Vitamin deficiency diseases

Diseases Linked to Diet

Nevertheless, while they appeared to have little effect on the prevailing views concerning the etiology of human disease, by the late 1800s several empirical associations had been made between diet and disease.

Diseases empirically associated with diet were:

Scurvy

Beriberi

Rickets

Pellagra

Night blindness.

Scurvy

For several centuries it has been known that scurvy, the disease involving apathy, weakness, sore gums, painful joints, and multiple hemorrhages, could be prevented by including in the diet green vegetables or fruits.

Descriptions of cases in such sources as the Eber papyrus (ca. 1150 bc) and writings of Hippocrates (ca. 420 bc) are often cited to indicate that scurvy was prevalent in those ancient populations. Indeed, signs of the disease are saidto have been found in the skeletal remains of primitive humans. Scurvy was common in northern Europe during the Middle Ages, a time when local agriculture provided few sources of vitamin C that lasted through the winter.

Vitamin deficiency diseases

 

Beriberi

It is said that signs consistent with beriberi (e.g., initial weakness and loss of feeling in the legs leading to heart failure, breathlessness and, in some cases, edema) are described in ancient Chinese herbals (ca. 2600 bc). Certainly, beriberi has been a historic disease prevalent in many Asian populations subsisting on diets in which polished (i.e., “white” or  dehulled) rice is the major food. For example, in the 1860s, the Japanese navy experienced the disease affecting 30–40% of its seamen. Interesting clinical experiments conducted in the 1870s with sailors by Dr Kanehiro Takaki, a British trained surgeon who later became Director General of the Japanese Naval Medical Service, first noted an association between beriberi and diet: Japanese sailors were issued lower protein diets than their counterparts in European navies which had not seen the disease. Takaki conducted an uncontrolled study at sea in which he modified sailors’ rations to increase protein intake by including more meat, condensed milk, bread, and vegetables at the expense of rice. This cut both the incidence and severity of beriberi dramatically, which he interpreted as confirmation of the disease being caused by insufficient dietary protein. The adoption of Takaki’s dietary recommendations by the Japanese navy was effective – eliminating the disease as a shipboard problem by 1880 – despite the fact that his conclusion, reasonable in the light of contemporaneous knowledge, later proved to be incorrect.

Rickets

Rickets, the disease of growing bones, which manifests itself in children as deformations of the long bones (e.g., bowed legs, knock knees, curvatures of the upper and/ or lower arms), swollen joints, and/or enlarged heads, is generally associated with the urbanization and industrialization of human societies. Its appearance on a wide scale was more recent and more restricted geographically than that of either scurvy or beriberi. The first written account of the disease is believed to be that of Daniel Whistler, who wrote on the subject in his medical thesis at Oxford University in 1645. A complete description of the disease was published shortly thereafter (in 1650) by the Cambridge professor Francis Glisson, so it is clear that by the middle of the seventeenth century rickets had become a public health problem in England. However, rickets appears not to have affected earlier societies, at least not on such a scale. Studies in the late 1800s by the English physician T. A. Palm showed that the mummified remains of Egyptian dead bore no signs of the disease. By the latter part of the century, the incidence of rickets among children in London exceeded one-third; by the turn of the century, estimates of prevalence were as high as 80% and rickets had become known as the “English disease.” Noting the absence of rickets in southern Europe, Palm in 1890 was the first to point out that rickets was prevalent only where there is relatively little sunlight (e.g., in the northern latitudes).

Pellagra

Pellagra, the disease characterized by lesions of the skin and mouth, and by gastrointestinal and mental disturbances, also became prevalent in human societies fairly recently. There appears to have been no record of the disease, even in folk traditions, before the eighteenth century. Its first documented description, in 1735, was that of the Spanish physician Gaspar Casal, whose observations were disseminated by the French physician Fran├žois Thiery, whom he met some years later after having been appointed as physician to the court of King Philip V. In 1755, Thiery published a brief account of Casal’s observations in the Journal de Vandermonde; this became the first published report on the disease. Casal’s own description was included in his book on the epidemic and endemic diseases of northern Spain, Historia Natural y Medico de el Principado de Asturiaswhich was published in 1762, i.e., 3 years after his death. Casal regarded the disease, popularly called mal de la rosa, as a peculiar form of leprosy. He associated it with poverty, and with the consumption of spoiled corn (maize). In 1771, a similar dermatological disorder was described by the Italian physician Francesco Frapolli. In his work Animadversiones in Morbum Volgo Pelagrum, he reported the disease to be prevalent in northern Italy. In that region corn, recently introduced from America, had become a popular crop, displacing rye as the major grain. The local name for the disease was pelagra, meaning rough skin. There is some evidence that it had been seen as early as 1740. At any rate, by 1784 the prevalence of pellagra (now spelled pellagra) in that area was so great that a hospital was established in Legano for its treatment. Success in the treatment of pellagra appears to have been attributed to factors other than diet – e.g., rest, fresh air, water, sunshine. Nevertheless, the disease continued to be associated with poverty and the consumption of corn-based diets.

Night Blindness

Night blindness, the inability to see under low levels of light, was one of the first recorded medical conditions. Writings of Ancient Greek, Roman, and Arab physicians show that animal liver was known to be effective in both the prevention and cure of the disease. The Eber papyrus (ca. 1150 bc) described its treatment by the squeezing of liquid from a lamb’s liver (now known to be a good source of vitamin A in well-nourished animals) directly into the eyes of the affected patient. The use of liver for the prevention of night blindness became a part of the folk cultures of most seafaring communities. In the 1860s, Hubbenet and Bitot noted the presence of small, foamy white spots on the outer aspects of the conjunctiva of patients with night blindness – lesions that have become known as “Bitot’s spots.” Corneal ulceration, now known to be a related condition resulting in permanent blindness, was recognized in the eighteenth and nineteenth centuries in association with protein-energy malnutrition as well as such diseases as meningitis, tuberculosis, and typhoid fever.

REFERENCE

The Vitamins

Fourth Edition

Gerald F. Combs, Jr

Professor Emeritus

Cornell University

Ithaca, NY

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