Pellagra and Pellagrous Insanity during the Long Nineteenth Century

A new disease, first identified in Italy in the 1760s, came to be called pelle agra, meaning ‘rough skin’, after its first manifestation. But pellagra did not stop there; it was eventually identified as the disease of the four ‘d’s: dermatitis, diarrhoea, dementia and death. Contemporaries were also struck by how the appearance and spread of the pellagra epidemic coincided with the start and spread of maize cultivation and consumption. That said, the precise link between maize and pellagra, its nature as a deficiency disease (in this case a lack of niacin), and an effective treatment for the terrible scourge, all eluded medicine until the 1930s. And whilst debate continued over the exact causation, the number of Italian sufferers grew, eventually reaching over 100,000. How Italy lived with endemic pellagra, especially in the insanity it caused, is the focus of our book. Our aims in writing Rough Skin are various: to set pellagra and pellagrous insanity in a wider context of man-made or societal (anthropogenic) diseases, where poverty, diet and disease meet; to contribute to recent efforts to trans-nationalise Italian history, with comparisons to related issues in the USA and the UK; to explore how medical and scientific research was carried out during the long nineteenth century and the uncertainties this engendered, in terms of classification, explanation, diagnosis and treatment; to explore the experience of pellagrous insanity from the sufferer’s point of view and its social and economic ramifications for peasant families; to contribute to the history of mental illness and psychiatry, particularly in Italy. By combining the skills of a social and cultural historian (Gentilcore) with those of a clinical psychologist trained in the history and philosophy of science (Priani), we hope to offer a unique perspective. Rough Skin brings together the different methods and approaches of a range of disciplines – economic and social history, agrarian history, environmental history, history of medicine and science, the history of psychiatry – in order to reconstruct the impact of a single food plant (maize) and a single disease (pellagra) over the long nineteenth century. We use a wide range of printed and archival sources: 1) the writings of Italian medical investigators into the causes, classification, diagnosis and treatment of both pellagra and pellagrous insanity; 2) the proceedings of the Italian Pellagrological Congress and the main scientific journal in the field, the Rivista pellagrologica italiana; 3) newspapers, which frequently reported pellagra-related stories; 4) the archival records, and in particular the thousands of patient files, of the two main psychiatric hospitals of Italy’s Veneto region, San Clemente (for women) and San Servolo (for men).