Between 1906 and 1940 more than 3 million Americans were affected by pellagra with more than 100,000 deaths, yet the epidemic resolved itself right after dietary niacin fortification. Pellagra deaths in South Carolina numbered 1,306 during the first ten months of 1915; 100,000 Southerners were affected in 1916. At this time, the scientific community held that pellagra was probably caused by a germ or some unknown toxin in corn. The Spartanburg Pellagra Hospital in Spartanburg, South Carolina, was the nations first facility dedicated to discovering the cause of pellagra. It was established in 1914 with a special Congressional appropriation to the U.S. Public Health Service (PHS) and set up primarily for research. In 1915, Dr. Joseph Goldberger, assigned to study pellagra by the Surgeon General of the United States, showed it was linked to diet by observing the outbreaks of pellagra in orphanages and mental hospitals. Goldberger noted that children between the ages of 6 and 12 (but not older or younger children at the orphanages) and patients at the mental hospitals (but not doctors or nurses) were the ones who seemed most susceptible to pellagra. Goldberger theorized that a lack of meat, milk, eggs, and legumes made those particular populations susceptible to pellagra. By modifying the diet served in these institutions with "a marked increase in the fresh animal and the leguminous protein foods," Goldberger was able to show that pellagra could be prevented. By 1926, Goldberger established that a diet that included these foods, or a small amount of brewers yeast, prevented pellagra.
Megalopapilla is a non-progressive human eye condition in which the optic nerve head (optic disc) has an enlarged diameter, exceeding 2.1 mm with no other morphological abnormalities. Clinical features
In megalopapilla the optic disc diameter exceeds 2.1 mm (or surface area more than 2.5 mm2) with an increased cup-to-disc ratio. Although the optic disc is looks abnormal, the disc colour, sharpness of disc margin, rim volume, configuration of blood vessels and intraocular pressure will be normal. Visual field is normal except for an enlarged blind spot. Visual acuity may be normal, or occasionally reduced. Types
There are two types of megalopapilla. Type 1, which is the most common, is bilateral with a normal configuration of the optic cup. Type 2 is unilateral with a superiorly displaced cup that eliminates the adjacent neuro-retinal rim. Diagnosis and differential diagnosis
Large disc size can be seen in fundus examination by ophthalmoscopy. Since OCT is not influenced by disc size, it can be used in differentiating normal and glaucomatous eyes with large discs.Since the clinical appearance of megalopapilla resembles that of glaucomatous optic disc, it should be differentiated from Normal tension glaucoma and other pseudo-glaucomatous diseases. Other conditions that resembles megalopapilla includes coloboma of optic disc and orbital optic disc glioma. History
Bock and Franceschetti were the first to use the term megalopapilla to describe larger-than-normal optic disks. == References ==