Pellagra, Part 2

This episode on the pellagra epidemic focuses on its prevalence in the U.S. in the early 20th century. Some of the scientific work done to understand it involves self-experimentation, and some of it is ethically problematic by today’s standards.

Research:

• Akst, Daniel. “Pellagra: The Forgotten Plague.” American Heritage. December 2000. https://www.americanheritage.com/pellagra-forgotten-plague
• Baird Rattini, Kristin. “A Deadly Diet.” Discover. Mar2018, Vol. 39 Issue 2, p70-72.
• Bridges, Kenneth. “Pellagra.” Encyclopedia of Arkansas. https://encyclopediaofarkansas.net/entries/pellagra-2230/
• Clay, Karen et al. “The Rise and Fall of Pellagra in the American South.” National Bureau of Economic Research Working Paper 23730. 2018. http://www.nber.org/papers/w23730
• Cleveland Clinic. “Pellagra.” 07/18/2022. https://my.clevelandclinic.org/health/diseases/23905-pellagra
• Crabb, Mary Katherine. “An Epidemic of Pride: Pellagra and the Culture of the American South.” Anthropologica , 1992, Vol. 34, No. 1 (1992), pp. 89-103. Via JSTOR. https://www.jstor.org/stable/25605634
• Flannery, Michael A. “’Frauds,’ ‘Filth Parties,’ ‘Yeast Fads,’ and ‘Black Boxes’: Pellagra and Southern Pride, 1906-2003.” The Southern Quarterly. Vol. 53, no.3/4 (Spring/Summer 2016).
• Gentilcore, David and Egidio Priani. “Pellagra and Pellagrous Insanity During the Long Nineteenth Century.” Mental Health in Historical Perspective. Palgrave Macmillan. 2023.
• Ginnaio, Monica. “Pellagra in Late Nineteenth Century Italy: Effects of a Deficiency Disease.” Population-E, 66 (3-4), 2011, 583-610.
• Hung, Putzer J. “Pellagra: A medical whodunit.” Hektoen International: A Journal of Medical Humanities. https://hekint.org/2018/09/18/pellagra-a-medical-whodunit/
• Jaworek, Andrzej K. et al. “The history of pellagra.” Dermatol Rev/Przegl Dermatol 2021, 108, 554–566 DOI: https://doi.org/10.5114/dr.2021.114610
• Kean, Sam. “Joseph Goldberger’s Filth Parties.” Science History Institute Museum and Library. https://www.sciencehistory.org/stories/magazine/joseph-goldbergers-filth-parties/
• Kiple, Kenneth F. and Virginia H. “Black Tongue and Black Men: Pellagra and Slavery in the Antebellum South.” The Journal of Southern History , Aug., 1977, Vol. 43, No. 3. https://www.jstor.org/stable/2207649
• Kraut, Alan. “Dr. Joseph Goldberger & the War on Pellagra.” National Institutes of Health Office of NIH History and Stetten Museum. https://history.nih.gov/pages/viewpage.action?pageId=8883184
• Marks, Harry M. “Epidemiologists Explain Pellagra: Gender, Race and Political Economy in the Work of Edgar Sydenstricker.” Journal of the History of Medicine and Allied Sciences , JANUARY 2003. https://www.jstor.org/stable/24623836
• Morabia, Alfredo. “Joseph Goldberger’s research on the prevention of pellagra.” J R Soc Med 2008: 101: 566–568. DOI 10.1258/jrsm.2008.08k010.
• Park, Youngmee K. et al. “Effectiveness of Food Fortification in the United States: The Case of Pellagra.” American Journal of Public Health. May 2U(H). Vol. 90. No. 5.
• Peres, Tanya M. “Malnourished.” Gravy. Southern Foodways Alliance. Fall 2016. https://www.southernfoodways.org/malnourished-cultural-ignorance-paved-the-way-for-pellagra/
• Pinheiro, Hugo et al. “Hidden Hunger: A Pellagra Case Report.” Cureus vol. 13,4 e14682. 25 Apr. 2021, doi:10.7759/cureus.14682
• A. C. Wollenberg. “Pellagra in Italy.” Public Health Reports (1896-1970), vol. 24, no. 30, 1909, pp. 1051–54. JSTOR, https://doi.org/10.2307/4563397. Accessed 13 Feb. 2025.
• Rajakumar, Kumaravel. “Pellagra in the United States: A Historical Perspective.” SOUTHERN MEDICAL JOURNAL • Vol. 93, No. 3. March 2020.
• Savvidou, Savvoula. “Pellagra: a non-eradicated old disease.” Clinics and practice vol. 4,1 637. 28 Apr. 2014, doi:10.4081/cp.2014.637
• SEARCY GH. AN EPIDEMIC OF ACUTE PELLAGRA. JAMA. 1907;XLIX(1):37–38. doi:10.1001/jama.1907.25320010037002j
• Skelton, John. “Poverty or Privies? The Pellagra Controversy in America.” Fairmount Folio: Journal of History. Vol. 15 (2014). https://journals.wichita.edu/index.php/ff/article/view/151
• Tharian, Bindu. "Pellagra." New Georgia Encyclopedia, 20 September 2004, https://www.georgiaencyclopedia.org/articles/science-medicine/pellagra/.
• University Libraries, University of South Carolina. “A Gospel of Health: Hilla Sheriff's Crusade Against Malnutrition in South Carolina.” https://digital.library.sc.edu/e

Episode Transcript

Speaker 1 (00:01):
Welcome to Stuff You Missed in History Class, a production
of iHeartRadio.

