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Red Madness:
How a Medical Mystery Changed What We Eat


"AN AWFUL and LOATHSOME DISEASE"


A pellagra victim.

In 1902, a young Georgia farmer sought a doctor’s help. The man felt too weak to work. He vomited when he ate. His skin was covered with blisters and crusty scabs.

The doctor was shocked. His patient appeared to have pellagra, a dreaded disease in southern Europe. Pellagra was known for its 4-D symptoms: dermatitis (a red rash), diarrhea, dementia (insanity), and death. No case had ever been reported in the United States.

Within a few years, tens of thousands of Americans had been struck down by the devastating illness. Most of the victims lived in the South. Many went mad as the disease attacked their brain, and about 30% died. As the disease swept the country, people panicked. Would they or their loved ones catch it and die?

CLUES

No one was sure what caused pellagra or how to cure it. Did it come from eating corn, a favorite southern food? Since it seemed to run in families, was it hereditary? Was pellagra spread by an insect carrying a dangerous microbe? Was it contagious, passed from a victim to everyone around him?

The United States Public Health Service was determined to find the answers. The Surgeon General appointed a skilled epidemiologist to lead the investigation. In 1914, Dr. Joseph Goldberger headed to the South in search of clues.

Joseph Goldberger
Joseph Goldberger

 

 

 

 


Goldberger noticed more cases of pellagra among certain groups of people—sharecroppers and tenant farmers; cotton mill workers; children in orphanages; prisoners; and patients in insane asylums. After careful observations, he formed a hypothesis: Pellagra was caused by a diet high in corn and cereals and low in animal-protein foods (meat, eggs, milk).


Pellagra struck all age groups.

FILTH PARTIES

Goldberger and his Public Health Service team set out to test this hypothesis with a series of experiments. In orphanages and a sanitarium, they fed pellagra victims a diet containing more animal-protein foods—and cured them. Next, by eliminating these foods from the menu, they brought on pellagra in healthy volunteer prison inmates.

To prove that pellagra was not contagious, Goldberger and a group of his colleagues (including his wife) held several “filth parties". They injected each other with blood from pellagra victims. Then they ate ”the most nauseating diabolical concoctions” of the victims’ feces, urine, dried skin, and saliva. Bon appétit!

None of the filth party guests developed pellagra.

SOLVED, BUT NOT OVER

By 1916, Goldberger had proved that pellagra was caused by a diet deficiency. But he didn’t know exactly what crucial element in food prevented the disease. Despite years of searching, he died before anyone discovered the final solution to the mystery.

In 1937, Conrad Elvehjem, a biochemist, identified that missing element—nicotinic acid, now known as niacin or vitamin B3. Later research showed that the amino acid tryptophan, found in high-protein foods, also prevents pellagra because the body is able to change it into niacin.

Today niacin is added to bread, flour, cornmeal, and cereals. Pellagra is rare in the United States. But during the first half of the twentieth century, more than 3,000,000 Americans became victims of the “awful and loathsome” disease, and at least 100,000 died.


The rash appeared on skin
exposed to sun
.




FIND OUT MORE!

Online

  • "Pellagra."
    www.pbslearningmedia.org/resource/odys08.sci.life.gen.pellagra/pellagra/
    Watch a five-minute video about Joseph Goldberger’s pellagra research, from A Science Odyssey.

  • "Dr. Joseph Goldberger and the War on Pellagra.” Office of NIH History.
    History.nih.gov/exhibits/Goldberger/
    View an online exhibit about Goldberger’s life, including photographs.

  • “BAM! Body and Mind.” Centers for Disease Control and Prevention.
    bam.gov
    This fun website is aimed at teens and includes information about food, nutrition, diseases, safety, and physical activity. Play the online games and try the recipes for healthy treats.


  • “Dietary Guidelines for Americans.” U.S. Departments of Agriculture and Health and Human Services.
    health.gov/dietaryguidelines
    Site includes lists of vitamin, nutrient, and calorie content of foods. Read the government’s recommendations for improving diet, and find links to other resources on nutrition and physical activity.


  • “Nutrition Information for You.” U.S. Department of Agriculture.

    Another photo of the
    ravages of pellagra.


    nutrition.gov
    Discover extensive information on nutrition and food. In the “What’s in Food” section, find out everything you want to know about your food, including nutrients, vitamins, and additives. Learn which foods have the highest niacin content. The “Life Stages: Adolescents” section is designed especially for teens.


  • United States Public Health Service (USPHS)
    usphs.gov
    Learn about the mission of the PHS and the opportunities for a career in public health.

Especially for Teachers

  • CDC
    BAM! (Body and Mind) Teacher’s Corner
    www.cdc.gov/bam/teachers/index.html
    Find resources, links, activities, free handouts and downloads, games, and quizzes linked to national education standards for science and health.


  • EXCITE!
    www.cdc.gov/excite/
    CDC’s site for “Excellence in Curriculum Innovation through Teaching Epidemiology and the Science of Public Health" has many helpful links to activities, resources, articles, books, and internet sites.

  • DETECTIVES IN THE CLASSROOM
    www.montclair.edu/Detectives/
    Check out the epidemiology curriculum for science, mathematics, and health teachers in middle and high schools.


The rash on face and neck was often butterfly-shaped.

Books

  • Kraut, Alan M. Goldberger’s War: The Life and Work of a Public Health Crusader. New York: Hill and Wang, 2003. (The most recent biography of Goldberger.)

  • Parsons, Robert P. Trail to Light: A Biography of Joseph Goldberger. Indianapolis: Bobbs-Merrill, 1943.

  • Frankenburg, Frances Rachel. Vitamin Discoveries and Disasters: History, Science, and Controversies. Santa Barbara, CA: Praeger, 2009.

  • Mullan, Fitzhugh. Plagues and Politics: The Story of the United States Public Health Service. New York: Basic Books, 1989.

  • Roe, Daphne A. A Plague of Corn: The Social History of Pellagra. Ithaca, NY: Cornell University Press, 1973.

  • Etheridge, Elizabeth W. The Butterfly Caste: A Social History of Pellagra in the South. Westport, CT: Greenwood Publishing, 1972.

Photos of cotton farmers and mill workers from Library of Congress, and of Goldberger from CDC.

 

   

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