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NOVEMBER 1, 2024
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century ago, Augusta sat squarely in the middle of a medical battlefield, and the lives of millions of people hung in the balance. The war was being fought against a known but mysterious enemy. Its name was pellagra, but how it waged war against humans was the subject of intense debate. And a war it was: a single case reported in Georgia in 1902 quickly bloomed into an epidemic across the South. One of the first major outbreaks was documented at Alabama’s State Hospital for Colored Insane, where 88 inmates were afflicted, of whom 57 died. South Carolina alone had some 30,000 cases of this miserable disease in 1912, infamous for its Four Ds: diarrhea, dermatitis, dementia, and death. Across 15 southern states, pellagra caused an average of 7,000 deaths a year for several decades, ultimately taking some 100,000 lives. It was so loathsome and disfiguring that doctors initially believed it to be a form of leprosy, and in Italy it was given the apt and descriptive name mal de la misera. In 1914, US Surgeon General Rupert Blue asked one of the best epidemiologists in the US Public Health Service, Dr. Joseph Goldberger, to investigate pellagra.
CORN-FEDCALAMITY It was a huge medical, political, and social challenge, but Goldberger was up to the task. While there was plenty of pellagra out in the countryside, some of Goldberger’s earliest observations were made possible by controlled environments, places like prisons, orphanages, and mental asylums. In such places it was possible to document conditions and test treatment theories. For example, he noted in such facilities that patients and inmates often had pella-
gra, but staff members never did. That was a major key to checking the “non-communicable disease” box. From the start he suspected pellagra was related to dietary deficiencies. He tested the theory using two parallel experiments, one just down the road from Augusta. (He also collaborated with Virgil P. Sydenstricker of the Medical College of Georgia on a pellagra study in 1927.) In the first experiment, his laboratories were
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two orphanages in Jackson, MS, where pellagra was rampant. Goldberger arranged for the orphans at both institutions to be fed a more varied diet that regularly included fresh meat and plenty of milk. Virtually every case of pellagra dramatically improved or vanished within weeks. His next experiment was conducted in Milledgeville at the Georgia State Lunatic, Idiot, and Epileptic Asylum, which opened in 1842 and eventually became the largest mental asylum in the world (and also eventually became the shorter and more appropriately named Central State Hospital). At Milledgeville, a control group of patients continued to be fed their normal diet, while the experimental group received a varied, healthier diet. Everyone in the second group recovered. In a third study at Rankin State Prison Farm in Mississippi, Goldberger deliberately induced pellagra in twelve healthy volunteer subjects (prisoners) by altering their diets to one typical of many Southerners: biscuits, mush, grits, brown gravy, cornbread, sweet potatoes, cane syrup, and coffee. It may sound innocuous, but within six months, half of the men had developed pellagra (and all Please see CORN-FED page 3
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