Pellagra – A Medical Mystery – Extra History

Pellagra – A Medical Mystery – Extra History

November 1, 2019 100 By Ewald Bahringer


In 1902, a new disease appeared in the American South. Each spring red scabby rashes would flare up among victims’ faces, arms and legs. They’d become depressed and lose weight, suffering
terrible diarrhea. The worst cases went mad, speaking to the dead or snatching up kitchen
knives to hunt invisible intruders. When the weather cooled, the
rashes faded until next spring. In the decade to come, the plague whipped through orphanages and mental
asylums, mill towns and villages. Between 1907-1912 doctors confirmed 25,000 cases. 40% of the inflicted died. The disease had a name: Pellagra. And no one knew what caused it. [Birth of the People] This episode is brought to you
by Child and Teen Checkups. Every child needs a check-up at least once a year. If you live in Minnesota, they can help. Learn more at GetCTC.com February, 1914. Dr. Joseph Goldberger of the Public Health Service is battling a diphtheria outbreak
in Detroit when he gets a letter. It’s from his boss, the Surgeon General, and orders him to report for a new position as the
service’s new pellagra investigator. Now, Goldberger is a good choice. Intelligent, vigorous, and tenacious, the son of
Hungarian shepherds, Goldberger and his family had immigrated to the US when he was 7, settling in the Jewish enclave of New York’s Lower East Side. Through sheer hard work and
the city’s new public schools, he’d gained admittance and graduated from medical school Bored with private practice, he joined the Public Health
Service and spent the next 15 years fighting epidemics. During that time, he battled yellow fever in Puerto Rico, studied typhoid in Washington’s hygienic laboratory, pushed back dengue fever in Texas, and fought typhus in Mexico, catching nearly every disease he studied. In that time, he developed a reputation as
one of America’s leading epidemiologists In one case, he was ordered to identify a smallpox-like
disease that had puzzled Philadelphia doctors for years, but within days, Goldberger proved it wasn’t
a disease at all — he traced the outbreak to invisible mites that lived in straw bedding, Pellagra, he knew would not be so easy. He’d seen the alarming headlines about the epidemic. Even worse, he had seen how the
unscrupulous were pushing quack cures, touting opiate medicines that “cured the disease”. Fringe doctors endorsed extreme treatments,
like transfusions with irradiated blood. Before deploying to the South,
Goldberger did a deep dive, reading everything he could about the disease Doctors had first identified it among Spanish peasants in 1735 and found it in Italy decades later. Some Americans even claimed the disease had traveled with Italian immigrants, but Goldberger doubted it. He’d started his career screening immigrants at the Port of New York, and if that were true, the outbreak would have started there. A conference on the disease had
strongly implicated spoiled corn. The southern poor existed on cornmeal after all, and champions of the newly proven germ theory
thought it was transmitted person to person. But pellagra was a poor man’s disease, rarely affecting the rich, and germs
didn’t really care about such distinctions. Rather, Goldberger suspected that pellagra wasn’t about what you got, but what you weren’t getting. It might be diet-related, a deficiency disease like scurvy. In fact, the previous investigator suspected just that. But when Goldberger stormed the
South, he did so with an open mind. He visited the most affected institutions,
orphanages and insane asylums, and observed their population for three months. What he saw confirmed his theory. If Pellagra were a germ, it would affect everyone
equally, but the doctors and nurses never got sick. Moreover, they had the first choice of food at mealtimes, and by the time the patients and the orphans got
their turn, most of the meat and milk were gone. The remaining food comprised the staple diet of the
southern poor: cornbread molasses and fatback bacon, canned vegetables if they were lucky. If pellagra was linked to diet, Goldberger reasoned, he should be able to prevent it with dietary changes. In September 1914, he conducted an experiment at three institutions with endemic pellagra. He picked two orphanages in Mississippi
and a sanitarium in Georgia. For six months, he provided the subjects with a diet of
eggs, fresh milk, legumes and lean protein. The results were dramatic. Come spring, only a single victim had
a reoccurrence, with no new cases. The diet had not only prevented pellagra, it had cured it. but that wasn’t enough FOR SCIENCE! After all, if pellagra was a deficiency disease, then
Goldberger should be able to induce it with diet. And his resulting experiment was…uhhh… Let’s just say it was probably unethical even back then. He got 12 prisoners to volunteer as test subjects in exchange for pardons from the governor of Georgia. For six months, he isolated them in an outbuilding, and restricted their diet to low-calorie, low-nutrition foods. Of the 11 that completed the study, 6 developed pellagra. Bingo. But many scientists enamored with germ theory continued to insist that pellagra was communicable, and Goldberger knew just how to answer that. He threw a party. Not just any party mind you – a filth party. A reoccurring event that was halfway
