Pellagra, Part 2

This episode on the pellagra epidemic focuses on its prevalence in the U. S. in the early 20th century. Some of the scientific work done to understand it involves self-experimentation, and some of it is ethically problematic by today’s standards.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

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  Robert, Mick, Bill, and Jessa strut back down memory lane for season two, sharing lessons on life, love, and loss. These are the kind of insights that only come from experience. So tune in to Silver Linings with The Old Gays on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts. Workplace chaos. We've all been there. Deadlines are slipping, projects are piling up, and suddenly you realize the missing piece is the right person. That's when you say, this is a job for sponsored jobs. With Indeed Sponsored Jobs, your job post gets a boost so you can connect with quality candidates faster. In fact, sponsored jobs posted directly on Indeed are 95% more likely to report a hire than non-sponsored jobs.

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• 2:13Holly Frey?

  Welcome to Stuff You Missed in History Class, a production of iHeart Radio.

• 2:24Tracy V. Wilson?

  Hello and welcome to the podcast. I'm Tracy V. Wilson.

• 2:27Holly Frey?

  And I'm Holly Frey.

• 2:29Tracy V. Wilson?

  Here is part two of our episode on pellagra, something I did not realize was going to need two parts when I started. I was totally unaware that there was a whole history of pellagra in Italy that took place before it really became a problem in the United States. And I was only aware of the US stuff before working on this. Last time, we talked about what pellagra is, its appearance, and eventual, maybe not disappearance, but like resolution in Italy, and some of the social and economic factors that led to a rise in pellagra in the southern United States in the early 20th century. Today, we're going

• 3:10Tracy V. Wilson?

  to talk more about how pellagra became a huge public health problem in the United States, and the efforts to find its cause and a solution for it. To be clear, we are mostly focused on the southern United States here, because that's where pellagra reached really epidemic levels. But pellagra could and did happen anywhere in the country that was facing poverty and a lack of access to a range of foods. This episode includes some human and animal experimentation. And if you have listened to our episode on epidemic diseases from not that long ago, some of the human experimentation, I would

• 3:52Tracy V. Wilson?

  rank as about equivalent to how gross the experimentation was with norovirus. There are also some experiments we'll be talking about that were not so viscerally disgusting in that way, but they would not pass ethics review boards today.

• 4:11Holly Frey?

  So as we said at the end of last episode, the first known report of pellagra in medical literature in the US was published in 1902. But investigations over the following decades revealed that there had been outbreaks going back to at least the first decades of the 19th century. Most of those 19th century outbreaks had taken place before medical textbooks in the US mentioned pellagra at all. So, most American practitioners didn't know anything about it, and those patients had consequently been misdiagnosed. But after Henry Fauntleroy Harris's 1902 description of a farmer who had been developing a debilitating illness

• 4:51Holly Frey?

  with a rash every spring for about 15 years, other reports soon followed.

• 4:58Tracy V. Wilson?

  We also talked last time about the three M's of meal, molasses, and meat, which made up the bulk of the diets of a lot of the poorest people in the United States in the late 19th and early 20th centuries. This included the diets of people who were living in institutions like mental asylums and orphanages, because they were generally being fed the cheapest food possible. One example was Mount Vernon Asylum for the Colored Insane in Mount Vernon, Alabama. This hospital had been established as a state-run segregated mental hospital for black patients in 1900. Prior to that, it had been an arsenal

• 5:41Tracy V. Wilson?

  and military barracks, and in that earlier time, that's where physician Walter Reed had confirmed that yellow fever was transmitted by mosquitoes.

• 5:51Holly Frey?

  Dr. George H. Circe reported an outbreak of disease in 88 patients at the hospital in the early fall of 1906, publishing a paper on it in the Journal of the American Medical Association the following year. He said that these were not the first cases of pellagra at the hospital, that there had been a few cases every summer since patients were first transferred to the hospital in 1901, but that they had not been recognized as pellagra. When a much bigger outbreak started, doctors at the hospital had gone to Circe for help, and he reported that of those 88 cases, 57 had died, for a mortality rate of about 64%.

• 6:33Tracy V. Wilson?

  In his paper, Circe described the disease as endemic and systemic, involving skin lesions and disturbance of the digestive tract and nervous system. He said it should be classed as food poisoning, similar to ergotism, which comes from eating food that's contaminated with ergot fungus, or latharism, which comes from eating large amounts of certain legumes that contain a neurotoxin. And he made an observation that would hold true in other outbreaks in the United States. Quote, "The disease occurs among the poorer classes and in institutions where the diet is at times limited.

