Despite its relatively long history, the fact that pellagra was a nutritional disease was not recognized until after the U.S. physician Joseph Goldberger launched his classic epidemiologic studies in 1913. By that time, the state of South Carolina alone recorded over 30,000 cases of pellagra and a mortality rate of 40 percent (National Institutes of Health, 2000).

As early as 1900 (Roe, 1973), British epidemiologist Fleming Sandwith suggested that the leprosy-like pellagra was associated with a diet of bad maize. Although this point was shared by Casal more than a century ago (the first reporter of pellagra, see Slide 6), political and economic prides prevented Spanish people from accepting the reality that they were facing a problem of poverty.

Upon receiving his assignment from the U.S. Surgeon General, Goldberger’s first step was to travel through the South to observe the epidemic. In 1913, Goldberger conducted an experiment on a number of Mississippi inmates who volunteered for the study in exchange for a pardon. The experiment involved the use of different diets, including the poor Southern diet that Goldberger had suspected to be associated with pellagra. When the volunteers came down with pellagra from eating the poor corn diet, the researcher and his co-workers tried hard to deliberately catch the disease from these victims but without success. In spite of the fact that this classic evidence showing pellagra to be noncommunicable, Goldberger found it difficult to convince the medical community who at the time had an obsession with infectious disease.