Speaker 2 (00:11):
Hello, and welcome to the podcast. I'm Tracy V. Wilson
and I'm Holly Frye. Here is part two of our
episode on pelagra, something I did not realize was going
to need two parts when I started, I was totally
unaware that there was a whole history of pelagor in
Italy that took place before it really became a problem

(00:33):
in the United States, and I was only aware of
the US stuff before working on this. Last time, we
talked about what pelagor is, its appearance and eventual maybe
not disappearance, but like resolution in Italy, and some of
the social and economic factors that led to a rise
in pellagra in the Southern United States in the early

(00:56):
twentieth century. Today, we're going to talk more about how
pelagora became a huge public health problem in the United
States and the efforts to find its cause and a
solution for it. To be clear, we are mostly focused
on the Southern United States here because that's where pelagora
reached really epidemic levels, but pelagra could and did happen

(01:18):
anywhere in the country that was facing poverty, and a
lack of access to a range of foods. This episode
includes some human and animal experimentation, and if you have
listened to our episode on epotymous diseases from not that
long ago, some of the human experimentation I would rank

(01:40):
as about equivalent to how gross the experimentation was with neurovirus.
There are also some experiments will be talking about that
we're not so viscerally disgusting in that way, but they
would not pass ethics review boards today.

Speaker 1 (01:58):
So as we said at the end of last episode,
the first known report of pelagra in medical literature in
the US was published in nineteen oh two, but investigations
over the following decades revealed that there had been outbreaks
going back to at least the first decades of the
nineteenth century. Most of those nineteenth century outbreaks had taken

(02:19):
place before medical textbooks in the US mentioned pelagra at all,
so most American practitioners didn't know anything about it, and
those patients had consequently been misdiagnosed. But after Henry Fauntleroy
Harris's nineteen oh two description of a farmer who had
been developing a debilitating illness with a rash, every spring

(02:40):
for about fifteen years. Other reports soon followed.

Speaker 2 (02:45):
We also talked last time about the three ms of meal, molasses,
and meat, which made up the bulk of the diets
of a lot of the poorest people in the United
States in the late nineteenth and early twentieth centuries. This
included the diets of people who were living in institutions
like mental asylums and orphanages, because they were generally being

(03:09):
fed the cheapest food possible. One example was Mount Vernon
Asylum for the Colored Insane in Mount Vernon, Alabama. This
hospital had been established as a state run segregated mental
hospital for black patients in nineteen hundred. Prior to that,
it had been an arsenal and military barracks, and in

(03:31):
that earlier time that's where physician Walter Reid had confirmed
that yellow fever was transmitted by mosquitoes.

Speaker 1 (03:38):
Doctor George H. Searcy reported an outbreak of disease in
eighty eight patients at the hospital in the early fall
of nineteen oh six, publishing a paper on it in
the Journal of the American Medical Association the following year.
He said that these were not the first cases of
pelagra at the hospital, that there had been a few
cases every summer since patients were first transferred to the

(04:01):
hospital in nineteen oh one, but that they had not
been recognized as pelagra. When a much bigger outbreak started,
doctors at the hospital had gone to Circe for help,
and he reported that of those eighty eight cases, fifty
seven had died, for a mortality rate of about sixty
four percent.

Speaker 2 (04:21):
In his paper, sirirc described the disease as endemic and systemic,
involving skin lesions and disturbance of the digestive tract and
nervous system. He said it should be classed as food poisoning,
similar to ergotism, which comes from eating food that's contaminated
with ergate fungus, or latherism, which comes from eating large

(04:44):
amounts of certain legumes that contain a neurotoxin. And he
made an observation that would hold true in other outbreaks
in the United States. Quote the disease occurs among the
poorer classes and in institutions where the diet is at
times limited. It develops most frequently among adults and in

(05:04):
females more frequently than in males. Of the eighty eight
patients at Mount Auburn eighty of them had been women,
and two thirds had been at the hospital for more
than a year. Eighty percent of them had experienced fair
or good health before developing pelagra. Circi described pelagra as

(05:24):
being caused by quote continuous eating of damaged corn and poverty.
Poor hygienic surroundings, and exposure to the sun's rays have
been given as predisposing factors. He specifically referenced the work
of Cesar Lombroso, who we talked about in Part one,
and the idea that pelagor was caused by eating spoiled

