Joseph Goldberger

American physician (1874–1920)

Goldberger, the son of Jewish immigrants, was brought to America at the age of six. He was educated at the College of the City of New York and at Bellevie Hospital Medical School. After a brief period in private practice Goldberger joined the US Public Health Service in 1899, remaining there for the rest of his life.

Goldberger worked as a field officer for many years, making contributions to the understanding and control of such diseases as yellow fever, typhus, and dengue. He is, however, mainly remembered for his authoritative investigation of the nature, causation, and treatment of pellagra. This disease, which became widely known in America after the Civil War, is typified by chronic diarrhea, roughening of the skin, a sore tongue, and involvement of the nervous system. Death from secondary infection or general emaciation was not uncommon.

When Goldberger began his work in 1913 it was thought that the disease was caused by an unknown toxin produced by bacterial fermentation during storage of grain. But stimulated by the work of Frederick Gowland Hopkins and Casimir Funk, Goldberger directed his attention to deficiency diseases. He began a classic investigation into the connection between pellagra and diet in various asylums and orphanages of the southern states. He was immediately struck by the fact that the staff of such institutions – with a diet containing milk, eggs, cheese, and meat – remained free of the disease while the inmates, subsisting virtually on cereals alone, frequently suffered from epidemics of pellagra.

It was a relatively simple matter to show that the disease could be eliminated by supplementing the inmates' diet with milk. He was further able to trade the offer of a pardon with 11 inmates of a Mississippi prison for their adoption of a diet of corn, rice, sugar, pork fat, potatoes, and turnips. Within a few months 7 of the 11 were showing early symptoms of pellagra. Attempts to transmit the disease by contact with the clothes, excreta, and vomit of the patients ended in failure. Whatever such a factor might be, he was able to show by 1920 that sufficient of it was contained in a daily dose of 15–30 grams of yeast, and by this means alone Goldberger was able to prevent the 10,000 deaths a year attributable to pellagra in the USA.

The active ingredient involved was shown in 1937 by Conrad Elvehjem (1901–1962) to be nicotinic acid (niacin), part of the vitamin B complex.

In the pantheon of epidemiologists, Joseph Goldberger (1874–1927) ranks high. An Austrian immigrant, he grew up in New York, attended Bellevue Hospital Medical College, and began working with the U.S. Public Health Service in 1899. He had a distinguished career, investigating yellow fever with Milton Rosenau, typhoid in the Potomac River basin, dengue in Texas, louse-borne typhus, and other infectious diseases of public health importance.

In 1914, Goldberger turned his attention to pellagra, which was then prevalent in the southern United States. As Milton Terris has pointed out, Goldberger's achievement in unraveling the true nature of this previously mysterious disease equals John Snow's groundbreaking work on cholera. Pellagra causes a characteristic symptom cluster of skin eruptions, loose bowel movements, wasting of body mass, and in severe cases, mental and intellectual damage. When Goldberger began his investigation, a government commission had recently concluded that pellagra was an infectious disease of unknown nature, perhaps aggravated by a protein-deficient diet. Based on logical conclusions from three basic facts, Goldberger showed the infection hypothesis to be wrong. Goldberger knew that staff in institutions where pellagra was common among inmates did not get the disease; that it was much commoner in isolated rural regions than in cities, where people were in closer contact; and that it was associated with poverty. Goldberger concluded that pellagra must be due to a dietary deficiency.

His subsequent investigations, often in collaboration with Edgar Sydenstricker and others, included experiments with rhesus monkeys; a dietary survey of affected and unaffected families; and experiments using himself, his colleagues, and his own wife, in which they subjected themselves to ingestion and inhalation of bodily secretions. None of his investigations revealed evidence of a transmissible agent. The final stage of the investigation was another human experiment done on the residents of orphanages (without the ethical approval such studies would require now). This identified the pellagra-preventing factor, which was found to be associated with foods containing high concentrations of vitamin B. Unfortunately, Goldberger died before this factor, nicotinic acid, or niacin, was isolated and chemically identified.

(SEE ALSO: Nutrition; Snow, John; Sydenstricker, Edgar)

Bibliography

Terris, M. (1964). Goldberger on Pellagra. Baton Rouge: Louisiana State University Press.

— JOHN M. LAST