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42.GOLDBERGER: DIETARY DEFICIENCY AND DISEASE

THE TALL, slim doctor with the piercing eyes was making rounds of the orphanage with his young assistant. In orderly lines of twos, children were marching by. Suddenly, a small boy broke from the line, ran to the tall doctor and grabbled him about the legs. Looking up from a face shining with shy admiration, the boy said: “Are you the man giving us all the good things to eat?”
“Yes,” said the doctor, a rare smile illuminating his face, “do you like them?”
“Oh, indeed we do. I hope you won’t stop!”

The smile lingered briefly as an attendant shooed the small boy back into line. Then the customary seriousness returned, and the flashing eyes continued their rapid, restless survey of the surroundings. Particularly, Dr. Goldberger studies the faces of the little folk. Why must they suffer these unsightly pellagrous lesions, and all the accompanying discomforts? Why had pellagra visited over half the children in the orphanage, year after year, during the seventeen years the institution had been in existence? Would the new diets he had prescribed cure the afflicted? Would they prevent a recurrence of pellagra next sprint?

Dr. Goldberger’s mind impatiently demanded answers, but his scientific training warned that only time would tell. Meantime, there were so many things to attend to. .

Dr. Waring could manage studies at the orphanages; he’d have to see how Dr. Willets was getting along at the State Sanitarium. Then, there was the appointment with the Governor . . .
That was the way Dr. Joseph Goldberger, surgeon in the United States Public Health Service, went about his work. By this time, 1914, Dr. Goldberger was a veteran; his record as an investigator in matters of health and sanitation was well established. When a particularly knotty problem demanding immediate action faced the Surgeon General, it was likely that Dr. Goldberger would be hurried on the mission. Now, there was the problem of pellagra. If anybody could find the answers, Goldberger could.

Dr. Goldberger did find the answers to the causes and cure for pellagra; proved them beyond doubt in the face of powerful opposition from some of his medical colleagues; and thereby he helped put on solid footing the foundations for scientific study of vitamins and nutrition.

Diseases which are now known to have been caused by nutritional deficiencies were observed and described in the writings of Hippocrates and of Pliny. Beriberi has been known in the Orient for three thousand years. James Lind, in 1757, recognized that scurvy could be cured or prevented by juices of citrus fruits. Pellagra had first been studies comprehensively in 1730 by Gaspar Casal, physical of Oviedo, Spain; and its name, first used by Frapolli, in 1771, derived from the Italian words, pelle agra, meaning “rough skin.” It came to notice in Spain and in Italy after introduction of corn from the New World as a food product. Pellagra was first described in North America in 1864, although undoubtedly it had been widespread long before. By the first decades of the twentieth century, it had become a serious and baffling problem in southern United States.

Did it arise, as some physicians believed, from a powerful, unknown toxin, perhaps in corn? Or, was it caused by infectious microorganisms, as other physicians believed? The affliction defied the usual patterns of infections: it was a disease commonly associated with poverty; unlike infections, it struck more often in rural regions than in crowded cities; it was particularly serious among inmates of institutions, such as orphanages, prisons, or asylums – yet it never was noted among attendants or administrative staffs, even though their work brought them in close contact with patients.
Modern knowledge of the entire field of nutritional deficiencies stems from the work of Casimir Funk, who, in 1911, described the isolation from rich polishings of an active substance that would cure beriberi. His work was preceded by that of a group of Dutch medical officers in the East Indies: Eijkman, in 1897, established that beriberi among prisoners could be cured and prevented by adding rice polishings to their diet; his successor, Grijns, postulated the then revolutionary idea that the disease was due to a nutritional deficiency, and not to toxicity or infection. Funk, believing the substance he had isolated had characteristics of the chemical family known as amines suggested the term, “vitamine,” and went on to develop the theory of deficiency diseases, and of existence of dietary factors specific for the cure of each: the “antiberiberi vitamine,” the “antiscurvy vitamine,” and the like.

Meantime, pellagra had become so widespread in the cotton-growing areas in southern United States that it was seriously affecting the economy. Cotton producers put pressure upon Senators and Congressmen from the South; and they, in turn, put pressure on the United States Public Health Service to do something about pellagra. Although an able staff from the Public Health Service already had spent five years studying the disease, and every conceivable clue had been traced down – none had led to a satisfactory answer. So, early in 1914, Surgeon General Rupert Blue ordered Dr. Goldberger to leave Detroit’s diphtheria problems in the hands of an assistant and take over investigations of pellagra in the cotton country.

