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Grain Itch (ACARO-DERMATITIS Urticarioides): A Study of A New Disease in This Country.

Grain Itch (ACARO-DERMATITIS Urticarioides): A Study of A New Disease in This Country. The journal of cutaneous diseases VOL. XXVIII FEBRUARY, 1910 NO. 2 BY JAY FRANK SCHAMBERG, M. D., Philadelphia. In the spring and summer of 1909, this peculiar eruptive disease became quite prevalent in Philadelphia and neighboring towns. Editors's Comment PROLOGUE, SUMMER 1909. Twenty crew members from a private yacht berthed in Philadelphia were admitted to St Agnes Hospital for treatment of a debilitating itchy eruption. The exanthema resembled chicken pox, smallpox, hives, and scabies but was clearly none of these. In the next few days, the disease developed on other ships at harbor and in neighborhoods throughout the city. Overwhelmed, the Chief of St Agnes appealed to the city's Bureau of Health for a skin expert. Their choice, Dr Jay Schamberg, could not have been better: Schamberg was not only a brilliant dermatologist, but ironically he had written the first account of this mysterious ailment. Eight years before, Dr Schamberg had described an “An epidemic of a peculiar and unfamiliar disease of the skin.”1 Having called attention to its most prominent features, other dermatologists realized that this syndrome had gone unrecognized for over 60 years in Europe and was, indeed, a seasonal summertime affliction in Philadelphia itself. Even the great Schamberg could contribute nothing to its cause. Schamberg's identification of his eponymous condition might have been the end of the story until employees of a ritzy hotel contracted the disease. Now that the affliction was threatening to ruin Philadelphia's lucrative summer tourist season, the Bureau of Health appealed to a higher authority and begged the United States Public Health Service to send one of their epidemiologists to resolve the mystery. Dr Joseph Goldberger, an eager young investigator who had already earned plaudits for his work with yellow fever, dengue fever, and typhoid, was immediately dispatched to the City of Brotherly Love. In the next 48 hours, Dr Goldberger would prove his worth. DAY 1. Upon disembarking from the Washington-Baltimore train, Dr Goldberger was briefed by Schamberg himself. Though Goldberger showed little interest in the dermatologic aspects of the outbreak, he intensely interrogated Schamberg as to among where, when, and among whom the cases were becoming manifest. He took particular note that the victims were all poor, that there was often a simultaneous appearance of multiple cases in the same ship or house, and yet the disease never spread to adjoining lodgings. Once hospitalized, the victims consistently recovered within days. Goldberger concluded that the disease was not caused by an environmental toxin, infectious agent, or dietary factor. This left Goldberger only one logical yet brilliantly intuitive conclusion: Schamberg disease was due to a minute insect, barely motile, that dwelt on an article with which the patients were in close contact. Goldberger excluded clothing (since even when hospitalized, the patients wore their same clothes), which left only bedding as a potential hiding place for the culprit. Schamberg and Goldberger began visiting the homes of their patients and soon realized that, indeed, all of them had been sleeping on new straw mattresses. Wasting no time, Goldberger thrust his left arm into one of the suspect beddings, arranged for 3 volunteers to sleep on the same, and waited for the morning to confirm or refute his theory. DAY 2. Dawn revealed that the volunteers had developed Schamberg disease, as had Goldberger but just on his left arm. Sifting the straw bedding through a fine sieve, Goldberger discovered 5 tiny bugs. He divided his findings into 2 Petri dishes, one of which he applied directly to his skin, the other he first pretreated with chloroform. Several hours later, he had developed an eruption only under the untreated dish. Anyone less assiduous would probably have stopped here, but Goldberger was constitutionally incapable of leaving any stone unturned. Therefore, he applied watch glasses containing the insects to 3 more volunteers, while he, himself, took a specimen to the nation's leading entomologist. The expert identified Goldberger's bug as Pediculosis ventriculosis, a wheat-infesting mite, and the next morning all 3 volunteers awoke with the characteristic eruption of Schamberg disease. Within a 48-hour span, Goldberger had isolated, identified, and proven the cause of a condition that had eluded doctors for more than 60 years. He returned to Washington, case closed. EPILOGUE. Subsequent investigations showed that this grain mite fed on larger insects present in the straw mattresses; its eggs hatched in warmer weather, explaining the seasonal variation. Goldberger would go on to far more significant contributions to public health, culminating in his research into the cause and cure of pellagra. Typically for this self-effacing giant, he chose to have his ashes scattered over the Potomac River. Among all the memorials, monuments, and statues in our nation's capital, there is none to Dr Joseph Goldberger. This article was made possible by Parson RP. Trail to Light: A Biography of Joseph Goldberger. Indianapolis, IN: Bobbs-Merrill; 1943. References 1. Schamberg JF An epidemic of a peculiar and unfamiliar disease of the skin. Phila Med J1901;8 (7) 5- 6 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Grain Itch (ACARO-DERMATITIS Urticarioides): A Study of A New Disease in This Country.

Archives of Dermatology , Volume 146 (2) – Feb 1, 2010

Grain Itch (ACARO-DERMATITIS Urticarioides): A Study of A New Disease in This Country.

