52 Loaves by William Alexander Read Free Book Online Page B

written on it: “pellagra.”
    I wanted to tell the Charleston gentry how fortunate they were to be here at all; how as recently as seventy years ago, the bread that the people of South Carolina were eating was responsible for skin lesions, insanity, and death. That people with full stomachs were mysteriously dying of malnutrition. That governors of this proud state were both the fiercest critics of the New Yorker who saved thousands of South Carolinians’ lives and the first to adopt his cure. This event had brought me to ground zero of one of the most fascinating epidemiologicalstories in our nation’s history. I hadn’t figured all of it out yet myself—especially the bread part—but I was starting to put the pieces together.
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    If you’ve ever been in the American South, one of the first things you notice is that people are big. Traveling through Alabama, South Carolina, Georgia, Mississippi, the places where most of college football’s offensive linemen seem to come from, you don’t see a lot of people, black or white, rich or poor, who seem mal-nourished. Yet many of these people are the grandchildren and great-grandchildren of the tenant farmers and mill workers who died by the thousands of malnutrition in the richest nation in the world in the first quarter of the twentieth century.
    The disease they were dying from was pellagra. This was the reason, remember, cited by the King Arthur Flour Baker’s Hotline for the presence of niacin in every bag of flour and every loaf of bread sold in the United States. Although seen occasionally in Italy for centuries, pellagra was relatively unknown in the United States until about 1908 and even then was largely confined to the South, where it was known as the disease of the four Ds: dermatitis, diarrhea, dementia, and death. Much like AIDS in the 1980s, it arrived on the scene as a mystery disease. There seemed to be no rhyme or reason to why one neighbor caught it and another did not. If contracted, it was horrifying. The first symptoms were oft en a severe dermatitis—a rash on the face, arms, and hands—which was followed by diarrhea and, when the illness progressed, severe dementia. The lucky ones reached the fourth D and died.
    Because pellagra was most frequently found among poor Italian peasants who subsisted mainly on polenta and, in this country, among poor Southerners who consumed large amounts of corn in the form of grits, corn bread, and mush, it was widelybelieved to be caused by ingesting an unidentified fungus that grows on corn. This seemed reasonable because another fungus, called ergot, which grows on rye and other grains, was known to cause similar skin and psychological symptoms (later in the century, chemists would isolate LSD from ergot).
    By 1914, pellagra, almost unknown in America five years earlier, was the second-leading cause of death in South Carolina. In just five southern states, the mystery disease was killing some four thousand people a year and infecting hundreds of thousands more. The government convened a blue-ribbon panel of scientists that discounted the corn connection, concluding that pellagra was caused by an infectious disease carried by a microorganism. Their reasoning? In the southern United States, pellagra was a common condition in prisons, insane asylums, and orphanages, whose residents lived in close quarters, oft en without proper sanitation. But which microorganism, and how to fight it, they couldn’t say, so the U.S. Public Health Service, initially slow to wake to the worsening epidemic, put their best man on the job.
    That would be Dr. Joseph Goldberger, a Jewish immigrant from Hungary raised on New York’s Lower East Side. Goldberger had built a reputation for himself in combating the infectious diseases of the day—yellow fever, dengue, typhus, diphtheria—yet he was shocked by what he saw in the Carolinas, Mississippi, Alabama, Georgia, and Kentucky: orphans with