The argument about pellagra in 1915 and 1916 was conducted over a rash. The evidence was a set of menus. The Service printed them in full, and they are reprinted here from the reports, with the quantities, because nothing in the controversy answers so many of its questions so briefly.

What the eleven men ate

From Public Health Reports, 12 November 1915, “Bill of Fare, Ended August 8, 1915”:

August 2. Breakfast: biscuits, fried mush, grits and brown gravy, sirup, coffee with sugar. Dinner: corn bread, cabbage, sweet potatoes, grits, sirup. Supper: fried mush, biscuits, rice, gravy, cane sirup, coffee, sugar.

August 3. Breakfast: biscuits, mush, rice, gravy, sirup, coffee, sugar. Dinner: corn bread, collards, sweet potatoes, grits, sirup. Supper: biscuits, mush, grits, gravy, sirup, coffee, sugar.

August 4. Breakfast: biscuits, mush, grits, gravy, sirup, coffee, sugar. Dinner: corn bread, collards, sweet potatoes, rice, sirup. Supper: biscuits, mush, grits, gravy, sirup, coffee, sugar.

August 5. Breakfast: biscuits, mush, grits, gravy, sirup, coffee, sugar. Dinner: corn bread, collards, sweet potatoes, grits, sirup. Supper: biscuits, mush, rice, gravy, sirup, coffee, sugar.

August 6. Breakfast: biscuits, mush, rice, gravy, sirup, coffee, sugar. Dinner: corn bread, collards, sweet potatoes, grits, sirup. Supper: biscuits, mush, grits, gravy, sirup, coffee, sugar.

August 7. Breakfast: biscuits, mush, grits, gravy, sirup, coffee, sugar. Dinner: corn bread, collards, sweet potatoes, rice, sirup. Supper: biscuits, mush, grits, gravy, sirup, coffee, sugar.

August 8. Breakfast: biscuits, mush, grits, gravy, sirup, coffee, sugar. Dinner: corn bread, collards, sweet potatoes, grits, sirup. Supper: biscuits, mush, rice, gravy, sirup, coffee, sugar.

“The quantities of the different articles of food consumed during the above-named week were as follows: Biscuits, 41.81 pounds; corn bread, 24.56 pounds; grits, 27.06 pounds; rice, 24.25 pounds; fried mush, 33.87 pounds; brown gravy, 37.81 pounds; sweet potatoes, 23.62 pounds; cabbage, 4.25 pounds; collards, 23.75 pounds; cane sirup, 5.94 pounds, making a total of 255.67 pounds of food consumed during the week, or 3.32 pounds per man per day, having a caloric value of 2,952 calories per man per day. The sugar was white granulated, the sirup a ‘homemade’ cane sirup. No vegetable fats entered into the diet. The corn meal and grits were of the best quality obtainable in the local market and the same as used at one of the orphanages (‘M. J.’), Jackson, Miss., at which a feeding experiment to prevent pellagra was conducted and at which no pellagra occurred this year.”

The paper in the Journal of the American Medical Association of 12 February 1916 adds 8.75 pounds of sugar to the week and lists the ingredients: “wheat flour (patent), corn meal, (corn) grits, corn starch, white polished rice, standard granulated sugar, cane syrup, sweet potatoes, pork fat (fried out of salt pork), cabbage, collards, turnip greens and coffee. In the preparation of the biscuits and of the corn bread ‘Royal’ baking powder was used.” The brown gravy was flour and pork fat. “Except for one meal in which 4 ounces of meat were included, the animal proteins and legumes were almost entirely excluded.”

The work of the same week: “whitewashing fences and buildings, 2½ days; sawing lumber (ram sawmill), 2 days; rest, 2½ days.”

Two things in the table do most of the arguing. The first is 2,952 calories, which is a working man’s ration; the men were not starved, and the disease was not hunger. The second is the list of what is absent: no milk, no eggs, no lean meat, no beans or peas, and almost no fruit. Goldberger’s October 1914 conclusion had been that pellagra depended on “some yet undetermined fault in a diet in which the animal or leguminous protein component is disproportionately small and the nonleguminous vegetable component disproportionately large.” The Rankin table was that sentence made into meals.

What the orphans ate

The diet that stopped the disease at orphanage “M. J.” in Jackson was printed for the week of 1 to 7 January 1915, in the paper of 22 October 1915. For all ages, breakfast was oatmeal with sugar and milk, and biscuit with butter, daily, with boiled frankfurters one morning; the matrons and the big boys had fried bacon on six mornings; every child under twelve had a cup of about seven ounces of milk and an egg, “scrambled, fried, or boiled,” on six mornings. Dinner through the week was vegetable soup of tomatoes, potatoes, corn, onions and rice; navy beans or lima beans boiled, nearly every day; roast beef on three days and frankfurters on one; baked sweet potatoes; light bread; pie, cake or stewed pears; corn bread on two days. Supper was light bread with stewed prunes, pumpkin or apples, or syrup, or milk; the children over twelve had boiled grits or rice with fried bacon or beef hash. “All under 12 years received about 7 ounces of milk daily in addition to the bread and stewed fruit or sirup.”

