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FROM TOP: TRANSACTIONS OF THE NATIONAL CONFERENCE ON PELLAGRA/SOUTH CAROLINA STATE BOARD OF HEALTH.1909/INTERNET BOOK ARCHIVE;

NIH; SOUTH CAROLINIANA LIBRARY, UNIVERSITY OF SOUTH CAROLINA

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One day in April 2014, Mathilde

Tissier noticed her hamsters

were acting a little odd. The Cricetus

cricetus in her lab at the University of

Strasbourg in France, once happily

subsisting on a corn-based diet, were

now banging their feeder against the

cage, their tongues swollen and black,

and had begun to eat their pups alive.

As Tissier reported in the Proceedings

of the Royal Society B in January

2017, she suddenly had cannibal

hamsters on her hands.

“I was shocked,” says Tissier, a

conservation biologist. “I thought I did

something wrong.” Searching for an

explanation, Tissier teased out a thread

that wove through America’s past. Some

of the symptoms she saw in both the

mothers and surviving pups resembled

those of a debilitating disease called

pellagra. The illness affected more than

3 million people and killed more than

100,000 in the United States, primarily

in the South, between 1900 and 1940.

The quest to understand and cure

the outbreak combined research, social

politics and economic forces — and, as

Tissier saw firsthand, it’s a history we’d

do well to remember.

SCOURGE OF THE SOUTH

In the early 1900s, cases of a mysterious

malady started appearing every

summer in the South. At first, patients

felt melancholy and weak. Some then

developed swollen tongues and drooled

excessively. As the disease advanced,

people displayed a symmetrical

photosensitive rash across their

limbs, neck and face. Some patients’

symptoms disappeared a few months

later, only to recur the following year.

For others, the disease progressed

through the four Ds: dermatitis,

diarrhea, dementia and death.

In 1907, physicians at two Southern

mental institutions began to suspect

their patients’ symptoms were the result

of pellagra, Italian for

“rough or dry skin.”

The disease was first

identified in 1735 by

Spanish physician

Gaspar Casál, who

called it mal de la rosa

(disease of the red

rash). In the intervening

centuries, pellagra was

particularly widespread

— and well documented — in northern

Italy, with cases reported as far afield

as South Africa and Egypt. The U.S.,

historically, had seen few cases. Clearly,

something had changed. But what?

One of the first doctors who made

the connection to pellagra was James

Babcock of the South Carolina State

Hospital for the Insane. In 1908, he

traveled to Italy and confirmed that

he and his colleagues were right about

the disease’s diagnosis. He went on

to organize the first U.S. conferences

on pellagra, where two competing

theories on the disease’s cause went

head to head.

One theory held that pellagra was an

infectious disease carried by Simulium

flies. “This was the golden era of

the germ theory,” says University of

South Carolina internal medicine and

infectious disease specialist Charles

Bryan, author of Asylum Doctor: James

Woods Babcock and the Red Plague

of Pellagra. Yellow fever, malaria and

Rocky Mountain spotted fever all had

been proven in recent years to have an

insect vector. Why not pellagra?

The other leading theory —

originating back with Casál himself

— suggested that

corn, of all things,

was to blame.

Some proponents

regarded only

spoiled corn as the

culprit. Others, including Casál, focused

on the corn-based diet common among

impoverished victims, and advocated

treating pellagrins (those suffering from

the disease) with a more varied diet.

The U.S. Public Health and Marine

Hospital Service — soon to be known

as the Public Health Service (PHS), a

precursor to the National Institutes of

Health — began studying pellagra in

1909. But as the illness spread — South
      Carolina alone reported 30,000 cases by
      1912 — Surgeon General Rupert Blue
      felt increasing pressure to escalate PHS
      efforts. In 1914, he assigned the PHS
      pellagra studies to Joseph Goldberger.

GOLDBERGER’S CRUSADE

A Jewish doctor from New York who’d

emigrated from Hungary might seem an

odd pick to lead a Southern campaign,

but it did make sense. “In many ways,

Goldberger was the perfect choice,”

says American University historian

A Deadly Diet

A disease that devastated the American South a century ago lives on.

BY KRISTIN BAIRD RATTINI

Dermatitis was

a symptom of

pellagra (above).

South Carolina’s

Spartanburg

Pellagra

Hospital (left)

was dedicated

to finding the

disease’s cause.

James

Babcock

History

Lessons