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TYPES OF NUTRITIONAL DEFICIENCY: NIACIN
LACK of niacin, until recently called nicotinic acid, is always associated in the popular mind with pellagra, a dis-ease of our own South. But, like other vitamin deficiencies, it has its milder manifestations, and occurs commonly as one phase of multiple deficiency. Pellagra was recognized as a specific disease by the Spanish physician, Casal, in 1735.6 The name "pellagra" (pelle agro, rough skin) was introduced by Frapolli of Italy in 1771.7 Over 150 years of study revealed the economic importance of the disease and its preva-lence in Spain, Italy, Rumania, Egypt, Africa, and the southern states of our own country. It was not until Joseph Goldberger and his associates in the United States Public Health Depart-ment conducted a series of experiments between 1915 and 1930 that pellagra was conclusively proved to be a defi-ciency disease. The most dramatic of these studies was the famous prison farm experiment in Mississippi. A group of convicts voluntarily ate a pellagra-producing diet for a period of months, developed typical pellagra, and were pardoned by the progressive gov-ernor of the state for their service to humanity.8 Goldberger recognized spontaneous blacktongue in dogs as the analogue of human pellagra, and devised a diet for producing experimental blacktongue. Using this method of biological assay, he demonstrated the relative value of our common available foods in prevent-ing pellagra. In 1930, Goldberger and Sebrell found that powdered extracts of liver, then in use for the treatment of pernicious ane-mia, were very effective in curing ex-perimental blacktongue in dogs." By 1932 Boggs and Padget were able to report a large series of moderately severe pellagrins which were cured by pow-dered extracts of liver.10 Later in the same year Smith and Ruffin reported excellent results in a small series of cases treated with a crude aqueous ex-tract of whole liver.1' In 1933 Ramsdell and Magness and Spies began to inject into the muscles or into the blood a specially purified fraction of liver.12 This was of definite value in patients who were too ill to take food by mouth. By 1935 Spies had succeeded in reducing the pellagra mor-tality from 32 per cent to 6 per cent.13 While the liver treatment was a striking improvement over the old yeast treat-ment, still from 6 to 10 per cent of the severely ill pellagrins continued to die of the disease. It was obvious that the mortality in pellagra could not be reduced much be-low 6 per cent until the pure vitamin was isolated so that ten to a hundred times the amount present in the best extracts of liver could be given directly into the blood stream of the severely ill pellagrins. In 1937, Elvehjem, Madden, Strong, and Woolley at the University of Wis-consin isolated nicotinic acid amide from liver and showed that nicotinic acid and nicotinic acid amide cured experimental blacktongue.'4 The value of nicotinic acid, or niacin, in the treatment of pel-lagra was demonstrated independently and almost simultaneously by four dif-ferent groups of workers. The first pub-lished report was by Fouts and his associates in November 1937.15 On De-cember 18, 1937 two communications appeared-one by Harris of England 16 and the other by Smith, Ruffin, and Smith of Duke.'7 Spies, Cooper, and Blankenhorn had treated successfully seventeen cases by February 1938.18 These early reports have been confirmed by scores of other investigators in this country and abroad. Niacin may be given by mouth or by intravenous injection. Consequently it is now possible to save patients who are so nearly dead that they can no longer take medication by mouth. Many pa-tients with severe mental symptoms who formerly progressed to hopeless insanity can be restored to normal. Jolliffe and his associates were able to cure with niacin a large percentage of patients with a severe mental type of pellagra which before was almost always fatal.19 Soon, however, Spies, Sebrell, Sydenstricker, and others began to report that some pellagrins treated with nicotinic acid made a rapid improvement for a period of days and then began to show signs of other types of deficiencies.20 The laboratory studies by Sebrell and Onstott, and by Margolis, Margolis, and Smith, showed that these associated symptoms were caused by secondary de-ficiencies in the diet and that they could be corrected by feeding supplementary vitamins, or more easily by crude prod-ucts like yeast or liver.21 The niacin treatment is dramatic and life-saving, because this vitamin cures the cardinal symptoms of pellagra. But it is now clear that niacin is not a sub-stitute for food, and the prevention of pellagra presents the same problem to-day that faced Goldberger in 1930. Goldberger's diet of lean meat, fish, milk, eggs, and fresh fruit and vege-tables will prevent pellagra, but the population must have the means to ob-tain these foods and must be educated to eat them, to protect them not only from pellagra but also from other die-tary deficiencies.
David T. Smith, M.D., is professor of bacteriology and associate professor of medicine at Duke University, Durham, North Carolina, where he has been work-ing continuously since 1930 on pellagra and other vitamin deficiencies, both in the clinics and in the laboratory. Prior to 1930 he made a study of vitamin C deficiencies in connection with the de-velopment of intestinal tuberculosis. He is joint author of The Vitamins in Ther-apy, in Blumer's System of Therapy (1941).
NiacinAuthor(s): David T. SmithReviewed work(s):Source: Annals of the American Academy of Political and Social Science, Vol. 225, Nutritionand Food Supply: The War and After (Jan., 1943), pp. 33-35Published by: Sage Publications, Inc. in association with the American Academy of Political and SocialScienceStable http://www.forestpure.com/