The Forgotten Plague

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Goldberger kept up the fight on several fronts, including, crucially, the laboratory. A few vitamins had been discovered by the early 1920s, and work was also in progress with amino acids. Goldberger recognized that the South was too poor to feed itself properly, so he and his staff set out to identify the missing pellagra nutrients and supply them cheaply. He and his men tested nearly every common food for its usefulness against pellagra, and four years later they announced that brewer’s yeast was a cure. Southerners, including Hayne, ridiculed the idea. Then, in 1927, the Mississippi River overwhelmed its banks and left 112 counties in twelve states under water, and pellagra raged anew. At Goldberger’s urging, the American Red Cross distributed nearly six tons of brewer’s yeast, with cures resulting in a few weeks. The daily treatment cost three cents.

Goldberger died of kidney cancer in 1929, at the age of 54. To his widow’s despair, rumors spread that he had died of pellagra. Hayne attacked him at the next Southern Medical Association meeting, where an Egyptian specialist blamed pellagra on a bean toxin and a Virginia doctor suspected a virus. A Tulane professor insisted it was an iron deficiency.

The newspapers were kinder and lionized Goldberger at least as far as Peru, although some American papers carried subheadlines like “Jew Discovered Cause of Pellagra” and “The Wandering Jew who Whipped Pellagra.”

Pellagra persisted in the South until World War II, but by 1928 it was beginning a steady slide into oblivion. Public education helped enormously, and for the next twenty years yeast was distributed throughout the South. Even Hayne came around. In 1931 he gave out several tons of the stuff in South Carolina.

Pellagra finally fell victim to a variety of forces. Science was among them, but so were politics and economics. The prolonged slump in cotton prices during the 1930s forced farmers to diversify and grow more food. Rural electrification encouraged the spread of refrigeration. New Deal programs distributed stoves and pressure cookers, which promoted gardening and home canning.

In 1937 Dr. Conrad A. Elvehjem, at the University of Wisconsin, identified nicotinic acid, a B complex vitamin, as the deficiency that caused pellagra. Starting in World War II, commercially produced white bread was enriched with “niacin”—made up as a more palatable name than nicotinic acid (which derives from the fact that the vitamin can be obtained by oxidizing nicotine). In 1945 Wisconsin researchers found that corn significantly increases the body’s niacin requirement, while milk reduces it. Later research showed that the amino acid tryptophan, which is found in milk and turkey, fights the deficiency because the body makes niacin from the acid.

Pellagra was eliminated, but not before 30 years of terrible suffering after the answer was known. Science, it seems, was not enough. “I’m only a bum doctor,” Goldberger told the writer Paul de Kruif, “and what can I do about the economic conditions of the South?”

Not much. In The Butterfly Caste, a concise and readable history of pellagra, the author Elizabeth W. Etheridge puts it this way: “As a public relations man, Goldberger was a failure. … As a social reformer … he was hardly a success. … As a medical detective, however, he was a genius.”