The Pellagra Story

Pellagra, also called the disease of the four D's — dermatitis, diarrhea, dementia and — took the lives of thousands in the Southern states of America during the early part of the twentieth century. Data is sketchy, but by 1912, the State of California alone reported 30,000 cases and a mortality rate of 40 percent. Today, pellagra is virtually unknown because we know that it is caused by a vitamin B3 deficiency.

The popular medical theory at the time was that the disease was caused by germs. However, Dr. Joseph Goldberger, who was asked to head an investigation into the situation in 1914, found that orphans and inmates contracted the disease, but staff never did. Goldberger knew from years of experience working on infectious diseases that germs did not distinguish between inmates and employees. Instead, he believed that the disease was caused by the insufficient corn-based diet of the poor.

Shipments of food, which Goldberger had requested from Washington, were provided to children in two Mississippi orphanages and to inmates at the Georgia State Asylum. Results were dramatic; those who were fed a diet of fresh meat, milk and vegetable instead of a corn-based diet recovered from pellagra. Those without the disease, who ate the new diet, did not contract it.

Amazingly, many of those convinced of the germ theory refused to abandon their view, even after Dr. Goldberger experimented on eleven healthy volunteer prisoners at the Rankin State Prison Farm in 1915. Offered pardons in return for their participation, the volunteers ate a corn-based diet. Six of the eleven showed pellagra rashes after five months. Angry because his experiment was dubbed “half-baked” and a fraud, Dr. Goldberger and his assistant injected each other with pellagrin blood, swabbed out the secretions of a pellagrin's nose and throat and rubbed them into their own noses and throats, and also swallowed capsules containing scabs of pellagrins' rashes. Volunteers joined them, yet none got pellagra. Despite these efforts, a few physicians remained opponents of his dietary theory. And Goldberger's warnings — which turned out to be true — to authorities of a dramatic increase in pellagra when the prices of cotton wool dropped dramatically in 1920, fell on deaf ears. They believed that any negative characterization of their region would discourage economic investment and tourism in the South. The Southern pride and prosperity were on the line.

The interesting end of this drama is that the land reform Goldberger believed necessary to eliminate pellagra was accomplished not by scientific reasoning but by the invasion of boll weevils. The insect destroyed cotton fields and forced Southerners to diversify their crops. By growing more food crops, they improved their diets and suffered less from pellagra.

By the time of Dr. Goldberger’s death in 1929, he still hadn't discovered precisely what was missing from the diets of pellagrins. During the next decade, Conrad A. Elevjhem learned that a deficiency of nicotinic acid, better known as B vitamin niacin or vitamin B3, resulted in canine black tongue disease. In studies conducted in Alabama and Cincinnati, Dr. Tom Spies found that nicotinic acid cured human pellagrins as well. Tulane University scientists discovered that the amino acid tryptophan was a precursor to niacin. When tryptophan was added to commercial foods such as bread to “fortify” them, it prevented the scourge of the South. Thanks to all these efforts that resulted in knowledge of the cause of pellagra, one doesn't hear about it any more, except for infrequent occurrences during times of famine and displacement.