Joseph Goldberger

In 1914, Goldberger was asked by US Surgeon General Rupert Blue to investigate pellagra, then an endemic disease in the Southern US.[4] Previously it had been rather rare in the United States, but an epidemic broke out in 1906, primarily in the South, and continued until the 1940s.[1] By 1912, South Carolina alone had 30,000 cases, and with a death rate of 40%, pellagra had devastating effects on the region.[5]

Pellagra was a painful skin disease commonly found in tropical regions. Some physicians at the time believed that the disease arose in consequence of bad genes, airborne germs, or miasma resulting from poor sanitary conditions.[6] Goldberger's theory that pellagra was associated with diet contradicted the most widely accepted medical opinion that pellagra was an infectious disease. The germ theory of disease had recently become popular in not only the medical field but also the public's consciousness. As a result, the germ theory was often generalized to far more ailments than it actually caused. Goldberger, in contrast, suspected that diet was the true cause, which he came to believe through his observation that hospital staff who worked closely with pellagra patients did not fall sick themselves.[1] Furthermore, pellagra cases were overwhelmingly poor Southerners, especially African Americans and sharecroppers. This was a group that often ate filling and starchy but nutrient-poor foods, especially those derived from corn.[1]

His investigation into pellagra led him to conduct two parallel experiments starting in 1914.[1] In one study, he investigated two orphanages that were experiencing rampant pellagra. A group of 172 orphans had the disease already, while 168 subjects did not. With federal funding, he switched them to a more varied diet that included fresh meat, vegetables, milk, and eggs.[1][5] After several weeks, there were no new cases and almost all of the afflicted orphans had recovered. In the two years of the study, there was only one new case.[1]

His next experiment took place at the Georgia State Sanitarium, the largest mental asylum in the South. Like the orphanages, the asylum had high rates of pellagra. However, this experiment included both an experimental and a control group. Also, he studied two categories of human subjects: black women and white women. By assessing their dietary intake, Goldberger aimed to test his hypothesis. The control group continued receiving the same food as before, but the experimental group was given a more balanced diet. Over the two-year span, half of the control group was sick while everyone on the varied diet recovered. In fact, the latter group improved so much that there was a high dropout rate, since many subjects became well enough to leave the institution. Unfortunately, after the study, the funding for more nutritious food dried up and the pellagra rates in the orphanages and asylum returned to pre-study levels.[1]

Goldberger's next objective was to confirm the relationship between poor diet and pellagra. To do this, he met with Earl L. Brewer, the governor of Mississippi, in 1915. He requested access to prisoners of the Rankin State Prison Farm to try and induce pellagra in them. He chose this prison in particular because it previously had no cases of pellagra. After negotiation, Earl accepted Goldberger's request in return for pardons for the prisoners (some of whom had connections with the governor).[1]

Goldberger experimented on 11 healthy volunteers from the Rankin State Prison Farm for this 9-month study. The subjects were put on a strict and heavily monitored corn-based diet lacking meat, milk, and vegetables. Goldberger observed that the subjects became weaker and weaker as the days went on. After six months, five of the eleven patients contracted pellagra and the rest had symptoms corresponding to pellagra. The prisoners reported enduring agony once they were afflicted, and some even tried to drop out of the study but were prevented from doing so.[1] Despite his careful experiments, Goldberger's discovery proved socially and politically unacceptable, and he made little progress in gaining support for the treatment of pellagra. Besides the popularity of the germ theory, opposition also came from Southern leaders who resented a Northerner claiming that the pellagra outbreak was a product of the region's widespread poverty.[1] Consequently, Goldberger became extremely frustrated. He conducted one final experiment, referred to as "filth parties", to silence the critics. In 1916, he injected 16 volunteers—including himself, his wife, and his assistant—with pellagric blood over 7 trials. Afterwards they experienced diarrhea and nausea but did not contract the disease. However, this effort too was rejected by critics for using almost entirely male subjects when pellagra was supposedly more common in females.[1]

Though Goldberger established a clear link between pellagra and diet, he never discovered the specific nutrient deficiency that caused it.[1] It was not until 1937 that Conrad Elvehjem discovered that pellagra is caused by a dietary lack of the B vitamin niacin, along with reduced levels of the essential amino acid tryptophan. Tom Spies also contributed to this finding.