The Man Who Ate Scabs to Save the American South

The true story of Joseph Goldberger, the pellagra epidemic, and one of the most committed acts of scientific frustration in American history

Image credit: Unsplash-Ahmed

In the early 1900s, something was eating the American South alive. Literally eating people from the outside in, starting with a rash that wrapped around the neck like a collar made of poor decisions. Then came the diarrhea. Then the dementia. Then, for about forty percent of the people who got it, death.

By 1912, South Carolina alone had tens of thousands of cases, a number that you’d think would make a government sit up straight. Instead, the medical establishment stared at the situation like a cat watching a ceiling fan: vaguely interested, deeply confused, and not at all helpful.

They had theories. They always do, don’t they? We love theories. “Shockingly,” most of them were wrong. I know, I couldn’t believe it either.

In 1914, the United States Surgeon General handed Joseph Goldberger the worst job in American medicine and told him to figure out what was happening. Goldberger was an infectious disease specialist who had previously solved outbreaks, making him a sensible choice in this situation. Probably the only sensible thing they did.

But it also made no sense whatsoever, because pellagra was contagious in exactly zero ways, a fact Goldberger confirmed almost immediately. The medical establishment would spend the next fifteen years refusing to believe him. I mean, nothing motivates institutional denial quite like the possibility that poverty is the real problem. It’s always the less privileged people, isn’t it?

Anyway, this is where things get weird.

Nobody Bothered to Notice

Pellagra was everywhere in the institutions of the rural South. Orphanages. Psychiatric hospitals. Prison farms. Typical places where people were already suffering, and the staff walked past them every day without catching the disease themselves. Goldberger noticed this instantly. If pellagra were contagious, the doctors and nurses would be dropping like flies. They were not dropping. They were, however, eating differently.

The patients were living on the three M diet: meal (cornmeal), meat (salt pork), and molasses. It was a diet created by someone who had clearly never met a vitamin. It was cheap, filling, and nutritionally bankrupt. And it was the same diet being served in every institution where pellagra was exploding like a slow-motion bomb.

Goldberger changed the diet. The pellagra went away. He documented this thoroughly and submitted it to the medical community.

The medical community responded with the scientific equivalent of “cute story, bro.” They already knew everything and were never wrong. Duh.

The Thompson-McFadden Commission had already declared pellagra infectious, and once a theory is printed in a report, it becomes holy scripture. Goldberger was a federal physician who had cured people with vegetables and protein, and the establishment’s position was essentially: interesting, but no.

So Goldberger did what any reasonable scientist would do when faced with institutional stubbornness and a preventable mass-casualty situation.

He escalated.

The Filth Parties

Joseph Goldberger named these himself. He called them filth parties. This is noteworthy because it tells you exactly what kind of man we are dealing with.

His logic was straightforward. If pellagra were contagious, exposure to infected bodily materials should transmit it. If he could expose himself and others to those materials and not get pellagra, that would prove it wasn’t contagious. It was airtight reasoning. The execution was… not.

He started with skin scabs. He scraped them off patients, mixed them with flour and cracker crumbs, rolled them into little pills, and ate them. Then he convinced colleagues to eat them too. Then he added urine. Then feces. Then, nasal secretions. The pills kept getting worse, like a tasting menu curated by Satan, and nobody got pellagra.

He also documented all of this and once again presented it to the medical community. The medical community remained unconvinced. I just can’t believe it, I am shocked. Shocked, I say.

At this point, a normal person might have accepted defeat. Goldberger was not normal. Goldberger studied the situation and decided the obvious next step was to involve his wife.

Mary

Mary Goldberger was, by all accounts, a supportive partner with a commendable tolerance for nonsense. This is relevant because it explains, though does not excuse, what happened next.

Goldberger had been eating scab pills in front of witnesses for months. The establishment still wasn’t convinced. So he escalated again. He drew blood from an active pellagra patient, mixed it with his own blood, and injected the mixture into his wife’s arm. Then he infected her with patient material through additional methods that medical historians describe with a level of clinical detachment that suggests they needed a moment. Okay, it was feces and snot. There, I said it.

Mary did not get pellagra. Neither did Goldberger.

He put everything down on paper and shared it with the medical community, which clearly had a knack for being confidently wrong. The real reason they kept brushing him off had nothing to do with science, though.

If pellagra was just a result of not getting enough nutrients, then that meant poverty was the real issue. And if poverty were the issue, someone would have to tackle it. Not exactly a popular idea.

It was much easier to keep blaming the corn.

Goldberger Was Right

The American South in the early 1900s had a narrative about itself, and that narrative did not include “we are starving our own people.” Pellagra was concentrated among poor White Southerners and Black Southerners living in mill towns, tenant farms, and institutions. The establishment had a theory for this, and that theory was not “systemic poverty and exploitation.”

The theory was genetics.

Eugenics was really popular back then, and a lot of people believed that poor folks in the South were just naturally prone to getting pellagra. This idea was both trendy and convenient because it meant no one had to actually make any changes. The problem was seen as something wrong with the people rather than the conditions they lived in. So when Goldberger came in and started curing orphans with eggs and fresh meat, it didn’t really fix the issue; it just provided a temporary distraction from the real story.

Goldberger understood this perfectly. He said publicly that pellagra was a disease of poverty, that it could be eliminated by improving diets, and that improving diets required addressing the economic conditions producing them. He was not subtle.

The response was also not subtle. Southern medical and political figures called him a Yankee. They called him an outsider. One critic suggested his findings were the result of being Jewish and therefore constitutionally incapable of understanding Southern culture, which is not a scientific argument but was apparently considered suitable.

Goldberger kept publishing, however. But the establishment kept dismissing. People kept dying.

He passed away in 1929, still not getting the recognition he deserved and still debating with folks who had made up their minds before even looking at the facts. He was also pretty baffled that taking scab pills in front of witnesses hadn’t cleared things up.

The Punchline

In 1937, eight years after Goldberger passed away, scientists finally figured out that pellagra was caused by not getting enough niacin, which is a B vitamin. This was exactly what Goldberger had been trying to shout from the rooftops, even going as far as eating bits of other people’s skin flakes like a total maniac.

Fixing the problem was pretty straightforward. Back in the early 1940s, the U.S. made it a requirement to add niacin to flour and bread. This move helped wipe out pellagra, a disease that had taken the lives of tens of thousands of Americans and had triggered a lot of denial, eugenics talk, and even a memorable dinner party. Within a few years, it was gone.

All of it was confirmed. Eight years after he died.

Science.

Hi, I’m Heather, and I tell my embarrassing stories so you don’t feel so alone in the world. Sometimes the embarrassing story belongs to an entire medical institution.