Dr Phil Hammond, GP, lecturer and presenter of BBC2's Trust Me, I'm a Doctor

Do you ever hark back to the glory days before the boring old randomised controlled trial when doctors either made it up as they went along or experimented on themselves?

To top it all, a few even ate bits of their patients.

Take pellagra. Or rather don't.

It sounds like a pasta dish, but if you dredge the recesses of your mind you may recall that it's characterised by the three Ds – diarrhoea, dermatitis and dementia. Or, to the layman, the runs, scaly skin and madness. Not pretty.

At the turn of this century, doctors were convinced that pellagra was caused by some sort of infection.

In the USA, where this disease had previously been only episodic, suddenly there were huge and totally unexplained outbreaks. Hundreds of people died.

As the Journal of the American Medical Association concluded in 1914 (Vol 62: 8-12), it is in all probability a specific infectious disease communicable from person to person by means at present unknown.

Dr Joseph Goldenberg of the US Public Health Service was keen to find out if it really was infectious and decided to do an experiment.

He started off gently. He extracted blood from one of his patients who had a nasty little outbreak of pellagra and injected it into his own shoulder. Then he collected phlegm from the mouth and nose of the patient and rubbed it into his own mouth and nose.

It's worth remembering that this was a disease for which there was no known cure.

Nausea, vomiting, bloody diarrhoea, depression, psychosis, scaly skin – these were all things he could look forward to if the experiment worked. It didn't.

Alas, he concluded that he hadn't gone far enough, because three days later he decided to go the whole hog.

First he swallowed some sodium bicarbonate to neutralise the acid in his stomach – to maximise his chances of getting infected.

Then he swallowed, in turn, samples of urine, faeces and skin taken from his obliging if somewhat puzzled patient. Not surprisingly, he got one of the three Ds, diarrhoea, but he didn't develop pellagra.

I can't help feeling that, at this point, most people would have decided to give it a rest. But a few days later he was back having another go.

This time he managed to persuade four close friends to join him in once more eating skin, faeces and urine from a pellagra patient. Perhaps he invited his friends round to dinner and just pretended there was nothing else on the menu.

His wife was keen not to be left out, but the thought of her eating another man's skin and faeces was clearly too much for the good doctor. Instead he injected her with blood taken from a woman dying of pellagra. It's nice to know he had some sensitivities.

None of them got pellagra.

Goldenberg repeated this experiment an unbelievable seven times, by which point he must have acquired quite a taste for bits of his patients. He finally convinced himself that this was not an infectious disease.

After many more years of research, he tracked down a cure: brewer's yeast.

Pellagra was finally attributed to a shortage in the diet of one of the B vitamins, niacin, and the reason for the outbreak became clear.

By the turn of the century, people had changed their eating habits, going from wholemeal grain to fancier and finer ground grain. Unfortunately this process also removed some essential vitamins, crucially niacin.

With niacin added back in, the pellagra epidemic disappeared. Good for Goldenberg. So, what can we deduce?

Eating your patients is probably unnecessary. But it's more fun than guidelines.

Guidelines in Practice, December 1998, Volume 1
© 1998 MGP Ltd
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