"AN AWFUL and LOATHSOME DISEASE"
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?
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.
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).
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.
Especially for Teachers
Photos of cotton farmers and mill workers from Library of Congress, and of Goldberger from CDC.