The Forgotten Plague


It was also tied to poverty, although few understood this yet. The disease ravaged mental institutions and orphanages. In 1914, 190 people died at the vast Georgia state sanitarium in Milledgeville, where pellagra passed tuberculosis as the number one killer.


Ignorance made matters worse. Tennessee moved to isolate all victims, wrongly declared pellagra a transmissible disease, and required physicians to report it. Many hospitals turned sufferers away, and in one case student nurses went on strike when told to treat pellagra patients. A whole body of lore grew up around the disease as patent medicines flourished and doctors tried more than 200 remedies, from arsenic to electroshock. One myth held that Jews were immune.

The federal government began working to quell the disease and the growing hysteria in 1909. Claude H. Lavinder, a capable U.S. Public Health Service officer, led the effort, but unfortunately he couldn’t get anywhere. In 1912 two Northern philanthropists, Col. Robert M. Thompson of New York and J. H. McFadden of Philadelphia, created the Thompson-McFadden Commission and donated fifteen thousand dollars for a study that concluded diet was irrelevant; pellagra was reported to be spread from person to person with a strong inverse correlation to sewage systems, and the report speculated that the disease might be an intestinal infection spread by contaminated food.

By 1914 there was a clamor for action, and Surgeon General Rupert Blue, a native of South Carolina, believed he knew just the man for the job. Joseph Goldberger had been born in 1874 to a Jewish family in the Carpathian village of Girald. Seven years later his family emigrated from what was then the Austro-Hungarian Empire. Yiddish was his native tongue, and his parents never did learn English. The Goldbergers lived above their grocery store on Manhattan’s Lower East Side, and all seven children helped out. Joe made deliveries, but his ineptitude as a grocer was almost a family joke, and so he was allowed to indulge his love of reading. He seemed to take after a great-grandfather who was an eminent local Hebrew scholar.

By the time he was 18, Joe had finished his second year of engineering studies at the City College of New York, where he stood fifth in a class of six hundred. He switched to medicine at Bellevue Hospital Medical College after attending a lecture with a friend. Bellevue students were exposed to clinical material hard to duplicate elsewhere. The hospital treated about twenty thousand patients a year, including poor immigrants, alcoholics, and prostitutes presenting a vast array of symptoms and diseases.

Goldberger set upon the place with the energy—indeed the monomania—that would later become his trademark. He was a stern-looking six-footer with reddish brown hair, wire-rimmed spectacles, and a stubborn thrust to his jaw. Though stoop-shouldered and reserved, he was a man of great humor and warmth in private. When he was not in classes or in a lab, he ransacked the school library, devouring thousands of case histories. He graduated second in his class—by tenths of a point —in 1895 and was first on the internship exams.


Bored in private practice, he applied to the U.S. Navy Medical Corps when the Spanish-American War broke out in 1898, but he was shut out. The Navy was the most aristocratic of our armed services, and naval surgeons were the most status-conscious of military men. His biographer, Dr. Robert Parsons, himself a naval surgeon, implies with some disgust that anti-Semitism left no room for a Goldberger: “Racially and euphonically, it was not a name consonant with the social distinctions of the Navy of that day.”

This was a break for history. After the Navy rejected him, Goldberger answered an ad for the U.S. Marine Hospital Service, which accepted recruits by examination. Characteristically he finished first.

He couldn’t have found a better home. In 1902 this agency became the U.S. Public Health Service and Marine Hospital, and although it retained a military flavor—the top man was the Surgeon General, and everyone had a rank and a weird opéra bouffe uniform for formal occasions—its main task was fighting disease. Contrary to usual perceptions about government bureaucracy, the PHS was a model of efficiency, and its history verges on the glorious. It hired smart, dedicated young physicians who routinely risked death in the line of underpaid duty. PHS alumni went on to positions of prominence at the nation’s top hospitals and medical schools.

By the time he was sent South to fight pellagra, Goldberger was an established medical sleuth of brilliance and tenacity. An expert on mosquitoes and intestinal worms, he was already responsible for a number of major public health advances. His work on the communicability of measles cut the quarantine period by half, and he proved that Brill’s disease, a fever found in New York City, was none other than typhus.