• 7:14Tracy V. Wilson?

  It develops most frequently among adults and in females more frequently than in males. Of the 88 patients at Mount Auburn, 80 of them had been women, and 2/3 had been at the hospital for more than a year. 80% of them had experienced fair or good health before developing pellagra."

• 7:35Holly Frey?

  Circe described pellagra as being caused by, quote, "continuous eating of damaged corn, and poverty, poor hygienic surroundings, and exposure to the sun's rays have been given as predisposing factors." He specifically referenced the work of Cesar Lombrozo, who we talked about in part one, and the idea that pellagra was caused by eating spoiled or contaminated corn. He said he had sent a sample of the corn meal served at the hospital, which was supposedly the best meal that was being made in the West, to a plant pathology lab, which had described it as, quote, "wholly unfit for human use,

• 8:14Holly Frey?

  that it was made of moldy grain and contained quantities of bacteria and fungi of various sorts, some of which were identified."

• 8:24Tracy V. Wilson?

  He went on to say, quote, "As for the treatment, there are no specific remedies. The essential management consists in placing the patient in good hygienic surroundings and trying to improve the general health by good nourishing foods, and such tonics as may seem indicated. Arsenic, iron, and pepsin preparations were the remedies on which most support was placed and which sometimes seemed to influence the disease favorably." The affected patients at the hospital were taken off of cornbread and grits, and they were given wheat bread and potatoes instead with no other changes to their diet.

• 9:02Holly Frey?

  A set of eight unaffected patients were also placed on a diet of cornbread and grits as an experiment. One developed pellagra and another showed signs of the disease. All of them started to show signs of poor health, so their diets were changed also.

• 9:21Tracy V. Wilson?

  Circe ended his 1907 article by saying that he had heard the western corn crop of 1905 had been damaged by wet weather. So that was what the hospital would have been using in 1906 when the outbreak happened. So he had sent a sample of the corn they'd gotten in 1907 to the same lab to be tested. The lab said that this newer batch of corn was up to standard, so Circe added it back into the patients' diets.

• 9:52Holly Frey?

  Circe wrote that after his 1906 report, other cases of pellagra had been identified at the Hospital for the Insane at Tuscaloosa, and that as there was more awareness of the disease, he expected more reports to follow.

• 10:06Tracy V. Wilson?

  In 1908, James Babcock, superintendent of the South Carolina Hospital for the Insane, traveled to Italy to see patients there firsthand so that he could compare their conditions to what he was witnessing in South Carolina. This basically allowed him to confirm that he was also seeing pellagra. Babcock also organized the first US Conference on Pellagra, which took place on November 3rd and 4th of 1909. Almost 400 physicians attended.

• 10:39Holly Frey?

  In Italy, for the most part, there had been agreement that pellagra was caused by corn. But the medical community had been at odds over whether the issue was about nutrition or about some kind of toxin contaminating the corn. In the US, a different disagreement developed, whether pellagra was caused by corn or whether it wasn't. This disagreement can be framed as the zeists versus the anti-zeists, with zeist coming from zia ma's, the scientific name for corn.

• 11:11Tracy V. Wilson?

  Most of the 41 speakers at this 1909 conference were zeists, although many of them had very different explanations for the exact role that corn played in pilaugra. And the anti-zeists similarly had a lot of different reasons for thinking that the corn was not the cause. Some of them were motivated by the germ theory of disease and the fact that researchers had started identifying specific microorganisms that caused a range of diseases, including tuberculosis and cholera. These were things people had previously attributed to things like environmental causes.

• 11:52Tracy V. Wilson?

  Some were working off the idea that not only did microorganisms cause disease, but that every disease had one specific cause and that that cause for all diseases was a microorganism.

• 12:08Tracy V. Wilson?

  This was also happening during the eugenics movement in the United States, so there were people who thought pilaugra, or at least a predisposition for pilaugra, was the result of bad breeding.

• 12:22Holly Frey?

  And some of the anti-zeist response was more emotional. Much of the corn in the US was being grown in the Midwest, and a Midwestern sense of identity had started to coalesce, one that was centered on agriculture. The idea that Midwestern corn was causing illness was damaging to that sense of regional identity. And there were also obvious worries that connecting pilaugra to corn would damage the corn industry and the Midwestern economy.

• 12:51Tracy V. Wilson?

  This ran parallel to a sense of Southern pride and identity. Those three M's that we talked about in part one of meal, meat, and molasses had formed the foundation of a lot of Southern cuisine. People wanted to find an explanation for pilaugra that did not land on Southerners' own foods, which were close to their hearts, making them sick. Also, pilaugra, hookworm, and malaria were all prevalent in the South at this point. All of these could cause symptoms like diarrhea, abdominal pain, fatigue, and malaise.

