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BOOK REVIEW |
Johns Hopkins School of Medicine
550 North Broadway
Suite 700
Baltimore, MD 21205
E-mail: rdsemba{at}jhmi.edu
In the early 20th century, pellagra was a leading cause of death in the American South, inspiring fear as a possible contagious disease and killing thousands of poor rural folk and institutional inmates who subsisted on a monotonous diet of pork fat, corn bread, and molasses. The US government devoted a huge proportion of its budget to combat this malady, and the central figure in these efforts was Dr Joseph Goldberger. In Goldberger's War: The Life and Work of a Public Health Crusader, Alan Kraut presents both the public and personal sides of Goldberger, from the near heroics of his pellagra studies to his views on God as "Infinite Intelligence." Kraut provides new and valuable material and insight on Goldberger as gleaned from his correspondence and related archives.
Joseph Goldberger was a Jewish immigrant who grew up in New York City, where his parents ran a grocery store on the East Side. He became a physician and joined the US Public Health and Marine Hospital Service, where he established his reputation through investigations of typhoid fever, yellow fever, measles, dengue, and diphtheria. Although Goldberger is best known for his pellagra studies, the first third of this book is devoted to his early family life and work on infectious diseases—background that is essential to understanding Goldberger's subsequent approach to pellagra.
In 1914, Surgeon General Rupert Blue appointed Goldberger to direct the investigations into pellagra, which was widely considered to be an infection and one that was becoming epidemic in orphanages, asylums, and mill towns. Goldberger showed that changing the diet—by including meat, dairy products, and legumes—decreased the incidence of pellagra. Kraut evenly details the ethical aspects of Goldberger's Rankin State Prison Farm experiment in light of the attitudes and practices of the time. In this notable study, Goldberger produced pellagra in convicts by feeding them a traditional, monotonous Southern diet. The participants in this study were offered pardons by the governor in return. To provide further evidence that pellagra was not infectious, Goldberger, his wife, and his associates ingested or were injected with urine, blood, skin scrapings, and feces from patients with pellagra. From reading about his long travels through the South, as chronicled in letters to his wife Mary, there emerges the impression of an indefatigable crusader who sadly sacrificed much of his family life in pursuit of science.
The story of pellagra in the American South is not merely one of niacin deficiency that was nearly deciphered and conquered, because there were many complex forces at play. As declared by Goldberger, "The problem of pellagra is in the main a problem of poverty." The interactions of social forces, stigmatization, economic development, and the idea of progress are amalgamated in this compelling book. Goldberger's investigations were brilliant and systematically conducted, and students of epidemiology, nutrition, and public health should be familiar with this episode in American history. Kraut has brought further original aspects of pellagra to light in his research, and his biography of Joseph Goldberger should become a standard for the study of nutritional deficiencies.
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