The Forgotten Plague

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In a matter of weeks Goldberger had the answer. Many investigators before him had thought pellagra was caused by something people ate. Goldberger knew instinctively it was from something they didn’t eat. A few scientists before him had speculated along these lines, including Dr. Giovanni Battista Marzari, as early as 1810, and another, Dr. F. M. Sandwith, as late as 1912. But Goldberger would prove it.

“The writer desires to invite attention to certain observations recorded in the literature of pellagra the significance of which appears entirely to have escaped attention,” he wrote in the June 26, 1914, issue of Public Health Reports , urging fresh milk, meat, and eggs to combat the disease.

He was appalled by the poverty and the misery of the South in those days, but unfortunately he missed the political implications of his own scientific insight. What he was really saying was that across the South there was famine. The problem was not infection or moldy corn. It was poverty. Pellagra was a symptom as much as a disease. He would spend the next 15 years trying to make Southerners listen.

First he set about proving his hypothesis. At Milledgeville he isolated two wards of 40 victims each, left their unsanitary conditions unchanged, and cured them all in a year with a healthier diet. In other wards pellagrins, as those who suffer from the ailment are called, continued to die on the three M’s.

In Jackson, Mississippi, Goldberger found an orphanage that served grits, gravy, biscuits, and syrup for breakfast; a roll for lunch; and boiled vegetables and vegetable soup, corn bread, and molasses for dinner. Aghast, he ordered the children stuffed like French geese with milk, eggs, meat, beans, and oatmeal, all at federal expense. They cheered when he visited. In the summer of 1914 this crowded, dirty institution and another one a short distance away had 204 cases of pellagra. By the spring of 1915 they were still crowded and dirty, but the formerly listless children were bursting with energy. “They are all well,” Goldberger exulted in a letter home.

He did this again and again, with help from a team of PHS doctors. Yet his findings weren’t accepted. He was attacked at medical conferences, in the press, and even from the pulpit. One of the Jackson orphanages didn’t even change its annual Thanksgiving appeal for “molasses, corn, flour, sugar, grits, cured meats, all kinds of canned goods.” At some institutions where he had wiped out pellagra, the three M’s were reinstated, and the disease returned.

Goldberger’s impatience didn’t help. The October 1915 triennial meeting of the Association for the Study of Pellagra was startled by front-page news from Washington, B.C. The Public Health Service had declared that pellagra resulted from a poor diet and the deteriorating status of Southern workers following the industrial depression of 1907. Dr. James A. Hayne of South Carolina, Goldberger’s chief adversary in the years to come, not only scoffed at his findings but complained that “when you tell [a] health officer that the way to stop this thing is to make the whole people of the state change their mode of living, you put a proposition up to him that is almost impossible.”

Ten days later the Southern medical establishment was thrown into an uproar when Goldberger’s amazing prison experiment was unveiled. Early in 1915 he persuaded Mississippi’s governor, Earl Brewer, to offer pardons to any twelve convicts willing to participate in a secret study at Rankin Prison Farm, near Jackson. Rankin was free of pellagra. Six murderers and other felons volunteered, and they were moved into relatively luxurious and scrupulously clean quarters to prevent “infection.” A good cook was provided, and the men’s diet was gradually changed until they had their fill of biscuits, mush, coffee, syrup, grits, and so forth. The inmates couldn’t believe their good fortune.

Goldberger’s experiment would today be considered unethical, but it was a dramatic success. He induced pellagra by diet alone in a group of healthy white men—those least prone to the disease—to prove his theory. He calculated that if he could bring on pellagra, he could cure it.

The Rankin experiment had a six-month deadline, and although the subjects were wrecks in its final weeks, the skin lesions considered crucial for a diagnosis still hadn’t appeared. Goldberger and his disciple Dr. George Wheeler couldn’t believe it. Then, on September 12,1915, dermatitis was discovered. Six cases of pellagra were confirmed. Goldberger wrote to his wife: “We have really and truly produced pellagra in great big vigorous men by just feeding them properly, or rather, ‘improperly.’ This is way beyond anything I had anticipated.”

In a dramatic ceremony Governor Brewer delivered the pardons as promised, and he asked the men to stay on so that they could be fed and cared for properly. Some wept, but they “all went off like a lot of scared rabbits,” Goldberger reported. Said one: “I have been through a thousand hells.”