WEBVTT - Pellagra, Part 2 0:00:01.320 --> 0:00:04.240 Welcome to Stuff You Missed in History Class, a production 0:00:04.400 --> 0:00:10.920 of iHeartRadio. 0:00:11.920 --> 0:00:15.080 Hello, and welcome to the podcast. I'm Tracy V. Wilson 0:00:15.160 --> 0:00:18.400 and I'm Holly Frye. Here is part two of our 0:00:18.440 --> 0:00:22.119 episode on pelagra, something I did not realize was going 0:00:22.160 --> 0:00:26.560 to need two parts when I started, I was totally 0:00:26.640 --> 0:00:29.760 unaware that there was a whole history of pelagor in 0:00:29.840 --> 0:00:33.199 Italy that took place before it really became a problem 0:00:33.240 --> 0:00:35.400 in the United States, and I was only aware of 0:00:35.440 --> 0:00:40.159 the US stuff before working on this. Last time, we 0:00:40.240 --> 0:00:45.640 talked about what pelagor is, its appearance and eventual maybe 0:00:45.640 --> 0:00:48.920 not disappearance, but like resolution in Italy, and some of 0:00:48.960 --> 0:00:52.159 the social and economic factors that led to a rise 0:00:52.440 --> 0:00:56.160 in pellagra in the Southern United States in the early 0:00:56.240 --> 0:00:59.480 twentieth century. Today, we're going to talk more about how 0:00:59.520 --> 0:01:03.080 pelagora became a huge public health problem in the United 0:01:03.120 --> 0:01:06.280 States and the efforts to find its cause and a 0:01:06.319 --> 0:01:10.080 solution for it. To be clear, we are mostly focused 0:01:10.120 --> 0:01:13.600 on the Southern United States here because that's where pelagora 0:01:13.720 --> 0:01:18.679 reached really epidemic levels, but pelagra could and did happen 0:01:18.840 --> 0:01:21.800 anywhere in the country that was facing poverty, and a 0:01:21.920 --> 0:01:26.440 lack of access to a range of foods. This episode 0:01:26.520 --> 0:01:31.000 includes some human and animal experimentation, and if you have 0:01:31.240 --> 0:01:35.080 listened to our episode on epotymous diseases from not that 0:01:35.240 --> 0:01:40.600 long ago, some of the human experimentation I would rank 0:01:40.720 --> 0:01:46.920 as about equivalent to how gross the experimentation was with neurovirus. 0:01:48.680 --> 0:01:51.160 There are also some experiments will be talking about that 0:01:51.320 --> 0:01:54.560 we're not so viscerally disgusting in that way, but they 0:01:54.560 --> 0:01:57.720 would not pass ethics review boards today. 0:01:58.680 --> 0:02:00.920 So as we said at the end of last episode, 0:02:00.920 --> 0:02:04.480 the first known report of pelagra in medical literature in 0:02:04.520 --> 0:02:08.800 the US was published in nineteen oh two, but investigations 0:02:08.840 --> 0:02:12.160 over the following decades revealed that there had been outbreaks 0:02:12.200 --> 0:02:14.359 going back to at least the first decades of the 0:02:14.480 --> 0:02:19.240 nineteenth century. Most of those nineteenth century outbreaks had taken 0:02:19.280 --> 0:02:23.639 place before medical textbooks in the US mentioned pelagra at all, 0:02:23.880 --> 0:02:27.840 so most American practitioners didn't know anything about it, and 0:02:28.040 --> 0:02:33.240 those patients had consequently been misdiagnosed. But after Henry Fauntleroy 0:02:33.320 --> 0:02:36.560 Harris's nineteen oh two description of a farmer who had 0:02:36.600 --> 0:02:40.680 been developing a debilitating illness with a rash, every spring 0:02:40.800 --> 0:02:44.720 for about fifteen years. Other reports soon followed. 0:02:45.800 --> 0:02:50.640 We also talked last time about the three ms of meal, molasses, 0:02:50.720 --> 0:02:53.720 and meat, which made up the bulk of the diets 0:02:53.760 --> 0:02:56.280 of a lot of the poorest people in the United 0:02:56.320 --> 0:03:00.240 States in the late nineteenth and early twentieth centuries. This 0:03:00.280 --> 0:03:04.359 included the diets of people who were living in institutions 0:03:04.520 --> 0:03:09.079 like mental asylums and orphanages, because they were generally being 0:03:09.120 --> 0:03:14.600 fed the cheapest food possible. One example was Mount Vernon 0:03:14.720 --> 0:03:19.480 Asylum for the Colored Insane in Mount Vernon, Alabama. This 0:03:19.639 --> 0:03:23.720 hospital had been established as a state run segregated mental 0:03:23.760 --> 0:03:28.160 hospital for black patients in nineteen hundred. Prior to that, 0:03:28.320 --> 0:03:31.000 it had been an arsenal and military barracks, and in 0:03:31.040 --> 0:03:35.080 that earlier time that's where physician Walter Reid had confirmed 0:03:35.120 --> 0:03:38.040 that yellow fever was transmitted by mosquitoes. 