Goldberger, Joseph B. 1874-1929

GOLDBERGER, JOSEPH B. 1874-1929

The pellagra detective

The Microbe Hunter

Joseph Goldberger was a Hungarian who immigrated to the United States with his family at the age of seven. They lived in the East Side of Manhattan and ran a grocery store where Joseph worked as a delivery boy. A bright student, he entered the City College of New York at age sixteen. Goldberger first planned to become a civil engineer, but two years after he dropped in on a lecture at Bellevue Hospital Medical College, he changed his mind and decided to become a doctor. After graduating from Bellevue Hospital Medical College in 1895, he had a private practice until he joined the United States Public Health Service in 1899. For the next fourteen years he was a microbe hunter, fighting yellow fever, dengue fever, typhus, and typhoid in the United States and Mexico. His most important battle, however, remained ahead.

A Mysterious Malady

The disease pellagra was first described in the United States during the Civil War and was probably one of the causes of the high death rate in the Southern prison camps. Pellagra is characterized by an extreme form of dermatitis, digestive disorders that include diarrhea, and nervous and mental abnormalities. Between 1909 and 1913 two surveys confirmed that pellagra was widespread in the South and also seemed to support the view that the disease was infectious. The United States Public Health Service decided to investigate the disease, and in 1914 the surgeon general selected Goldberger to take charge.

Investigating Pellagra

Goldberger investigated pellagra at two orphanages in Mississippi. In each orphanage more than half of the children had pellagra in spite of a diet that was nutritious by the standards of that day. Goldberger decided that the disease could not be infectious: the adult attendants did not have pellagra; not all of the children had the disease; and there was no evidence of transmission from the affected to the healthy even though they lived closely together. He noted that the disease affected mostly children over three years old and saw that their diet was deficient in meat and other protein foods. Children under three in the institutions received milk, but the older ones did not. The healthy adult attendants received meat as part of their diet. Goldberger got funds from the Public Health Service, fed the children milk and meat, and in the next few months pellagra disappeared.

The Disease Detective

To determine that the cause of pellagra was dietary and not infectious, Goldberger observed carefully who in a community had the disease and who did not, and then he tried to see how the two groups differed. In the field he was tireless, Nearly every night he went to a different community and quizzed the local doctors or asylum supervisors. He asked people what they ate and whether their privies were screened (in case pellagra did turn out to be a contagious malady spread by flies). In 1915 he selected two groups of patients for study in a state sanatorium in Georgia where pellagra was frequently found. Both groups were kept under similar conditions, but one group continued to receive the regular institutional diet while the other group was given a diet higher in protein. Pellagra did not occur in the group receiving the supplement. Goldberger and his associates attempted unsuccessfully to transmit pellagra to volunteers with bodily materials obtained from patients who had the disease, but they could discover no risk factor other than diet.

The Deficiency Disease

Later work by other scientists would show that pellagra developed from a lack of the B vitamin niacin or the body's own synthesis of it from the amino acid tryptophan. Poor people in the South were always heavy cornbread eaters, but in normal times they got their niacin and tryptophan requirements from meat, milk, and vegetables. As pre-World War 1 economic circumstances brought hardship on southern workers, a diet lacking these essentials became the norm on southern tables and brought about the appearance of an epidemic. As a result of Goldberger's work thousands of lives were saved, and pellagra eventually vanished from the South.

Sources:

James Bordley III and A. McGehee Harvey, Two Centuries of American Medicine, 1776-1976 (Philadelphia: W. B. Saunders, 1976);

Edward Shorter, The Health Century (New York: Doubleday, 1987).