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In the middle of the 18th Century, Don Pedro Casal described a condition in the Spanish town of Aveida in the Asturias region. The local term was "mal de la rosa" from the peculiar red necklace-like rash around the exposed regions of the neck. The malady which later spread to several other countries (Northern Italy, Southern France, Romania, Russia and Egypt) was associated with poverty and the production of corn. The disease had a progressive course and was characterised by dermatitis, diarrhea, dementia and death (the 4 Ds).

It was only in the early years of this century that the disease began to reach epidemic proportions in the North American continent, forcing authorities in the US to take action. In 1914 Rupert Blue, the Surgeon General, assigned Joseph Goldberger, a little known officer of the US Public Health Service, to tackle "one of the knottiest and most urgent problems facing the Service" at that time. Dr. Goldberger, an immigrant physician trained at Bellevue Hospital Medical College, had by the age of 40 acquired extensive experience in investigating infectious diseases.

Given below is some of the information available to Dr. Goldberger from two institutions:

From the Georgia State Sanitarium for the treatment of insanity:

GROUP Total Number Cases Percentage
Inmates 418 32 7.65
Employees 293 0 0

Note: The number of cases refers to those that developed the condition after admission to the sanitarium.

From the Orphanage at Jackson, Miss. on July 1st 1914, 68 out of 211 orphans had the disease, giving prevalence of 32%. A further categorisation by age group yielded the following data:

< 6 25 2 8
6-12 120 65 54.2
>12 66 1 1.5


From the perspective of this course, epidemiological studies prove particularly useful for exploring the interactions between science and society. I chose Goldberger's early studies into pellagra as they show how preconceived notions provide a stumbling block for acceptance of ideas that seem so obvious to us. The data taken from his early studies provided a particularly useful starting point for students to think through possible causes for the affliction. They also served to highlight some of the ethical issues involved in conducting such studies.

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