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Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990.

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Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.

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Goldberger and the Mal de la Rosa*

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When Goethe crossed the Alps from Austria into Italy in 1786, he made many observations on pellagrins, recording in his journal:

I know little, if anything, pleasing to say about the people. As soon as the sun rose over the Brenner paths in the Alps I noticed a decided change in their appearance, and especially displeasing to me was the brownish tan color of the women. Their features indicated misery, and the children were just as pitiful to behold; the men were little better, though their general features were regular and good.I believe the cause of this sickly condition is found in the continued use of Turkish and heath corn.

In 1735 Casal announced that pellagra was a malady caused by food, and for nearly two centuries a group called zeists held the belief that intoxication of poisons in Indian corn caused pellagra. In 1905 Sabmon proposed a different etiology, claiming that pellagra was an insect-borne disease, similar to sleeping sickness, malaria, and yellow fever, leading to a second group called anti-zeists. Although pellagra was almost two centuries old in Europe, the question of etiology was still unanswered in 1908 when pellagra was noted to be alarmingly prevalent in southern parts of the United States, particularly in prisons and orphanages. In the report of the distinguished Thompson–McFadden Commission in 1914, this conclusion was reached: "Pellagra is in all probability a specific infectious disease communicable from person to person by means at present unknown." Such was the situation when the U.S. Public Health Service appointed one of its members, Joseph Goldberger, to work on the problem. What is remarkable about Goldberger's achievement is not only that he determined the general cause of pellagra but that he did so with brilliant method.

Already highly regarded for his research on infectious diseases, Goldberger confessed to his wife on receiving this assignment at age 40, "I have never faced anything with greater reluctance" (M.F. Goldberger, 1956). He knew nothing about pellagra and had never seen a case before he began to visit pellagrins in orphanages, insane asylums, prisons, and hospitals throughout the South. A colleague of his wrote that "Goldberger with a new problem was emotionally the boy with a new pair of skates and intellectually Sherlock Holmes with a new murder mystery" (Parsons, 1931).

Goldberger made two distinct observations quickly: (1) that the attendants of pellagrins never got pellagra; and (2) that orphans age 6 through 12 years suffered overwhelmingly from pellagra. With the first observation he considered the disease noncontagious. The second observation led him to believe that it was of dietary etiology, because orphans under age 6 got a large quantity of milk, and orphans over age 12 obtained a better supply of meat. By improving the diet of orphans he noted recovery from pellagra and no recurrence, drawing the conclusion that "pellagra may be prevented by appropriate diet without alteration in the environment, hygenic or sanitary" (Goldberger, Waring, and Willets, 1915).

Goldberger sought to prove his theory by an experiment at a Mississippi penitentiary. In exchange for their pardon, 11 convicts volunteered to eat a pellagra-producing diet. Goldberger's report follows:

The diet given them consisted of biscuits, fried mush, grits and brown gravy, syrup, corn bread, cabbage, sweet potatoes, rice, collards, and coffee with sugar. All components of the dietary [sic] were of the best quality and were properly cooked.

Although the occurrence of nervous symptoms and gastro-intestinal disturbances was noted early, it was not untilabout five months after the beginning of the restricted diet, that the skin symptoms so characteristic of pellagra began to develop. The symptoms are considered as typical, every precaution being taken to make sure they were not caused by any other disease. The convicts upon whom the experiment was being made, as well as twenty other convicts who were selected as controls, were kept under continuous medical surveillance. No cases of pellagra developed in camp, excepting among those men who were on the restricted diet. The experimenters have, therefore, drawn the conclusion that pellagra has been caused in at least six of eleven volunteers as a result of the one-sided diet on which they subsisted. (U.S. Public Health Service, 1915)

In spite of the evidence, many physicians remained unconvinced of pellagra's dietary etiology. Goldberger went on to conduct astonishing experiments on himself and willing associates to rule out the possibility of an infectious origin. His wife wrote this account:

Secretions were obtained by wiping the nose and naso-pharynx of pellagra patients with a cotton swab. These swabs were transferred at once, rubbing them over the mucosa and naso-pharynx first of Dr. Wheeler by Dr. Goldberger, and then of Dr. Goldberger by Dr. Wheeler. Further experiments took place in that month, and in May and June of 1916. Seven separate groups (twenty men and one woman) swallowed in capsules the most neauseating diabolical concoctions made up of secretions of blood, feces, and urine of pellagra patients. Dr. Goldberger himself was a member of each of these groups. On May 7, 1916, I begged to be one of the volunteers and joined him, Dr. Wheeler, and four other men at the hospital in Spartanburg. The men would not consent to my swallowing the pills, but I was given by hypodermic in the abdomen an injection of the blood of a woman dying of pellagra. Not one of us ever showed, as a result, any symptoms of pellagra. (M.F. Goldberger, 1956)

Before he died at age 55, Goldberger wrote 47 papers on pellagra. On his deathbed, he received word that Harvard University nominated him for a Nobel Prize for the fifth time unsuccessfully.

References

  1. Goldberger J, Waring CH, Willets DG. A test of diet in the prevention of pellagra. South Med J. 1915;8:1043–44.
  2. Goldberger MF. Dr. Goldberger. His wife's recollections. J Am Diet Assoc. 1956;32:724–27. [PubMed: 13357255]
  3. Parsons RP. The adventurous Goldberger. Ann Med Hist. 1931;3:534–39.
  4. Roberts SR. Pellagra: history, distribution, diagnosis, prognosis, treatment, and etiology. St. Louis: CV Mosby, 1912.
  5. US Public Health Service. Public Health Service discovers cause and cure of pellagra—pellagra caused by insufficient protein diet. South Med J. 1915;8:1042–43.

Mal de la Rosa is a Spanish term for pellagra, meaning "sickness of the rose."

Footnotes

*

Mal de la Rosa is a Spanish term for pellagra, meaning "sickness of the rose."

Copyright © 1990, Butterworth Publishers, a division of Reed Publishing.
Bookshelf ID: NBK713PMID: 21250289
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