The link between poor nutrition, poverty, and a deadly disease called pellagra was first identified by the physician Joseph Goldberger in the early 21st century.

Goldberger (1874–1929) was born in Hungary and immigrated to New York City as a boy. After medical school at New York University, he enlisted in the United States Marine Hospital Service (later the US Public Health Service) and became well known for his skill at figuring out and fighting the causes of infectious diseases. He traveled the country battling yellow fever, typhoid fever, and Shamberg’s disease, an itchy skin ailment caused by bed mites. In 1914, the United States surgeon general asked him to focus on pellagra, a skin disease that was reaching epidemic proportions throughout the country.

Pellagra, also known as mal de la rosa, was responsible for more than 100,000 deaths in the United States in the first 4 decades of the 20th century; the southern states were especially affected and had a much higher mortality rate. Doctors sometimes described pellagra as the disease of the four Ds, in reference to its four distinguishing symptoms: dermatitis, dementia, diarrhea, and death. When Goldberger began to study the disease, he was struck by the fact that in mental hospitals, orphanages, and other institutions, inmates became sick, but staff didn’t. He decided, against popular opinion, that the disease could not be contagious, that something else had to be at play. When Goldberger requested that food shipments of fresh meat, milk, and vegetables be delivered to children in two Mississippi orphanages and to inmates at the Georgia State Asylum, pellagra at those institutions disappeared. He determined that some nutrient missing from a corn-based diet, popular in the poverty-stricken South, prevented the disease.

Goldberger spent the rest of his life searching for this “pellagra preventive factor,” but never solved the mystery. He fell sick and died before realizing that the mystery nutrient was the B vitamin niacin, a discovery made in the next decade, largely thanks to Goldberger’s work.

ADDITIONAL FACTS

  1. Frustrated and determined to convince his contemporaries that pellagra was not contagious, Goldberger and supporters held “ filth parties” in which they shared bodily fluids with those of diseased people: They injected themselves with the blood of people with pellagra, swallowed capsules containing scabs of pellagra rashes, and rubbed affected people’s mucus into their own throats and noses.
  2. The pellagra epidemic was somewhat lessened by a plague of boll weevils that struck cotton fields in the South during the 1920s. The infestation forced many farmers to switch to other crops instead of relying totally on cotton, which in turn caused them to eat a healthier diet.
  3. Pellagra has been suggested as a possible source of the myth of vampirism. Like vampires, people with pellagra are sensitive to sunlight, they often don’t eat (because of diarrhea), and their tongues can swell and become red from malnutrition, evoking thoughts of blood.