Joseph Goldberger was one of the doctors who made extraordinary efforts to discover the relationship between our health and what we eat.
Nutrition, which is all the rage these days, has long been a neglected area of medicine.
Strange as it may seem, research on the relationship between food and health has been remarkably slow, and a significant part of the knowledge has been acquired thanks to doctors who have experimented on themselves, putting their own lives at risk.
Doctors like Joseph Goldberger, a Jew from New York who arrived in the extreme south of the United States in 1914.
There, he took an intellectual leap that led him to unravel a mystery, save tens of thousands of lives and force governments, for the first time, to take action on what people ate.
He had been sent by the US Surgeon General (the government’s chief spokesman on public health affairs) to investigate an epidemic that was sweeping through the southern states of the country.
Pellagra was a horrible disease. It started with what looked like a mild sunburn on the backs of her hands and turned into a butterfly-shaped rash on her face.
Then came depression, confusion and dementia. In 40% of cases it ended in the death of the patients.
It killed thousands of Americans every year and sickened tens of thousands.
Goldberger’s mission was to find the cause.
a crucial detail
The disease had appeared out of nowhere, and in homes where there was an “infected” person there was an 80% chance that the other residents would acquire the condition.
Unsurprisingly, it was considered highly contagious, and those suffering from it were shunned like lepers.
Goldberger had the support of the Surgeon General, but as the son of immigrants, he always considered himself an outsider, a maverick.
“All his life, Joseph Goldberger was fascinated by the American West and the Wild West. And much of his work as a medical detective and his fight against the epidemic was an extension of that desire to be an adventurer that has made something valuable,” says Alan Kraut , author of Goldberger’s War (“Goldberger’s War”, in free translation) at the BBC.
“He saw himself partly as a lone cowboy swimming upstream, firing scientific bullets,” confirms physician Don Sharp, Goldberger’s nephew.
Goldberger traveled throughout the southern United States, tracking the disease in prisons, orphanages and nursing homes.
And I noticed something amazing. Pellagra affected the inmates but not the staff.
He realized then that it couldn’t be an infectious disease, as most of his fellow doctors insisted. It had to be something else.
He soon became convinced that there was something in the diet that was causing pellagra. But Goldberger knew that criticizing Southern food like someone Northern wasn’t going to make it popular.
“To get scientists to support his belief that pellagra was a dietary deficiency and not a bacterial disease, he needed evidence,” says Kraut.
It was then that he devised a controversial experiment.
He decided he was going to take 12 perfectly healthy men and give them pellagra.
The “volunteers” would come from a Mississippi prison.
At that time many people, especially poor people, ate what was considered a typical southern delicacy, and nothing else.
They ate crispy bacon—the layer of fat under the skin on a pig’s back—, cornmeal, and molasses.
“All the inmates had to do was eat regular food, no fresh meat, eggs, vegetables or greens,” explains Goldberger’s nephew.
“Initially, participants thought it was great.”
But after six months, all the prisoners developed pellagra and Goldberger stopped the experiment.
He was now fully convinced that a dietary deficiency was the cause of pellagra.
But the scientific community disagreed.
“They criticized the methodology and the results and insisted that whatever Goldberger showed, it was a bacterial disease and he hadn’t found the germ,” says Kraut.
Goldberger was furious. “Those stupid, selfish, envious, prejudiced neigh their supposed criticism.”
By this point, he was so desperate that he was willing to do anything.
To silence the critics and prove without a doubt that pellagra was not an infectious disease, he decided to do something even more controversial: test it on himself.
“I have not imposed any restrictions of any kind… No attempt has been made to prevent ‘natural infection’,” he wrote.
The first thing he did was go to the local pellagra hospital and, using a cotton swab, he collected the mucus from the patients nose and stuffed it into his own nostril.
“The time between collection and inoculation was less than two hours.”
“By the way, perhaps it should be taken into account that some of the secretions applied to the nasopharynx must have been ingested,” he said.
Next, he collected urine, skin, and stool samples.
“The patient who provided the stool was suffering from a severe case and had four loose bowel movements a day.”
He mixed these ingredients with wheat flour to make a pill… and he swallowed it.
“There’s definitely a disgusting quality to the idea of ingesting other people’s feces and skin scabs,” Kraut points out, probably echoing what you’re thinking.
“We as a family have always found it incredible that he put himself at risk like this. Often when we talk about it among family members or groups of friends, we cringe,” says Sharp.
Goldberger even convinced his colleagues to participate in experiments, which he called the “dirty party.”
As if feces and urine weren’t enough, Goldberger had one last surprise for them: blood.
He collected blood from a patient to inject into each of the volunteers, including his wife, Mary.
“I think my grandmother wanted to do everything she could to silence the critics,” Sharp says.
“The men wouldn’t let me swallow the pills, but they gave me an injection in my abdomen with the blood of a woman who was dying of pellagra,” Mary wrote.
Any kind of disease could have been transferred to that needle.
“It was a leap of faith. I didn’t need courage.”
Mary’s faith was rewarded.
None of the volunteers got sick.
“My grandfather was very moved and very happy that none of the people who attended the dirty party were suffering from anything serious apart from a little diarrhea.”
“And certainly none of them had pellagra.”
Goldberger thought he finally had it: He had all the evidence he needed to prove that pellagra wasn’t contagious.
The condition must have been caused by something deficient in the Southern diet.
His case was absolutely irrefutable. It was time to make it public and accept the applause.
But what he received was a barrage of violent and scathing criticism from the southern populace.
“Whether (the fact that) he was a Jew and a New Yorker and a Federalist played a part in how he was treated and berated or if it was just what he was saying, we’ll obviously never know,” notes Sharp.
Goldberger realized that he would never convince doctors that pellagra was caused by a dietary deficiency unless he found a simple, inexpensive cure.
A few years later…
In 1923, Goldberger finally found what he was looking for, and the discovery happened in a curious way.
He had experimented with dogs, trying to give them pellagra by feeding them a southern diet.
The problem was that the dogs didn’t want to eat that food.
Then he added what he described as an appetite stimulant.
Months passed and the dogs were still healthy.
Eventually Goldberger realized that the stimulant was what protected the animals—it was the answer he’d been searching for all these years.
And here it is.
It is not animal, it is not vegetable, it is not mineral. It’s yeast.
In 1927, Goldberger’s time had finally come.
The floods had triggered another pellagra epidemic. And Goldberger brought the leaven to the refugees.
It was amazing. A few teaspoons a day were enough to cure them.
Goldberger was finally proclaimed a hero.
A few years later, a chemist finally isolated the pellagra-preventive factor in yeast. It’s a vitamin called niacin.
The US government has ordered factories to fortify flour with niacin. Other countries followed suit and pellagra soon became a rare disease.
We now know that niacin is essential for healthy skin and proper functioning of the digestive and nervous systems.
But what Goldberger really showed was the strong link between food and health. There is a direct relationship between what we eat and how we live and what will make us sick, and that’s exactly what Joseph Goldberger wanted the world to understand.
*This article is based in part on the BBC series “Medical Mavericks”.
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