(05:45):
or contaminated corn. He said he had sent a sample
of the corn meal served at the hospital, which was
supposedly the best meal that was being made in the West,
to a plant pathology lab which had described it as
quote whole unfit for human use, that it was made
of moldy grain and contained quantities of bacteria and fungi

(06:07):
of various sorts, some of which were identified. He went
on to say, quote As for the treatment, there are
no specific remedies. The essential management consists in placing the
patient in good hygienic surroundings and trying to improve the
general health by good nourishing foods, and such tonics as

(06:28):
may seem indicated. Arsenic iron and pepsin preparations were the
remedies on which most support was placed and which sometimes
seemed to influence the disease favorably. The affected patients at
the hospital were taken off of cornbread and grits and
they were given wheat bread and potatoes instead, with no
other changes to their diet. A set of eight unaffected

(06:51):
patients were also placed on a diet of cornbread and
grits as an experiment. One developed pelagra and another showed
signs of the disease. All of them started to show
signs of poor health, so their diets were changed. Also,
sears ended his nineteen oh seven article by saying that

(07:11):
he had heard the western corn crop of nineteen oh
five had been damaged by wet weather, so that was
what the hospital would have been using in nineteen oh
six when the outbreak happened, so he had sent a
sample of the corn they'd gotten in nineteen oh seven
to the same lab to be tested. The lab said
that this newer batch of corn was up to standards,

(07:35):
so Searcy added it back into the patient's diets. Searce
wrote that after his nineteen oh six report, other cases
of pelagra had been identified at the Hospital for the
Insane at Tuscaloosa, and that as there was more awareness
of the disease, he expected more reports to follow. In
nineteen oh eight, James Babcock, superintendent of the South Carolina

(07:58):
Hospital for the Insane, traveled to Italy to see patients
their first hand so that he could compare their conditions
to what he was witnessing in South Carolina. This basically
allowed him to confirm that he was also seeing pelagra.
Bobcock also organized the first US Conference on pelagra, which

(08:19):
took place on November third and fourth of nineteen oh nine.
Almost four hundred physicians attended. In Italy, for the most part,
there had been agreement that pelagora was caused by corn,
but the medical community had been at odds over whether
the issue was about nutrition or about some kind of
toxin contaminating the corn. In the US, a different disagreement

(08:43):
developed whether pelagora was caused by corn or whether it wasn't.
This disagreement can be framed as the Zeus versus the
anti Ziists, with Zeist coming from Zma's the scientific name
for corn. Of the forty one speakers at this nineteen
oh nine conference were Zeists, although many of them had

(09:06):
very different explanations for the exact role that corn played
in pelagra, and the anti ziists similarly had a lot
of different reasons for thinking that the corn was not
the cause. Some of them were motivated by the germ
theory of disease and the fact that researchers had started
identifying specific microorganisms that caused a range of diseases, including

(09:32):
tuberculosis and cholera.

Speaker 1 (09:34):
These were things.

Speaker 2 (09:34):
People had previously attributed to things like environmental causes. Some
were working off the idea that not only did microorganisms
cause disease, but that every disease had one specific cause,
said that that cause for all diseases was a microorganism.

(09:55):
This was also happening during the eugenics movement in the
United States dates, so there were people who thought pelagra,
or at least a predisposition for pelagra, was the result
of bad breeding.

Speaker 1 (10:10):
And some of the anti ziist response was more emotional.
Much of the corn in the US was being grown
in the Midwest, and a Midwestern sense of identity had
started to coalesce. One that was centered on agriculture. The
idea that Midwestern corn was causing illness was damaging to
that sense of regional identity, and there were also obvious

(10:32):
worries that connecting pelagra to corn would damage the corn
industry and the Midwestern economy. This ran parallel to a
sense of Southern pride and identity. Those three ms that
we talked about in Part one of meal, meat, and
molasses had formed the foundation of a lot of Southern cuisine.

(10:54):
People wanted to find an explanation for pelagra that did
not land on Southerner's own foods, which were close to
their hearts making them sick. Also, pelagra, hookworm, and malaria
were all prevalent in the South at this point. All
of these could cause symptoms like diarrhea, abdominal pain, fatigue,

(11:15):
and malaise. These diseases themselves all carried a lot of stigma,
and all this had fed into negative stereotypes of Southerners
as lazy. So the idea that people were to blame
because of what they were eating was like adding insult
to injury. The attendees at the first conference on pelagra

(11:37):
resolved to start a national Association for the study of Pelagra,
and Babcock was elected as its president. Also in nineteen
oh nine, the US Public Health Service, at the time
part of the Marine Hospital Service, appointed doctor Claude Lavender
to head up the service's study of pelagra. Lavender worked
with Babcock to translate Cesar Limbroso's Italian were on pellagra

