Joseph Goldberger: Pellagra, Corn and the Proof of a Dietary Disease

Joseph Goldberger: Life and Career

From a Hungarian village and Manhattan’s Lower East Side to the Public Health Service, years of chasing yellow fever, typhus and measles, and fifteen years as the government’s pellagra chief.

The Pellagra Experiments: Orphanages, a Prison Farm and the Filth Parties

The diet trials, the 1915 Rankin prison farm experiment, the 1916 self-inoculation experiments and the cotton-mill village survey that together showed pellagra was a dietary disease.

Corn, Brewer’s Yeast and the P-P Factor

Why a corn-based diet caused pellagra, why lime-cooked corn did not, black tongue in dogs, and how brewer’s yeast led to the naming of factor P-P in 1926.

From Factor P-P to Niacin: Goldberger’s Legacy

Elvehjem’s 1937 identification of nicotinic acid, the role of tryptophan, enriched flour, the end of endemic pellagra in the United States, and pellagra in the world today.

1. Who Joseph Goldberger Was

Goldberger was born on 16 July 1874 in Girált, in the Kingdom of Hungary (today Giraltovce in Slovakia). In 1883, as a boy, he emigrated with his family to the United States, where they settled on the Lower East Side of Manhattan. He entered the City College of New York to study engineering, switched to Bellevue Hospital Medical College after hearing a lecture by Austin Flint Jr., and received his medical degree in 1895. After two years of private practice in Wilkes-Barre, Pennsylvania, he joined the US Marine Hospital Service — later the Public Health Service — in 1899, and stayed in it for the rest of his life.

For more than a decade he was an epidemic fighter. He worked against yellow fever in Mexico, Puerto Rico and the Gulf states, studied typhus, dengue and typhoid, and caught several of the diseases he studied. With John F. Anderson he showed that measles could be passed on by an agent small enough to slip through a filter, and that lice carry typhus. In 1914, Surgeon General Rupert Blue put him in charge of the Service’s pellagra investigations. He died of kidney cancer in Washington, D.C., on 17 January 1929, aged 54, having been nominated several times for the Nobel Prize. The full story is in Joseph Goldberger: Life and Career.

2. Pellagra and the Puzzle of 1914

Pellagra was unknown in Europe until maize arrived from the Americas. Eighteenth-century physicians — Gaspar Casál in Spain and Francesco Frapolli in Italy — described it among poor peasants who lived on corn. In the United States it was first reported in 1902 and spread across the South over the next two decades. Historians estimate that it killed at least 100,000 people in the southern states between 1900 and 1940; about half of the victims were African-American and more than two-thirds were women. People with the disease were shunned, a fear historians call “pellagraphobia.”

When Goldberger took up the problem, there were several rival explanations. The Italian school blamed a toxin in spoiled corn. The London-based tropical-medicine physician Louis Sambon proposed an insect-borne infection. Casimir Funk’s 1912 “vitamine” idea had been applied to pellagra by Fleming Sandwith and by Rupert Blue himself. A privately funded body, the Thompson-McFadden Pellagra Commission, studied six mill villages around Spartanburg, South Carolina, between 1912 and 1914 and concluded that pellagra was probably infectious. Historians Charles Bryan and Shane Mull have written that the long resistance to a dietary explanation cost many lives.

3. The Discovery on One Page

Within about four months of starting, Goldberger concluded from simple observations that pellagra was a dietary disease. The most telling was that nurses and attendants in institutions where pellagra was common almost never caught it from the patients — something hard to explain for an infection, but easy to explain if the staff ate a different diet. He published this reasoning in “The etiology of pellagra” in Public Health Reports in 1914.

