National data is sketchy, but by 1912, the state of South Carolina alone reported 30,000 cases and a mortality rate of 40 percent. In the United States, pellagra has often been called the disease of the four D's - dermatitis, diarrhea, dementia, and death. Although it was not conclusively identified in the United States until 1907, there are reports of illness that could be pellagra as far back as the 1820s. A loathsome skin disease, it was called mal de la rosa and often mistaken for leprosy. Pellagra was first identified among Spanish peasants by Don Gaspar Casal in 1735. Even as Koop has been critical of personal behavior and social policies that could put populations at risk of acquiring the AIDS virus, Goldberger warned Americans about the crucial link between poor nutrition as the result of poverty and the onset of a scourge known as pellagra. Joseph Goldberger, Surgeon in the United States Public Health Service, was doing much the same thing. Everett Koop and a new generation of public health professionals suffered social criticism in their public health pronouncements on AIDS, Dr. Pellagra killed many poor Southerners in the early part of the 20th century.Įighty years ago, long before Dr. Joseph Goldberger discovered the cause of pellagra, a disease resulting from a diet deficient in vitamin B.
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