(12:00):
into English. A wave of research into pelagor followed this,
but it was not initially productive, and we will talk
about why after a sponsor break. A lot of the

(12:22):
writing on pelagra in the United States in the first
decade of the nineteen hundreds had drawn on Italian work
that had connected the disease to corn consumption in some way.
But then in nineteen ten, the London School of Tropical
Medicine published a report saying that pelagor was caused by

(12:42):
a microbe that was being spread by insects. A Pelagra
Investigation Committee had been established in the UK that year,
and it had funded a research trip to Italy that
was carried out by physician Lewis Sambon. Sambon had been
born in Italy and had moved to the UK to

(13:02):
head up the School of Tropical Medicine. His earlier work
included the study of sleeping sickness in Uganda. He had
correctly concluded that sleeping sickness was caused by a parasite
that was transmitted by the Sizi fly. In his pelagra study,
he noted some commonalities between pelagra and insect born diseases

(13:26):
like sleeping sickness, and concluded that it was not about
the corn, that it was a disease carried by some
kind of biting insect, probably gnats, that were also common
in the same rural areas where corn was a big
part of people's diets. In Italy, pelagra had become much
less common, and the general consensus for decades had been

(13:49):
that it was corn related, So this report really did
not get a lot of traction there. Many Italian doctors
dismissed it entirely, even calling it absurd. But in the US,
Sambon's conclusion really appealed to all the researchers who were
looking for some kind of explanation for pelagra that did
not trace back to Midwestern corn or southern diets. This

(14:12):
included the state of Illinois, whose Investigatory Commission on Pelagra
was established in nineteen ten and largely focused on Sambon's work.

Speaker 2 (14:22):
My read on this is that Simbon's conclusions on pelagra
were really influenced by his own preconceptions based on his
earlier successful work on insect born diseases, and this may
have also been true for one of the commissions that
started studying pelagra in the nineteen teens. That was the

(14:44):
Thompson McFadden Commission, named for its two primary funders, Robert M. Thompson,
who was in mining, and Henry McFadden, who was a
cotton merchant. Both of these men had a vested interest
in determining a cause and treatment for pellagra, since it
was prevalent in the mining camps and mill towns where

(15:05):
the workers in their industries lived.

Speaker 1 (15:08):
The researchers who were part of this commission carried out
their work in and around Spartanburg, South Carolina, where local
officials agreed to cooperate and where the situation was critical.
There were about thirty thousand reported cases of pelagra, with
a fatality rate of about forty percent. Investigators went house

(15:29):
to house asking about who lived there, their ages and sexes,
whether any of them had pelagra, and what they ate.
Doctors also diagnosed cases of pelagra during these visits.

Speaker 2 (15:43):
The primary investigators for this commission were all microbiologists, and
they discounted links to things like economic conditions and the
maize and the gnats that Sambon had cited before, focusing
on trying to pinpoint a specific microbial cause. In their

(16:03):
second progress report, they didn't name a specific cause for pelagra,
but they reported that pelagora rates were the highest in
the places that did not have an enclosed sewer system
and people were using unscreened privies. Also, if one person
in a household had pelagra, usually at least one other

(16:26):
person had it as well. They wrote, quote, we are
inclined to regard intimate association in the household and the
contamination of food with the excretion of pelagrons as possible
moods of distribution of the disease. Pelagrins was the term
being used to describe people with pelagra, so these researchers

(16:49):
were saying that pelagra spread from person to person when
the waste of someone with pelagra contaminated the food other
people were eating. That contamination was spreading in neighborhoods where
there was no sanitary system for dealing with human waste.
They also noted some of the same demographic patterns as
Henry Fauntleroy Harris had in his nineteen oh two paper

(17:12):
that we talked about earlier. Polagor was far more common
in women. They reported five hundred twenty eight cases in
women and two hundred twelve in men. They also found
far more cases among white people than among black people,
but noted that the cotton mill villages that they were
researching were almost exclusively white. Yeah, when you looked at

(17:34):
a broader sample of the population, it was the opposite.
It was a lot more common among black people. They
just were looking at a sample that was mostly white.
A sewer system was built in Spartan Mills, after which
pelagora rates there did start to decline, and so this
wound up reinforcing the idea that the sanitary conditions had

(17:58):
been involved in the polagrasp. One possible explanation for why
this sewer system quote worked is that the building of
the sewer brought some more money into the town, which
allowed people to buy a richer variety of food. But
we don't really know. The connection to the sewers wasn't

(18:21):
about some kind of waste contamination that was contaminating the food.
It was that the people that were living in places
that were so poor that they had no sewer system
couldn't afford to buy a richer variety of food. Just
to make that clear, the Thompson McFadden Commissions reports deepened
the division between the Zeists and the anti Ziists. Claude Lavender,

(18:43):
who had been heading up the government's response to the disease,
wrote in a nineteen thirteen report quote, it is not
to be understood from them that there are only two
theories of the cause of pelagra. On the contrary, there
are scores of theories. The Zeists agree in one thing only,
and that is that, either directly or indirectly, pelagra is

