perhaps also denied access to game meat from aristocrats’ forests and
streams, may havealwayssuffered from pellagra. The disease as epidemic,
however, seems intimately associated with industry—with mining and
manufacturing worker villages without gardens and with concentrated,
industrial-scale agriculture, where owners and bosses also discovered extra
profit in depriving workers (here sharecroppers, mostly) of garden plots
and forcing them to depend on company stores. This phenomenon was
relatively new in the American South toward the end of the nineteenth cen-
tury—like pellagra itself—and it became morbid during the twentieth cen-
tury.
The great British epidemiologist Fleming Sandwith, who worked in
Egypt during the s and then traveled through Italy and compared his
own experiences with pellagrins to other physicians’, observed and publi-
cized the international correlation of pellagra with corn. Peasants in Upper
(i.e., southern) Egypt ate millet and were free of the disease; peasants in
Lower Egypt depended on corn, and there was an epidemic of pellagra.
When he wrote to American physicians in , though, Sandwith met only
silence or puzzlement. And after , when American public health doc-
tors swarmed over the South, few if any seemed to be aware of Sandwith’s or
other Europeans’ work. Many persistently assumed that pellagra originated
with a germ that was transmitted by aerosol or physical contact among the
laboring poor. A few early eugenicists attributed pellagra to bad genes. To
settle the debate, the U.S. Public Health Service assigned one of its finest
medical detectives to the region, in .
Dr. Joseph Goldberger (–) was by no means alone in confirm-
ing Sandwith’s conviction that pellagra was a dietary disorder, but there is
justice in Goldberger’s celebration as principal hero of pellagra’s ultimate
defeat, years after his premature death from cancer. A son of eastern Euro-
pean Jews who brought him to New York when Joseph was nine, Goldberger
grew up in the fabled jumble of the Lower East Side and graduated from
the Bellevue Medical College in . He tried private medicine in New Jer-
sey but found the work unsatisfying, so in he joined the Public Health
Service. A few years later he met and married Mary Farrar, who was a grand-
niece of Jefferson Davis. The couple would be posted to the lower South,
home of Mary’s ancestors, for most of their married lives, but they also
made periodic excursions to spots tropical and foreign while Goldberger
waged one good war after another. He fought yellow fever in Louisiana, Mis-
sissippi, Puerto Rico, and Mexico; typhus in Mexico City; and dengue fever