• 13:29Tracy V. Wilson?

  These diseases themselves all carried a lot of stigma and all this had fed into negative stereotypes of Southerners as lazy. So the idea that people were to blame because of what they were eating was like adding insult to injury.

• 13:46Holly Frey?

  The attendees at the first conference on pellagra resolved to start a national association for the study of pellagra and Babcock was elected as its president. Also in 1909, the US Public Health Service, at the time, part of the Marine Hospital Service, appointed Dr. Claude Lavender to head up the service's study of pellagra. Lavender worked with Babcock to translate Cesar Lombroso's Italian work on pellagra into English.

• 14:15Tracy V. Wilson?

  They wave of research into pellagra followed this, but it was not initially productive, and we will talk about why after a sponsor break.

• 14:30Speaker 01

  That sound? That's pro squash. Some of the fastest rallies in sport played inches from the crowd. The National Squash League is back in full swing for season four. The sport is heading to the 2028 Olympics for the first time, and you can see it up close right now in a city near you. Watch every match for free on YouTube. Search National Squash League and hit subscribe or follow live updates on Instagram at NSL.Sport.

• 14:58Speaker 04

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• 15:00Tracy V. Wilson?

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• 15:28Tracy V. Wilson?

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• 15:35Speaker 05

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• 15:41Tracy V. Wilson?

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• 15:52Tracy V. Wilson?

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• 17:41Tracy V. Wilson?

  A lot of the writing on Pellagra in the United States in the first decade of the 1900s had drawn on Italian work that had connected the disease to corn consumption in some way. But then in 1910, the London School of Tropical Medicine published a report saying that Pellagra was caused by a microbe that was being spread by insects.

• 18:07Tracy V. Wilson?

  A pellagra investigation committee had been established in the UK that year, and it had funded a research trip to Italy that was carried out by physician Louis Zambon. Zambon had been born in Italy and had moved to the UK to head up the School of Tropical Medicine. His earlier work included the study of sleeping sickness in Uganda. He had correctly concluded that sleeping sickness was caused by a parasite that was transmitted by the sitzifly. In his pellagra study, he noted some commonalities between pellagra and insect-borne diseases like sleeping sickness, and concluded that it was not about the corn, that it was a

• 18:51Tracy V. Wilson?

  disease carried by some kind of biting insect, probably gnats, that were also common in the same rural areas where corn was a big part of people's diets.

• 19:02Holly Frey?

  In Italy, pellagra had become much less common, and the general consensus for decades had been that it was corn-related. So this report really did not get a lot of traction there. Many Italian doctors dismissed it entirely, even calling it absurd. But in the US, Zambon's conclusion really appealed to all the researchers who were looking for some kind of explanation for pellagra that did not trace back to Midwestern corn or Southern diets. This included the state of Illinois, whose investigatory commission on pellagra was established in 1910 and largely focused on Zambon's work.

• 19:41Tracy V. Wilson?

  My read on this is that Zambon's conclusions on pellagra were really influenced by his own preconceptions, based on his earlier successful work on insect-borne diseases. And this may have also been true for one of the commissions that started studying pellagra in the 19-teens. That was the Thompson McFadden Commission, named for its two primary funders, Robert M. Thompson, who was in mining, and Henry McFadden, who was a cotton merchant. Both of these men had a vested interest in determining a cause and treatment for pellagra, since it was prevalent in the mining camps and mill towns where the workers in their

• 20:26Tracy V. Wilson?

  industries lived.

• 20:28Holly Frey?

  The researchers who were part of this commission carried out their work in and around Spartanburg, South Carolina, where local officials agreed to cooperate and where the situation was critical. There were about 30,000 reported cases of pellagra with a fatality rate of about 40%. Investigators went house to house, asking about who lived there, their ages and sexes, whether any of them had pellagra, and what they ate. Doctors also diagnosed cases of pellagra during these visits.

• 21:03Tracy V. Wilson?

  The primary investigators for this commission were all microbiologists, and they discounted links to things like economic conditions and the maize and the gnat that Sambon had cited, before focusing on trying to pinpoint a specific microbial cause. In their second progress report, they didn't name a specific cause for pellagra, but they reported that pellagra rates were the highest in the places that did not have an enclosed sewer system, and people were using unscreened privies. Also, if one person in a household had pellagra, usually at least one other person had it as well.

• 21:48Tracy V. Wilson?

