Red Madness: How a Medical Mystery Changed What We Eat by Gail Jarrow (review)

It started with three symptoms: rash, diarrhea, fatigue. The rash could pass for sunburn, except for the predictable patterns in which it presented. By the time it was diagnosed, the patient had often reached a state a dementia and was weeks or even days from death. The illness was already known among rural populations in Europe and named “pellagra” (rough skin) by the Italians. When it reached epidemic proportions in early twentieth-century America, doctors took notice, and the hunt was on for the culprit and a cure. Jarrow treads in the medical gumshoes’ footsteps, tracking clues down blind alleys of poverty and contagion, and follows medical reasoning from hypotheses to human experimentation (that would never be allowed by today’s standards) while examining the political contentions that caused public health setbacks even after effective treatment had been discovered. The central figure of the story, Dr. Joseph Goldberger of the Public Health Service, and his colleagues eventually eradicate what turns out to be a nutritional deficiency disease through dietary changes and the addition of nicotinic acid, or niacin, to flour. Though disease is likely not on most kids’ radar, its historical prevalence and peril make it a riveting subject, and Jarrow intersperses plenty of brief case histories and poignant photographs of sufferers throughout the text to keep the human interest angle as compelling as the medical mystery. Index, sources notes, bibliography, and timeline are included, as well as a fascinating FAQ section that delves further into the interrelationship between nicotinic acid, tryptophan, foods, and food preparation, and explores why pellagra is thankfully no longer a household word.