0:03:38.960 --> 0:03:42.400 Doctor George H. Searcy reported an outbreak of disease in 0:03:42.520 --> 0:03:45.240 eighty eight patients at the hospital in the early fall 0:03:45.280 --> 0:03:48.240 of nineteen oh six, publishing a paper on it in 0:03:48.280 --> 0:03:51.640 the Journal of the American Medical Association the following year. 0:03:52.640 --> 0:03:55.240 He said that these were not the first cases of 0:03:55.400 --> 0:03:58.000 pelagra at the hospital, that there had been a few 0:03:58.040 --> 0:04:01.240 cases every summer since patients were first transferred to the 0:04:01.240 --> 0:04:04.360 hospital in nineteen oh one, but that they had not 0:04:04.440 --> 0:04:08.880 been recognized as pelagra. When a much bigger outbreak started, 0:04:09.040 --> 0:04:11.760 doctors at the hospital had gone to Circe for help, 0:04:12.280 --> 0:04:15.680 and he reported that of those eighty eight cases, fifty 0:04:15.720 --> 0:04:19.160 seven had died, for a mortality rate of about sixty 0:04:19.200 --> 0:04:19.880 four percent. 0:04:21.000 --> 0:04:26.360 In his paper, sirirc described the disease as endemic and systemic, 0:04:26.960 --> 0:04:30.880 involving skin lesions and disturbance of the digestive tract and 0:04:31.000 --> 0:04:35.360 nervous system. He said it should be classed as food poisoning, 0:04:35.600 --> 0:04:39.520 similar to ergotism, which comes from eating food that's contaminated 0:04:39.560 --> 0:04:44.279 with ergate fungus, or latherism, which comes from eating large 0:04:44.279 --> 0:04:48.479 amounts of certain legumes that contain a neurotoxin. And he 0:04:48.560 --> 0:04:52.080 made an observation that would hold true in other outbreaks 0:04:52.120 --> 0:04:56.320 in the United States. Quote the disease occurs among the 0:04:56.400 --> 0:05:00.320 poorer classes and in institutions where the diet is at 0:05:00.360 --> 0:05:04.640 times limited. It develops most frequently among adults and in 0:05:04.720 --> 0:05:08.800 females more frequently than in males. Of the eighty eight 0:05:08.960 --> 0:05:12.400 patients at Mount Auburn eighty of them had been women, 0:05:12.760 --> 0:05:14.920 and two thirds had been at the hospital for more 0:05:14.960 --> 0:05:19.320 than a year. Eighty percent of them had experienced fair 0:05:19.480 --> 0:05:24.880 or good health before developing pelagra. Circi described pelagra as 0:05:24.960 --> 0:05:30.160 being caused by quote continuous eating of damaged corn and poverty. 0:05:30.320 --> 0:05:34.240 Poor hygienic surroundings, and exposure to the sun's rays have 0:05:34.360 --> 0:05:39.400 been given as predisposing factors. He specifically referenced the work 0:05:39.480 --> 0:05:42.200 of Cesar Lombroso, who we talked about in Part one, 0:05:42.600 --> 0:05:45.799 and the idea that pelagor was caused by eating spoiled 0:05:45.920 --> 0:05:50.159 or contaminated corn. He said he had sent a sample 0:05:50.279 --> 0:05:52.600 of the corn meal served at the hospital, which was 0:05:52.640 --> 0:05:55.840 supposedly the best meal that was being made in the West, 0:05:56.240 --> 0:05:59.000 to a plant pathology lab which had described it as 0:05:59.080 --> 0:06:03.240 quote whole unfit for human use, that it was made 0:06:03.279 --> 0:06:07.279 of moldy grain and contained quantities of bacteria and fungi 0:06:07.400 --> 0:06:12.000 of various sorts, some of which were identified. He went 0:06:12.040 --> 0:06:14.760 on to say, quote As for the treatment, there are 0:06:14.800 --> 0:06:19.279 no specific remedies. The essential management consists in placing the 0:06:19.360 --> 0:06:23.240 patient in good hygienic surroundings and trying to improve the 0:06:23.320 --> 0:06:27.960 general health by good nourishing foods, and such tonics as 0:06:28.000 --> 0:06:32.760 may seem indicated. Arsenic iron and pepsin preparations were the 0:06:32.800 --> 0:06:36.880 remedies on which most support was placed and which sometimes 0:06:36.960 --> 0:06:41.480 seemed to influence the disease