  They wrote, quote, "We are inclined to regard intimate association in the household and the contamination of food with the excretion of pellagrens as possible modes of distribution of the disease."

• 22:04Holly Frey?

  Pellagrens was the term being used to describe people with pellagra. So these researchers were saying that pellagra spread from person to person when the waste of someone with pellagra contaminated the food other people were eating. That contamination was spreading in neighborhoods where there was no sanitary system for dealing with human waste. They also noted some of the same demographic patterns as Henry Fauntleroy Harris had in his 1902 paper that we talked about earlier. Pellagra was far more common in women. They reported 528 cases in women and 212 in men. They also found far more cases among white people than among black people, but noted

• 22:48Holly Frey?

  that the cotton mill villages that they were researching were almost exclusively white.

• 22:53Tracy V. Wilson?

  Yeah, when you looked at a broader sample of the population, it was the opposite. It was a lot more common among black people. They just were looking at a sample that was mostly white.

• 23:05Tracy V. Wilson?

  A sewer system was built in Spartan Mills, after which pellagra rates there did start to decline. And so this wound up reinforcing the idea that the sanitary conditions had been involved in the pellagra spread. One possible explanation for why this sewer system, quote, "worked" is that the building of the sewer brought some more money into the town, which allowed people to buy a richer variety of food, but we don't really know. The connection to the sewers wasn't about some kind of waste contamination that was contaminating the food. It was that the people that were living in places that were so poor that they had no

• 23:49Tracy V. Wilson?

  sewer system couldn't afford to buy a richer variety of food, just to make that clear.

• 23:56Holly Frey?

  The Thompson McFadden Commission's reports deepened the division between the zeists and the anti-zeists. Claude Lavender, who had been heading up the government's response to the disease, wrote in a 1913 report, quote, "It is not to be understood from them that there are only two theories of the cause of pellagra. On the contrary, there are scores of theories. The zeists agree in one thing only, and that is that either directly or indirectly, pellagra is ideologically related to maize. While the anti-zeists agree in one thing only, and that is that the disease bears no such relation to maize. The zeists, however, do not agree among themselves, nor do the anti-zeists show any more harmony in their views.

• 24:41Holly Frey?

  Without going into the details of the various theories and shades of opinion, it may be said that the great struggle now centers around the question, is pellagra a kind of food poisoning from maize, or is it due to some parasite infecting the human body?"

• 24:58Tracy V. Wilson?

  In 1912, which was the same year that the Thompson McFadden Commission started its investigation, Polish biochemist Kazimir Funk coined the word vitamin as vital amines, and he connected deficiencies in these vital amines to diseases. He noted similarities among pellagra, berry berry, rickets, and scurvy, all of which are understood as vitamin deficiency diseases today. He observed that these diseases tended to erupt in countries where, quote, "a certain unvarying diet is partaken for long periods." People had already

• 25:39Tracy V. Wilson?

  figured out that berry berry, which is a thiamine deficiency, could be treated and prevented with rice bran, and that scurvy, which was a vitamin C deficiency, could be treated with a variety of fresh fruits and vegetables. We have a whole episode on scurvy. Funk argued that there was probably a dietary treatment for pellagra as well.

• 26:03Holly Frey?

  By 1914, Claude Lavender had not been successful in finding a definite cause for pellagra, and he asked to be assigned to other work. U.S. Surgeon General Rupert Blue appointed Dr. Joseph Goldberger as his replacement. Goldberger was from a Jewish family from the Austro-Hungarian Empire, who had moved to the United States when he was about nine. After becoming a doctor, he had worked in private practice for a while before joining the United States Marine Hospital Service. He had worked as an immigration inspector in the port of New York before moving on to studying and fighting infectious diseases. He had fought outbreaks of yellow fever, dengue fever, and typhoid, among others.

• 26:47Holly Frey?

  When he was appointed to study pellagra, he was in Detroit, helping to fight a diphtheria outbreak.

• 26:54Tracy V. Wilson?

  Yeah, his public health and infectious disease work has been described as monumental and heroic. He did a ton, and a lot of it he was doing at risk to his own health. That same year, the state sanitarium in Milledgeville, Georgia was in the middle of a pellagra crisis. Almost 200 people had died and pellagra had passed tuberculosis as the leading cause of death at the hospital. The federal government had started to see this situation as really urgent and Goldberg was given a budget of $80,000 for his investigation. That was out of the entire US public health budget of $200,000.

• 27:38Holly Frey?

