Pellagra, Part 1

Summary

Podcast Summary: Stuff You Missed in History Class – Pellagra, Part 1

Podcast Information

• Title: Stuff You Missed in History Class
• Host/Author: iHeartPodcasts (Holly Fry and Tracy B. Wil)
• Episode: Pellagra, Part 1
• Release Date: March 3, 2025

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Introduction

In the episode titled "Pellagra, Part 1," hosts Holly Fry and Tracy B. Wil delve into the history and impact of pellagra, a significant vitamin deficiency disease that affected populations in both Europe and the United States. Building on previous discussions about vitamin deficiencies, this episode aims to unravel why pellagra emerged as a critical health crisis despite corn being a staple food in the Americas for thousands of years.

Notable Quotes:

• Tracy B. Wil [02:29]: "Pellagra epidemic of the early 20th century may have been the deadliest epidemic of a specific nutrient deficiency in US history."

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Understanding Pellagra

What is Pellagra?

Pellagra is a disease resulting from a deficiency in niacin (vitamin B3). Niacin is crucial for producing nicotinamide adenine dinucleotide (NAD), a coenzyme essential for over 400 enzymes involved in cellular energy production and various critical functions.

Key Points:

• Symptoms: Pellagra is characterized by the "three Ds": dermatitis (skin rashes), diarrhea, and dementia. If untreated, it can lead to death, known as the "fourth D."
• Dietary Sources: Niacin is abundant in foods like fish, meats, whole grains, peanuts, seeds, and fortified processed foods. The body can also synthesize niacin from the amino acid tryptophan.
• Risk Factors: Modern cases are rare but can occur in areas with restrictive diets, alcoholism, certain medical conditions, or in populations relying heavily on maize as a staple.

Notable Quotes:

• Tracy B. Wil [05:30]: "There are more than 400 enzymes in the human body that require NAD to work, and that is more than any other vitamin-derived coenzyme."
• Tracy B. Wil [07:54]: "These symptoms can be resolved through a nutritious diet that is high in niacin and today, niacin supplementation. But if it's left untreated, pellagra can progress to a fourth D, which is death."

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Pellagra in Europe: The Italian Experience

Historical Context: Pellagra was notably prevalent in northern Italy during the 19th century, particularly among the impoverished who relied heavily on polenta—a dish traditionally made from various grains but increasingly from corn after its introduction from the Americas.

Key Points:

• Early Descriptions: The first known description in Europe was by Gaspar Cazale Julian in 1735 in Asturias, Spain, describing it as "maldela rosa" (rose disease) due to the characteristic red rash.
• Adoption of Maize: Indigenous methods of preparing maize, such as nixtamalization, were not adopted in Europe. This process makes niacin bioavailable, preventing deficiency.
• Medical Theories: Italian physicians like Filippo Lusana and Cesare Lombroso debated whether pellagra was due to protein deficiency or corn toxicity. The consensus eventually leaned towards niacin deficiency.
• Legislative Action: In 1902, Italy passed laws to combat pellagra by regulating corn quality, improving food distribution, and providing financial support to affected populations. These measures significantly reduced pellagra rates by 1905.

Notable Quotes:

• Tracy B. Wil [25:09]: "By 1778, Italian physician Gaetano Strombio had established a hospital just for pellagra patients in Legnano, Italy, and he also wrote a three-volume work on the disease."
• Maria Tremarki [24:01]: "He thought that people who ate fresh, wholesome maize would not develop pellagra, but people who ate spoiled maize would."

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Spread and Recognition of Pellagra in the United States

Early Presence: While pellagra had been present in Europe, its recognition in the United States lagged. The first well-documented case in U.S. medical literature appeared in 1902, coinciding with Italy's legislative efforts.

Key Points:

• Underdiagnosis: Before 1902, pellagra cases in the U.S. were often misdiagnosed or overlooked in medical texts.
• Social and Economic Factors: Post-Civil War Reconstruction in the South led to economic hardships, exploitation through sharecropping, and a reliance on maize as a cheap, staple food.
• Agricultural Changes: Innovations like the Beall degerminator allowed for the mass processing of corn, stripping away its nutritious parts and making niacin inaccessible, thereby increasing pellagra risk.
• Population Vulnerability: Sharecroppers and mill workers, often impoverished and reliant on cornmeal, fatty meats, and molasses, became susceptible to pellagra due to their limited and nutritionally poor diets.

Notable Quotes:

• Tracy B. Wil [32:30]: "As pellagra was declining in Italy, it was starting to escalate in the U.S and we'll get into that after a sponsor break."
• Maria Tremarki [37:59]: "Harris was a doctor who lived in Atlanta who also served as secretary of the Georgia State Board of Health... he published a whole book on pellagra 17 years later."

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Conclusion and Transition to Part 2

The episode concludes by highlighting the contrasting trajectories of pellagra in Italy and the United States. While Italy managed to curb the epidemic through legislative action and improved nutrition, the United States was just beginning to grapple with its own pellagra crisis, influenced by industrialization and socio-economic disparities. The hosts tease Part 2, which will explore the gruesome self-experimentation and unethical medical experiments conducted in the U.S. to understand and combat pellagra.

Notable Quotes:

• Tracy B. Wil [43:53]: "That is all. What we will get to next time."
• Maria Tremarki [43:57]: "Do you have some listener mail to take us out of this peppy topic?"