favorably. The affected patients at 0:06:41.480 --> 0:06:44.520 the hospital were taken off of cornbread and grits and 0:06:44.560 --> 0:06:47.400 they were given wheat bread and potatoes instead, with no 0:06:47.520 --> 0:06:51.839 other changes to their diet. A set of eight unaffected 0:06:51.880 --> 0:06:55.560 patients were also placed on a diet of cornbread and 0:06:55.680 --> 0:07:00.520 grits as an experiment. One developed pelagra and another showed 0:07:00.600 --> 0:07:04.000 signs of the disease. All of them started to show 0:07:04.040 --> 0:07:07.280 signs of poor health, so their diets were changed. Also, 0:07:08.680 --> 0:07:11.760 sears ended his nineteen oh seven article by saying that 0:07:11.920 --> 0:07:15.640 he had heard the western corn crop of nineteen oh 0:07:15.680 --> 0:07:19.280 five had been damaged by wet weather, so that was 0:07:19.360 --> 0:07:22.000 what the hospital would have been using in nineteen oh 0:07:22.000 --> 0:07:25.320 six when the outbreak happened, so he had sent a 0:07:25.480 --> 0:07:28.520 sample of the corn they'd gotten in nineteen oh seven 0:07:28.640 --> 0:07:31.880 to the same lab to be tested. The lab said 0:07:31.880 --> 0:07:35.440 that this newer batch of corn was up to standards, 0:07:35.440 --> 0:07:39.960 so Searcy added it back into the patient's diets. Searce 0:07:40.120 --> 0:07:43.560 wrote that after his nineteen oh six report, other cases 0:07:43.600 --> 0:07:46.160 of pelagra had been identified at the Hospital for the 0:07:46.200 --> 0:07:49.800 Insane at Tuscaloosa, and that as there was more awareness 0:07:49.800 --> 0:07:53.920 of the disease, he expected more reports to follow. In 0:07:54.040 --> 0:07:58.320 nineteen oh eight, James Babcock, superintendent of the South Carolina 0:07:58.400 --> 0:08:02.600 Hospital for the Insane, traveled to Italy to see patients 0:08:02.640 --> 0:08:06.040 their first hand so that he could compare their conditions 0:08:06.040 --> 0:08:10.000 to what he was witnessing in South Carolina. This basically 0:08:10.040 --> 0:08:13.680 allowed him to confirm that he was also seeing pelagra. 0:08:14.600 --> 0:08:19.480 Bobcock also organized the first US Conference on pelagra, which 0:08:19.520 --> 0:08:23.360 took place on November third and fourth of nineteen oh nine. 0:08:23.440 --> 0:08:28.960 Almost four hundred physicians attended. In Italy, for the most part, 0:08:29.000 --> 0:08:32.200 there had been agreement that pelagora was caused by corn, 0:08:32.760 --> 0:08:35.600 but the medical community had been at odds over whether 0:08:35.640 --> 0:08:38.680 the issue was about nutrition or about some kind of 0:08:38.760 --> 0:08:43.840 toxin contaminating the corn. In the US, a different disagreement 0:08:43.880 --> 0:08:48.400 developed whether pelagora was caused by corn or whether it wasn't. 0:08:49.000 --> 0:08:52.520 This disagreement can be framed as the Zeus versus the 0:08:52.559 --> 0:08:57.600 anti Ziists, with Zeist coming from Zma's the scientific name 0:08:57.679 --> 0:09:02.640 for corn. Of the forty one speakers at this nineteen 0:09:02.640 --> 0:09:06.640 oh nine conference were Zeists, although many of them had 0:09:06.880 --> 0:09:11.559 very different explanations for the exact role that corn played 0:09:11.600 --> 0:09:16.080 in pelagra, and the anti ziists similarly had a lot 0:09:16.080 --> 0:09:19.120 of different reasons for thinking that the corn was not 0:09:19.320 --> 0:09:22.720 the cause. Some of them were motivated by the germ 0:09:22.840 --> 0:09:26.439 theory of disease and the fact that researchers had started 0:09:26.480 --> 0:09:32.040 identifying specific microorganisms that caused a range of diseases, including 0:09:32.080 --> 0:09:33.640 tuberculosis and cholera. 0:09:34.320 --> 0:09:35.120 These were things. 0:09:34.960 --> 0:09:40.360 People had previously attributed to things like environmental causes. Some 0:09:40.840 --> 0:09:45.280 were working off the idea that not only did microorganisms 0:09:45.320 --> 0:09:50.160 cause disease, but that every disease had one specific cause, 0:09:50.280 --> 0:09:54.840 said that that cause for all diseases was a microorganism. 