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Asylum Doctor

James Woods Babcock and the Red Plague of Pellagra

Charles S. Bryan

Publication Year: 2014

During the early twentieth century thousands of Americans died of pellagra before the cause—vitamin B3 deficiency—was identified. Credit for ending the scourge is usually given to Dr. Joseph Goldberger of the U.S. Public Health Service, who proved the case for dietary deficiency during 1914−1915 and spent the rest of his life combating those who refused to accept southern poverty as the root cause. Charles S. Bryan demonstrates that between 1907 and 1914 a patchwork coalition of American asylum superintendents, local health officials, and practicing physicians developed a competence in pellagra, sifted through hypotheses, and set the stage for Goldberger’s epic campaign. Leading the American response to pellagra was Dr. James Woods Babcock (1856–1922), superintendent of the South Carolina State Hospital for the Insane from 1891 to 1914. It was largely Babcock who sounded the alarm, brought out the first English-language treatise on pellagra, and organized the National Association for the Study of Pellagra, the three meetings of which—all at the woefully underfunded Columbia asylum—were landmarks in the history of the disease. More than anyone else, Babcock encouraged pellagra researchers on both sides of the Atlantic. Bryan proposes that the early response to pellagra constitutes an underappreciated chapter in the coming-of-age of American medical science. The book also includes a history of mental health administration in South Carolina during the early twentieth century and reveals the complicated, troubled governance of the asylum. Bryan concludes that the traditional bane of good administration in South Carolina and excessive General Assembly oversight, coupled with Governor Cole Blease’s political intimidation and unblushing racism, damaged the asylum and drove Babcock from his post as superintendent. Remarkably many of the issues of inadequate funding, political cronyism, and meddling in the state’s health care facilities reemerged in modern times. Asylum Doctor describes the plight of the mentally ill during an era when public asylums had devolved into convenient places to warehouse inconvenient people. It is the story of an idealistic humanitarian who faced conditions most people would find intolerable. And it is important social history for, as this book’s epigraph puts it, “in many ways the Old South died with the passing of pellagra.”

Published by: University of South Carolina Press

Title Page, Frontispiece, Copyright, Dedication, Quote

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pp. ix-xii


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pp. xiii-xvi

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pp. xvii-xxii

This book traces back to 1944−1946 when I was a toddler living with relatives in Anderson, South Carolina, where my uncle ran a textile mill. A silver bowl of tan-colored tablets sat on the mahogany dining table. I snitched them by the handful. I loved the taste—brewer’s yeast.
When my father came back from the war we returned to Columbia, where...

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pp. xxiii-xxviii

In the fall of 1908 Mildred Corley began to act strangely. She seemed distant. She neglected her children. She dressed poorly. She stared into space, heard voices, and talked to people who weren’t there. Her family doctor sent her to the State Hospital for the Insane in Columbia. When relatives visited the next summer she barely recognized them, and vice versa. Her...

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1. Jimmie: “To Fit Ourselves for Future Usefulness”

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pp. 1-24

Chester, South Carolina, late evening of February 16, 1865. A Confederate army surgeon holds up his eight-year-old son and points to a lit-up spot on the horizon. “Jimmie,” the man says grimly, “that’s Columbia burning.”
The boy would transcend the mediocre primary and secondary schools of post-Civil War South Carolina by going north for 17 years. There he...

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2. Superintendent: Hoping, Moping, and Coping

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pp. 25-76

James Woods Babcock returned to South Carolina in 1891 as the state’s first fully-trained psychiatrist or, to use the then-current term, “alienist.” He had attained at age 35 what was then a psychiatrist’s highest ambition: to be an asylum superintendent. However, the South Carolina Lunatic Asylum was an extreme example of the deterioration of public asylums into convenient...

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3. Founder of the Movement: Zeists and Anti-Zeists

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pp. 77-112

In December 1907 Babcock recognized a symptom complex consistent with pellagra, widely thought not to exist in the United States. He was unaware that George H. Searcy of Alabama had made the same observation earlier that year. Over the next two years, Babcock with his Columbia colleagues verified that the disease was pellagra, convened two conferences...

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4. How Bad It Was: “All Who Enter Here Leave Hope Behind”

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pp. 113-142

The 1909 national pellagra conference in Columbia was in many ways the high-water mark of collaboration, good will, and civic pride in the public response to the epidemic. As it became increasingly apparent that the disease struck mainly in pockets of poverty and deprivation, pellagra like hookworm became for many southerners an embarrassment they preferred...

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5. Sambon’s Obsession: Pellagrins, Pellagrologists, and Pellagraphobia

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pp. 143-172

Between the first (1909) and second (1912) national conferences at the South Carolina State Hospital, pellagra became epidemic in the Southeast and a concern throughout the nation. American physicians established a competence in the disease. Louis Sambon’s version of the infection hypothesis replaced Cesare Lombroso’s version of the spoiled-corn...

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6. So Near, So Far: Funk Was Right but Few Listened

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pp. 173-192

In 1912 Casimir Funk, a 28-year-old Polish-born chemist working in London, proposed the vitamin-deficiency hypothesis for pellagra. Among those who took him seriously were Surgeon General Rupert Blue of the U.S. Public Health Service, and Fleming Sandwith of London. On the evening of October 3, 1912, at Babcock’s invitation, Blue and Sandwith separately...

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7. A Plain Farmer’s Daughter: “The War against the Woman”

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pp. 193-222

In March 1914 Babcock resigned under pressure from Coleman Livingston Blease, possibly the most controversial governor in South Carolina history. As the story is usually told, Blease had at least two reasons to get rid of the superintendent. First, he wanted to get even with Ben Tillman, Babcock’s friend and sponsor but Blease’s mentor-turned-enemy...

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8. The Blind Men of Hindustan: “The Diet of the Well-to-Do”

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pp. 223-258

Babcock did well in practice. He set up a clinic and built a small private sanitarium in Columbia. He taught medical students at the Medical College in Charleston. Nora Saunders worked with him until 1919, when she went north to start a new career. Despite success in practice and at teaching, one of his daughters reminisced that “Doctor Babcock never...

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Perspective: Asylum Doctor

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pp. 259-264

In 1930 two graduate students, one at the University of South Carolina and the other at the University of Chicago, chose the South Carolina State Hospital for their master’s degree theses. The South Carolina student wrote of Babcock: “When it is considered how little he had to work with, his accomplishments at the hospital deserve much...

Appendix 1: Mortality and Full Recoveries (as Percentages of Patients Treated) by Race, South Carolina State Hospital for the Insane, 1891–1914

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pp. 265-266

Appendix 2: Parallels in the Histories of Beriberi and Pellagra

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pp. 267-268

Appendix 3: A Chronology of Pellagra and Niacin

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pp. 269-276

Appendix 4: Summary of the Four Major Pellagra Conferences held at the South Carolina State Hospital for the Insane, 1908–1915

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pp. 277-278

Notes for Researchers

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pp. 279-282

Abbreviations Used in Notes

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pp. 283-284


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pp. 285-354


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pp. 355-388


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pp. 389-402

E-ISBN-13: 9781611174915
E-ISBN-10: 1611174910
Print-ISBN-13: 9781611174908

Page Count: 432
Publication Year: 2014