Photo: Man with Pellagra on arms

By 1912, Joseph Goldberger had been a member of the U.S. Public Health Service for 13 years. In 1914, the surgeon general appointed him to tackle the crisis of pellagra. Pellagra had been a low-level problem throughout the South for years, but crop failures and an economic downturn had raised it to epidemic proportions. The disease causes skin rashes, mouth sores, diarrhea, and if untreated, mental deterioration. Goldberger's first step was to simply observe. He traveled tirelessly through the South, taking notes, asking questions, and watching. He noticed that the diet of poor people in the region consisted of cornbread, molasses, and a little pork fat. It seemed that the poorer people were, the more likely they were to get pellagra. Institutions such as prisons, asylums, and orphanages also had a limited diet and a great deal of pellagra -- among inmates. Goldberger gradually concluded that the disease was not infectious at all, but strictly a matter of diet.

In 1915, he conducted experiments on inmates at a Mississippi prison, who volunteered for the study in exchange for a pardon. Because it was a farm prison, its inmates had a fairly balanced diet. Goldberger's volunteers were given the poor Southern diet he had seen associated with pellagra. That was the only difference. The other inmates ate the usual farm fare. Every effort was made to prevent and rule out infectious transmission. And within months, the volunteers came down with pellagra. Then the researchers tried to catch the disease from those already suffering -- they couldn't. The pellagra symptoms disappeared when the volunteers were given meat, fresh vegetables, and milk.

Despite this conclusive evidence, Goldberger had trouble convincing others what he had found. He spent the rest of his life looking for what exactly was missing in the diet that caused pellagra, but this would not be uncovered until after his death. He also was thwarted by the medical world's obsession with infectious disease, newly understood and in some cases treatable, and the political world's resistance to hearing that poor social conditions could cause disease.

In 1937, researcher Conrad Elvehjem found that nicotinic acid, or niacin, prevented and cured pellagra in dogs. It works as well in humans. Niacin is one of the B vitamins. During the 1930s, great strides were made in understanding the way vitamins work in the chemistry of our bodies.