(19:05):
ideologically related to MAZE, while the Antiziists agree in one
thing only, and that is that the disease bears no
such relation to MAZE. The Zeists, however, do not agree
among themselves, nor do the Antisiasts show any more harmony
in their views. Without going into the details of the
various theories and shades of opinion, it may be said

(19:27):
that the great struggle now centers around the question is
pelagra a kind of food poisoning from maze? Or is
it due to some parasite infecting the human body. In
nineteen twelve, which was the same year that the Thompson
McFadden Commission started its investigation, Polish biochemist Casimir Funk coined

(19:49):
the word vitamin as vital amines, and he connected deficiencies
in these vital amines to diseases. He noted similarities among
them pelagra, berry berry, ricketts, and scurvy, all of which
are understood as vitamin deficiency diseases today. He observed that

(20:09):
these diseases tended to erupt in countries where quote a
certain unvarying diet is partaken for long periods. People had
already figured out that barry berry, which is a thiamin deficiency,
could be treated and prevented with rice brand and that scurvy,
which was a vitamin sea deficiency, could be treated with

(20:30):
a variety of fresh fruits and vegetables. We have a
whole episode on scurvy. Funk argued that there was probably
a dietary treatment for pelagra as well. By nineteen fourteen,
Claude Lavender had not been successful in finding a definite
cause for pelagra, and he asked to be assigned to

(20:51):
other work. US Surgeon General Rupert Blue appointed doctor Joseph
Goldberger as his replacement. Goldberger was from a Jewish family
from the Austro Hungarian Empire who had moved to the
United States when he was about nine. After becoming a doctor,
he had worked in private practice for a while before
joining the United States Marine Hospital Service. He had worked

(21:15):
as an immigration inspector in the Port of New York
before moving on to studying and fighting infectious diseases. He
had fought outbreaks of yellow fever, dengey fever, and typhoid,
among others.

Speaker 1 (21:27):
When he was appointed to study pelagra, he was in
Detroit helping to fight a diphtheria outbreak. Yeah.

Speaker 2 (21:34):
His public health and infectious disease work has been described
as like monumental and heroic. He did a ton and
a lot of it. He was doing at risk to
his own health. That same year, the State Sanitarium in Millageville, Georgia,
was in the middle of a pelagora crisis. Almost two

(21:55):
hundred people had died and pelaga had passed tuberculosis as
the leading cause of death at the hospital. The federal
government had started to see the situation as really urgent
and Goldberger was given a budget of eighty thousand dollars
for his investigation that was out of the entire US
public health budget of two hundred thousand dollars.

Speaker 1 (22:18):
Goldberger studied conditions at the hospital and noticed something that
George H. Searcy had also described in his reports on
the pelagra outbreak at Mount vernonn Asylum, almost a decade before.
Pelagor was affecting only the patients, not staff. Staff were
in close contact with the patients all day, and some

(22:40):
of them lived at the facility. If the disease had
been communicable, whether it was being spread through insects or
some other vector, it would have affected staff as well. Theoretically,
staff and patients were eating the same food, but Goldberger
learned that the staff were served first, so they usually
took the best food for themselves, and the staff also

(23:03):
had options to supplement their diets beyond what the hospital served.
Although most of Goldberger's background was in infectious diseases, he
started researching pelagra as a possible nutritional deficiency. This is
where we will get to the human experimentation that we
talked about at the beginning of the show and some

(23:24):
of its fairy growths. We'll have more on that after
a sponsor break.

Speaker 2 (23:37):
In nineteen fourteen, Joseph Goldberger started polagor research at two
orphanages in Jackson, Mississippi, where more than two hundred total
children had developed the disease during the spring and summer.
He found that pelagra only seemed to affect children between
the ages of six and twelve, and they were all

(23:58):
mostly eating biscuits, grits, corn meal, and syrup. I'm not
sure if the syrup was his word for molasses, but
something sugary and syrupy. Even though the general conditions at
the orphanages were not good in terms of things like
sanitation and overcrowding and overall health, he left those conditions

(24:19):
as they were for the sake of this experiment.

Speaker 1 (24:23):
At both orphanages. In his words quote, a very decided
increase was made in the proportion of the fresh animal
and of the leguminous protein foods. This included milk, eggs, beans,
and peas, and at breakfast the children were served oatmeal
rather than corn grits. Other foods were added as well.

(24:45):
After the implementation of this diet, the children were observed
for a year. One of the orphanages had no recurrences
of pelagra the following spring and summer. The other had
just one. A similar experiment with similar results was carried
out at the Georgia State Sanitarium in nineteen fifteen. Goldberger

(25:05):
began reporting his results in the Southern Medical Journal and
in public health reports. This research strongly suggested that a
diet containing a variety of foods could prevent pelagra, and
he wanted to confirm whether pelagra could also be induced
through diet.