  Goldberg studied conditions at the hospital and noticed something that George H. Circe had also described in his reports on the pellagra outbreak at Mount Vernon Asylum almost a decade before. Pellagra was affecting only the patients, not staff. Staff were in close contact with the patients all day and some of them lived at the facility. If the disease had been communicable, whether it was being spread through insects or some other vector, it would have affected staff as well. Theoretically, staff and patients were eating the same food, but Goldberg learned that the staff were served first,

• 28:18Holly Frey?

  so they usually took the best food for themselves. And the staff also had options to supplement their diets beyond what the hospital served.

• 28:27Tracy V. Wilson?

  Although most of Goldberg's background was in infectious diseases, he started researching pellagra as a possible nutritional deficiency. This is where we will get to the human experimentation that we talked about at the beginning of the show and some of it's very gross. We'll have more on that after a sponsor break.

• 28:54Speaker 01

  That sound? That's pro squash. Some of the fastest rallies in sport played inches from the crowd. The National Squash League is back in full swing for season four. The sport is heading to the 2028 Olympics for the first time, and you can see it up close right now in a city near you. Watch every match for free on YouTube. Search National Squash League and hit subscribe or follow live updates on Instagram at NSL.Sport. Cash Flow Crunch? OnDeck's small business line of credit gives your business immediate access to funds up to $200,000.

• 29:28Speaker 06

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• 29:52Tracy V. Wilson?

  Guess who's back in the house? The old gays return for season two of Silver Linings, their hit podcast from iHeart's Ruby Studio in partnership with ViiV Healthcare. Just wait until you hear what hosts Robert McMillan and Jess A. have in store this time around. They strut back down memory lane, navigating life, love, loss, and everything that shaped them along the way. And as usual, someone just might break into song. From leather bars to bathhouses, dance floors to drag brunch, nothing stays off limits. These are the kinds of insights that can only come from experience. So listen to your elders, honey, and discover the silver linings you can take with you. All sass, zero filter, and decades of perspective from four friends

• 30:36Tracy V. Wilson?

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• 31:38Holly Frey?

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• 32:08Tracy V. Wilson?

  In 1914, Joseph Goldberg started pellagra research at two orphanages in Jackson, Mississippi, where more than 200 total children had developed the disease during the spring and summer. He found that pellagra only seemed to affect children between the ages of six and 12, and they were all mostly eating biscuits, grits, cornmeal, and syrup. I'm not sure if the syrup was his word for molasses, but something sugary and syrupy. Even though the general conditions at the orphanages were not good in terms of things like sanitation and overcrowding and overall health, he left those conditions as they were for the sake of this experiment.

• 32:54Holly Frey?

  At both orphanages, in his words, quote, "A very decided increase was made in the proportion of the fresh animal and of the leguminous protein foods. This included milk, eggs, beans, and peas, and at breakfast, the children were served oatmeal rather than corn grits. Other foods were added as well." After the implementation of this diet, the children were observed for a year. One of the orphanages had no recurrences of pellagra the following spring and summer. The other had just one. A similar experiment with similar results was carried out at the Georgia State Sanitarium. In 1915, Goldberg began reporting

• 33:37Holly Frey?

  his results in the Southern Medical Journal and in public health reports.

• 33:42Tracy V. Wilson?

  This research strongly suggested that a diet containing a variety of foods could prevent pellagra, and he wanted to confirm whether pellagra could also be induced through diet. He worked with Earl Brewer, governor of Mississippi, to arrange an experiment at Rankin State Prison Farm, which did not have a history of pellagra among the people incarcerated there. 12 healthy men were recruited from this study, although one of them was found to have a previously undetected medical condition, and he was dismissed. These men were offered pardons for their participation. That would be seen as unethical and coercive today.

• 34:25Tracy V. Wilson?

  They were placed on a largely corn-based diet. And after about five months, six of them had developed the rash that is characteristic of pellagra. So this supported the idea that a primarily corn-based diet could cause pellagra.

• 34:44Holly Frey?

  Goldberg's conclusions really inflamed a lot of the cultural responses that we talked about earlier. While there were some Southern leaders and advocates who called for food aid to the South to combat any dietary deficiencies, many, many others were outraged. This was fueled by attitudes dating back to before the Civil War and reinforced during Reconstruction, and perceptions that a Jewish New Yorker, seen as a paternalistic, moralizing outsider, had come to pass judgment on the South, its people, and its food. Anti-Zeists doubled down on the insistence that this wasn't about food, and it specifically wasn't about corn,

• 35:27Holly Frey?

  and that there must be an infectious agent at work.

• 35:30Tracy V. Wilson?

