds with a detailed pathological report. Treatment suggestions are offered. Discussion follows.
The President notes that pellagra was a significant health concern for the state during the year and refers to the “mode of infection” and cure.
This paper gives a detailed summary of treatment recommendations, noting to “do everything possible to aid nutrition;” lengthy discussion follows. It includes, “Information for the Public About Pellagra.” Mill village studies of Spartanburg, NC (the Thompson-McFadden Commission, 1912) are referenced, noting the use of milk reduced incidents of the disease and rules out “corn meal as an essential cause of pellagra.” The possibility of an insect vector is also discussed.
Pruett addresses pellagra prevention and notes that the unresolved nature of its etiology makes confident assertions about the topic difficult. He believes that arsenic therapy may have some benefit, and refers to the Thompson-McFadden Commission, criticizing the infection theory by warning against too hasty and abandonment of the spoiled maize or spoilage theory in general.
Ray notes that no “routine treatment” is currently available and that pellagra is very hard to diagnose in its early stages. He observes that early diagnosis is important and relies upon drug therapy, but offers no specific recommendations.