0:09:55.679 --> 0:09:59.360 This was also happening during the eugenics movement in the 0:09:59.480 --> 0:10:02.520 United States dates, so there were people who thought pelagra, 0:10:02.880 --> 0:10:07.760 or at least a predisposition for pelagra, was the result 0:10:07.880 --> 0:10:09.800 of bad breeding. 0:10:10.240 --> 0:10:13.920 And some of the anti ziist response was more emotional. 0:10:14.679 --> 0:10:17.079 Much of the corn in the US was being grown 0:10:17.160 --> 0:10:20.480 in the Midwest, and a Midwestern sense of identity had 0:10:20.480 --> 0:10:25.400 started to coalesce. One that was centered on agriculture. The 0:10:25.480 --> 0:10:29.360 idea that Midwestern corn was causing illness was damaging to 0:10:29.440 --> 0:10:32.880 that sense of regional identity, and there were also obvious 0:10:32.920 --> 0:10:36.480 worries that connecting pelagra to corn would damage the corn 0:10:36.559 --> 0:10:41.560 industry and the Midwestern economy. This ran parallel to a 0:10:41.640 --> 0:10:46.280 sense of Southern pride and identity. Those three ms that 0:10:46.320 --> 0:10:49.120 we talked about in Part one of meal, meat, and 0:10:49.240 --> 0:10:53.560 molasses had formed the foundation of a lot of Southern cuisine. 0:10:54.320 --> 0:10:57.960 People wanted to find an explanation for pelagra that did 0:10:58.040 --> 0:11:01.680 not land on Southerner's own foods, which were close to 0:11:01.720 --> 0:11:07.479 their hearts making them sick. Also, pelagra, hookworm, and malaria 0:11:07.520 --> 0:11:11.000 were all prevalent in the South at this point. All 0:11:11.080 --> 0:11:15.520 of these could cause symptoms like diarrhea, abdominal pain, fatigue, 0:11:15.600 --> 0:11:21.199 and malaise. These diseases themselves all carried a lot of stigma, 0:11:21.600 --> 0:11:25.319 and all this had fed into negative stereotypes of Southerners 0:11:25.480 --> 0:11:29.720 as lazy. So the idea that people were to blame 0:11:29.920 --> 0:11:32.760 because of what they were eating was like adding insult 0:11:32.880 --> 0:11:36.880 to injury. The attendees at the first conference on pelagra 0:11:37.040 --> 0:11:41.040 resolved to start a national Association for the study of Pelagra, 0:11:41.520 --> 0:11:45.680 and Babcock was elected as its president. Also in nineteen 0:11:45.720 --> 0:11:48.679 oh nine, the US Public Health Service, at the time 0:11:48.760 --> 0:11:52.720 part of the Marine Hospital Service, appointed doctor Claude Lavender 0:11:52.840 --> 0:11:56.600 to head up the service's study of pelagra. Lavender worked 0:11:56.600 --> 0:12:00.680 with Babcock to translate Cesar Limbroso's Italian were on pellagra 0:12:00.920 --> 0:12:06.160 into English. A wave of research into pelagor followed this, 0:12:06.400 --> 0:12:09.480 but it was not initially productive, and we will talk 0:12:09.520 --> 0:12:22.080 about why after a sponsor break. A lot of the 0:12:22.120 --> 0:12:25.880 writing on pelagra in the United States in the first 0:12:25.960 --> 0:12:29.800 decade of the nineteen hundreds had drawn on Italian work 0:12:29.840 --> 0:12:33.800 that had connected the disease to corn consumption in some way. 0:12:34.800 --> 0:12:37.960 But then in nineteen ten, the London School of Tropical 0:12:38.000 --> 0:12:42.680 Medicine published a report saying that pelagor was caused by 0:12:42.720 --> 0:12:48.040 a microbe that was being spread by insects. A Pelagra 0:12:48.280 --> 0:12:52.240 Investigation Committee had been established in the UK that year, 0:12:52.320 --> 0:12:55.400 and it had funded a research trip to Italy that 0:12:55.559 --> 0:12:59.880 was carried out by physician Lewis Sambon. Sambon had been 0:13:00.080 --> 0:13:02.760 born in Italy and had moved to the UK to 0:13:02.960 --> 0:13:06.760 head up the School of Tropical Medicine. His earlier work 0:13:06.840 --> 0:13:11.320 included the study of sleeping sickness in Uganda. He had 0:13:11.520 --> 0:13:15.960 correctly concluded that sleeping sickness was caused by a parasite 0:13:16.000 --> 0:13:20.760 that was transmitted by the Sizi fly. In his pelagra study, 0:13:20.840 --> 0:13:25.800 he noted some commonalities between pelagra and insect born diseases 0:13:26.240 --> 0:13:30.240 like sleeping sickness, and concluded that it was not about 0:13:30.240 --> 0:13:33.240 the corn, that it was a disease carried by some 0:13:33.360 --> 0:13:37.760 kind of biting insect, probably gnats, that were also