The Forgotten Plague


One week later, at a meeting of the Southern Medical Association, in Dallas, Goldberger was pilloried in absentia—not for his ethics but for his results. Speaker after speaker trotted out the old standbys: corn bread, Italians, amoebae, cane sugar, and infection. The personal attacks on Goldberger- whose report noted that the Rankin inmates’ diet had been the same as the average poor Southerner’s—were vitriolic.

Goldberger kept a furious silence, privately calling his critics “blind, selfish, jealous, prejudiced asses.” He could take solace that, historically, his experience was typical. In 1753 James Lind reported that two oranges and a lemon a day would cure scurvy (vitamin C deficiency), but the British Navy waited 43 years to adopt his findings. Similarly, Christiaan Eijkman and Gerrit Grijn showed in the 1890s that whole-grain rice prevented beriberi (vitamin B 1 deficiency), but those findings took 10 years to be accepted.

Goldberger continued to crusade. At a state hospital in Columbia, South Carolina, he mixed samples of a pellagrin’s scales and intestinal discharge with flour into a kind of tablet, and he ate it. Days before, he had injected himself with blood and lesion materials from a pellagrin. When nothing happened, Goldberger launched a series of “filth parties.” In the spring of 1916 he and fifteen associates tried to contract pellagra by eating or injecting the blood, feces, urine, skin scales, and nasal secretions of pellagra sufferers. When Goldberger’s wife, Mary, was injected with a pellagrin’s blood, a nurse became hysterical.

“We had our final ‘filth party’… this noon,” he wrote. “If anyone ever got pellagra that way, we three should certainly have it good and hard! We just feasted on filth.” No one was infected, and the results were reported worldwide. Still, doubts persisted. In the fall of 1916 the Thompson-McFadden Commission stated flatly that pellagra was an infectious disease caused by poor sanitation.

Goldberger set about gathering epidemiological data to augment his experimental results. In a comprehensive five-year study that combined sociology, medicine, economics, and statistics, he and Edgar Sydenstricker, a PHS economist, surveyed nearly 24 cotton-mill villages in South Carolina. They documented every aspect of family diet and living conditions, and they discovered that pellagra was more widespread—but perhaps less lethal—than previously suspected. Most cases were among children, who rarely got medical attention.

No wonder. Sydenstricker and Goldberger were dismayed by the squalor. The economist noted that, since 1904, wages for the workers had risen 25 percent but food prices were up 60 percent. The study showed a perfect inverse correlation between income and pellagra: People with sewers didn’t get the disease; they lived in better neighborhoods because they had more money.

Goldberger didn’t reveal these findings immediately, fearing they might arouse intense protest and torpedo his study. Instead he lead a massive public education campaign in cooperation with several states, and this seemed to help. So did World War I. Mill wages rose rapidly from 1916 to 1920, while food prices rose more slowly. At last pellagra grew scarce.

Cotton and tobacco prices collapsed in 1920, and the boll weevil appeared everywhere. A new outbreak of pellagra was inevitable. In July 1921 Goldberger issued a public warning. His words made page one of The New York Times and other newspapers. As he predicted, pellagra exploded throughout the South. President Harding personally took an interest.


The Southern response was one of denial. A newspaper editor said Southern bounty made gout a bigger threat than pellagra. States indignantly rejected offers of free condensed milk and meat from the Borden Milk Company and the Institute of American Meat Packers. The South would bear its troubles in a “manly and courageous way,” huffed the Memphis Commercial Appeal . “Don’t the dern fools know that for four long years the confederate soldiers had mighty little else to eat except swine bosom, corn pone and molasses,” demanded the Birmingham, Alabama, News , “and there never was a case of pellagra heard of in the army?” (The idea of perfect health among the Confederate forces is of course fantastical.)