  Yes, some of the tone of this conversation at the time was basically Goldberg saying, "There is famine in the South, and we need to take action to save people's lives." And his most vocal critics were like, "That is an insult. How dare you."

• 35:48Holly Frey?

  Defensiveness will make people do really foolish things.

• 35:51Tracy V. Wilson?

  Uh huh. So based on these criticisms, on April 26th of 1916, Goldberg started a series of experiments to try to prove that no, there was not an infectious agent at work. Most of the 17 participants in these experiments were doctors, but one of them was also his wife. They intentionally exposed themselves to the bodily fluids of pellagra patients, including their blood and swabs from their noses and throats. They also exposed themselves to skin from the patients' rashes.

• 36:32Tracy V. Wilson?

  This happened through things like injections and compounded pills that they swallowed. Basically, if you can imagine a way to get material from one person's body into another, they tried that. These were nicknamed filth parties. No one got pellagra from them.

• 36:53Holly Frey?

  Did they get other things?

• 36:56Tracy V. Wilson?

  Did they get hepatitis? I don't know.

• 37:00Holly Frey?

  Uh, even so, in November of that year, there were doctors at the Southern Medical Association annual meeting who still maintained that Goldberg was wrong. In particular, South Carolina State Health Officer James A. Hayne insisted that pellagra was infectious. He continued to publicly criticize Goldberg and his findings for years, no matter how much evidence was presented or how that evidence was framed. He later compared Goldberg to fascist dictator Benito Mussolini and described his ideas as having been, quote, "rammed down their throats."

• 37:40Tracy V. Wilson?

  Good thing we've been talking about stuff rammed down our throats for more than a century.

• 37:46Holly Frey?

  My least favorite phrase on the planet, perhaps.

• 37:49Tracy V. Wilson?

  I know. Also, in 1916, Goldberger started working with a team to study the relationship between Pellagra and the Southern economy. His collaborators included Edgar Seidenstricker, who had a background in labor economics and was a statistician. Their work was deeply critical of the exploitive systems that were at work in the South, including sharecropping and the cotton monoculture. Another researcher, Carl A. Groth, also studied the mining camps in Walker County, Alabama, and confirmed that Pellagra was not affected by a person's heredity or their race, but that rates of the disease

• 38:31Tracy V. Wilson?

  were directly correlated with income, making the food that people could afford the most likely explanation.

• 38:40Holly Frey?

  One of the criticisms of Goldberger's work was that it had been carried out in the controlled settings of orphanages and asylums. So in 1918, he did his own mill studies, as the Thompson McFadden Commission had done. He selected seven cotton mill villages in South Carolina and screened every person in every household for Pellagra. Everyone was very poor, but the households in which at least one person had Pellagra were the ones where there was little to no animal protein in their diets, although what they were eating wasn't necessarily limited to just corn.

• 39:18Tracy V. Wilson?

  Through all of this, Pellagra rates had continued to rise and fall in conjunction with changes in economic factors and food availability. So, for example, a bull weevil infestation in Alabama in 1915 led to them spiking. Although the disease was most prevalent in the South, it could be found all over the U.S., really anywhere that people could not afford a variety of food and were just subsisting on one specific staple.

• 39:50Holly Frey?

  But then, over the late 19 teens and early 1920s, researchers, including Goldberger, Russell Henry Chittenden, and Frank Pell Underhill, found one particular thing that seemed to prevent pellagra: brewers yeast, which we know today is high in protein, B vitamins, and other nutrients. This discovery came from experiments on pellagra in dogs. It was difficult to induce pellagra in dogs because most dogs don't want to eat nothing but cornmeal. So researchers were using brewers yeast to try to stimulate their appetites. It turned out the brewers yeast protected them from developing pellagra.

• 40:32Tracy V. Wilson?

  Yeah, Goldberger had also, at the same time, been systematically trying to find something that would work as a protective. And then this happened with the dogs. Brewers yeast was also inexpensive, and Goldberger started advocating for the use of brewers yeast to treat and prevent pellagra. When the Mississippi River flooded in 1927, causing immense destruction and widespread crop devastation, Goldberger warned that there would probably be an increase in pellagra rates to follow. He called for education about the use of brewers yeast and distribution of brewers yeast to affected communities. The Red Cross delivered 12,000 pounds

• 41:17Tracy V. Wilson?

  of brewers yeast to flood-affected areas. There was still widespread malnutrition in the wake of this flood, and there were also racial disparities as Black people were kept out of a lot of the relief camps. But Goldberger is credited with helping to mitigate some of the worst outcomes of this catastrophe.

• 41:39Holly Frey?