between an experiment and a publicity stunt. In short, he gathered a group of volunteers, including his assistant and his wife,
and they all tried to catch pellagra. And, uh, if you’re eating while watching this, fair warning, because the name was not false advertising. The party kicked off by drawing blood from a pellagra victim and injecting it into each other. Then they’d swab the victims’ nasal cavity
and stick the cotton up their own nose. Next they’d swab the victims’ throat, then their own. And fnally, they’d prepare a mixture from the victims’ feces, urine, and rash scabs, make it into a pill, (eugh), and swallow it. Guess what? No one got pellagra. Oh, diarrhea for sure. I mean that pill alone. (gulhlglha) But not pellagra. While these filth parties convinced the scientists, Goldberger was increasingly running up
against a tougher crowd: southern leaders See, southern elites were just more comfortable with pellagra being a communicable disease. To pin it on diet would be an indictment against the southern cotton economy, which relied on paying sharecroppers and tenant farmers low wages. Despite the pushback, Goldberger increasingly used social science to indicate a link between the southern labor system and pellagra. To make ends meet, farmers had to turn
the food-processing fields over to cotton, eliminating their source of fresh meat and vegetables. Now they existed solely off a poor diet of cornmeal
and canned goods imported from the Midwest. But admitting that would mean that there
was something deeply wrong in the south. After all, how could the south attract businesses if they thought the workers were sick and starving? How could they attract tourists? So when Goldberger convinced President
Harding to champion food aid a coalition of southern congressmen and governors pushed back, turning down the aid and challenging Goldberger’s
science. Pellagra had become politicized. But messaging wasn’t Goldberger’s only problem. His cure wasn’t scalable. Even if the government got involved, no one could afford to feed everyone in the South a meat and eggs. However, if he could discover what
elements in that diet cured pellagra, he might be able to wipe out the disease once and for all. So he decided to try out different possible cures using dogs who got a variation
of pellagra called black tongue. First he tried to induce black tongue with a poor
diet of cereals, but the dogs refused to eat it until he added brewers’ yeast to give it flavor. But the dogs didn’t develop black tongue. They switched the flavoring and
all of the sudden, black tongue. Hey, wait a minute. Why didn’t the first diet work? He added the brewers’ yeast back in, and
sure enough, the black tongue disappeared. He had his cure: a simple cheap cure that wouldn’t spoil and was easy to distribute. And none too soon, because in 1927, the
Mississippi River flooded, displacing millions. Goldberger personally traveled with the American Red Cross, distributing brewers’ yeast to refugee camps to tame the pellagra outbreaks. It helped, but what he saw only drove home the point that the southern economy
and poverty was the real culprit. For the next two years, Goldberger continued to search for elements and brewers’ yeast that cured pellagra, but he fell increasingly tired and ill. Cancer. He worked from bed. In 1929, a rabbi scattered Joseph Goldberger’s ashes on the Potomac. In 54 years of life he’d saved thousands
and received five Nobel Prize nominations. But Goldberger’s work didn’t end. His assistants and colleagues continued on, and in 1937 a chemist at the University of Wisconsin identified the mysterious element in brewers’ yeast: Niacin. Even better, niacin proved to
be the ultimate preventative. It could be used to enrich foods that lacked it, like bread and cereals, without affecting the taste. So in 1941, with the government worrying that the country might not be healthy enough to fight a World War, both businesses and government agreed to enrich foods like bread corn meal and even snacks. with the pellagra slaying additive. The southern economy was changing as well. In the 1920s an aggressive parasite called the boll weevil decimated the ability of the south to produce cotton, forcing agriculture to diversify and freeing up farmland for vegetables and meat. Then the booming wartime economy moved much of the free labor in the south to defense
manufacturing jobs that paid more, improving diets. Between 1900-1940, pellagra infected 3 million Americans, killing up to a hundred thousand, but by the 1950s, it was gone. Goldberger’s mission, which began w ith that letter in 1914, was finally accomplished. Once again, thanks to Child and Teen
Checkups for sponsoring this episode. We all know that diet is a really
important factor in your health, but it doesn’t stop there. Children should receive a health check-up every year. Ben Franklin is credited with saying, “An ounce of prevention is worth a pound of cure,” and that still holds true today. Early detection is key, especially for kids. If you live in Minnesota, learn more at getctc.com If you don’t, click the other link in the description below.