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Key Takeaways

• Niacin Importance: Pellagra underscores the critical role of vitamins in human health and the impact of dietary deficiencies.
• Cultural Practices Matter: Indigenous food preparation methods like nixtamalization played a significant role in preventing nutrient deficiencies.
• Socio-Economic Impact: Economic exploitation and dietary limitations can lead to widespread health crises.
• Medical Recognition: Accurate diagnosis and understanding of nutrient deficiencies were delayed in Western medicine, hindering timely interventions.

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Listen to Part 2 of "Pellagra" to continue exploring this pivotal yet grim chapter in nutritional history.

Transcript

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And I'm Holly Fry. Together we invite you into the dark and winding corridors of historical true crime.

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Welcome. My name is Paola Pedrosa, a medium and the host of the Ghost Therapy Podcast, where it's not just about connecting with deceased loved ones, it's about learning through them and their new perspective. I think God sent me this gift so I can show it to the world. And most of all, I help people every single day. Listen to the Ghost Therapy podcast on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hey, it's Alec Baldwin. This past season on my podcast, here's the thing, I spoke with more actors, musicians, policymakers, and so many other fascinating people like writer and actor Dan Aykroyd. I love writing more than anything. You're left alone, you know, you do three hours in the morning, you write three hours in the afternoon. Go pick up a kid from school and write at night. And after nine hours you come out with seven pages and then you're moving on. Listen to here's the thing on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

[Maria Tremarki]

Welcome to Stuff youf Missed in History Class, a production of iHeartRadio.

[Tracy B. Wil]

Hello and welcome to the podcast. I'm Tracy B. Wil.

[Maria Tremarki]

And I'm Holly Fry.

[Tracy B. Wil]

Holly's episode on Hydroponics from not that long ago made just a casual reference to vitamin deficiency. And that reminded me that I have been wanting to do an episode on Pellagra and kind of similar to our episode on iodized salt from June of last year, if you don't remember that episode. I knew the basics of why salt was iodized, but not really the details of what a problem goiter had been before they put the iodine in the salt. I already had a general sense that pellagra is a vitamin deficiency. And I also knew that it was a widespread problem in the southern U.S. other parts of the U.S. too, but especially the south in the early 20th century. That has also come up on the show before, but that has never quite made sense to me because I knew pellagra had something to do with eating corn. But people in the Americas have been eating corn for at least 10,000 years. So why did it take millennia for pellagra to become a problem and also to become a huge problem? The pellagra epidemic of the early 20th century may have been the deadliest epidemic of a specific nutrient deficiency in US history. I could kind of imagine various explanations for what would have caused this, but I did not actually know the answer. And so now we have this episode, and actually we have two of them. Because it turns out that while I had mostly heard about pellagra in the United States, there's a whole history also in southern Europe, especially in Italy, that I was not aware of at all. So today we will be talking about what pellagra is and why it became a problem in Italy in the 19th century, and also the first reports of its existence in the United States. And then part two will have the rest of the US Story, which is gonna involve some pretty gross self experimentation as well as some medical experiments that definitely would not get the okay from ethics review boards today.

[Maria Tremarki]

As Tracy just said, pellagra is a vitamin deficiency, specifically a deficiency in niacin, also called vitamin B3. The word niacin is derived from another name for this nutrient, nicotinic acid. Because it was first identified and synthesized in experiments involving nicotine in 1873. That makes it the first major vitamin to be synthesized at that point, though Western medicine had no concept of essential nutrients as we know them today. And the word vitamin hadn't even been coined yet. That wouldn't happen for almost 40 more years. So people knew nicotinic acid existed, but they had no sense of what it did in the body or how important it is to human life.

[Tracy B. Wil]

Without getting too far into the weeds of biochemistry, the body breaks niacin down into important coenzymes, including one called nicotinamide adenine dinucleotide, or nad you can think of a coenzyme as a helper molecule helping enzymes to start necessary chemical reactions. In the body, NAD is particularly important. There are more than 400 enzymes in the human body that require NAD to work, and that is more than any other vitamin derived coenzyme. A lot of those chemical reactions are involved with providing energy to cells, and some of the others are part of a range of just critical cellular functions.

[Maria Tremarki]

So when the body doesn't get enough niacin, it can't make enough nad, which means a lot of necessary chemical reactions cannot get started in the way that they should. Often, the first places to show obvious signs of a problem are parts of the body where cellular turnover is really fast. So like the skin and the lining of the digestive tract, or which use a lot of energy. Like the brain.

[Tracy B. Wil]

This means pellagra can cause a whole collection of symptoms. For the skin, there's a characteristic red or darkened rash that often occurs in the areas that get the most sun exposure. This rash can scale and blister and peel. For the digestive tract, there's diarrhea. And for the brain, there are problems with cognition and mental health. This collection of symptoms is often summarized as the three Ds. That's dermatitis, diarrhea and dementia. People don't always have all three Ds at once, though, and when they do, their condition is typically already very advanced. And this can also be a vicious cycle, because if you have chronic diarrhea or dementia, that can dampen your desire to eat, and then that makes it even harder to get enough niacin. These symptoms can be resolved through a nutritious diet that is high in niacin and today, niacin supplementation. But if it's left untreated, pellagra can progress to a fourth D, which is death.