  While some of the South had been reluctant to accept a dietary explanation of pellagra, or to ask for or accept food relief, this flood was truly a massive disaster. It was so huge in scale and devastation that it removed some of the stigma around asking for help, especially asking for food help. Afterward, many of the doctors who had kept looking for an infectious cause of pellagra were more willing to accept that it was caused by a nutritional deficiency. The Red Cross also continued to deliver brewers yeast, distributing 500,000 pounds of it over the next decade.

• 42:19Tracy V. Wilson?

  On October 31, 1928, Goldberger gave a speech before the American Dietetic Association in which he said, quote, "The problem of pellagra is in the main a problem of poverty. Education of the people will help, but improvement in basic economic conditions alone can be expected to heal this festering ulcer in the body of our people." But much of the effort to cure pellagra and prevent it societally did not involve trying to reduce poverty. There definitely were efforts to provide food aid and other assistance during the Great Depression and other times of crisis, and there were various anti-poverty

• 43:04Tracy V. Wilson?

  programs, but the bigger and more long-term focus involving pellagra was on fortifying food.

• 43:11Holly Frey?

  Biochemist Conrad Elvheim isolated niacin, also called vitamin B3, in 1937. By 1938, bakers had started voluntarily producing bread using a high vitamin yeast, which helped reduce pellagra rates. As synthesized vitamins became less expensive, bread products and other foods were fortified with vitamins directly. A lot of this was like what we discussed in our episode on the iodization of salt, voluntary efforts by food producers and state laws requiring fortification. This continued into the 1940s with 28 states passing some

• 43:51Holly Frey?

  kind of mandatory law for fortifying bread or flour between 1942 and 1949.

• 43:58Tracy V. Wilson?

  I was telling my spouse about what this episode was about, and he said, "Is that why they spray vitamins on breakfast cereal?" Yes. I mean, other deficiencies too, but yes. Economic systems also changed during those decades. Obviously, poverty still exists. There are still food deserts where people cannot get access to the foods that they need to eat to live. But the sharecropping system started to fade in the wake of the mechanization and industrialization of the farm industry in the 1930s and 40s. That, of course, caused its own disruption to people's lives and circumstances,

• 44:40Tracy V. Wilson?

  but it did mean that people were not in a situation where they were sharecropping and they could only get food at a commissary. Falling cotton prices in the 1930s also led to some diversification in the crops that were being planted. The payment of wages in scrip, which had been common in mill towns and mining towns and locked people into buying their food only from a company store and nowhere else, that was outlawed under the Fair Labor Standards Act of 1938.

• 45:12Holly Frey?

  With food fortification and social and economic shifts, the Pilagre crisis in the US was largely over by the start of World War II. But between 1906 and 1940, there had been approximately 3 million cases and 100,000 deaths from the disease. About half of those deaths were among black people, and about 2/3 of them were women. This was something that some of the researchers, including Goldberger, commented on at the time. Because of ongoing patterns of racism and bigotry, black people in any given community tended to be in the poorest class with the fewest resources and were sometimes excluded from receiving food aid or other support.

• 45:56Holly Frey?

  The gender disparity is a little more complicated. It's possible that there were some physiological factors involved in the absorption and use of niacin in women's bodies, but some of this was probably connected to gender roles and family dynamics. In most families, women were the ones procuring and preparing food, and mothers and wives often deprived themselves so the rest of the family could eat.

• 46:22Tracy V. Wilson?

  Joseph Goldberger did not live to see the isolation of niacin or the end of the Pilagre epidemic. He died of cancer on January 17, 1929.

• 46:34Tracy V. Wilson?

  His critics spread rumors that he had really died of pellagra.

• 46:38Holly Frey?

  The exact mechanisms of niacin in the body and how it relates to pellagra continued to be studied for decades after the 1940s. And the discovery of nystomalization's role in making nutrients in corn more bioavailable is comparatively recent. Researchers started publishing work analyzing the available nutrients in nystomalized corn in the 1950s, with research confirming that nystomalization increases the availability of tryptophan and niacin by the late 1980s. During our lifetimes.

• 47:12Tracy V. Wilson?

  Yeah, yeah. I had trouble pinning down exactly when that research happened because that's a, that's a thing, that's a series of terms to try to do sort of a literature review on. And I found various papers over the course of those decades that were related to it in one way or another. And then also I would find other papers that were about pellagra in some other way, written from like the 70s, that just seemed unaware that nystomalization was even a factor in anything. So even if it was more understood, like that

• 47:52Tracy V. Wilson?

  had not spread through all of the research community. Anyway, we'll talk about some things on Friday, I'm sure, in our behind the scenes. I have some listener mail.

