- Goldberger's War: The Life and Work of a Public Health Crusader
Joseph Goldberger (1874-1929), a physician who served in the United States Public Health Service, fought epidemics of typhoid, dengue, typhus, and yellow fevers, as well as measles and diphtheria—but it is his campaign against pellagra in the Southern United States for which he is best known. During his field studies, Goldberger contracted yellow, dengue, and typhus fevers, but lived to contribute astute observations about their mode of transmission and to help local authorities, as well as federal public health officials, to work to eradicate them. Along the way he met and married Mary Farrar, daughter of a wealthy New Orleans attorney; their marriage, at first opposed but eventually accepted by his Jewish and her Episcopalian family, was based on strong mutual love but was severely tested by his long periods out in the field and away from the family.
Goldberger's systematic studies of pellagra, which led him to identify it as a diet-related disease rather than a contagious one, occupy the major portion of Alan Kraut's narrative. He contrasts Goldberger's steadfast pursuit of scientific evidence that favored diet as the cause of pellagra with the actions of certain Southern physicians and local authorities, who for self-serving reasons clung to the idea that it was an infectious disease. He describes Goldberger's crusade against the conditions of poverty and the dysfunctional social structure that were fostering the pellagragenic diets, a crusade that engendered anger and resentment from those in the South who wished to emphasize their improving economic and social conditions.
Early in his studies Goldberger observed that employees in pellagra-ridden institutions did not contract the disease from the patients, making it different from the other epidemics he had studied and perhaps implicating the institutional diet. He was also guided by reports of pellagra from Illinois that seemed to suggest that diet was involved. In feeding studies conducted in Mississippi orphanages and a Georgia mental hospital, he identified dietary protein sources, and specifically the amino acid tryptophan, as cures for pellagra, but he did not follow up on the tryptophan observation. Confusingly, brewer's yeast, devoid of significant protein, was also curative. In a Mississippi prison he produced symptoms of pellagra by altering the diet of selected prisoners. Moreover, through consuming and injecting bodily materials from pellagra patients into himself, his wife, and certain colleagues he directly demonstrated that the condition was not contagious. Goldberger died of cancer while trying to identify the curative agent in the yeast, and it was some years later that Conrad Elvehjem and his group at Wisconsin demonstrated that it was the B-vitamin niacin in brewer's yeast that was effective—and even later, that niacin coenzymes could be formed in the body from tryptophan. After Goldberger's death, his widow lobbied for the formation of a National Institute of Health, and the U.S. Congress, in recognition of Goldberger's service to the nation, enacted a pension for her.
Kraut has based his intriguing and well-documented story on histories by Elizabeth W. Etheridge and Daphne A. Roe, records maintained by the Public Health Service, major archival collections of related papers, correspondence [End Page 146] between Mary and Joseph when they were apart, and interviews with family members. In describing Goldberger in heroic dimensions he has, perhaps inevitably, lost some of the nuances regarding the character and motives of both the hero and the contrasting villains, as well as the important contributions of many others in overcoming pellagra. With the advantage of hindsight, at times Kraut draws more definite conclusions from Goldberger's experiments than those drawn by Goldberger at the time; and, although he acknowledges the serious ethical issues related to those experiments that will arise in the minds of today's readers, he does not examine them in any detail. While nutrition scientists may be mildly irritated by occasional minor errors regarding technical aspects of the science...