Indeed, Dr. Goldberger was well fitted for his new assignment. He had already proved to be an able clinician, a good bacteriologist, an epidemiologist, and a parasitologist, as well as an excellent investigator.

Joseph Goldberger was born July 16, 1874, on a peasant tenant farm near Giralt, Austria-Hungary (now a part of Czechoslovakia). Crop failures plagued the peasants, and fascinating tales came back from relatives in the New World. In 1881, when Joseph was seven, father Samuel and mother Sarah Goldberger, decided to make the break: they converted all their resources to cash and sailed for New York. They settled on the lower East Side, and the family’s eight children were sent to school. Samuel peddled on the Bowery until they could open a little grocery store. Joseph and his brothers were delivery boys; but Joseph usually had a book under his coat. He haunted libraries and second-hand book stalls. At home, his upbringing was strictly Jewish orthodox; at school, his companions were of every race and creed.

At sixteen, Joseph entered the course of civil engineering at New York City College, standing fifth in his class of six hundred at the end of his second year. However, his friend, Pat Murray, who had entered Bellevue Hospital Medical College, persuaded Joseph to accompany him to hear Dr. Austin Flint, Jr., deliver a medical lecture. To the consternation of his family, Joseph transferred to medicine, entering the Bellevue school. In 1895, he graduated second in his class, and stood at the top of the list for appointment as an intern at Bellevue Hospital. There he demonstrated a remarkable aptitude for precise, accurate detail in reports.

The lower East side offered little opportunity for a young physician, so Dr. Goldberger entered practice in Wilkes Barre, Pennsylvania. Two years there convinced him that private practice was not his field. There was money to be made – but no adventure. To Joseph, money without adventure had no appeal. Dr. Goldberger was never to be entirely free of petty financial worries – but adventure he found indeed.

After unsuccessfully trying to join the Navy as the Spanish American War began,
Dr. Goldberger entered the Public Health Service in 1899, as an assistant surgeon. His first assignment at Ready Island, Delaware, brought him under the influence of Farrar Richardson, who gave Goldberger sound instruction and free rein to improve on routine inspection methods then in use. In 1902, Surgeon General Walter Wyman sent Dr. Goldberger to Tampico, Mexico, to study yellow fever. Within five years, spent in Tampico and in New Orleans, Dr. Goldberger became one of the world’s authorities on yellow fever – a disease of which he himself nearly died.

In 1906, Dr. Goldberger dealt his family another shock: he announced his intent to marry a pretty Gentile girl – Mary Farrar, daughter of a prominent New Orleans family and niece of Farrar Richardson. The Farrar family, no less than the Goldbergers, had serious misgivings – but neither the stubborn doctor nor his equally determined fiancée would be swayed. They were married April 19, 1906. Mary’s life was to be no bed of roses, for Dr. Goldberger’s protracted assignments away from home, his constant exposure to danger, and his poor scale of pay, gave rise to many anxieties. His first son was but thirty-six hours old when Dr. Goldberger was assigned to Brownsville, Texas, to study dengue fever – and he suffered a severe attack of the disease before his work there was finished. Apart from these problems, theirs was a happy marriage, blessed by three sons and a daughter.

Dr. Goldberger was to spend several years in laboratories in Washington, D.C., and at Woods Hole, Massachusetts, becoming an expert on helminthology. In 1909, his acute powers as a “health detective” were spectacularly demonstrated. A disease, first described by Schamberg in 1901, had appeared in epidemic form every spring in Philadelhpia, manifesting itself as a temporarily disfiguring and acutely itching skin disease. Assigned to try to track down the responsible agent, Dr. Goldberger went to Philadelphia. Within forty-eight hours, he had eliminated the possibility of germ infection; had determined that the disease was caused by vermin; and had isolates specimens of the villain – the tiny acarine mite (Pediculoides ventricosus) which was carried to its victims in mattresses filled with fresh wheat straw. Sterilization of mattresses ended this source of human discomfort.

At Woods Hole, Dr. Goldberger formed a friendship with Dr. H.T. Ricketts, of the University of Chicago, who had done work on Rocky Mountain spotted fever. Later, in 1909, the two were to meet again in Mexico City, working on typhus. Dr. C.J.H. Nicolle, a French physician working in Tunis, had been first to describe transmission of typhus by the body louse. Dr. Goldberger’s work confirmed this; and further, he demonstrated that the head louse could transmit typhus. His work also