• 48:07Holly Frey?

  Fabulous.

• 48:09Tracy V. Wilson?

  This listener mail is from Kristin, who wrote in after our episode on Yon Arison. This says, "Hi Holly and Tracy. I'm a longtime listener and repeat fan mail writer. I love your episodes and am particularly interested when I find a personal connection to the story you are telling, as is the case in your recent episode on Yon Arison." I am half Icelandic by descent, and so I'm tickled by your interest in the land of my forefathers. During the podcast, Tracy tossed in a comment that it's quite likely that all Icelanders are descended from Jón Arson in one way or another. I thought to myself, challenge, accepted, and went to the Icelandic genealogy database, that

• 48:53Tracy V. Wilson?

  is at icelandicroots.com, to see if I could establish a personal connection to Jón Arson. Lo and behold, Tracy was right. I am related to Jón Arson, who is my 12 times great grandfather, or Lankofé. I'm sorry if I did not do a great job of pronouncing that term. Not only that, but I am related to him through 15 different lines of descent, see attached family tree. This is due to the fact that Iceland's population has always been relatively small, so most people are related. In fact, when I was in Reykjavik on a business trip some years back, I was invited to a small get together after work where I met a recently

• 49:34Tracy V. Wilson?

  retired bishop of Iceland, Peter Stegerson. I feel like I left a syllable out of that, but I don't think I could do it again. I mentioned that my mother's family was from Iceland, and he responded that we must be related. After I tossed a few ancestral names out, he said, of course, we are distant cousins. I was able to confirm his statement recently on the Icelandic Roots genealogical database. What fun to have an automatic conversation starter like this. I'm including a photo of four generations of my family: me, my mother, my Amma, and my Langanma. I am not saying their names for the sake of privacy, but

• 50:14Tracy V. Wilson?

  they are in the email. This photo was actually taken in Canada, which is in Gimli in Manitoba, which is the largest Icelandic settlement outside of Iceland. For pet tax, I've run out of current pets to introduce you to, so I'm going back in time to our family's first kitty. Early one Saturday morning, the wife of my father's boss showed up at our door. When my mother opened the door, the woman said, here, and shoved a kitten in a can of cat food into my mother's hands, and then strode quickly away.

• 50:48Tracy V. Wilson?

  We children, of course, were thrilled at the idea of a kitten. My parents bowed to the inevitable. They both had a quirky sense of humor and decided to name our cat Fido. Fido quickly grew from a small kitten to an extremely large cat. The attached photo shows Fido being held by then-three-year-old brother for scale. Fido lived to the ripe old age of 22, despite receiving the excessive love from all four of us kids. Lastly, this made me cry when I first read it. And so I'm going to try to read it without crying.

• 51:20Holly Frey?

  Fingers crossed.

• 51:21Tracy V. Wilson?

  I don't know if I can, but I'm going to try.

• 51:23Holly Frey?

  We'll see.

• 51:23Tracy V. Wilson?

  Lastly, I want to thank you for your gentle benedictions at the end of each Friday Behind the Scenes Podcasts. Kristin just goes on to talk about how you're dealing with some things. And this positive message at the end of your show gives me a little lift going into the weekend. This did make me cry when I first read it. I'm crying a little bit right now. Thanks for everything, Kristin. Thank you so much, Kristin. I love the confirmation of the interrelatedness of folks in Iceland. It is a small island and the population is small. What a great family picture also. And then we have a picture of a small child

• 52:04Tracy V. Wilson?

  holding a large, very fluffy, white and gray kitty cat. And the cat is almost as big as this child's whole torso. I love all of this. Thank you so much for this email and for all this about your family and for your very gentle thank you at the end. I loved this. It made me tear up and gave me a little bit of a lift for the rest of the day. If you would like to send us a note about this or any other podcast, we're at [email protected]. And you can subscribe to our show on the iHeartRadio app and anywhere else you like to get your podcasts.

• 52:53Tracy V. Wilson?

  Stuff You Missed in History Class is a production of iHeartRadio. For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

• 53:10Speaker 01

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• 53:38Holly Frey?

  A rare disease diagnosis can change your life, but it doesn't have to define your future. In season seven of Untold Stories: Life with a Severe Autoimmune Condition, host Martine Hackett continues the conversation with people living with MG, CIDP, and the broader rare disease community, exploring what comes after diagnosis through stories of hope, progress, and connection. Produced by Ruby Studio in partnership with Argenx. Listen on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts.

• 54:09Tracy V. Wilson?

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• 55:14Speaker 00

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