CYNTHIA D. BERTELSEN

Dr. Joseph Goldberger stands watching the children eating. He’s about to prove his hunch that pellagra occurred in the face of nutritional deprivation.

He devoted years to discovering what caused the curse of corn, pellagra. Although the fat cats in the South of the time, and we’re talking early 20^th-century here, didn’t want to spend money on feeding programs, Goldberger managed to set up situations where he proved that insects and bacteria had nothing to do with the scourge of pellagra. A serious public health problem at the time, mostly seen among poor whites and African Americans, the elimination of pellagra testifies to the power of government to aid the destitute in spite of the protestations of landowners and mill owners and politicians.

No, pellagra existed because poverty drove people to eat the cheapest, and increasingly processed, foods possible: cornmeal, molasses, and fatback. Like many of their ancestors anywhere in the world, the pellagrins – as the sufferers were called – found themselves in early spring looking at thick scaly skin on their hands, the butterfly rash across their cheeks, and the oozing necklaces drooping down from their necks to their chests. Generally, these skin lesions appear where there’s been sun exposure.  A number of symptoms pop up, but most descriptions focus on the four Ds: diarrhea, dermatitis, dementia, death. In many cases, people improved once fresh foods became available after long winters, making the disease a seasonal thing. But many people did not improve much, because poverty and debt precluded spending money on food, even on seeds or livestock.

Niacin, or the lack of it, turned out to be the major culprit in Goldberger’s case. But poverty and politics also played important roles.

Pellagra still presents problems in places where corn underscores the daily diet, particularly in areas where crop failure or other catastrophes occur, putting a strain on the food supply. Epidemiologists recorded the disease recently in Malawi, Mozambique, Angola, Zimbabwe, Nepal, and Angola.

The name pellagra actually comes from the Italian, meaning “sour skin,” first recorded in 1771 by Dr. Francisco Frapolli of the Ospedale Maggiore in Milan, Italy.  A Spanish physician, Dr. Gaspar Casal of Oviedo in the Asturias region, described what the peasants called mal de la rosa. The Spanish painter, Francisco Goya, included a pellagra sufferer in his painting, The Miracle of St. Anthony, in the dome of San Antonio de la Florida in Madrid.

But we’re not talking about just any corn. In the Old World, corn is not treated to free bound niacin. People who depend on corn to provide the bulk of their diet will suffer from pellagra, if they cannot include other foods rich in niacin alongside the corn. This is what happened parts of southern Europe, particularly Italy, where peasants took to corn for a number of reasons, one being its ease in cultivation. But they did not adopt the Native Americans’ nixtamalization process, instead believing that their advanced milling technology would grind the grain well enough to bypass the old process.

Niacin ensures adequate cellular function due to its essential role in two similar coenzymes (ie, nicotinamide adenine dinucleotide [NAD] and nicotinamide adenine dinucleotide phosphate [NADP]).

The process of nixtamalization, as used by people in the New World, allows niacin to be more readily available in corn, which is deficient in tryptophan. Note that a double whammy exists here because the liver can synthesize tryptophan from niacin.  (For a detailed explanation and pictorial depiction of nixtamalization, click HERE.)

Let’s end this very brief description of pellagra with some food for thought:

Pellagra affected people’s behavior, as well as their appearance. Families tended to hide their pellagrins away. Malaise, apathy, and weakness would affect people’s ability to work. Neurological factors such as anxiety, hallucinations, insomnia, and stupor impacted even more on people’s ability to function normally.  Many times, these symptoms appeared before the skin changes did. These symptoms no doubt led to stereotypes about certain classes of people. It all raises questions about how diseases impacted daily productivity throughout history.

Read more about pellagra and the Southern diet:

Brenton B, Paine R. Pellagra and Paleonutrition: Assessing the Diet and Health of Maize Horticulturalists through Skeletal Biology. Nutritional Anthropology 22(2): 2-9. 2000.

Covey, Herbert C. and Eisnach, Dwight. What the Slaves Ate: Recollections of African American Foods and Foodways from the Slave Narratives. Denver: ABC-CLIO, 2009.

Etheridge, Elizabeth W. The Butterfly Caste: A Social History of Pellagra in the South. Westport, Conn.: Greenwood Publishing Company, 1972.

Goldberger Joseph. Experimental pellagra in the human subject brought about by a restricted diet. Public Health Reports 30: 3336, 1915.

Kraut, Alan M. Goldberger’s War: The Life and Work of a Public Health Crusader. Hill & Wang, 2004.

Roe, Daphne A. A Plague of Corn: The Social History of Pellagra. Ithaca: Cornell University Press, 1973.

Taylor, Joel G. Eating, Drinking, and Visiting in the South: an Informal History. Baton Rouge: Louisiana State University Press, 2008. Chapter 6: “Cornmeal and Salt Pork: The Food of the Slaves.”

© 2012 C. Bertelsen