Speaker 2 (25:25):
He worked with Earl Brewer, Governor of Mississippi, to arrange
an experiment at Rankin State Prison Farm, which did not
have a history of pelagra among the people incarcerated there.
Twelve healthy men were recruited from this study, although one
of them was found to have a previously undetected medical
condition and he was dismissed. These men were offered pardons

(25:49):
for their participation that would be seen as unethical and
coercive today. They were placed on a largely corn based diet,
and after about five five months, six of them had
developed the rash that is characteristic of pelagra. So this
supported the idea that a primarily corn based diet could

(26:11):
cause pelagra. Goldberger's conclusions really inflamed a lot of the
cultural responses that we talked about earlier. While there were
some Southern leaders and advocates who called for food aid
to the South to combat any dietary deficiencies, many many
others were outraged. This was fueled by attitudes dating back

(26:33):
to before the Civil War and reinforced during reconstruction, and
perceptions that a Jewish New Yorker seen as a paternalistic,
moralizing outsider, had come to pass judgment on the South,
its people, and its food. Anti ziasts doubled down on
the insistence that this wasn't about food, and it specifically

(26:54):
wasn't about corn, and that there must be an infectious
agent at work. Yeah. Some of the tone of this
conversation at the time was basically Goldberger saying, there is
famine in the South and we need to take action
to save people's lives, and his most vocal critics were like,
that is an insult.

Speaker 1 (27:15):
How dare you? Defensiveness will make people do really foolish things.
Uh huh.

Speaker 2 (27:22):
So, based on these criticisms, on April twenty sixth of
nineteen sixteen, Goldberger started a series of experiments to try
to prove that no, there was not an infectious agent
at work. Most of the seventeen participants in these experiments
were doctors, but one of them was also his wife.

(27:45):
They intentionally exposed themselves to the bodily fluids of pelagora patients,
including their blood and swabs from their noses and throats.
They also exposed themselves to skin from the patient's This
happened through things like injections and compounded pills that they swallowed. Basically,

(28:08):
if you can imagine a way to get material from
one person's body into another, they tried.

Speaker 1 (28:15):
That.

Speaker 2 (28:16):
These were nicknamed filth parties. No one got pelagor from them.
Did they get other things though? Did they get hepatitis?

Speaker 1 (28:26):
I don't know. Uh. Even so, in November of that year,
there were doctors at the Southern Medical Association annual meeting
who still maintained that Goldberger was wrong. In particular, South
Carolina State health officer James A. Hayn insisted that pelagra

(28:47):
was infectious. He continued to publicly criticize Goldberger and his
findings for years, no matter how much evidence was presented
or how that evidence was framed. He later compared Goldberger
to fascist dictator Benito Mussolini and described his ideas as
having been quote rammed down their throats.

Speaker 2 (29:09):
Good thing. We've been talking about stuff rammed down our
throats for more than a century.

Speaker 1 (29:15):
My least favorite phrase on the planet.

Speaker 2 (29:17):
Perhaps. Also in nineteen sixteen, Goldberger started working with a
team to study the relationship between pelagra and the Southern economy.
His collaborators included Edgar Seidenstricker, who had a background in
labor economics and was a statistician. Their work was deeply

(29:38):
critical of the exploitive systems that were at work in
the South, including sharecropping and the cotton monoculture. Another researcher,
carl A. Grot, also studied the mining camps in Walker County, Alabama,
and confirmed that pelagor was not affected by a person's
heredity or their race, but that rates of the disease

(30:00):
were directly correlated with income, making the food that people
could afford the most likely explanation. One of the criticisms
of Goldberger's work was that it had been carried out
in the controlled settings of orphanages and asylums, so in
nineteen eighteen he did his own mill studies as the

(30:21):
Thompson McFadden Commission had done. He selected seven cotton mill
villages in South Carolina and screened every person in every
household for pelagra. Everyone was very poor, but the households
in which at least one person had pelagra were the
ones were there was little to no animal protein in

(30:41):
their diets, although what they were eating wasn't necessarily limited
to just corn. Through all of this, pelagor rates had
continued to rise and fall in conjunction with changes in
economic factors and food availability. So, for example, a bull
weavil infac station in Alabama in nineteen fifteen led to

(31:03):
them spiking. Although the disease was most prevalent in the South,
it could be found all over the US, really anywhere
that people could not afford a variety of food and
were just subsisting on one specific staple.

Speaker 1 (31:19):
But then, over the late nineteen teens and early nineteen twenties,
researchers including Goldberger, Russell, Henry Chittenden, and Frank pell Underhill
found one particular thing that seemed to prevent pelagra. Brewers yeast,
which we know today is high in protein, B vitamins,
and other nutrients. This discovery came from experiments on pelagra

(31:42):
in dogs. It was difficult to induce pelagra in dogs
because most dogs don't want to eat nothing but corn meal,
so researchers were using brewers yeast to try to stimulate
their appetites. It turned out the brewers yeast protected them
from developing pelagon.

