An Abandoned Asylum and a Forgotten Disease

https://www.youtube.com/watch?v=H444mAlUcaE

It’s an easily-recognizable building. Located at the corner of Bull Street and Elmwood Street, the old South Carolina State Hospital is passed by plenty of people every day. Many know at least some of the building’s history. But much of it has been forgotten.

“The South Carolina State Hospital was founded largely upon the idea that mental illness could perhaps be cured and at least palliated,” said Dr. Charles Bryan, a professor at the University of South Carolina School of Medicine.

The State Hospital was built in 1827, and took in thousands of patients until its closing in 2005. According to hospital records found in the South Carolina State Archives, there were a plethora of reasons for admittance into the hospital including “idiocy” and “imbecility.” Likewise, there were many causes of death in the hospital, mainly from diseases.

We can all name a handful of deadly diseases that plagued our ancestors but we no longer worry about. But there is one disease that wiped out hundreds in the hospital that most people today have never even heard of.

Pellagra.

“Pellagra is one of the classic vitamin deficiency diseases. This was not established firmly until the 1940s but it’s a deficiency of the vitamin niacin,” said Dr. Bryan. He studied the disease and wrote a book on the matter titled “Asylum Doctor: James Woods Babcock and the Red Plague of Pellagra.”

Niacin is better known as vitamin B3. It is commonly found in red meat and vegetables, so people today get plenty of the nutrient regardless of their eating habits.

So why were so many people dying from this disease? And more importantly, how were they getting it in the hospital? Well, one other food source that contains niacin is corn, though in a small degree.

“There’s a component of the department of mental health’s history which is kind of fascinating and that’s that there’s a farm called asylum farm,” said John Sherrer, Director of Cultural Resources for Historic Columbia. “Asylum farm at one point was winning a national award for the amount of corn that it was producing per acre.”

According to Dr. Bryan, the germ of the corn that held all of the nutrients was being removed due to the belief that the corn would spoil if it were left it. This corn was then fed to patients in the hospital, and symptoms began to develop.

“Pellagra is the 3 D’s: Dermatitis, diarrhea, and dementia to which a fourth D was often added which is death,” said Dr. Bryan. “The case fatality rate of pellagra was substantial. Perhaps up to 25%.”

The disease had been around since the 1700s, as it was discovered in Italy. It wasn’t until the early 1900s that cases started to pop up in the United States, and South Carolina, specifically the State Hospital, was one of the first places it was seen.

What physicians didn’t know was how to classify the disease. The symptoms were clear, but no one knew what exactly was causing it and whether it was infectious.

Dr. James Woods Babcock, the superintendent of the State Hospital from 1856–1922, spearheaded the response to pellagra in the United States.

“It was here in Columbia, South Carolina that four significant meetings took place which were key events in the history of pellagra,” said Dr. Bryan.

The first of those conferences was held in 1908. It was a regional conference that saw physicians come from all over the state. There were also physicians from North Carolina, Georgia and Washington, D.C. What came of the conference was the first publication in English regarding the disease.

The success of the first conference inspired Babcock and company to host a second conference one year later in 1909. This one saw more than 400 physicians come from all over the United States as well as parts of Europe and North Africa.

“The prevailing thought was that it was caused by spoiled corn,” according to Dr. Bryan. This is why the germ of the corn was removed in milling and refining.

A third conference was held in Columbia three years later, with physicians again coming from all parts of the world to try to figure out what exactly this disease was. But again, they missed the mark.

“People thought it might be an infectious disease.”

An infectious disease seemed like a logical explanation looking at the death records for the hospital. Between 1915 and 1918, 1,747 patients died in the State Hospital. Of those, 696 died from pellagra, nearly 40%. To put that in perspective, tuberculosis killed 129 people during that same span, 7.4%.

It wasn’t until the fourth conference in 1915 that medical experts were able to say with certainty that pellagra was a dietary deficiency disease. Joseph Goldberger, the Surgeon General of the United States at the time, was one of the main players in diagnosing the disease as dietary.

As more people learned about the disease, it became less of a problem and eventually forgotten. I reached out to three faculty members from the University of South Carolina Nursing Department to see if they had any knowledge of pellagra. Their responses surprised me.

“I would like to help — but, I have no knowledge of this disease,” said one.

“I am not familiar with that disorder,” said another.

Even the dean of the department was unable to tell me anything about the disease, showing that the threat of pellagra in the United States is all but gone.

In large part thanks to that easily-recognizable building that plenty of people pass every day, not knowing it helped fix a problem they never even knew we had.