Everything here is from the paper Goldberger read to the Southern Medical Association at Atlanta on 16 November 1916 and published in Public Health Reports the next day, “The Transmissibility of Pellagra: Experimental Attempts at Transmission to the Human Subject.” He wrote it in the flat voice of a laboratory notebook, and the flatness is the point: the doses were measured, the hours were counted, and the people who swallowed the material were named only by initials.

The volunteers

“Some 20 individuals volunteered to submit themselves to experimentation. It was not practicable, however, to utilize more than 16 of them. These included 1 woman.” They were between twenty-six and forty-two; thirteen were physicians; eight lived in Washington, four in New Orleans, two in Spartanburg, one in Columbia and one at Milledgeville. “No restraint of any sort was imposed. They were advised to continue their customary habits of life and diet, and were permitted to travel freely in attending to their personal or official business.” Five of them, by their work, were in daily contact with pellagra anyway.

The list at the end of the paper gives each volunteer by initials, age, post and station. Four can be named with confidence from the Service’s own records: G-J, “medical officer, 42 years, stationed at Washington, D. C., major part of the time spent in field work in Southern States, participated in all seven experiments,” is Goldberger; W-GA, “medical officer, 31 years, stationed at Spartanburg,” is George A. Wheeler, who had lived at the Rankin farm through 1915; S-E, “statistician, 35 years, stationed at Spartanburg,” is Edgar Sydenstricker; W-DG, “assistant epidemiologist, 42 years, stationed at Milledgeville, Ga.,” is David G. Willets, who had run the asylum wards. The fifth is “G-MHF, housewife, 35 years, resides at Washington, D. C. The only woman among the volunteers. Participated in experiment No. 3 at Spartanburg, S. C.”: Mary Humphreys Farrar Goldberger.

The materials

“The materials used were blood, nasopharyngeal secretions, epidermal scales from pellagrous skin lesions, urine, and feces. The blood was administered by intramuscular or subcutaneous injection, the secretions by application to the mucosa of the nose and nasopharynx, scales, and excreta by mouth.” Before the scales and excreta each volunteer took ten to twenty grains of sodium bicarbonate, “to reduce gastric acidity and thus minimize the possibly germicidal effect of the gastric juice,” and the material was “always taken on an otherwise empty stomach.”

Seventeen patients supplied it, “of various types and of different grades of severity, including three fatal cases”: one at the Washington Asylum Hospital, one at the Charity Hospital in New Orleans, three at the South Carolina State Hospital for the Insane at Columbia, and twelve at Spartanburg, at the Service’s Pellagra Hospital and the county farm. Because the Thompson-McFadden Commission suspected the privy, “the infectivity of both urine and feces was tested six times”; blood was tested twice, secretions twice, scales three times.

Group 1: Spartanburg, 25 April

Case No. 1 was a white woman admitted to the Pellagra Hospital on 14 April with a moderately acute first attack, her rash eleven days old. “The blood was drawn from a vein at one of the elbows, defibrinated, and 5 c. c. were injected without delay into the left deltoid of W-GA and 6 c. c. into that of G-J.” Her nose and nasopharynx were wiped with a cotton swab and the swab rubbed at once over the nose and nasopharynx of each man, a separate swab for each. “Both men felt some soreness and stiffness for a day or two in the muscle into which the blood was injected; otherwise nothing was observed.”

Group 2: Columbia, 28 April

At the asylum, scales and urine were taken from two patients, one in a severe first attack and one in a mild second, and faeces from a third who “was suffering from a severe attack and was having four soft bowel movements a day.” The scales, scraped from the skin, weighed about a tenth to a fifth of a gram. The urine was a fresh catheter specimen from each; the faeces were obtained with a water enema and were liquid. “The scales with about 4 c. c. of each specimen of urine and with about the same quantity of the liquid feces were worked up into a pilular mass with wheat flour and in this form swallowed by volunteer G-J, 30 minutes after taking 20 grains of sodium bicarbonate and about 1 to 1½ hours after collecting.” He took another twenty grains afterwards. “For several days after the ingestion of the foregoing materials this volunteer experienced some slight epigastric fullness and eructations of gas after a meal. On the third day a diarrhea with frequent, painless, watery, and rather gaseous evacuations developed. The diarrhea lasted about a week.” It was still with him on 7 May.

Group 3: Spartanburg, 7 May

This was the largest party, and the one Mary Goldberger joined. Blood was drawn from three patients, one with “a mild ninth recurrent attack,” one with “a moderately acute second attack,” one with “a severe acute second attack,” defibrinated and pooled, and seven cubic centimetres injected under the skin of each of six volunteers: G-J, S-E, T-WF, W-DG, W-GA and G-MHF. “The time elapsing between drawing and injecting the blood was under two hours.” Secretions from four patients, including the woman of 25 April, were mixed in salt solution and rubbed with six fresh swabs round the nose and throat of each of the five men. Scales from two patients, 0.1 and 0.22 grams, were mixed and divided among the five, “each of whom swallowed his portion in the form of a ‘powder’ about seven hours after they were collected.” Then the excreta: ten cubic centimetres of urine and five grams of solid faeces from each of the three blood donors, worked into a pill with flour, divided five ways, so that “each took therefore the equivalent of about 2 c. c. of urine and 1 gram of feces from each of the three patients,” three to nine hours old. “A sixth volunteer, G-MHF, received blood only.”