common 0:13:37.960 --> 0:13:41.040 in the same rural areas where corn was a big 0:13:41.080 --> 0:13:45.640 part of people's diets. In Italy, pelagra had become much 0:13:45.720 --> 0:13:49.000 less common, and the general consensus for decades had been 0:13:49.120 --> 0:13:52.199 that it was corn related, So this report really did 0:13:52.200 --> 0:13:55.920 not get a lot of traction there. Many Italian doctors 0:13:55.960 --> 0:14:00.600 dismissed it entirely, even calling it absurd. But in the US, 0:14:00.679 --> 0:14:04.319 Sambon's conclusion really appealed to all the researchers who were 0:14:04.320 --> 0:14:08.360 looking for some kind of explanation for pelagra that did 0:14:08.360 --> 0:14:12.839 not trace back to Midwestern corn or southern diets. This 0:14:12.920 --> 0:14:16.679 included the state of Illinois, whose Investigatory Commission on Pelagra 0:14:16.840 --> 0:14:21.480 was established in nineteen ten and largely focused on Sambon's work. 0:14:22.920 --> 0:14:26.360 My read on this is that Simbon's conclusions on pelagra 0:14:26.600 --> 0:14:30.480 were really influenced by his own preconceptions based on his 0:14:30.680 --> 0:14:36.440 earlier successful work on insect born diseases, and this may 0:14:36.480 --> 0:14:39.840 have also been true for one of the commissions that 0:14:39.960 --> 0:14:44.160 started studying pelagra in the nineteen teens. That was the 0:14:44.200 --> 0:14:49.800 Thompson McFadden Commission, named for its two primary funders, Robert M. Thompson, 0:14:49.880 --> 0:14:53.440 who was in mining, and Henry McFadden, who was a 0:14:53.480 --> 0:14:57.560 cotton merchant. Both of these men had a vested interest 0:14:57.680 --> 0:15:01.320 in determining a cause and treatment for pellagra, since it 0:15:01.480 --> 0:15:05.600 was prevalent in the mining camps and mill towns where 0:15:05.640 --> 0:15:07.920 the workers in their industries lived. 0:15:08.720 --> 0:15:11.640 The researchers who were part of this commission carried out 0:15:11.680 --> 0:15:15.680 their work in and around Spartanburg, South Carolina, where local 0:15:15.720 --> 0:15:19.800 officials agreed to cooperate and where the situation was critical. 0:15:20.520 --> 0:15:24.120 There were about thirty thousand reported cases of pelagra, with 0:15:24.160 --> 0:15:29.240 a fatality rate of about forty percent. Investigators went house 0:15:29.280 --> 0:15:33.360 to house asking about who lived there, their ages and sexes, 0:15:33.680 --> 0:15:37.000 whether any of them had pelagra, and what they ate. 0:15:37.880 --> 0:15:42.160 Doctors also diagnosed cases of pelagra during these visits. 0:15:43.280 --> 0:15:49.000 The primary investigators for this commission were all microbiologists, and 0:15:49.120 --> 0:15:53.760 they discounted links to things like economic conditions and the 0:15:53.800 --> 0:15:58.600 maize and the gnats that Sambon had cited before, focusing 0:15:58.680 --> 0:16:03.640 on trying to pinpoint a specific microbial cause. In their 0:16:03.680 --> 0:16:08.280 second progress report, they didn't name a specific cause for pelagra, 0:16:08.840 --> 0:16:12.000 but they reported that pelagora rates were the highest in 0:16:12.040 --> 0:16:15.920 the places that did not have an enclosed sewer system 0:16:16.520 --> 0:16:21.920 and people were using unscreened privies. Also, if one person 0:16:21.960 --> 0:16:25.800 in a household had pelagra, usually at least one other 0:16:26.000 --> 0:16:29.840 person had it as well. They wrote, quote, we are 0:16:29.960 --> 0:16:34.880 inclined to regard intimate association in the household and the 0:16:34.960 --> 0:16:40.920 contamination of food with the excretion of pelagrons as possible 0:16:41.000 --> 0:16:45.840 moods of distribution of the disease. Pelagrins was the term 0:16:45.880 --> 0:16:49.560 being used to describe people with pelagra, so these researchers 0:16:49.600 --> 0:16:53.040 were saying that pelagra spread from person to person when 0:16:53.080 --> 0:16:56.880 the waste of someone with pelagra contaminated the food other 0:16:56.920 --> 0:17:01.720 people were eating. That contamination was spreading in neighborhoods where 0:17:01.720 --> 0:17:05.120 there was no sanitary system for dealing with human waste. 