[Maria Tremarki]

A lot of foods are high in niacin, including fish like tuna, salmon and anchovies. Meats including beef, chicken, turkey and pork, especially liver Whole grains, including brown rice, peanuts, various seeds and potatoes. And today, a number of processed foods are fortified with niacin. We're going to talk more about that in part two. The body can also produce its own niacin from the amino acid tryptophan, which is also found in a range of foods, including poultry, various seeds, eggs, fish, cheese, and soybeans. So people who have access to a variety of foods and are able to acquire and eat and digest those foods usually get enough niacin from their regular diet, and they aren't at a risk of developing pellagra that means in wealthier.

[Tracy B. Wil]

Parts of the world today, the people who are at the greatest risk of developing pellagra usually have some other factor involved, like highly restrictive diets. Whether they're by choice or by necessity. Eating disorders, gastrointestinal disorders, and various types of organ damage can also put people at a greater risk for pellagra, as can some illnesses and drugs. Severe alcohol use disorder can lead to pellagra as well. So today, pellagra is far more prevalent in poorer parts of the world, where people don't have access to or cannot afford a wide variety of foods, including places that are receiving large amounts of food aid in the form of donated corn.

[Maria Tremarki]

Which brings us to the connection between corn, also called maize, and pellagra. The term maize likely comes from the Taino word for this plant. Its first appearances in English are in Translations of 16th century Spanish accounts of these plants and and foods in the Caribbean. The English word corn, on the other hand, goes back centuries before maize was introduced to Europe. It was originally an Old English word that referred to grains more generally.

[Tracy B. Wil]

Indigenous people domesticated maize from a wild grass called teosinte in what's now southwest Mexico about 10,000 years ago. By about 7,000 years ago, it was being grown in what's now Panama. And by about 6,000 years ago, it had been introduced in northern South America. Then, roughly about 4,000 years ago, a hybrid version of this domesticated crop started to be introduced into areas farther away. And before long, corn was a staple crop in much of the Americas. As a plant, corn or maize had lots of uses in the farming technique known as the Three Sisters. Stalks of maize provided support for climbing bean vines. Corn husks could be used to make mats or fill bedding, or to make dolls. The stalks could be made into baskets or braided into cords. Dried cobs could be burned as fuel, and of course, the kernels of the corn could be eaten.

[Maria Tremarki]

In the region where corn was first domesticated, the process used to prepare the kernels for eating is now known in English as nishtimalization. This comes from the Nahuatl word nishtimal, which is the name for the food at the end of this process. Combining the words meaning ash and tamale, first dried corn kernels are steeped in alkaline water. Today this is often done with food grade lime or calcium hydroxide. But historically it has also involved things like ash, lye, limestone and seashells. After steeping, the kernels are drained and rinsed thoroughly.

[Tracy B. Wil]

This process removes the outer shell of the kernel, making it softer and easier to digest. It also deactivates the germ, which keeps the kernels from sprouting while they are being stored. The resulting kernels can also be ground into a flour called masa. Masa can be formed into a dough that can be used to make foods like tamales and tortillas. Whole kernels can also be boiled and used in dishes like pozole.

[Maria Tremarki]

All of that would have been apparent to the indigenous peoples who cultivated corn and developed this process. But nishtamalization also had another benefit that was not chemically understood until far more recently. Corn contains niacin, but that niacin is chemically bound in a way that means the body can't access or absorb it during digestion. That's not the case with nishtamalized corn. That process makes niacin and other essential nutrients more available to the body. Those other essential nutrients include calcium. There is 13 times more calcium available in nishtamalized corn than in corn that has not been through that process. In general, indigenous peoples across the Americas ate and eat a variety of foods, but this meant that if people were surviving mainly on corn because of some kind of disaster or a hardship, they weren't likely to develop pellagra.

[Tracy B. Wil]

Other indigenous peoples from other parts of these continents have other names for corn that has been prepared through a process. The word samp, which is a maize porridge, has possible roots in both Lenape and Algonquian languages. The word hominy comes from the Virginia Algonquian language, also known as Powhatan.

[Maria Tremarki]

When European colonists started arriving in the Americas, they had their first encounters with corn, and they wrote about it. The word nishtimal didn't show up in English until the late 19th century, when but English speakers were writing about foods like pozole, tamales, and tortillas. By the 17th century. The Oxford English Dictionary puts the first use of the word hominy in English as coming from the true travels, adventures, and observations of Captain John Smith into Europe, Asia, Africa, and America. John Smith is mostly known today for the highly romanticized versions of his encounter with madoaka, also known as Pocahontas. In a chapter covering the history of Virginia from 1624 to 1629, Smith describes the colonists food and drink for drink some malt the Indian corn, others barley, of which they make good ale, both strong and small, and such plenty thereof. Few of the upper planters drink any water, but the better sort are well furnished with sack, aqua vitae, and good English beer. The servants commonly feed upon milk homily which is bruised Indian corn pounded and boiled thick and milk for the sauce, but boiled with milk the best of all will feed off on it and leave their flesh with milk, butter and cheese with fish bull's flesh, for they seldom kill any other.

