Pellagra no longer stalks the nation as it once did. But during the early part of the 20th-century, pellagra, a disease that results from a diet deficient in niacin killed, many poor Southerners. Dr. Joseph Goldberger, a physician in the U.S. government’s Hygienic Laboratory, the predecessor of the National Institutes of Health, discovered the cause of pellagra and stepped on a number of medical toes when his research experiments showed that diet and not germs (the currently held medical theory) caused the disease. He also stepped on Southern pride when he linked the poverty of Southern sharecroppers, tenant farmers, and mill workers to the deficient diet that caused pellagra. (http://history.nih.gov/exhibits/goldberger/index.html)
The Pellagra Incident (1935). After millions of individuals die from Pellagra over a span of two decades, the U.S. Public Health Service finally acts to stem the disease. The director of the agency admits it had known for at least 20 years that Pellagra is caused by a niacin deficiency but failed to act since most of the deaths occurred within poverty-stricken black populations.In 1915 the U.S. Public Health Office induces pellagra in twelve Mississippi prisoners. All the prisoners are, however, volunteers and after the experiment they are cured (with proper diet) and released from prison.
In early 20th century America, pellagra seemingly emerged out of nowhere when, in late summer of 1906 near Mobile, Alabama, Dr. George H. Searcy noted a peculiar malady affecting 88 patients at the Mount Vernon Insane Hospital, a state facility for the “colored insane.” Searcy soon realized that he was facing an outbreak of pellagra with its characteristic four-d’s. He quickly reported his findings to his Medical Association of Alabama colleagues in 1907.
Soon, pellagra would become epidemic throughout the South, and thus the discovery of its etiology became crucial and much-debated. Lombroso’s theory of toxic cornmeal resurfaced, while eugenicists, promoting a popular but misguided theory of social “betterment,” suggested that its origin lay in racial or hereditary factors. In 1912 the privately endowed Thompson-McFadden Commission made an on-site study of pellagra in the South Carolina mill village of Spartanburg and concluded that the disease was infectious in nature. This erroneous report would haunt the medical profession for years as they searched for the real cause and cure of pellagra.
In 1914, the U.S. Public Health Service’s Dr. Joseph Goldberger (1874-1929) was already known for his success in fighting U.S. epidemics when he was asked to investigate pellagra. Through observations and experiments at Southern orphanages and prisons, Goldberger found that the disease was not infectious, but instead was caused by a deficiency in the diet. Many poor Southerners consumed a diet solely of meat, meal and molasses. Low-wages driving high-deficiency diets made the disease economic in origin. Goldberger’s conclusions were correct but unpopular in the South because of their negative implications for the Southern way of life. Also, many in the medical community remained unconvinced since all of Goldberger’s studies were conducted in controlled environments, unlike those of the Thompson-McFadden Commission. In 1918 he rectified this by confirming his conclusions with his own mill village studies, aided by a brilliant statistician, Edgar Sydenstricker.”
“I’ve seen,” said Goldberger, “the big difference between floks that die of pellagra and those who never get it, is that the pellagrans are poor.” And the “big difference between rich and poor,” he added, “is that the poor don’t get the right stuff to eat.
But what about pellagra’s regional base? Why did it strike so many in the South and so few in the North? The answer, said Goldberger, lay in the monotonous “3-M diet_ of the Southern poor: meet (fatback or slat pork), meal (cornmeal) and molasses. Pellagra was not a starvation disease, since its victims got plenty of calories. What they lacked was the protein that came from fresh meat, milk and vegetables.
The problem was worse in Mississippi. More than 16,000 cases of pellagra (resulting in 1,500 deaths) were reported by state officials in 1915 alone. A nutritional study done in the Delta showed about half of the residents with serious protein deficiencies. Few families owned a cow, and gardens were rare because the plantation owner demanded that corn be planted right up to the doorstep of their shacks. Were it not for growing of greens at odd seasons and fish caught in local ponds and rivers the sharecropper diet would have contained almost no protein at all.
In 1914, Dr. Goldberger ran a series of experiments in two pellagra-ridden Mississippi orphanages. Within a year, he had wiped out the disease in both places by adding milk, green vegetables and fresh meat to the normal fare of grits, lard, cornbread, slat pork and molasses. The next step was more dangerous, however, as Goldberger well understood. Having cured pellagra by adding protein to the diets of suffering children, the doctor now hoped to induce the disease by removing protein from the diets of healthy adults. (Worse than Slavery)
Goldberger had considerable experience in epidemiology and knowledge of infectious diseases when he was assigned by the Surgeon General in 1913 to undertake a study of the causation of pellagra.
Pellagra was not recognized as a problem in the United States until early in the 20th century. In 1912, Lavender of the U.S. Public Health Service estimated that more than 25,000 cases of pellagra had occurred in the United States in the previous five years and that the case fatality rate was 40%. The dominant thinking in the United States at the time Goldberger began his investigations was that pellagra was an infectious disease. As a result of studies in South Carolina, the Thompson-McFadden Pellagra Commission concluded in 1913 that “1) The supposition that the ingestion of good or spoiled maize is the essential cause of pellagra is not supported by our study; and 2) Pellagra is in all probability a specific infectious disease communicable from person to person by means at present unknown.” These conclusions were elaborated by Siler et al. (1914).
In less than three months after beginning his investigation, Goldberger (1914) published his first paper on pellagra. In a document of a little over three pages, Goldberger summarized the epidemiology of the disease as follows. Pellagra cannot be communicable. The cause is dietary. Prevention should result from a “reduction in cereals and vegetables and canned foods that enter to a large extent in the dietary of many of the people in the South and an increase in fresh animal food component such as fresh meats, eggs and milk.” In support of these views Goldberger pointed out that 1) in institutions where pellagra was prevalent, no case had ever occurred in nurses or attendants; 2) the disease was essentially rural; and 3) it was associated with poverty, which in turn was associated with a diet deficient in animal foods.
Alan Kraut described Dr. Joseph Goldberger’s battle to eradicate pellagra. The condition plagued people in a large area of the southern United States and was classified as an infectious disease, until Dr. Goldberger proved that pellagra was in fact a nutritional deficiency caused by insufficient quantities of niacin in the diet. (source: http://www.spartasc.com/georgealexanderwheeler.htm)