Abstract

The journal of cutaneous diseases VOL. XXVIII FEBRUARY, 1910 NO. 2 BY JAY FRANK SCHAMBERG, M. D., Philadelphia. In the spring and summer of 1909, this peculiar eruptive disease became quite prevalent in Philadelphia and neighboring towns. Editors's Comment PROLOGUE, SUMMER 1909. Twenty crew members from a private yacht berthed in Philadelphia were admitted to St Agnes Hospital for treatment of a debilitating itchy eruption. The exanthema resembled chicken pox, smallpox, hives, and...
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References (1)

Publisher
American Medical Association
Copyright
Copyright © 2010 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archdermatol.2009.376
Publisher site
See Article on Publisher Site

Abstract

The journal of cutaneous diseases VOL. XXVIII FEBRUARY, 1910 NO. 2 BY JAY FRANK SCHAMBERG, M. D., Philadelphia. In the spring and summer of 1909, this peculiar eruptive disease became quite prevalent in Philadelphia and neighboring towns. Editors's Comment PROLOGUE, SUMMER 1909. Twenty crew members from a private yacht berthed in Philadelphia were admitted to St Agnes Hospital for treatment of a debilitating itchy eruption. The exanthema resembled chicken pox, smallpox, hives, and scabies but was clearly none of these. In the next few days, the disease developed on other ships at harbor and in neighborhoods throughout the city. Overwhelmed, the Chief of St Agnes appealed to the city's Bureau of Health for a skin expert. Their choice, Dr Jay Schamberg, could not have been better: Schamberg was not only a brilliant dermatologist, but ironically he had written the first account of this mysterious ailment. Eight years before, Dr Schamberg had described an “An epidemic of a peculiar and unfamiliar disease of the skin.”1 Having called attention to its most prominent features, other dermatologists realized that this syndrome had gone unrecognized for over 60 years in Europe and was, indeed, a seasonal summertime affliction in Philadelphia itself. Even the great Schamberg could contribute nothing to its cause. Schamberg's identification of his eponymous condition might have been the end of the story until employees of a ritzy hotel contracted the disease. Now that the affliction was threatening to ruin Philadelphia's lucrative summer tourist season, the Bureau of Health appealed to a higher authority and begged the United States Public Health Service to send one of their epidemiologists to resolve the mystery. Dr Joseph Goldberger, an eager young investigator who had already earned plaudits for his work with yellow fever, dengue fever, and typhoid, was immediately dispatched to the City of Brotherly Love. In the next 48 hours, Dr Goldberger would prove his worth. DAY 1. Upon disembarking from the Washington-Baltimore train, Dr Goldberger was briefed by Schamberg himself. Though Goldberger showed little interest in the dermatologic aspects of the outbreak, he intensely interrogated Schamberg as to among where, when, and among whom the cases were becoming manifest. He took particular note that the victims were all poor, that there was often a simultaneous appearance of multiple cases in the same ship or house, and yet the disease never spread to adjoining lodgings. Once hospitalized, the victims consistently recovered within days. Goldberger concluded that the disease was not caused by an environmental toxin, infectious agent, or dietary factor. This left Goldberger only one logical yet brilliantly intuitive conclusion: Schamberg disease was due to a minute insect, barely motile, that dwelt on an article with which the patients were in close contact. Goldberger excluded clothing (since even when hospitalized, the patients wore their same clothes), which left only bedding as a potential hiding place for the culprit. Schamberg and Goldberger began visiting the homes of their patients and soon realized that, indeed, all of them had been sleeping on new straw mattresses. Wasting no time, Goldberger thrust his left arm into one of the suspect beddings, arranged for 3 volunteers to sleep on the same, and waited for the morning to confirm or refute his theory. DAY 2. Dawn revealed that the volunteers had developed Schamberg disease, as had Goldberger but just on his left arm. Sifting the straw bedding through a fine sieve, Goldberger discovered 5 tiny bugs. He divided his findings into 2 Petri dishes, one of which he applied directly to his skin, the other he first pretreated with chloroform. Several hours later, he had developed an eruption only under the untreated dish. Anyone less assiduous would probably have stopped here, but Goldberger was constitutionally incapable of leaving any stone unturned. Therefore, he applied watch glasses containing the insects to 3 more volunteers, while he, himself, took a specimen to the nation's leading entomologist. The expert identified Goldberger's bug as Pediculosis ventriculosis, a wheat-infesting mite, and the next morning all 3 volunteers awoke with the characteristic eruption of Schamberg disease. Within a 48-hour span, Goldberger had isolated, identified, and proven the cause of a condition that had eluded doctors for more than 60 years. He returned to Washington, case closed. EPILOGUE. Subsequent investigations showed that this grain mite fed on larger insects present in the straw mattresses; its eggs hatched in warmer weather, explaining the seasonal variation. Goldberger would go on to far more significant contributions to public health, culminating in his research into the cause and cure of pellagra. Typically for this self-effacing giant, he chose to have his ashes scattered over the Potomac River. Among all the memorials, monuments, and statues in our nation's capital, there is none to Dr Joseph Goldberger. This article was made possible by Parson RP. Trail to Light: A Biography of Joseph Goldberger. Indianapolis, IN: Bobbs-Merrill; 1943. References 1. Schamberg JF An epidemic of a peculiar and unfamiliar disease of the skin. Phila Med J1901;8 (7) 5- 6

Journal

Archives of DermatologyAmerican Medical Association

Published: Feb 1, 2010

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