[Tracy B. Wil]

Some of these foods made from nishtimalized corn made their way into the colonists diets. Hominy became a staple in parts of British colonial territory where it became associated with the poorer classes as a staple food. Farther to the south than areas that were primarily colonized by Spain, people were making and eating all kinds of foods with nishtamalized corn and these foods all still exist. You can buy things like masa flour or masa harina and hominy and foods made with them in stores or from people who make them in the Americas today. I will note if it says hominy grits on the label and it's like an instant grits product that might not actually be made with hominy, that might just be cornmeal. There's a bunch of grits manufacturers that are still using the word hominy almost out of nostalgia, not out of what the food actually contains.

[Maria Tremarki]

But when returning Europeans brought corn with them to Europe, nichtamalization did not really go with them and this caused problems. We'll talk more about it after a sponsor break.

[Holly Fry]

Hey y'all, I'm Maria Fernanda Diez. My podcast when youn're Invisible is my love letter to the working class people and immigrants who shaped my life. I get to talk to a lot of people who form the backbone of our society, but who have never been interviewed before. Season 2 is all about community organizing and being underestimated. All the greatest changes have happened when a couple of people said this sucks.

[Tracy B. Wil]

Let'S do something about it.

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I can't have more than $2,000 in my bank account or else I can't get disability benefits. They won't let you succeed. I know we get paid to serve you guys, but like be respectful. We're made out of the same things. Bone, body, blood. It's rare to have black male teachers. Sometimes I am the lesson and I'm also the testament. Listen to when you're invisible as part of the Mike UA Podcast Network, available on the iHeartRadio app, Apple Podcasts or wherever you get your podcasts. Hey, this is Mel Reed, LPGA Tour winner and six time ladies European Tour winner and Kira K. Dixon, NBC sports reporter and host. You forgot to say warmer. Miss America by the way. And we've got new podcasts. Quiet Please with Mel and Kira. We are bringing you spicy takes on sports and pop culture, some golf haps, and interviews with incredible people who have figured out how to make golf their superpower. Or just people we like, plus tales from the road and everything in between. By the way, golf isn't just for the dads, Brads and chads. Yeah, it's actually life's cheat code and we're not going to be quiet about it on or off the course. We're bringing on some of our friends like Michelle We, Heather McMahon, Amanda Baliotis. So if you want to keep up with us and here is Yap. Tune into our new podcast. Listen to Quiet Please with Mel and Kyra, an iHeart women's sports production in partnership with Deep Blue Sports and Entertainment. You can find us on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Presented by Capital One, founding partner of iHeart Women's Sports. Welcome to the Criminalia podcast. I'm Maria Tremarke.

[Maria Tremarki]

And I'm Holly Fry. Together we invite you into the dark and winding corridors of historical true crime.

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Lost, I found hope with community and I made my way back this season. Join me on my journey through addiction and recovery. A story told in 12 steps. Listen to Crumbs as part of the Michael Lura Podcast Network, available on the.

[Tracy B. Wil]

Iheartradio app, Apple Podcasts, or wherever you get your podcasts. A lot of foods that are eaten around the world today were first cultivated by the indigenous peoples of the Americas and the Caribbean. When Europeans returned from voyages across the Atlantic. They brought plants like potatoes, tomatoes, peanuts, pumpkins, and, of course, corn. Corn in particular had a massive impact on lives, ecology, and agriculture. In the places where it was introduced. It had a high yield relative to the amount of work that it took to grow it and the amount of land that it required. It could be grown in relatively poor soil, including soil that wasn't suitable for other crops. In some regions, the growing season was long enough that people could grow a crop of wheat and then a crop of corn in the same field in the same year. People could also raise corn to feed animals like pigs, or they could feed parts of the corn plant to their livestock while eating most of the kernels themselves. The availability of maize as a food source has been credited with helping to protect people from famine in parts of Europe, Asia, and Africa, and with supporting population growth in areas where it made it easier for people to get enough to eat.

[Maria Tremarki]

It seems likely that the first people to bring maize to Europe had at least some experience with indigenous methods of growing and preparing it, even without the understanding of how that related to its nutrient content. But that knowledge wasn't maintained as maize continued to be introduced across the continent. Corn spread rapidly as an easy and cheap source of food, and in some regions it had completely supplanted other grains within about 200 years.

[Tracy B. Wil]

Eating corn that hasn't been nishtimalized is not really a big nutritional problem, as long as you are eating other foods as well, and some of those other foods contain niacin. But in places where corn became the cheapest and most available thing, there were inevitably people who wound up subsisting on it almost exclusively, especially in times of hardship, war, or famine. There were scattered outbreaks of pellagra as a result. Usually these were among the poorest people in a particular region. Sometimes these were seasonal, starting in the late winter and spring after people had been living mostly off of stored corn over the win and then resolving as people had access to a wider variety of foods after the harvest.

[Maria Tremarki]

The first known description of pellagra in writing was by Spanish physician Gaspar cazale Julian in 1735 who wrote about a disease that was occurring among peasants in Asturias, on the northern coast of Spain. He described it as the region's most horrible and stubborn disease. He called this maldela rosa, or rose disease, after the red rash that appeared on patients bodies. This often happened around the spring equinox, but it could occur during other parts of the year as well. And he talked about this rash as frequently appearing on the hands and feet, but also on the front part of the lower neck, extending down across the clavicles like a collar. Today, this particular part of the rash is known as the khazal collar or the cazale necklace. At the time, this was thought of primarily as a skin disease, and it was sometimes mistaken for Hansen's disease, which is also known as leprosy.

