This Shouldn’t Have Happened

An Avoidable Death

Fifteen years after the cause and cure of pellagra was identified, a 42 year-old first cousin (three times removed) died of pellagra with psychosis1 at the Florida State Hospital in Gadsden County. Fifteen years!

Meet Dr. Joseph Goldberger

In 1874, Joseph Goldberger was born in then-Hungary (now Slovakia) to Jewish parents. References vary, but most report he immigrated into the United States (New York City) with his parents in the early 1880s.2,3 At 16, he studied engineering but switched to medicine where he earned an M.D. in 1895 from what is now the New York University School of Medicine. After several years in a private medical practice in Wilkes-Barre, Pennsylvania, Dr. Golberger joined the Marine Hospital Service4 in 1899. His career as a uniformed assistant surgeon began with examining newly arrived immigrants in the port of New York.

Dr. Joseph Goldberger
(1874 – 1929)5

From about 1907 into 1914, orphanage, asylum, and other facility superintendents, physicians, and other public health officials were exploring a seemingly-new epidemic which was spreading quickly across the United States. The symptoms were noted especially-in but not exclusively among populations in the southern states. Initially considered an infectious disease, its victims were rejected as lepers and their symptoms were treated as similarly macabre.

“Pellagra was known as the disease of the three D’s: dermatitis, diarrhea, and dementia. Victims suffered scaling, leprous skin, intestinal distress, lethargy, and depression… Advanced stages involved hallucinations and even madness.”5

In 1914, Dr. Goldberger was asked by Rupert Blue, Surgeon General of the United States, to investigate the epidemic. As the symptoms were similar to, and turned out to be the same as, an illness noted in southern Europe during the eighteenth and nineteenth centuries, Dr. Goldberger began to observe significant differences between sufferers of this new illness and those of contagious diseases and genetic disorders.

Nutrition in the American South

Oh, this gets complicated… Later research and testing would show that pellagra was a nutritional deficiency of niacin and tryptophan. As pellagra cases were on the rise, so too was the consumption of large-mill processed, degerminated cornmeal. Degerming corn produced a longer-lasting product. It could then be stocked, sold, and stored for longer and at greater distances from the processing mills. However, this mass removal of the corn bran and germ (leaving only the endosperm) resulted in a refined product with reduced amounts of niacin and tryptophan. While indigenous American populations have consumed corn for centuries before the people in regions of pellagra outbreaks, the former’s process of “nixtamalization” didn’t create the nutritionally deficient product now seen with pellagra.

Some researchers argue that the average diet of the American Southerner, especially those in cotton-mill towns and among the poor, was as much a function of agriculture and economics as it was politics. Dr. Goldberger would show that diets that relied heavily on cornmeal (grits, biscuits, mush, etc.) and more affordable/accessible foods like cabbage, sweet potatoes, rice, collards, and coffee, produced pellagra. Dr. Goldberger, however, was of Jewish descent. He was an immigrant. He was a government employee. Many people perceived (incorrectly) that Dr. Goldberger was disparaging the farmer and way of life of the American South.

What’s Next?

Join us as we explore Dr. Golberger’s persistence, an experiment on Mississippi state prisoners, community reactions, what pellagra is, and is not, and where pellagra might remain a problem.


1. “Florida death certificates, 1877-1939,” database and digital images, ( : accessed 5 December 2018), search for Frank Hamilton, died 15 December 1931; death certificate 18644, Gadsden County, Florida Department of Health, Bureau of Vital Statistics, 1217 North Pearl Street, Jacksonville, Florida.

2. Kraut, Alan, Ph.D. “Dr. Joseph Goldberger and the War on Pellagra, By Alan Kraut, Ph.D.” National Institutes of Health. March 26, 2004. Accessed December 10, 2018.

3. Akst, Daniel. “The Forgotten Plague.” American Heritage. December 2000. Accessed December 10, 2018.

4. “Commissioned Corps of TheU.S. Public Health Service.” U.S. Public Health Service Home. July 28, 2007. Accessed December 10, 2018.

5. Image: Public Health Image Library (PHIL ID# 8164), Dr. Joseph Goldberger (1874 – 1929). Centers for Disease Control and Prevention, Office of the Associate Director for Communications, Division of Public Affairs (Public Domain).

6. Akst, Daniel. “The Forgotten Plague.” American Heritage. December 2000. Accessed December 10, 2018.