0:17:06.040 --> 0:17:09.000 They also noted some of the same demographic patterns as 0:17:09.040 --> 0:17:12.240 Henry Fauntleroy Harris had in his nineteen oh two paper 0:17:12.520 --> 0:17:16.240 that we talked about earlier. Polagor was far more common 0:17:16.240 --> 0:17:19.359 in women. They reported five hundred twenty eight cases in 0:17:19.400 --> 0:17:23.680 women and two hundred twelve in men. They also found 0:17:23.840 --> 0:17:27.159 far more cases among white people than among black people, 0:17:27.680 --> 0:17:30.240 but noted that the cotton mill villages that they were 0:17:30.280 --> 0:17:34.679 researching were almost exclusively white. Yeah, when you looked at 0:17:34.720 --> 0:17:39.040 a broader sample of the population, it was the opposite. 0:17:39.119 --> 0:17:41.280 It was a lot more common among black people. They 0:17:41.359 --> 0:17:44.000 just were looking at a sample that was mostly white. 0:17:46.000 --> 0:17:49.840 A sewer system was built in Spartan Mills, after which 0:17:49.920 --> 0:17:53.239 pelagora rates there did start to decline, and so this 0:17:53.520 --> 0:17:58.160 wound up reinforcing the idea that the sanitary conditions had 0:17:58.160 --> 0:18:04.639 been involved in the polagrasp. One possible explanation for why 0:18:04.680 --> 0:18:08.320 this sewer system quote worked is that the building of 0:18:08.400 --> 0:18:11.320 the sewer brought some more money into the town, which 0:18:11.400 --> 0:18:14.960 allowed people to buy a richer variety of food. But 0:18:15.040 --> 0:18:21.240 we don't really know. The connection to the sewers wasn't 0:18:21.280 --> 0:18:24.840 about some kind of waste contamination that was contaminating the food. 0:18:24.880 --> 0:18:27.240 It was that the people that were living in places 0:18:27.280 --> 0:18:29.919 that were so poor that they had no sewer system 0:18:30.400 --> 0:18:34.600 couldn't afford to buy a richer variety of food. Just 0:18:34.640 --> 0:18:39.200 to make that clear, the Thompson McFadden Commissions reports deepened 0:18:39.200 --> 0:18:43.920 the division between the Zeists and the anti Ziists. Claude Lavender, 0:18:43.960 --> 0:18:46.640 who had been heading up the government's response to the disease, 0:18:47.080 --> 0:18:50.239 wrote in a nineteen thirteen report quote, it is not 0:18:50.359 --> 0:18:52.760 to be understood from them that there are only two 0:18:52.840 --> 0:18:56.720 theories of the cause of pelagra. On the contrary, there 0:18:56.760 --> 0:19:01.119 are scores of theories. The Zeists agree in one thing only, 0:19:01.320 --> 0:19:05.040 and that is that, either directly or indirectly, pelagra is 0:19:05.119 --> 0:19:09.480 ideologically related to MAZE, while the Antiziists agree in one 0:19:09.520 --> 0:19:12.159 thing only, and that is that the disease bears no 0:19:12.359 --> 0:19:16.520 such relation to MAZE. The Zeists, however, do not agree 0:19:16.600 --> 0:19:20.320 among themselves, nor do the Antisiasts show any more harmony 0:19:20.359 --> 0:19:23.560 in their views. Without going into the details of the 0:19:23.640 --> 0:19:26.960 various theories and shades of opinion, it may be said 0:19:27.000 --> 0:19:30.520 that the great struggle now centers around the question is 0:19:30.640 --> 0:19:34.080 pelagra a kind of food poisoning from maze? Or is 0:19:34.160 --> 0:19:38.719 it due to some parasite infecting the human body. In 0:19:38.840 --> 0:19:42.360 nineteen twelve, which was the same year that the Thompson 0:19:42.480 --> 0:19:49.240 McFadden Commission started its investigation, Polish biochemist Casimir Funk coined 0:19:49.320 --> 0:19:55.000 the word vitamin as vital amines, and he connected deficiencies 0:19:55.080 --> 0:19:59.800 in these vital amines to diseases. He noted similarities among 0:19:59.840 --> 0:20:04.200 them pelagra, berry berry, ricketts, and scurvy, all of which 0:20:04.200 --> 0:20:09.719 are understood as vitamin deficiency diseases today. He observed that 0:20:09.760 --> 0:20:14.120 these diseases tended to erupt in countries where quote a 0:20:14.160 --> 0:20:19.680 certain unvarying diet is partaken for long periods. People had 0:20:19.720 --> 0:20:23.400 already figured out that barry berry, which is a thiamin deficiency, 0:20:23.560 --> 0:20:27.800 could be treated and prevented with rice brand and that scurvy, 0:20:27.920 --> 0:20:30.800 which was a vitamin sea deficiency, could be treated with 0:20:30.840 --> 0:20:33.919 a variety of fresh fruits and vegetables. We have a 0:20:33.960 --> 0:20:38.879 whole episode on scurvy. Funk argued that there was probably 0:20:38.960 --> 0:20:44.240 a dietary treatment for pelagra as well. By nineteen fourteen, 0:20:44.480 --> 0:20:48.000 Claude Lavender had not been successful in finding a definite 0:20:48.080 --> 0:20:50.960 cause for pelagra, and he asked to be assigned to 0:20:51.040 --> 0:20:56.040 other work. US Surgeon General Rupert Blue appointed doctor Joseph 0:20:56.080 --> 0:21:00.840 Goldberger as his replacement. Goldberger was from a Jewish family 0:21:00.920 --> 0:21:04.119 from the Austro Hungarian Empire who had moved to the 0:21:04.200 --> 0:21:08.240 United States when he was about nine. After becoming a doctor, 0:21:08.359 --> 0:21:10.800 he had worked in private practice for a while before 0:21:10.920 --> 0:21:15.000 joining the United States Marine Hospital Service. He had worked 0:21:15.000 --> 0:21:17.560 as an immigration inspector in the Port of New York 0:21:17.680 --> 0:21:21.960 before moving on to studying and fighting infectious diseases. He 0:21:22.000 --> 0:21:26.040 had fought outbreaks of yellow fever, dengey fever, and typhoid, 0:21:26.080 --> 0:21:26.840 among others. 0:21:27.440 --> 0:21:30.080 When he was appointed to study pelagra, he was in 0:21:30.160 --> 0:21:34.440 Detroit helping to fight a diphtheria outbreak. Yeah. 0:21:34.480 --> 0:21:38.520 His public health and infectious disease work has been described 0:21:38.600 --> 0:21:42.320 as like monumental and heroic. He did a ton and 0:21:42.400 --> 0:21:44.399 a lot of it. He was doing at risk to 0:21:44.440 --> 0:21:51.320 his own health. That same year, the State Sanitarium in Millageville, Georgia, 0:21:51.560 --> 0:21:55.160 was in the middle of a pelagora crisis. Almost two 0:21:55.320 --> 0:21:59.879 hundred people had died and pelaga had passed tuberculosis as 0:22:00.080 --> 0:22:04.000 the leading cause of death at the hospital. The federal 0:22:04.040 --> 0:22:07.520 government had started to see the situation as really urgent 0:22:07.680 --> 0:22:11.200 and Goldberger was given a budget of eighty thousand dollars 0:22:11.200 --> 0:22:14.840 for his investigation that was out of the entire US 0:22:14.960 --> 0:22:17.880 public health budget of two hundred thousand dollars. 0:22:18.880 --> 0:22:22.679 Goldberger studied conditions at the hospital and noticed something that 0:22:22.720 --> 0:22:26.679 George H. Searcy had also described in his reports on 0:22:26.720 --> 0:22:30.479 the pelagra outbreak at Mount vernonn Asylum, almost a decade before. 0:22:31.680 --> 0:22:37.240 Pelagor was affecting only the patients, not staff. Staff were 0:22:37.240 --> 0:22:40.000 in close contact with the patients all day, and some 0:22:40.040 --> 0:22:43.520 of them lived at the facility. If the disease had 0:22:43.560 --> 0:22:46.919 been communicable, whether it was being spread through insects or 0:22:46.960 --> 0:22:52.119 some other vector, it would have affected staff as well. Theoretically, 0:22:52.320 --> 0:22:55.840 staff and patients were eating the same food, but Goldberger 0:22:55.920 --> 0:22:59.520 learned that the staff were served first, so they usually 0:22:59.520 --> 0:23:03.080 took the best food for themselves, and the staff also 0:23:03.160 --> 0:23:06.920 had options to supplement their diets beyond what the hospital served. 0:23:07.920 --> 0:23:12.960 Although most of Goldberger's background was in infectious diseases, he 0:23:13.200 --> 0:23:18.560 started researching pelagra as a possible nutritional deficiency. This is 0:23:18.680 --> 0:23:21.679 where we will get to the human experimentation that we 0:23:21.720 --> 0:23:24.240 talked about at the beginning of the show and some 0:23:24.359 --> 0:23:27.320 of its fairy growths. We'll have more on that after 0:23:27.359 --> 0:23:28.200 a sponsor break. 0:23:37.680 --> 0:23:42.320 In nineteen fourteen, Joseph Goldberger started polagor research at two 0:23:42.560 --> 0:23:47.720 orphanages in Jackson, Mississippi, where more than two hundred total 0:23:47.800 --> 0:23:51.360 children had developed the disease during the spring and summer. 