Speaker 2 (32:01):
Yeah. Goldberger had also at the same time been systematically
trying to find something that would work as a protective
and then this happened with the dogs. Brewers yeast was
also inexpensive, and Goldberger started advocating for the use of
brewers yeast to treat and prevent pelagra. When the Mississippi

(32:22):
River flooded in nineteen twenty seven, causing immense destruction and
widespread crop devastation, Goldberger warned that there would probably be
an increase in pelagor rates to follow. He called for
education about the use of brewers yeast and distribution of
brewers yeast to affected communities. The Red Cross delivered twelve

(32:45):
thousand pounds of brewers yeast to flood affected areas. There
was still widespread malnutrition in the wake of this flood,
and there were also racial disparities as black people were
kept out of a lot of the relief camps, but
Goldberger is credited with helping to mitigate some of the

(33:05):
worst outcomes of this catastrophe. While some of the South
had been reluctant to accept a dietary explanation of pelagra
or to ask for or accept food relief, this flood
was truly a massive disaster. It was so huge in
scale and devastation that it removed some of the stigma

(33:25):
around asking for help, especially asking for food help. Afterward,
many of the doctors who had kept looking for an
infectious cause of pelagra were more willing to accept that
it was caused by a nutritional deficiency. The Red Cross
also continued to deliver Brewers yeast, distributing five hundred thousand

(33:45):
pounds of it over the next decade. On October thirty first,
nineteen twenty eight, Goldberger gave a speech before the American
Dietetic Association in which he said, quote, the problem of
pelagra is, in the main a prime problem of poverty.
Education of the people will help, but improvement in basic

(34:06):
economic conditions alone can be expected to heal this festering
ulcer in the body of our people. But much of
the effort to cure pelagra prevent it societally did not
involve trying to reduce poverty. There definitely were efforts to
provide food aid and other assistants during the Great Depression

(34:29):
and other times of crisis, and there were various anti
poverty programs, But the bigger and more long term focused
involving pelagra was on fortifying food. Biochemist Conrad Elvihim isolated
niacin also called vitamin B three in nineteen thirty seven.
By nineteen thirty eight, bakers had started voluntarily producing bread

(34:52):
using a high vitamin yeast, which helped reduce pelagra rates.
As synthesized vitamins became less expensive of bread products and
other foods were fortified with vitamins directly. A lot of
this was like what we discussed in our episode on
the iodization of salt, voluntary efforts by food producers and

(35:12):
state laws requiring fortification. This continued into the nineteen forties,
with twenty eight states passing some kind of mandatory law
for fortifying bread or flour between nineteen forty two and
nineteen forty nine. I was telling my spouse about what
this episode was about, and he said, is that why
they spray vitamins on breakfast cereal. Yes, I mean other

(35:36):
deficiencies too, But yes, economic systems also changed during those decades. Obviously,
poverty still exists. There are still food deserts where people
cannot get access to the foods that they need to
eat to live. But the sharecropping system started to fade

(35:57):
in the wake of the mechanization and industrialisation of the
farm industry in the nineteen thirties and forties. That of
course caused its own disruption to people's lives and circumstances,
but it did mean that people were not in a
situation where they were sharecropping and they could only get
food at a commissary. Following cotton prices in the nineteen

(36:19):
thirties also led to some diversification in the crops that
were being planted. The payment of wages in scrip, which
had been common in mill towns and mining towns and
locked people into buying their food only from a company
store and nowhere else. That was outlawed under the Fair
Labor Standards Act of nineteen thirty eight. With food fortification

(36:42):
and social and economic shifts, the pelagri crisis in the
US was largely over by the start of World War II,
but between nineteen oh six and nineteen forty there had
been approximately three million cases and one hundred thousand deaths
from the disease. About half of those deaths were among
black people, and about two thirds of them were women.

(37:04):
This was something that some of the researchers, including Goldberger,
commented on at the time. Because of ongoing patterns of
racism and bigotry, black people in any given community tended
to be in the poorest class, with the fewest resources,
and were sometimes excluded from receiving food, aid or other support.

(37:25):
The gender disparity is a little more complicated. It's possible
that there were some physiological factors involved in the absorption
and use of niosin in women's bodies, but some of
this was probably connected to gender roles and family dynamics.
In most families, women were the ones procuring and preparing food,

(37:46):
and mothers and wives often deprived themselves so the rest
of the family could eat. Joseph Goldberger did not live
to see the isolation of niosin or the end of
the polagra epidemic. He died of cancer on January seventeenth,
nineteen twenty nine. His critics spread rumors that he had
really died of pelagra. The exact mechanisms of niosin in

(38:09):
the body and how it relates to pelagra continued to
be studied for decades after the nineteen forties, and the
discovery of nichemalization's role in making nutrients in corn more
bioavailable is comparatively recent. Researchers started publishing work analyzing the
available nutrients and niche temalized corn in the nineteen fifties,

(38:31):
with research confirming that nichemalization increases the availability of triptafan
and niasin by the late nineteen eighties. During our lifetimes, yeah, yeah,
I had trouble pinning down exactly when that research happened,
because that's a that's a thing, that's a series of terms.
To try to do sort of a literature review on

(38:54):
UH And I found various papers over the course of
those decades that were related to it in one way
or another. And then also I would find other papers
that were about pellagorate in some other way, written from
like the seventies that just seemed unaware that niche stivialization

(39:17):
was even a factor in anything. So even if it
was more understood like that had not spread through all
of the research community. Anyway, we'll talk about some things
on Friday.

