The American South's Deadly Diet

To test his diet theory, Goldberger supplied what he called “a diet such as
that enjoyed by well-to-do people” — meat, milk and vegetables — to two
Mississippi orphanages and an asylum. Pellagra rates there plummeted. His
next quest: to induce pellagra in healthy subjects. In 1915, with pardons
in hand from Mississippi’s progressive governor, Goldberger recruited 12
healthy volunteers at the Rankin State Prison Farm to eat the three Ms
diet. Within the six-month trial period, six volunteers exhibited the
telltale dermatitis. Goldberger was convinced he had proven the link
between the Southern poverty diet and pellagra.

To bolster his case against the germ theorists, in 1916 Goldberger
conducted what he called filth parties. He tried to infect himself, his
wife and other volunteers with pellagra by injecting and ingesting the skin
scales, urine, feces, blood and saliva from pellagra patients. No one got
pellagra. He also organized extensive epidemiological studies of seven
villages that conclusively proved the link between pellagra and poverty.
The studies are still used in medical schools today and hailed for their
thorough, groundbreaking analysis of where economics, social conditions and
health intersect.

Yet pellagra raged on, propelled by plummeting cotton prices in 1920.
Goldberger advocated for food aid for the South, to mitigate what the PHS
called a “veritable famine” developing in the Cotton Belt due to poor
farmers’ diets. Southern politicians and businessmen railed against the
recommendation, which they perceived as an attack on their honor.
“Goldberger didn’t understand Southern pride,” Kraut says. “His mission was
to conquer the suffering and solve the medical mystery.” He still had a
ways to go.

The P-P Factor

Goldberger focused on identifying the missing dietary element, which he
called the P-P factor, for pellagra preventive. In 1922, he tried to induce
black-tongue disease — the canine analog of pellagra — in his laboratory
dogs by feeding them a diet typical of poor Southerners, plus brewer’s
yeast purely to stimulate the dogs’ appetite. The dogs remained healthy,
prompting suspicion. Without the yeast, the dogs developed pellagra.
Repeated testing on the dogs, then on human subjects, confirmed that
brewer’s yeast, a product the poor could afford, contained the P-P factor
that cured and prevented pellagra.

Goldberger was finally publicly vindicated in 1927. That spring, the
Mississippi River flooded, to devastating effect. The potential for a
widespread pellagra outbreak surged in flood-ravaged areas of Tennessee,
Arkansas, Louisiana and Mississippi. Goldberger oversaw the Red Cross’
distribution of 12,000 pounds of brewer’s yeast in those areas. That effort
cured most pellagrins within six to 10 weeks, prevented untold thousands
more cases and earned Goldberger the recognition that was long overdue —
though he wouldn’t enjoy it for long.

Goldberger died in 1929, the same year that pellagra cases at large started
declining. The Red Cross carried on his work; by 1937 it had distributed
500,000 pounds of brewer’s yeast — frequently referred to as Vitamin G for
Goldberger. That year, researchers identified niacin (abundant in brewer’s
yeast) as the elusive P-P factor, and doctors established a standard dosage
and therapy. Niacin has since become a dietary staple, now better known for
fighting high cholesterol than pellagra.

Today, pellagra is mostly relegated to history lessons and medical
reference books. But occasionally, such as during isolated outbreaks in a
refugee crisis, the world receives a vivid reminder of how the disease
still affects people. And as Tissier saw in her hamsters, it’s also a
lesson anyone caring for animals should keep in mind. This scourge is not
gone, just largely forgotten.

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