He then tested it in four steps:

Diet trials (from 1914). At two orphanages in Jackson, Mississippi, and at the Georgia State Sanitarium, the diet was changed to add fresh animal and leguminous protein foods — milk, buttermilk, eggs, beans and peas — and to cut back on corn. According to the account by epidemiologist Alfredo Morabia, new cases and recurrences virtually disappeared, while recurrences continued in comparison wards on the old diet. The 1923 final report concluded that pellagra could be completely prevented by diet.
The Rankin State Prison Farm (1915). With the governor of Mississippi offering pardons, eleven healthy volunteer convicts ate a restricted corn-based diet for several months. About half of them (five or six, by different counts) developed pellagra.
The transmission experiments (1916). Goldberger, his wife Mary and Public Health Service colleagues — sixteen or seventeen volunteers, by different counts — were injected with pellagrins’ blood, swabbed with their secretions and swallowed capsules made from their scabs and excreta. Nobody developed pellagra. These sessions became known as the “filth parties.”
The cotton-mill survey (from 1916). With the statistician Edgar Sydenstricker and the physician G. A. Wheeler, Goldberger recorded what families in seven South Carolina mill villages actually ate. Pellagra was concentrated in the poorer households with the least fresh meat and milk; sanitation did not explain it.

The subjects of these studies — institutionalised orphans, asylum patients and convicts offered pardons — are part of the history, and the deep-dive article reports them plainly. The details are in The Pellagra Experiments: Orphanages, a Prison Farm and the Filth Parties.

4. The Natural Source: Fresh Food, Brewer’s Yeast and Corn

The cure for pellagra came out of ordinary food. Through the 1920s, Goldberger and his colleagues tested foods one at a time for their power to prevent pellagra in people and its canine counterpart, black tongue in dogs: fresh beef, milk, butter, dried beans, casein, cowpeas, tomatoes, carrots, rutabaga, wheat germ and canned salmon, among others. In 1922, with W. F. Tanner, he suggested that a shortage of certain amino acids was probably the main cause — an idea later superseded, though it pointed in a useful direction, because the amino acid tryptophan turned out to be a raw material the body uses to make niacin.

In 1926 he named the protective substance factor P-P and showed it was distinct from the vitamin B of the time. Dried brewer’s yeast proved a rich and cheap source, and after the great Mississippi flood of 1927 — which Goldberger and Sydenstricker surveyed for pellagra — the Red Cross distributed yeast in the flood area.

Corn itself was the other half of the story. In Mexico and Central America, cooks have long simmered and soaked dried maize in water made alkaline with lime, a process called nixtamalization. Reviews of maize processing report that this frees much of the niacin held in a poorly absorbed, bound form in the grain. Together with a diet that also included beans and squash, it helps explain why the peoples of Mesoamerica, who ate more maize than anyone, were spared pellagra. Europeans and the farmers of the American South took up maize without the lime step, and historians add that new milling methods in the South removed vitamins from the grain. The full natural-source story is in Corn, Brewer’s Yeast and the P-P Factor.

5. Timeline at a Glance

1874 — Born 16 July in Girált, Kingdom of Hungary.
1883 — Emigrates with his family to New York’s Lower East Side.
1895 — Medical degree from Bellevue Hospital Medical College.
1899 — Joins the US Marine Hospital Service.
1902–1906 — Field work against yellow fever; later typhus, dengue and measles studies.
1902 — Pellagra first reported in the United States.
1914 — Appointed to lead the Public Health Service pellagra investigations; publishes “The etiology of pellagra”; orphanage and asylum diet trials begin.
1915 — Rankin State Prison Farm experiment in Mississippi.
1916 — Transmission (“filth party”) experiments; cotton-mill village survey begins with Sydenstricker and Wheeler.
1922 — Amino-acid hypothesis; black tongue in dogs adopted as an animal model.
1923 — Final report of the institutional diet trials.
1926 — Factor P-P named; brewer’s yeast identified as a rich source.
1927 — Pellagra survey of the Mississippi flood area.
1929 — Dies of kidney cancer in Washington, D.C., on 17 January.
1937 — Conrad Elvehjem identifies nicotinic acid as the anti-black-tongue (P-P) factor.
1938 — Nicotinic acid treatment of human pellagra reported.
1940s — Wartime enrichment of flour and bread; endemic pellagra disappears from the United States.

6. Later Significance

Goldberger did not live to see his factor named as a chemical. In 1937 Conrad Elvehjem and his colleagues at the University of Wisconsin isolated the anti-black-tongue factor from liver and identified it as nicotinic acid, a compound chemists had known for decades. Reports of nicotinic acid treating human pellagra followed in 1938. Over the 1940s and 1950s, pellagra came to be understood as a deficiency of niacin and of its precursor tryptophan — which helps explain why both Goldberger’s protein foods and his yeast worked. According to the neurologist and historian Douglas Lanska, the collapse of cotton and the diversification of Southern farming during the Depression contributed to an abrupt decline of pellagra in the early 1930s, and wartime fortification of foods finally ended endemic pellagra in the United States.