Speaker 1 (39:30):
I'm sure.

Speaker 2 (39:32):
In our behind the scenes, I have some listener mail.

Speaker 1 (39:36):
Fabulous.

Speaker 2 (39:38):
This listener mail is from Kristen who wrote in after
our episode on jan Arson. This says, Hi, Holly and Tracy.
I'm a longtime listener and repeat fan mail writer. I
love your episodes, and I'm particularly interested when I find
a personal connection to the story you are telling, as
is the case in your recent episode on Yan Arson.

(40:01):
I am half Icelandic by descent, and so am tickled
by your interest in the land of my forefathers. During
the podcast, Tracy toss in a comment that it's quite
likely that all Icelanders are descended from Yon Arson in
one way or another.

Speaker 1 (40:14):
I thought to.

Speaker 2 (40:15):
Myself, challenge accepted, and went to the Icelandic genealogy database
that is at icelandicgroots dot com to see if I
could establish a personal connection to Yon Arson lo and behold,
Tracy was right. I am related to Yon Rason, who
is my twelve times great grandfather or Lancofe. I'm sorry

(40:41):
if I did not do a great job of pronouncing
that term. Not only that, but I am related to
him through fifteen different lines of descents the attached family tree.
This is due to the fact that Iceland's population has
always been relatively small, so most people are related. In fact,
when I was in Reykievic on a business trip some
years back, I was invited to a small get together
after work where I met a recently retired Bishop of Iceland,

(41:06):
Peter Stegerson. I feel like I left a syllable out
of that, but I don't think I could do it again.
I mentioned that my mother's family was from Iceland, and
he responded that we must be related. After I tossed
a few ancestral names out, he said, of course we
are distant cousins. I was able to confirm his statement

(41:26):
recently on the s Icelandic Roots genealogical database. What funds
you have an automatic conversation starter like this? I'm including
a photo of four generations of my family, me, my mother,
my Ama, and my Lagama. I am not saying their
names for the sake of privacy, but they are in
the email. This photo was actually taken in Canada, which

(41:48):
is in Gimli in Manitoba, which is the largest Icelandic
settlement outside of Iceland for pat tax I run out
of current pets to introduce you to you, So I'm
going back in time to our family's first kitty. Early
one Saturday morning, the wife of my father's boss showed
up at our door. When my mother opened the door,
the woman said here and shoved a kitten and a

(42:09):
can of cat food into my mother's hands, and then
strode quickly away. We children, of course, were thrilled at
the idea of a kitten. My parents bowed to the inevitable.
They both had a quirky sense of humor, and decided
to name our cat Fido. Fido quickly grew from a
small kitten to an extremely large cat. The attached photo

(42:31):
shows Fido being held by then three year old brother
for Scale Fighter, who lived the ripe old age of
twenty two despite receiving the excessive love from all four
of us kids. Lastly, this made me cry when I
first read it, and so I'm going to try to
read it without crying. Fingers crossed. I don't know if

(42:51):
I can, but I'm gonna try. Lastly, I want to
thank you for your gentle benedictions. At the end of
each Friday behind the scenes podcasts. Kristen just going on
to talk about how dealing with some things and this
positive message at the end of your show gives me
a little lift going into the weekend. This did made
me cry when I first read it. I'm crying a
little bit right now. Thanks for everything, Kristin. Thank you

(43:12):
so much. Kristin.

Speaker 1 (43:14):
I love the.

Speaker 2 (43:15):
Confirmation of the interrelatedness of folks in Iceland. It is
a small islands and the population is small. What a
great family picture also, and then we have a picture
of a small child holding a large, very fluffy, white

(43:38):
and gray kitty cat. And this the cat is almost
as big as this child whole or so. I love
all of this. Thank you so much for this email
and for all this about your family, and for your
very gentle thank you at the end.

Speaker 1 (43:55):
I loved this. It made me.

Speaker 2 (43:58):
Tear up and gave me a little bit of a
lift for the rest of the day. If you would
like to send us a note about this or any
other podcast or at history podcasts at iHeartRadio dot com,
and you can subscribe to our show on the iHeartRadio
app and anywhere else you'd like to get your podcasts stuff.

(44:22):
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