0:23:52.520 --> 0:23:55.800 He found that pelagra only seemed to affect children between 0:23:55.800 --> 0:23:58.680 the ages of six and twelve, and they were all 0:23:58.720 --> 0:24:02.879 mostly eating biscuits, grits, corn meal, and syrup. I'm not 0:24:02.920 --> 0:24:05.639 sure if the syrup was his word for molasses, but 0:24:05.920 --> 0:24:11.000 something sugary and syrupy. Even though the general conditions at 0:24:11.000 --> 0:24:14.320 the orphanages were not good in terms of things like 0:24:14.400 --> 0:24:19.879 sanitation and overcrowding and overall health, he left those conditions 0:24:19.960 --> 0:24:23.160 as they were for the sake of this experiment. 0:24:23.600 --> 0:24:27.720 At both orphanages. In his words quote, a very decided 0:24:27.840 --> 0:24:30.840 increase was made in the proportion of the fresh animal 0:24:30.920 --> 0:24:36.520 and of the leguminous protein foods. This included milk, eggs, beans, 0:24:36.600 --> 0:24:39.879 and peas, and at breakfast the children were served oatmeal 0:24:40.320 --> 0:24:44.080 rather than corn grits. Other foods were added as well. 0:24:45.080 --> 0:24:48.400 After the implementation of this diet, the children were observed 0:24:48.400 --> 0:24:52.560 for a year. One of the orphanages had no recurrences 0:24:52.560 --> 0:24:56.560 of pelagra the following spring and summer. The other had 0:24:56.680 --> 0:25:01.159 just one. A similar experiment with similar results was carried 0:25:01.200 --> 0:25:05.679 out at the Georgia State Sanitarium in nineteen fifteen. Goldberger 0:25:05.720 --> 0:25:08.959 began reporting his results in the Southern Medical Journal and 0:25:09.080 --> 0:25:14.639 in public health reports. This research strongly suggested that a 0:25:14.760 --> 0:25:19.520 diet containing a variety of foods could prevent pelagra, and 0:25:19.560 --> 0:25:23.520 he wanted to confirm whether pelagra could also be induced 0:25:23.760 --> 0:25:24.439 through diet. 0:25:25.520 --> 0:25:29.320 He worked with Earl Brewer, Governor of Mississippi, to arrange 0:25:29.400 --> 0:25:33.280 an experiment at Rankin State Prison Farm, which did not 0:25:33.480 --> 0:25:37.000 have a history of pelagra among the people incarcerated there. 0:25:37.920 --> 0:25:41.600 Twelve healthy men were recruited from this study, although one 0:25:41.640 --> 0:25:44.720 of them was found to have a previously undetected medical 0:25:44.760 --> 0:25:49.199 condition and he was dismissed. These men were offered pardons 0:25:49.240 --> 0:25:52.600 for their participation that would be seen as unethical and 0:25:52.680 --> 0:25:58.280 coercive today. They were placed on a largely corn based diet, 0:25:58.720 --> 0:26:02.280 and after about five five months, six of them had 0:26:02.320 --> 0:26:06.359 developed the rash that is characteristic of pelagra. So this 0:26:06.480 --> 0:26:10.959 supported the idea that a primarily corn based diet could 0:26:11.000 --> 0:26:16.719 cause pelagra. Goldberger's conclusions really inflamed a lot of the 0:26:16.720 --> 0:26:20.920 cultural responses that we talked about earlier. While there were 0:26:21.000 --> 0:26:24.000 some Southern leaders and advocates who called for food aid 0:26:24.040 --> 0:26:28.879 to the South to combat any dietary deficiencies, many many 0:26:29.000 --> 0:26:33.640 others were outraged. This was fueled by attitudes dating back 0:26:33.680 --> 0:26:37.679 to before the Civil War and reinforced during reconstruction, and 0:26:37.800 --> 0:26:41.720 perceptions that a Jewish New Yorker seen as a paternalistic, 0:26:41.880 --> 0:26:45.639 moralizing outsider, had come to pass judgment on the South, 0:26:45.880 --> 0:26:50.359 its people, and its food. Anti ziasts doubled down on 0:26:50.400 --> 0:26:54.320 the insistence that this wasn't about food, and it specifically 0:26:54.520 --> 0:26:58.199 wasn't about corn, and that there must be an infectious 0:26:58.200 --> 0:27:01.480 agent at work. Yeah. Some of the tone of this 0:27:02.040 --> 0:27:06.199 conversation at the time was basically Goldberger saying, there is 0:27:06.400 --> 0:27:09.320 famine in the South and we need to take action 0:27:09.440 --> 0:27:13.760 to save people's lives, and his most vocal critics were like, 0:27:13.960 --> 0:27:15.320 that is an insult. 0:27:15.440 --> 0:27:20.479