This is the story of the public health doctor who found that pellagra, the “scourge of the south,” was caused by a flawed diet. Joseph Goldberger was the son of immigrant Orthodox Jewish parents who came to New York in 1883 and settled on the Lower East Side. At first he wanted to become an engineer and enrolled at the free City College, dividing his time between studying and helping at his father's grocery store. A neighbourhood Irish immigrant friend introduced him to the ultimate in engineering marvels—the human body—and young Goldberger became hooked on medicine. Entering Bellevue Hospital Medical College, he was further inspired by Dr Austin Flint and graduated in 1895.
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He passed the written and oral examinations for the US Marine Hospital Service, whose name was changed in 1912 to the US Public Health Service, and was commissioned as assistant surgeon. His first post was as medical inspector of newly arrived immigrants at the port of New York.
Assistant surgeon Thomas Richardson, scion of a prominent southern family, next assigned him to a quarantine station, where he learnt to recognise the signs of typhus, plague, cholera, and smallpox. The two men became firm friends, and Richardson introduced Goldberger to his cousin Mary, a pretty young southern belle and grand niece of the Confederate leader Jefferson Davis.
In the face of opposition from both their families they were married in 1906, and Mary, who shared his scientific curiosity, became the loyal supporter of his medical research. Goldberger's great opportunity arose when the surgeon general assigned him to investigate pellagra. By 1912 South Carolina alone had reported 30 000 cases, with a death rate of 40%.
Goldberger (together with a group of volunteers) disproved the current infectious theory of pellagra by ingesting bodily “materials” from the bodies of people with pellagra and even going so far as to inject Mary with blood from patients. After careful feeding experiments at an orphans' home, an insane asylum, and a prison farm in Mississippi, Goldberger concluded that pellagra was caused by a dietary deficiency of niacin and could be cured by adding brewer's yeast to the diet of people with the deficiency. Alert to social and economic factors involved in disease, he campaigned vigorously against the low wages of southern mill workers, which prevented them from acquiring a balanced diet.
Dr Joseph Goldberger died of hypernephroma in 1929. His portrait hangs in the director's office at the National Institutes of Health in Bethesda, Maryland.
Kraut concludes, “By the end of the century [in 1998], when a medical audience in Charleston, South Carolina, was asked how many had ever seen a case of pellagra, only a few of even the older physicians raised their hands.”
Alan M Kraut