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xxiii P r o l o g u e 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 behavior had become even stranger. They commented on a sunburn-like rash on her neck and the backs of her hands.That winter she did not know them at all.She lay expressionless in bed and rarely spoke.She had frequent diarrhea and was getting bedsores. She died a few months later. The death certificate read, “Pellagra.” Pellagra. “Pel-LAY-gra,” “pel-LAG-ra,” and “pel-LAH-gra” are all acceptable pronunciations. Most Americans are dimly aware of it, if they’ve heard of it at all. Medical students memorize it as “the disease of 4Ds”— dermatitis, diarrhea, dementia, and death—caused by deficiency of niacin (vitamin B3).They learn it as one of the classic vitamin-deficiency diseases, the others being scurvy, beriberi, rickets, and vitamin A deficiency.1 By one estimate pellagra affected 250,000 Americans at its peak and caused about 7,000 deaths each year in the fifteen southern states.2 Between 1907 and 1915, the period covered here, pellagra was a huge story in South Carolina and beyond. In 1910 Dr. Robert Wilson Jr., chairman of the State Board of Health, wrote that “no disease in the history of the State has ever aroused so much interest among the members of the medical profession and the laity”; in 1911 he called it “so prevalent that it forms a topic of conversation in the churches, in the streets, in the clubs and in the homes”; and in 1912 P r o l o g u e xxiv Prologue he added that it “menaces the industrial prosperity of South Carolina” by its toll on textile workers.3 Mildred Corley was one of untold thousands of Americans who died of pellagra before 1937,when investigators at the University of Wisconsin identified the deficient vitamin, leading to its addition to foodstuffs. The conquest of pellagra is commonly associated with a single name: Joseph Goldberger. In February 1914 Surgeon General Rupert Blue of the U.S. Public Health Service made Goldberger his chief pellagra investigator . Goldberger concluded within four months that the cause was inadequate , monotonous diet, not infection as many people thought.4 By the fall of 1915 Goldberger had both prevented and caused pellagra by dietary manipulation alone.Public health officials,politicians,and others rejected the dietary explanation,especially since it indicted southern poverty.Goldberger devoted the rest of his life to pellagra and, before his death from cancer, found an inexpensive way to prevent and treat the disease: brewer’s yeast. After Goldberger’s ashes were scattered into the Potomac River on January 18, 1929, Surgeon General Hugh Cumming wrote that “the disease which baffled the best medical talent of Europe for two centuries had yielded well within a decade to the researches of one American scientist.”5 The story is not so simple.In 1963 medical historian OwseiTemkin told the present author’s class of first-year medical students: “Great discoveries are seldom the work of one person.There is usually something ‘in the air,’so to speak.”That same year historian of science Thomas Kuhn coined the term “paradigm shift” for his thesis that new theories arise when older theories make us insecure by failing to account for all the facts.6 More recently Steven Johnson reviews what scholars call “the multiple”—a scientist goes public with a new idea only to find that others independently came up with the same idea—adding: “Good ideas are not conjured out of thin air; they are built out of a collection of existing parts.”7 Innovation springs “not from geniuses acting alone but from accumulated knowledge,constructive errors, and the ‘information spillover’ that emerges from collaborative settings.”8 However, the present author’s goal is to burnish, not blemish, Goldberger’s iconic image.Goldberger never told the story in quite the way it’s been told to later generations. Goldberger, a great man and apparently a nice man as well, gave ample credit to others on both sides of the Atlantic. When Goldberger went south in February 1914 the idea that faulty diet caused pellagra...

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