[Tracy B. Wil]

Although there were pockets of pellagra reported all around parts of southern Europe and the Mediterranean, it became a more widespread problem in what's now northern Italy, where one of the staple dishes was polenta. Polenta is often made with corn today, but it predates the introduction of corn to Italy. It had previously been made with various other grains or with nut or bean meal. People across economic classes ate polenta, but it was only the poorest people who needed to survive only on polenta and not much else. So when corn replaced other crops and became the prime ingredient in polenta, pellagra started to spread.

[Maria Tremarki]

The first person known to have described pellagra in Italy was physician Francesco Frappoli. In 17 he published his work in Milan in the Lombardi region of northern Italy, where he worked at the Ospedale Maggiore. He was the person to coin the term pellagra from Lombard words meaning rough skin.

[Tracy B. Wil]

By 1778, Italian physician Gaetano Strombio had established a hospital just for pellagra patients in Legnano, Italy, and he also wrote a three volume work on the disease. It had not taken long to make a connection between the disease and the consumption of corn, and Strombio thought that it was caused by spoiled bread and polenta.

[Maria Tremarki]

In 1789, Francesco Fanzago was a student doctor in Padua and described a patient at the hospital where he worked. She seemed to be in a daze and she had a dark, peeling rash on her hands and arms. She lived in the country and her mother told Fonzago that for the past two years, every spring she had become so weak that she could not do her work. Fonzago realized that this sounded like the pellagra that had been reported in Lombardy and that it was probably the Same condition as the one doctors in Padua had been describing as pelerina, or peeling off.

[Tracy B. Wil]

So a lot of what we have read so far has been focused on the rash and on other kind of more general symptoms, like weakness. But in 1806, physician Cesare Ruggieri of Venice published an account of the case of Matteo Lovatt. Lovatt had wanted to become a priest, but poor economic circumstances had led to him working as a shoemaker instead. And that really was not what he had wanted to do. Levat's symptoms initially included a flaking rash on his hands and feet. But then in 1802, he developed a serious mental illness, which involved an intense fixation on religion. First he castrated himself, and then he repeatedly tried to publicly crucify himself. One attempt involved nailing one of his hands and both of his feet to a cross that was tied to a beam inside of a building and then maneuvering the cross out the window. Bystanders came to his aid, and he survived this, but he died in an Asylum in 1806. When this account was translated into English about a decade later, the translator didn't have a word for dietesi pelagrosa and was translated into leprosy. Because at this point, pellagra had not really been introduced into the English speaking world as a concept.

[Maria Tremarki]

By the early 19th century, physicians in Italy had started to notice some similarities between pellagra and another vitamin deficiency disease, scurvy, which is caused by a lack of vitamin C. They didn't yet know what vitamins were, but both diseases involved the skin, and both of them progressed and worsened over time.

[Tracy B. Wil]

By the mid 19th century, physicians in Europe had started to think of diseases as each having one distinct cause. While there was general agreement in Italy that the cause of pellagra was something related to corn, a fierce disagreement developed about exactly how corn was involved. Physician Filippo Lusana and pathologist Carlo Frua wrote a study in 1856 that walked through a number of potential causes for pellagra, but then argued that the primary cause was a diet made up primarily of maize, which they argued did not contain enough protein to support human health. Although vitamins still had not been discovered, the first descriptions of proteins go back to the late 18th century, and the word protein had been coined almost 20 years before this. The term protein comes from Greek, meaning the first quality, and chemist Gerhard Johann Mulder had chosen this name because protein was believed to be a key component of food that was essential to human life.

[Maria Tremarki]

For a while, the idea that corn had insufficient protein was the primary idea for the cause of pellagra in Italy. Then, in 1869, Cesare Lombroso theorized that pellagra was being caused not by the protein content of maize, but by a toxin that was produced as it decayed. He thought that people who ate fresh, wholesome maize would not develop pellagra, but people who ate spoiled maize would. This led to intense debate in Italy about whether this was a disease of deficiency or of toxicity. And there were ongoing arguments in support of one conclusion or the other. There wasn't a sense that it might be contagious. Doctors and nurses cared for patients who were not kept isolated from the rest of the wards.

[Tracy B. Wil]

By the late 19th century, pellagra had reached really epidemic proportions in a lot of northern Italy, with patients overwhelming hospitals and mental institutions. According to census records, there were more than 100,000 pellagra patients in Italy in 1881. While the medical community still didn't entirely agree on exactly what was going on, Lombroso's idea of contaminated or decayed corn had gotten a lot of traction. So eventually, on July 21st of 1902, the Italian Parliament passed a law meant to try to curb pellagra. This law included banning the sale of immature, musty, or spoiled maze. Sanitation officials had the right to inspect grain processing and storage facilities. The law also included funds for health authorities to monitor pellagra cases and for the care of pellagra patients. Cases of pellagra had to be reported, and food was required to be distributed to poor pellagra patients and their families. The law also required the building of public maze drying ovens and the distribution of salt. School lunches were also provided to children in areas that had high rates of pellagra.