The changes from the old diet were these: milk at least twice a day for every child under twelve and three times for those under six, buttermilk added in April 1915; an egg at breakfast for every child under twelve, where eggs had been “except in cooking or for the sick” unknown; fresh meat three or four times a week instead of once; beans and peas “an important part of nearly every midday meal at all seasons”; oatmeal in place of grits; corn bread once a week and grits once or twice for the older children; and syrup, which had been on the table at two or three meals a day, stopped for some weeks and then allowed “in small amounts at only three or four evening meals a week.” The privies, the crowding and the water were left as they were.

What the asylum women ate

The weekly menu for the test ward at the Georgia State Sanitarium began on Monday with “Breakfast: grits, sweet milk, sugar, broiled steak, hot rolls, biscuits, coffee. Dinner: roast beef, gravy, peas, potatoes, rice, biscuits, buttermilk. Supper: stewed apples, light bread, coffee, buttermilk, sugar,” and ran the week on oatmeal, beef in some form at every breakfast and dinner, pea soup or peas, baked beans at most suppers, and buttermilk at dinner and supper. “About half a pound of fresh beef and 2 to 2½ ounces of dried field peas or dried beans enter into the daily ration. Oatmeal has almost entirely replaced grits as the breakfast cereal; sirup has been entirely excluded. Corn products, though greatly reduced, have not been entirely eliminated.” The nurses were told to watch that each patient ate it, which at an asylum was half the work: “To have a good, rich, mixed, well-balanced, and varied diet ‘on the family table’ is one thing; to eat it is quite another.”

The bill of fare of 1918

Three years later, in “Pellagra: Its Nature and Prevention,” Goldberger wrote the table the other way round, for a Southern family that had no doctor and little money. “Milk is the most important single food in balancing a diet and preventing or curing pellagra,” three glasses a day at least where meat and vegetables were short; half a pound of lean meat “at least three or four times a week” for those who took little milk; the dried soya bean, “but little known and relatively little used as human food in this country,” as the cheapest substitute for flesh; green vegetables or fruit, “preferably of both,” every day, “particularly important during the late winter and spring.” His “Pellagra-Preventing Bill of Fare” ran:

Breakfast. Sweet milk, daily. Boiled oatmeal with butter or with milk every other day. Boiled hominy grits or mush with a meat gravy or with milk every other day. Light bread or biscuit (one-fourth soy-bean meal), with butter, daily.

Dinner. A meat dish (beef stew, hash, or pot roast, ham or shoulder of pork, boiled or roast fowl, broiled or fried fish, or creamed salmon or codfish cakes, etc.), at least every other day. Macaroni with cheese, once a week. Dried beans (boiled cowpeas with or without a little meat, baked or boiled soya beans with or without a little meat), two or three times a week. Potatoes (Irish or sweet), four or five times a week. Rice, two or three times a week, on days with the meat stew or the beans. Green vegetables (cabbage, collards, turnip greens, spinach, snap beans or okra), three or four times a week. Corn bread (one-fifth soy-bean meal), daily. Buttermilk, daily.

Supper. Light bread or biscuit (one-fourth soy-bean meal), daily. Butter, daily. Milk (sweet or buttermilk), daily. Stewed fruit (apples, peaches, prunes, apricots), three or four times a week, on days when there is no green vegetable for dinner. Peanut butter, once or twice a week. Sirup, once or twice a week.

“Practically all the benefits of a ‘change of climate,’” he added, “may be had at home at the cost of two quarts of milk and half a dozen eggs or half a pound of stew beef a day.” He knew what that cost meant. “Milk for the family in these quantities is, however, frequently hard to procure.” The Rankin table and this one are the same table, read from opposite ends, and the distance between them, in 1918, was the price of a cow.

Sources

• Joseph Goldberger and G. A. Wheeler, “Experimental Pellagra in the Human Subject Brought About by a Restricted Diet,” Public Health Reports 30 (46), 12 November 1915, 3336–3339. The Rankin bill of fare and quantities. archive.org
• Joseph Goldberger, “Pellagra: Causation and a Method of Prevention,” Journal of the American Medical Association 66 (7), 12 February 1916, 471–476. The ingredients, the sugar and the single meal with meat. archive.org
• Joseph Goldberger, C. H. Waring and David G. Willets, “The Prevention of Pellagra: A Test of Diet among Institutional Inmates,” Public Health Reports 30 (43), 22 October 1915, 3117–3131. The orphanage and asylum menus. archive.org
• Joseph Goldberger, C. H. Waring and David G. Willets, “The Treatment and Prevention of Pellagra,” Public Health Reports 29 (43), 23 October 1914, 2821–2825. The October 1914 conclusion and “to eat it is quite another.” archive.org
• Joseph Goldberger, “Pellagra: Its Nature and Prevention,” Public Health Reports 33 (14), 5 April 1918, 481–488. The 1918 bill of fare. archive.org