Epidemiologists regard Goldberger’s work as a model of field investigation: observation, a testable hypothesis, controlled diet trials and a household survey that tied disease to income and food supply. Historians have also examined how the economic framing of the mill-village studies treated race and gender. Pellagra still occurs today where diets depend heavily on untreated maize, and in people with alcohol dependence, malabsorption or certain medicines such as isoniazid. The later story is told in From Factor P-P to Niacin: Goldberger’s Legacy, and the vitamin itself on the site’s Vitamin B3 (Niacin) page.

Key Research Papers

Goldberger J. The Etiology of Pellagra: The Significance of Certain Epidemiological Observations with Respect Thereto. Public Health Reports. 1914;29(26):1683. DOI: 10.2307/4570920
Goldberger J, Wheeler GA. Experimental Pellagra in the Human Subject Brought about by a Restricted Diet. Public Health Reports. 1915;30(46):3336. DOI: 10.2307/4572984
Goldberger J. The Transmissibility of Pellagra: Experimental Attempts at Transmission to the Human Subject. Public Health Reports. 1916;31(46):3159. DOI: 10.2307/4574262
Goldberger J, Wheeler GA, Sydenstricker E. A Study of the Relation of Diet to Pellagra Incidence in Seven Textile-Mill Communities of South Carolina in 1916. Public Health Reports. 1920;35(12):648. DOI: 10.2307/4575517
Goldberger J, Waring CH, Tanner WF. Pellagra Prevention by Diet among Institutional Inmates. Public Health Reports. 1923;38(41):2361. DOI: 10.2307/4576901
Goldberger J, Wheeler GA, Lillie RD, Rogers LM. A Further Study of Butter, Fresh Beef, and Yeast as Pellagra Preventives, with Consideration of the Relation of Factor P-P of Pellagra (And Black Tongue of Dogs) to Vitamin B. Public Health Reports. 1926;41(8):297. DOI: 10.2307/4577789
Elvehjem CA, Madden RJ, Strong FM, Woolley DW. Relation of Nicotinic Acid and Nicotinic Acid Amide to Canine Black Tongue. Journal of the American Chemical Society. 1937;59(9):1767-1768. DOI: 10.1021/ja01288a509
Elmore JG, Feinstein AR. Joseph Goldberger: an unsung hero of American clinical epidemiology. Ann Intern Med. 1994;121(5):372-5. PubMed PMID: 8042827
Morabia A. Joseph Goldberger’s research on the prevention of pellagra. J R Soc Med. 2008;101(11):566-8. PubMed PMID: 19029358
Mooney SJ, Knox J, Morabia A. The Thompson-McFadden Commission and Joseph Goldberger: contrasting 2 historical investigations of pellagra in cotton mill villages in South Carolina. Am J Epidemiol. 2014;180(3):235-44. PubMed PMID: 24966221
Bryan CS, Mull SR. Pellagra Pre-Goldberger: Rupert Blue, Fleming Sandwith, and The “Vitamine Hypothesis”. Trans Am Clin Climatol Assoc. 2015;126:20-45. PubMed PMID: 26330657
Marks HM. Epidemiologists explain pellagra: gender, race, and political economy in the work of Edgar Sydenstricker. J Hist Med Allied Sci. 2003;58(1):34-55. PubMed PMID: 12680009
Lanska DJ. Chapter 30: historical aspects of the major neurological vitamin deficiency disorders: the water-soluble B vitamins. Handb Clin Neurol. 2010;95:445-76. PubMed PMID: 19892133
Suri DJ, Tanumihardjo SA. Effects of Different Processing Methods on the Micronutrient and Phytochemical Contents of Maize: From A to Z. Compr Rev Food Sci Food Saf. 2016;15(5):912-926. PubMed PMID: 33401800
Hegyi J, Schwartz RA, Hegyi V. Pellagra: dermatitis, dementia, and diarrhea. Int J Dermatol. 2004;43(1):1-5. PubMed PMID: 14693013

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