Did Buddy Bolden die from pellagra?

Previously unpublished research on Buddy Bolden, the earliest known jazz musician, offers a persuasive new theory on his mental illness and institutionalization. https://t.co/a11TLSvlOk pic.twitter.com/4vtjFrTcZv

— Ted Gioia (@tedgioia) June 1, 2020

From the article:

Descriptions of other symptoms commonly found in pellagra patients are hauntingly reminiscent of what we know about Bolden. For instance, in Pellagra: An American Problem, published in 1912, author George M. Niles describes “cephalalgia of the severest sort” (i.e., headaches) as being a common complaint, along with a steep mental decline, “deepening from discontent to sadness, sadness to melancholy, melancholy to conformed melancholia, and on down the psychic decline to dementia.”

“These poor creatures are easily frightened, easily panic-stricken,” Niles writes. “They seek escape in flight, and hallucinations of poison often make them refuse food and drink to the point of inanition. As in some of the other delusional insanities, they are prone to feel the greatest antipathy for and fear of their dearest relatives and friends, attributing sinister motives to all attempted acts of kindness.”

The timing of the major known events in Bolden’s mental breakdown also seems like a possible clue. For instance, people with pellagra often had periodic psychotic episodes, such as those that afflicted Bolden, rather than a suddenly continual and permanent psychosis, at least in the earlier stages of the disease. These episodes tended to occur from year to year in spring or early summer. The thinking is that diets of marginalized people were even less varied during the winter, when produce was scarcer, and the resulting niacin deficiency would result in symptoms by spring and summer.

Bolden is known to have been arrested three times in New Orleans before he was finally sent to the insane asylum. The first was in the spring, on March 27, 1906; the second was in the summer, on September 9, 1906; and the third in the waning days of winter in the year he was committed, on March 13, 1907. What is believed to have been Bolden’s last public performance as a musician in New Orleans also came in the summer, during the Labor Day parade in 1906 amid an overbearing heat spell; Marquis writes that Bolden was felled either by exhaustion or “from some conduct.” (An “extreme aversion to all forms of exercise” and “weakness, particularly marked in the legs” were described as common ailments of pellagra patients in the 1919 book Pellagra.)

Yet:

Bolden and the people who knew him are long gone, and there are significant gaps in our knowledge about his medical history. Trying to figure out for sure whether pellagra caused his mental breakdown is a bit like having half of the pieces of a thousand-piece puzzle. They may fit neatly. But is it enough to tell what is pictured?

“A definitive diagnosis of pellagra is not possible,” said Dr. John J. Hutchings, an associate professor of clinical medicine at Louisiana State University Health Sciences Center in New Orleans who has expertise in both gastroenterology and psychiatry and who has routinely treated patients for vitamin deficiencies. “However, given the historically described symptoms and known local prevalence of nutritional deficiencies, it certainly would be prudent to include pellagra in the differential diagnosis and consideration as a potential contributor to the untimely demise of Mr. Bolden.”