The Forgotten Plague

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Goldberger was famously methodical. Investigating a typhoid outbreak in Washington, D.C., he practically barricaded himself into the Library of Congress, where he read about the disease in several languages, using translators for the languages he didn’t know. He was so reluctant to leave at closing time that the library eventually gave him a cot and an alarm clock. He slept only a few hours a night for days on end until he had read every word. Then he personally surveyed the entire Potomac basin in an attempt to chart every outfall and privy in the region.

He was also imaginative and fast. In Philadelphia he solved the mystery of Schamberg’s disease in 48 hours by plunging his arm into some suspicious-looking straw mattresses, contracting the debilitating rash, and then triumphantly isolating the mite responsible. He discovered that the holy water fonts at churches and convents in Mexico were rich breeding grounds for the mosquitoes that spread yellow fever. In village after village Goldberger would kneel, cross himself, and, when no one was looking, toss in a bichloride tablet.

He never stopped conducting research. When he caught yellow fever in 1902, he knew delirium would come, and he insisted that his ravings be recorded. “Waldo, Greene, McAdam, Groenvelt, Branham,” the notes reported. Goldberger was muttering the names of earlier public health officers who had died of yellow fever. In 1907 he got an agonizing case of dengue, and some two years later he nearly died of typhus. “I feel as proud of these notches as if I had received the Cross of the Legion of Honor,” he wrote.

PATENT MEDICINES TO COMBAT THE DISEASE FLOURISHED AS DOCTORS TRIED MORE THAN 200 REMEDIES, FROM ARSENIC TO ELECTROSHOCK.

Surgeon General Blue had picked the right man, although the timing was awkward. Throughout Goldberger’s career, towns, schools, and social clubs excluded Jews, and even the Jewish-owned New York Times accepted Christian-only help-wanted ads. Goldberger was not an observant Jew, although his letters show that he thought about God, and he wasn’t preoccupied with anti-Semitism. Still, because his fiancée was a Christian New Orleans debutante, he reminded her that he was “one of a race despised and respected—curious paradox!—by many if not all of your people.” She married him anyway—after her influential father checked his background as far as Girald and as high as the Surgeon General.

Goldberger went South in the spring of 1914, just as the annual pellagra crop was beginning to bear its fruit. Traveling light, he crisscrossed the region, stopping in Alabama, Georgia, Kentucky, Florida, South Carolina, Mississippi, and Virginia, and what he saw astonished him.

Goldberger had a healthy appetite, and he was horrified to discover that millions subsisted on “the three M’s”—meal, molasses, and meat. The meal was from corn, and the meat was fatback or salt pork. This was the diet of the poor in the rural communities and mill villages of the semifeudal South, and it differed sharply from the diet of poor Northerners, who rarely got pellagra. Affluent Southerners didn’t eat this way either. Nor did they get sick.

The three M’s went back to frontier days, but the labor-intensive Southern system of agriculture, dependent as it was on tenant farming and a strict cotton monoculture, enforced it. Cotton was planted right up to the doors of many rural shacks, leaving no room—and no time—for gardens. Fresh meat and produce weren’t widely available, and as Goldberger discovered to his rue, the poor often preferred a Model T to a cow when they did get some money. Cornmeal, molasses, and fatback were cheap, fast, and filling. They didn’t spoil easily. And they were especially pleasing to landowners and mill operators, who often provided food for their tenants and workers.

The problem was most in evidence at Southern orphanages and insane asylums, where Goldberger (who had read Oliver Twist) walked into a Dickensian nightmare. At Milledgeville, for example, the total per diem operating budget in 1910 amounted to 34.5 cents per patient, including salaries, meals, and supplies. A 3,000-acre farm attached to the facility was used mainly to grow cotton and corn. Breakfast was grits, beef hash, biscuits, and coffee. Lunch was a two-inch square of boiled beef, with vegetables cooked like “hog slop.” Dinner consisted of bread and syrup. One inmate complained he didn’t get enough to feed a “good hungry mockingbird.”

There were 365 cases of pellagra at Milledgeville in 1914. Yet not one staff member was afflicted. So how could pellagra be infectious? Goldberger was assured that the staffers were in close contact with patients all day and ate the same food from the same kitchen, but he discovered that this wasn’t exactly true. The staff fed itself first, taking the best foods and even milk, which patients rarely received. The staff also supplemented its meals with food purchased elsewhere.

Doctors didn’t catch pellagra either—not even Dr. Edward Francis, a PHS colleague of Goldberger who had contracted so many diseases in his career it seemed he might well sprout a cast if placed in a roomful of people with broken bones.