“About 10 days after the inoculation, one of the volunteers, T-WF, noted a slightly enlarged and somewhat tender lymph gland above the Poupart’s ligament of the side of the abdomen that was the site of the blood injection. This gradually subsided. None of the other volunteers experienced any inconvenience.”

Groups 4 and 5: Washington, 7 and 8 June

Case No. 8 was a woman at the Washington Asylum Hospital with “a typhoidal first attack, from which she died 10 days later (June 17, 1916).” On 7 June her urine, drawn by catheter at a quarter to nine in the morning, and two stools, one liquid and one “of soft puttylike consistency,” were worked up with cracker crumbs and flour, put into gelatine capsules and swallowed at half past twelve by five volunteers, C-RH, D-WF, McC-GW, G-J and S-AM. “Some hours after ingesting the above one of the volunteers, S-AM, developed abdominal discomfort accompanied by abnormal, gaseous evacuations. The movements increased in frequency, developing into a marked diarrhea, which lasted about two weeks. He has been well since.” On 8 June the same patient’s stools of the previous day and night, one of them now thirty-nine hours old and kept at room temperature, and a fresh catheter specimen of urine went in equal shares to G-J, L-JP and S-EA, who “experienced no inconvenience.”

Group 6: New Orleans, 13 June

A patient at the Charity Hospital with a mild first attack supplied urine by catheter and a liquid stool passed after a dose of magnesium sulphate. Five volunteers, A-CW, G-J, L-GB, M-MB and W-CL, each took “the equivalent of 2 c. c. of feces and 2 c. c. of urine,” twenty-five minutes after twenty grains of bicarbonate. “None of this group of volunteers experienced any appreciable effects.”

Group 7: Spartanburg, 25 June

“Material was obtained at Spartanburg, S. C., for a final experiment.” Scales were scraped from two patients at the Pellagra Hospital and were “not over four hours old when ingested.” Urine came from six patients, three at the county farm and three at the hospital; faeces from seven, two of them with diarrhoea; “the seven patients who furnished the material for this experiment were suffering from attacks of varying grades of severity, including two fatal cases.” The three volunteers, G-J, S-E and W-GA, each took “about 4 milligrams of scales, 6 c. c. of urine (1 c. c. from each patient), and 8 grams of feces (2 grams from case No. 13 and 1 gram from each of the other six patients),” none of it more than six hours old.

Goldberger “experienced some mild dyspeptic symptoms for a number of days immediately after this.” Sydenstricker “began to feel nauseated” within two or three hours; “the following morning he had three watery evacuations and 12 hours later a diarrhea began that lasted about a week. Nausea persisted for about the same period.” Wheeler “had some slight ill-defined dyspeptic symptoms for about 24 hours.”

The result

“The first experiment was made on April 25 and the last on June 25, so that the volunteers have now (Nov. 16, 1916) been under observation for from four and one-half to six and one-half months, approximately.” Observation had been kept “by association with a majority of the volunteers, by visits of inspection to the others, supplemented by reports from the volunteers themselves, or in the case of the laymen from medical officers with whom they are associated.”

“In four or five instances, as above noted, there were more or less marked immediate, but temporary, gastrointestinal reactions following, and, probably, due to the ingestion of the large doses of excreta. When one considers the relatively enormous quantities of filth taken the reactions experienced were surprisingly slight. One of the volunteers, S-EA, had an attack of renal colic of eight to nine days’ duration, from August 14 to August 22, 1916. Aside from this he, as well as the other volunteers, has enjoyed his usual health. None has developed any evidence justifying even a suspicion of pellagra.”

The summary counts the exposures: blood from four cases, secretions from four, scales from five, urine or faeces from sixteen; both urine and faeces swallowed by fifteen of the sixteen volunteers, five of whom also took blood, secretions and scales. “These experiments furnish no support for the view that pellagra is a communicable disease; they materially strengthen the conclusion that it is a disease essentially of dietary origin, brought about by a faulty, probably ‘deficient,’ diet.”

Goldberger thanked the superintendents and physicians of the asylum at Columbia, the Washington Asylum Hospital, the Charity Hospital and the Spartanburg county farm for the material, and Grimm at the Pellagra Hospital for help with the experiments themselves, and ended: “I have, finally, to make grateful acknowledgment of my indebtedness to those of my colleagues and associates of the service whose willing participation in a trying ordeal made this work possible.”

Sources

• Joseph Goldberger, “The Transmissibility of Pellagra: Experimental Attempts at Transmission to the Human Subject,” Public Health Reports 31 (46), 17 November 1916, 3159–3173. Every quotation and figure above. Issue scan at stacks.cdc.gov; the paper alone at archive.org