[Maria Tremarki]

Pellagra rates had already been declining for at least a decade before this law was passed, and they continued to drop afterward. According to the 1905 census, there were 55,000 pellagra patients, so that 1881 number had been cut roughly in half. The number of new cases was also dropping steadily, although that progress seemed slower in central and southern Italy, where pellagra had been less prevalent than in the north. The number of deaths per year also dropped, from almost 4,000 in 1898 to only 376 in 1907.

[Tracy B. Wil]

We've already talked about how pellagra is caused by a deficiency in gneiss and that it was not about spoilage in the corn. But some aspects of this law may really have helped with the pellagra rates in Italy, especially the ones that involved providing food and financial support to the affected people. In the late 19th century, there had also been a wave of immigration out of Italy, including to the United States, and often those immigrants sent money back home. And then that money made it possible for people to afford a richer variety of foods, including foods that contained niacin.

[Maria Tremarki]

However, as pellagra was declining in Italy, it was starting to escalate in the U. S and we'll get into that after a sponsor break.

[Holly Fry]

Hey y'all. I'm Maria Fernanda Diaz. My podcast when youn're Invisible is my love letter to the working class people and immigrants who shaped my life. I get to talk to a lot of people who form the backbone of our society, but who have never been interviewed before. Season 2 is all about community organizing and being underestimated. All the greatest changes have happened when a couple of people said, this sucks, let's do something about it. I can't have more than $2,000 in my bank account or else I can't get disability benefits. They won't let you succeed. I know we get paid to serve you guys, but like, be respectful. We're made out of the same things. Bone, body, blood. It's rare to have black male teachers. Sometimes I am the lesson and I'm also the testament. Listen to when youn're Invisible as part of the Mike Ultura Podcast Network, available on the iHeartRadio app, Apple Podcasts or wherever you get your podcasts. Hey, this is Mel Reid, LPGA Tour winner and six time Ladies European Tour winner and Kyra K. Dixon, NBC Sports reporter and host. You forgot to say warm and Miss America, by the way. And we've got a new podcast, Quiet Please with Mel and Kira. We are bringing you spicy takes on sports and pop culture, some golf haps and interviews with incredible people who have figured out how to make golf their superpower or just people we like. Plus tales from the road and everything in between. By the way, golf isn't just for the dads, brads and chads. It's actually life's cheat code and we're not going to be quiet about it on or off the course. We're bringing on some of our friends like Michelle We, Heather McMahon, Amanda Baliotis. So if you want to keep up with us and here is yap, tune into our new podcast, Listen to Quiet Please with Mel and Kira, an iHeart women's sports production in partnership with Deep Blue Sports and Entertainment. You can find us on the iHeartRadio app, Apple Podcasts or wherever you get your Podcasts presented by Capital One, founding partner of iHeart Women's Sports. Welcome to the Criminalia Podcast. I'm Maria Tremarke.

[Maria Tremarki]

And I'm Holly Fry. Together we invite you into the dark and winding corridors of historical true crime.

[Holly Fry]

Each season we explore a new theme, everything from poisoners and pirates to art thieves and snake oil products and those who made and sold them.

[Maria Tremarki]

We uncover the stories and secrets of some of history's most compelling criminal figures, including a man who built a submarine as a getaway vehicle. Yep, that's a fact.

[Holly Fry]

We also look at what kinds of societal forces were at play at the time of the crime, from legal injustices to the ethics of body snatching, to see what, if anything, might look different through today's perspective.

[Maria Tremarki]

And be sure to tune in at the end of each episode as we indulge in custom made cocktails and mocktails inspired by the stories. There's one for every story we tell.

[Holly Fry]

Listen to criminalia on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Welcome. My name is Paola Pedrosa, a medium and the host of the Ghost Therapy podcast, where it's not just about connecting with deceased loved ones. It's about learning through them and their new perspective. Join me on the Ghost Therapy podcast.

[Maria Tremarki]

Whoa.

[Holly Fry]

My lights in my living room just flickered.

[Tracy B. Wil]

I'm a little nervous.

[Maria Tremarki]

I'm excited.

[Holly Fry]

I'm excited nervous. You know, I'm very spiritual person, so I'm like, I'm ready and open. That was amazing. I feel so grateful right now. I got to speak to my great grandmother Abuela, and she gave me a lot of really good advice that I'm gonna have to really think about.

[Tracy B. Wil]

Wow.

[Holly Fry]

Okay, that's crazy. Yes, that is accurate. Listen to the Ghost Therapy podcast as part of the My Cultura Podcast network, available on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

[Tracy B. Wil]

The first best known description of pellagra in US medical literature was in 1902, the same year that Italy passed its law to try to curb the rate of pellagra there. There were certainly cases and outbreaks in the United States before that point, but most 19th century medical textbooks in the United States did not even mention this disease. Henry Fauntleroy Harris, who was the person who wrote this 1902 report, published a whole book on pellagra 17 years later. And its preface comments on how English writers had paid little attention to the disease while there was, quote, an enormous foreign literature on the subject. That enormous foreign literature was of course, mostly in Italian, and it went back almost 200 years. It wasn't until pellagra was firmly recognized as a serious problem in the US that researchers looked back at earlier disease reports and just found evidence of misdiagnosed pellagra outbreaks going back to at least the 1830s.

