Discover 3

History

Lessons

72 DISCOVERMAGAZINE.COM

CDC/PUBLIC HEALTH IMAGE LIBRARY

Alan Kraut, author of Goldberger’s
War: The Life and Work of a Public
Health Crusader. “He had experience as
an epidemic fighter on malaria, typhoid
and dengue fever, and on yellow fever
in the South. He was married to a
Southern woman. And he had lots of
lab experience.”
Right away, Goldberger saw a flaw
in the fly-infection theory: Institutions
with pellagra cases consistently
reported that staff members,
presumably vulnerable to
the same flies, weren’t
diagnosed with the disease.
The recent identification
of diseases caused by
dietary deficiencies further
convinced Goldberger that
a corn-based diet could be
pellagra’s cause.
The grain had only
recently become a popular
foodstuff. As “King Cotton”
and textile mills came to
dominate the South’s post-
Civil War economy, many
families converted all their
farmland to cotton. They
stopped planting vegetables
and keeping livestock.
As a result, many poor
Southerners now ate almost
exclusively what was called
the three Ms: low-quality
meat, molasses and meal (industrially
refined cornmeal) — the same cheap
gruel often served at orphanages and
asylums. Pellagra was most widespread
among populations subsisting on the
three Ms.
To test his diet theory, Goldberger
supplied what he called “a diet such
as that enjoyed by well-to-do people”
— meat, milk and vegetables — to
two Mississippi orphanages and an
asylum. Pellagra rates there plummeted.
His next quest: to induce pellagra in
healthy subjects. In 1915, with pardons
in hand from Mississippi’s progressive
governor, Goldberger recruited 12
healthy volunteers at the Rankin State

Prison Farm to eat the three Ms diet.

Within the six-month trial period,

six volunteers exhibited the telltale

dermatitis. Goldberger was convinced

he had proven the link between the

Southern poverty diet and pellagra.

To bolster his case against the

germ theorists, in 1916 Goldberger

conducted what he called filth parties.

He tried to infect himself, his wife and

other volunteers with pellagra by

injecting and ingesting the skin

scales, urine, feces, blood

and saliva from pellagra

patients. No one got

pellagra. He also organized

extensive epidemiological

studies of seven villages

that conclusively proved

the link between pellagra

and poverty. The studies are

still used in medical schools

today and hailed for their

thorough, groundbreaking

analysis of where economics,

social conditions and health

intersect.

Yet pellagra raged on,

propelled by plummeting

cotton prices in 1920.

Goldberger advocated for

food aid for the South,

to mitigate what the PHS

called a “veritable famine”

developing in the Cotton

Belt due to poor farmers’ diets.

Southern politicians and businessmen

railed against the recommendation,

which they perceived as an attack

on their honor. “Goldberger didn’t

understand Southern pride,” Kraut

says. “His mission was to conquer

the suffering and solve the medical

mystery.” He still had a ways to go.

THE P-P FACTOR

Goldberger focused on identifying the

missing dietary element, which he called

the P-P factor, for pellagra preventive.

In 1922, he tried to induce black-tongue

disease — the canine analog of pellagra

— in his laboratory dogs by feeding

them a diet typical of poor Southerners,

plus brewer’s yeast purely to stimulate

the dogs’ appetite. The dogs remained

healthy, prompting suspicion. Without

the yeast, the dogs developed pellagra.

Repeated testing on the dogs, then on

human subjects, confirmed that brewer’s

yeast, a product the poor could afford,

contained the P-P factor that cured and

prevented pellagra.

Goldberger was finally publicly

vindicated in 1927. That spring,

the Mississippi River flooded, to

devastating effect. The potential for a

widespread pellagra outbreak surged

in flood-ravaged areas of Tennessee,

Arkansas, Louisiana and Mississippi.

Goldberger oversaw the Red Cross’

distribution of 12,000 pounds of

brewer’s yeast in those areas. That effort

cured most pellagrins within six to 10

weeks, prevented untold thousands

more cases and earned Goldberger the

recognition that was long overdue —

though he wouldn’t enjoy it for long.

Goldberger died in 1929, the same

year that pellagra cases at large started

declining. The Red Cross carried on

his work; by 1937 it had distributed

500,000 pounds of brewer’s yeast —

frequently referred to as Vitamin G

for Goldberger. That year, researchers

identified niacin (abundant in brewer’s

yeast) as the elusive P-P factor, and

doctors established a standard dosage

and therapy. Niacin has since become

a dietary staple, now better known for

fighting high cholesterol than pellagra.

Today, pellagra is mostly relegated to

history lessons and medical reference

books. But occasionally, such as during

isolated outbreaks in a refugee crisis, the

world receives a vivid reminder of how

the disease still affects people. And as

Tissier saw in her hamsters, it’s also a

lesson anyone caring for animals should

keep in mind. This scourge is not gone,

just largely forgotten. D

Kristin Baird Rattini, a St. Louis-based

freelance writer, has written for national

publications for two decades.

To test his

diet theory,

Goldberger

supplied what

he called “a

diet such as

that enjoyed

by well-to-do

people.”

Joseph

Goldberger