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NIH Record

The Scientist as Social Crusader
Historian Kraut Offers Lessons from a Plague

By Judy Folkenberg

Working in the isolation of their laboratories, scientists sometimes forget that their discoveries can have far-reaching consequences in the larger society.

Dr. Alan Kraut, professor of history at American University, hopes that his forthcoming biography of former NIH scientist Dr. Joseph Goldberger will help show scientists the importance of history. Kraut recently spent 4 months at NIH's history office researching his book. He will give a Wednesday Afternoon Lecture at 3 p.m. Mar. 12 in Masur Auditorium, Bldg. 10, entitled "The Unwelcome Messenger: Dr. Joseph Goldberger -- An NIH Scientist as a Social Reformer."

Goldberger (1874-1929) started his medical practice in the small city of Wilkes-Barre, Pa. He soon became restless, so he joined the United States Marine Hospital Service, the forerunner of the U.S. Public Health Service (PHS), of which the National Institutes of Health later became a part. Goldberger fought epidemics of yellow fever, typhus, dengue fever and diphtheria before turning his attention to pellagra. A loathsome skin disease often mistaken for leprosy, it was first identified among Spanish peasants in the early 1700's. Although reports of the illness went as far back as the 1820's in the U.S., it wasn't conclusively identified in this country until 1907. Because of its symptoms it was called the disease of the 4 D's -- dermatitis, diarrhea, dementia, and death. Goldberger theorized that diet caused pellagra, not germs -- a hypothesis that contradicted then-current medical thought. The tip-off: In institutions such as orphanages, prisons, and insane asylums, employees remained disease-free while the inmates contracted pellagra. Germs did not distinguish between staff and inmates, noted Goldberger wryly.

To bolster his claims, Goldberger experimented on eleven healthy volunteer prisoners at Rankin State Prison in 1915. Offered pardons in return for their participation, the volunteers ate a heavily corn-based diet -- deficient in many vitamins including the B vitamin, niacin. Six of the eleven showed pellagra rashes after 5 months. This strongly supported the idea that diet caused pellagra, yet many scientists remained skeptical.

Goldberger was frustrated by his colleagues' resistance to the notion that pellagra was a nutritional deficiency rather than a germ disease. In a valiant -- and dramatic -- scientific effort, Goldberger injected 5 cubic centimeters of a pellagrin's blood into his assistant, Dr. George Wheeler. Wheeler then shot 6 centimeters of such blood into Goldberger. Later they swallowed capsules containing scabs of a pellagrin's rash. They had their nose and throats swabbed with secretions from a pellagrin's nose and throat. Even Goldberger's wife, Mary, joined in the experiments, which her husband dubbed "filth parties." Again Goldberger proved his point. Neither he nor any of his volunteers got pellagra from the injected "germs."

These final experiments convinced Goldberger that he had to step out of the laboratory and into society. Donning his mantle as social critic, Goldberger pointed out that the tenant farmer/sharecropping system which had replaced slavery forced tenant farmers and sharecroppers to grow only the crops demanded by owners. Cotton, the biggest moneymaker, was king. Small vegetable gardens or other crops took land out of cotton production, so poor southerners ate a diet heavy on corn, salt-pork, and molasses, a diet seriously deficient in vitamins, especially niacin. The real cure for pellagra was social reform, especially changes in the land tenure system and more diversified crops, noted Goldberger.

But Goldberger had stepped on some important toes, not to mention southern pride. In 1920, there was a dramatic drop in cotton prices and thus the income of poor southerners. Goldberger predicted an increase in pellagra and newspaper headlines warned of famine and plague. President Harding asked the PHS to increase the budget for hospitalization and supplies.

Southerners were enraged. Led by South Carolina Congressman Jimmy Byrnes, they denounced Goldberger's negative characterization of their region and feared that it would discourage economic investment and tourism. But Goldberger's prediction was correct. There was a dramatic increase of pellagra victims and deaths. Ironically, the boll weevil accomplished what Goldberger failed to do. Infestation of the cotton crop forced farmers to plant varied kinds of crops -- including a greater variety of vegetables.

Goldberger showed that brewer's yeast (rich in B vitamins) prevented the disease, as did a diet that included fresh lean meat, milk, and vegetables. His contribution to human health thus went beyond identifying the cause of disease to finding an inexpensive cure for it. Tragically, he died at age 55 from cancer, before the pellagra preventive factor was identified in the laboratory as niacin. Many people think Goldberger would have been awarded the Nobel prize had he lived long enough to complete his research.

"Goldberger was the rarest of a rare species, a hero," says Kraut. "He pursued truth, no matter what the outcome, made discoveries that benefitted mankind, and was remarkably free of self-promotion. That's not to say Goldberger didn't have an ego -- every scientist does -- but he had enormous humility."

Kraut's interest in the social milieu of medical research goes back to the early 1980's. An expert on immigration history (with two books to his credit: The Huddled Masses, The Immigrant in American Society 1880-1921, and American Refugee Policy and European Jewry -- 1933-1945) he then turned his attention to the history of medicine. This resulted in the book Silent Travelers, Germs, Genes, and the Immigrant Menace, a book on the stigmatization of immigrants as disease carriers.

"Medical researchers have a great deal to learn from history," said Kraut. For example, there are similarities between today's AIDS epidemic and the prevalence of venereal disease epidemics in the 1920's. All sexually transmitted diseases have a heavy moral context. "It's important to see how earlier generations handled diseases with social and moral implications. Once you've made a medical discovery," said Kraut, "you have to convince the public of its merits -- a task that is not always easy because of social or moral beliefs."

Kraut draws an important similarity between former Surgeon General C. Everett Koop and Goldberger. As Koop had been critical of personal behavior and social policies that put individuals at risk for the AIDS virus, so Goldberger warned Americans about the crucial link between poor nutrition brought about by risky farming practices resulting from an oppressive system of land distribution and pellagra.

"Great medical scientists do not isolate themselves from the social dimension of the human condition," Kraut concludes.

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