[Maria Tremarki]

Harris was a doctor who lived in Atlanta who also served as secretary of the Georgia State Board of Health, although he may not have started in that role yet when he reported on this case. The patient from his 1902 report was a farmer, and a staple of his diet was corn. He had a recurring debilitating illness that developed every spring, which had been going on for about 15 years. Every year his mental health declined and he experienced blistering of the skin on his arms and legs. This would start to get better over the summer and then resolve when the weather cooled. This farmer also had hookworm, which was treated, and he was given arsenic and iron as a pellagra treatment. This was a common treatment for pellagra at the time, but when that didn't work, he was advised to move to a cooler climate.

[Tracy B. Wil]

The cases and outbreaks from the 19th century in the US likely stemmed from social and economic factors. The southern United States had faced massive destruction and hardship during the Civil War and as a consequence of the centuries of enslavement that had led to the war. The post war Reconstruction had included efforts to rebuild the south and to offer aid and assistance to the freed people. Toward the end of Reconstruction, southern business and civic leaders started advocating for a new south, one that would be modernized and industrialized and urbanized with the building of new mills and factories and mines, and the construction of roads and railroads to connect these urban hubs. Agriculture was still a big part of the southern economy, but the primary focus was cash crops like cotton and tobacco.

[Maria Tremarki]

The people who were hyping up the idea of a new south were framing it as something that would modernize the region and bring prosperity while still retaining a strong southern identity and southern traditions. But that did not happen in practice. There was a wave of new mills and factories, but wages for people who worked in them were dramatically lower than what they would have been paid for the same jobs in the North. Although the Reconstruction era had worked toward equal rights for black people, white politicians and activists had intentionally rolled back most of those gains. These new industrial jobs were segregated, with black workers generally making the lowest pay for the least desirable work. A system of sharecropping also kept farmers tied to the land that they were working in. A lot of cases the land they had been working while they were enslaved and also kept them in debt to the landowner.

[Tracy B. Wil]

And all of this, of course, connected to the food that people were eating. Sharecropping was innately exploitive, and sharecroppers needed to earn as much money as they could to pay off their debts to landowners and to make ends meet. So a lot of them planted as much of a cash crop as possible. That left little to no land to grow food to live on. In some cases, some of their pay for their crops was in the form of credit At a plantation commissary. They could use this to buy provisions, but only the provisions that the landowner chose to stock. This was similar to the situation for mill workers who frequently lived in company towns and were paid in company script that could only be used at the company store.

[Maria Tremarki]

Sharecroppers and mill workers and other people facing similar economic hardship and exploitation had a similar foundation to their diets. It was often described as the three meal, meat and molasses. The meal was often cornmeal. Since corn was cheap by this point, it was being grown in vast quantities in the midwest and shipped to the south by train. The meat was usually fatback or salt pork. In other words, some of the cheapest cuts of meat, which are very fatty and don't contain much niacin. Molasses also contains a little bit of niacin, but again, not much. In addition to being inexpensive, these were often what was stocked at company stores and commissaries. Thanks to their low cost and their.

[Tracy B. Wil]

Long shelf life, People who had the ability to buy or grow other foods to supplement those three m's might be able to avoid developing pellagra. But the poorest people in the United States, especially in the South, Were living off of that and very little else. And then, in 1901, technological developments probably made this situation worse. John Beale of Decatur, Illinois, patented the Beall degerminator. This machine mechanically removed the germ and outer bran layers from corn kernels, Making it possible to separate all these parts and use them for different purposes. This made it easier and more efficient to make corn products without the germ, which meant that there was a way to keep corn from sprouting during storage without nishtamalizing it. There were other mechanical processing tools and milling tools before this, but the Beale degerminator was a big improvement over those earlier tools. This also made it a lot more possible to sell low quality meal that had been made from the least nutritious parts of the corn.

[Maria Tremarki]

It's not conclusively proven that this degerminator put people at greater risk of developing pellagra. But within a few years of its introduction, doctors were reporting outbreaks of pellagra in places like orphanages and institutions, and by the nineteen teens, the US Government was actively investigating.

[Tracy B. Wil]

That is all. What we will get to next time.

[Maria Tremarki]

Do you have some listener mail to take us out of this peppy topic?

[Tracy B. Wil]

