In the pantheon of epidemiologists, Joseph Goldberger (1874–1927) ranks high. An Austrian immigrant, he grew up in New York, attended Bellevue Hospital Medical College, and began working with the U.S. Public Health Service in 1899. He had a distinguished career, investigating yellow fever with Milton Rosenau, typhoid in the Potomac River basin, dengue in Texas, louse-borne typhus, and other infectious diseases of public health importance.
In 1914, Goldberger turned his attention to pellagra, which was then prevalent in the southern United States. As Milton Terris has pointed out, Goldberger's achievement in unraveling the true nature of this previously mysterious disease equals John Snow's groundbreaking work on cholera. Pellagra causes a characteristic symptom cluster of skin eruptions, loose bowel movements, wasting of body mass, and in severe cases, mental and intellectual damage. When Goldberger began his investigation, a government commission had recently concluded that pellagra was an infectious disease of unknown nature, perhaps aggravated by a protein-deficient diet. Based on logical conclusions from three basic facts, Goldberger showed the infection hypothesis to be wrong. Goldberger knew that staff in institutions where pellagra was common among inmates did not get the disease; that it was much commoner in isolated rural regions than in cities, where people were in closer contact; and that it was associated with poverty. Goldberger concluded that pellagra must be due to a dietary deficiency.
His subsequent investigations, often in collaboration with Edgar Sydenstricker and others, included experiments with rhesus monkeys; a dietary survey of affected and unaffected families; and experiments using himself, his colleagues, and his own wife, in which they subjected themselves to ingestion and inhalation of bodily secretions. None of his investigations revealed evidence of a transmissible agent. The final stage of the investigation was another human experiment done on the residents of orphanages (without the ethical approval such studies would require now). This identified the pellagra-preventing factor, which was found to be associated with foods containing high concentrations of vitamin B. Unfortunately, Goldberger died before this factor, nicotinic acid, or niacin, was isolated and chemically identified.
JOHN M. LAST
Terris, M. (1964). Goldberger on Pellagra. Baton Rouge: Louisiana State University Press.