I do. This is from Julie and Mackenzie, and Julie wrote an email titled Mary Bethune turned Lincoln around. So Julie wrote Holly and Tracy When I moved back to D.C. in 2019, I found a park close to me while walking my dog. It had a statue of Mary McLeod Bethune, and since I didn't know who she was, I checked to see if the history podcast I've been enjoying for more than 10 years had ever done an episode on her. You had not, so I was thrilled that you finally did one the statue is in Lincoln park, so named because a statue depicting Lincoln and a slave casting off his chains is there. The emancipation group was commissioned by recently freed slaves in 1875. Lincoln originally faced west toward the Capitol, but when the Mary Bethune statue was added to the park in 1974, Lincoln was turned to the east so that he now faces her. Bethune's statue is the first African American of any sex and the first to honor a woman on D.C. public lands. As an aside, the Lincoln statue has always made me uncomfortable. The way Lincoln looms over the kneeling black man in a very white savior kind of way. Apparently I'm not the only one, because during the Black Lives matter summer of 2020, there were attempts to tear it down along with so many other statues. The National Park Service barricaded it and it remains in Lincoln park unmolested. Here's the links that can make up your own minds. I've attached a couple of my own Very early morning dog walk Doc, Great photos of these two statues. One of them includes my pet Tax. Mackenzie is my blonde brindle staffy pit mix with goth eyeliner who has very big feelings and is far too excited to meet people, but is also the world's best snuggler. The muzzle is to prevent vet visits because given the opportunity, she will eat anything and everything, food or not. The pick in the car is a road trip where we were listening to stuff you miss in history class. Thank you for all you do. As long as you keep making them, I'll keep listening. Julie and Mackenzie Mackenzie, I am familiar with this, the statue of Lincoln. It's come up on the show before when we have been talking about a different statue of Lincoln, I needed to go make sure it wasn't this one we were talking about because it does. It looks exactly like the email said. And you know, while Lincoln did sign the Emancipation Proclamation and all that, the work that was done toward emancipation was so profoundly led by enslaved people themselves putting the pressure on to do that. And that's not what it looks like from this sculpture. We have a very adorable picture of Mackenzie at the Mary McLeod Bethune statue. I love that statue so much. And then, oh, what a cutie pie in the car and little harness.

[Maria Tremarki]

If I ever meet Mackenzie, there's no such thing as too friendly. It's fine.

[Tracy B. Wil]

Yeah, yeah, I, I definitely, I have said before, folks that are having their dogs out leashed in public, I love this so much. I know so many folks who have had really tragic encounters with off leash animals. And so anytime I see somebody who's whose puppy dog is on a leash, I'm like, I love you. We're friends.

[Maria Tremarki]

I'm too anxious for any other option. You know what I mean? Like, I can't imagine. Yeah, that poor dog would run away from me out of like the sheer desire to get away from my bad energy. They would be like, you are a nervous wreck.

[Tracy B. Wil]

I cannot deal with you right now.

[Maria Tremarki]

I gotta roll out. I got stuff to do.

[Tracy B. Wil]

Also, totally understandable about needing to keep your dog out in the world from eating things that should not be eaten. Having cats who are cats. Cats typically don't eat things. Except for the one who just perpetually wants to chew on plastic.

[Maria Tremarki]

We have two plastic chewers. What is up with that?

[Tracy B. Wil]

I don't know.

[Maria Tremarki]

Stop it, kids.

[Tracy B. Wil]

It's a whole meme about it on TikTok. Yeah, it's weird or there was a while back, but yeah. But there are a couple of things that I know can cause big problems for cats if they are eaten that I'm always on the watch for around our home to make sure they get disposed of properly. Like dryer sheets for one. Yeah. Anyway, so thank you so, so much for this email. These adorable pictures. If you would like to send us a note about this or any other podcast, we're at history podcastheartradio.com you can subscribe to our show on the iHeartRadio app and wherever else you like to get your podcasts. We'll be back on Wednesday with part two of this episode. Episode Stuff youf Missed in History Class is a production of iHeartRadio. For more podcasts from iHeartRadio. Visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

[Holly Fry]

Geico's motorcycle expertise gives me the coverage I need. Like 247 claims, I'm on cloud nine. Clouds are wholly unable to support the.

[Tracy B. Wil]

Weight of an adult human. What's happening? Furthermore, clouds are not numbered.

[Holly Fry]

Even if you procured a jetpack and.

[Tracy B. Wil]

Searched, you'd find no cloud numbered nine. However, at that altitude, you'd likely befriend.

[Holly Fry]

A flock of migrating snow geese.

[Tracy B. Wil]

Geese who'd encourage you to leave your 24.7geico motorcycle claims insurance behind, as they.

[Holly Fry]

Would take you in and even share.

[Tracy B. Wil]

Their dinner of crickets and clovers with you.

[Holly Fry]

Geico assumes no liability for any indigestion.

[Tracy B. Wil]

That may occur from a clover cricket dinner.

[Holly Fry]

Geico expertise for your motorcycle welcome to the Criminalia Podcast. I'm Maria Tremarke.

[Maria Tremarki]

And I'm Holly Fry. Together we invite you into the dark and winding corridors of historical true crime.

[Holly Fry]

Each season we explore a new theme, from poisoners to art thieves.

[Maria Tremarki]

We uncover the secrets of history's most interesting figures, from legal injustices to body snatching.

[Holly Fry]

And tune in at the end of each episode as we indulge in cocktails and mocktails inspired by each story.

[Maria Tremarki]

Listen to criminalia on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

[Holly Fry]

Welcome. My name is Paola Pedrosa, a medium and the host of the Ghost Therapy podcast, where it's not just about connecting with deceased loved ones. It's about learning through them and their new perspective. I think God sent me this gift so I can show it to the world. And most of all, I help people every single day. Listen to the Ghost Therapy podcast on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hey, it's Alec Baldwin. This past season on my podcast, here's the thing, I spoke with more actors, musicians, policymakers, and so many other fascinating people like writer and actor Dan Aykroyd. I love writing more than anything. You're left alone. You know, you do three hours in the morning, you write three hours in the afternoon. Go pick up a kid from school and write at night. And after nine hours, you come out with seven pages and then you're moving on. Listen to here's the thing on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.