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JEREMY:
Hello and welcome to another episode of Eat This Podcast with me, 
Jeremy Cherfas.

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This is the last episode in the current series, 
and I'm taking the opportunity to look closely at a problem of food

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and ill health, which I think is a cracking example of the huge 
difficulty involved in answering what seems like a very simple

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question: what causes a disease? To help me, 
I spoke to David Gentilcore,

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a professor of early modern history at Ca' Foscari University in 
Venice,

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and Dana Landress, an assistant professor in the Department of Medical 
History and Bioethics at the Department of History at the University

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of Wisconsin, Madison. The disease in question is pellagra, 
and they studied it in Italy and in the US.

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P ellagra used to be very serious, 
although you may not have heard of it.

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DAVID GENTILCORE:
At one point in the 1880s, it was affecting 100,000 people, 
but those are 100,000 documented cases.

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That means 100,000 peasants who've gone to see their doctor and the 
doctor has made a note of it,

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you know, provided this data to the authorities.

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So we can imagine that was only the tip of the iceberg.

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So that would have been the 1880s, 
1890s.

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And that's when admittance to the insane asylums in northern Italy 
also reached their peak.

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So basically half of the inmates of these asylums would be suffering 
from pellagrous insanity.

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JEREMY:
And in the US.

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DANA LANDRESS:
It is one of the leading causes of morbidity and mortality across the 
South in the early 20th century.

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And so, for instance, in Alabama there are a number of years in the 
1910s where it is the leading cause of death.

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In South Carolina, it ranks as top three, 
and in places like Louisiana,

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it ranks as top four causes of death.

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But for the most part, that data is concentrated on urban areas that 
are collecting sort of epidemiological tracking data at these and sort

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of major urban areas like New Orleans, 
like Spartanburg, South Carolina,

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like Atlanta. But we know that this is a disease that impacts rural 
communities as well.

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And we have rough estimates from the US Public Health Service data, 
which suggests that pellagra was impacting about 100,000 people per

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year up until about the mid 1940s. So the kind of end of the world 
Second World War.

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JEREMY:
Note that date. Not that long ago. And yet, 
from being a scourge less than a century ago,

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pellagra is now almost unheard of. Today, 
we know for

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sure that at one level at least, the cause of pellagra is a lack of 
vitamin B3,

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known as niacin. But there are many other ways to think of the cause 
of the disease,

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which is what this episode is all about.

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Anyway. Pellagra was first described in 1735 among poor peasant 
farmers in northern Spain.

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And in Italy, in the 1760s, they tended to say that it first appeared 
about a generation ago,

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so maybe the 1740s. But what is pellagra?

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DAVID GENTILCORE:
The first apparent symptom, and what gives the name to the disease in 
Italian,

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is the peeling off of the skin from the upper chest, 
the forearms and the lower legs.

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But it's more than just like, you know, 
a sunburn.

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It's actually the whole epidermis peeling off.

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Very painful, leaving scarring underneath.

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Gives the name pellagra -- pelle agra, 
meaning rough skin -- which is essentially what the peasants called

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it. And it's curious, it's one of those rare cases where a peasant 
name for a disease becomes the official medical name for the disease,

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since it was a new disease and there was no medical, 
you know, no fancy Latin or Greek name for it.

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DANA LANDRESS:
Clinicians typically call it symptoms the four D's diarrhoea, 
dermatitis,

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dementia, and, if left untreated, death.

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JEREMY:
Not nice at all. The big question, 
of course, was what exactly was pellagra?

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DAVID GENTILCORE:
You remember the initial phases of Covid.

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You know, if we're going to get anywhere with this, 
we need to know exactly what it is.

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And obviously in the 1760s, there is no way other than observation.

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They are very good, very, you know, 
good observers, trying to create a clinical picture of the disease.

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So they're very attentive. But the key issue for them is how to 
classify,

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what kind of disease ... Is it even new?

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Has it already existed? But we just didn't know.

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Is it a form of leprosy? Is it a form of scurvy?

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Is it a form of ergotism? And then, 
no, no, it's symptoms don't fit in with any of these.

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So it must be new. Okay, so if it's new, 
what exactly is it?

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And then, what do we do about it?

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JEREMY:
One early clue was that it was associated with maize, 
and also that it seemed to afflict only very poor people.

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Maize, remember, was still a relatively new crop in Europe, 
one that farmers had taken to with enthusiasm.

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DAVID GENTILCORE:
Maize is a fabulous crop. I mean, it grows where other crops won't.

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It has a shorter growing season than, 
say, wheat.

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It has really high yields. But where people want to turn it into flour 
and where

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they consume it in the form of polenta, 
that's what causes it.

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I mean, in terms of the social classes, 
we're essentially talking about landless labourers,

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landless peasants, field hands, tenant farmers, 
and people who don't really have much choice what to grow.

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Because if you're only growing that and maize becomes a cash crop, 
so you want to grow it.

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You know, it makes economic sense, 
but maybe at the expense of growing just other fruits and vegetables,

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which would have staved off pellagra.

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By the 1790s early 1800s, it's clear there's a link between maize 
cultivation,

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diet, and this new disease. They don't know what the mechanism is yet.

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They don't know what the link is. They don't know what the causal 
relationship is yet,

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but they see a correlation. And then you get two big theories emerging 
by the middle of the 19th century,

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which they fight it out for decades.

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JEREMY:
In some respects, it's a bit of an unfair fight because the 
competitors are pretty badly matched.

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DAVID GENTILCORE:
On the one hand, you have Cesare Lombroso, 
infamous founder of anthropological criminology

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and Lombroso is the most famous scientist in Italy.

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Yeah. He's the second most read Italian author after Collodi, 
who wrote Pinocchio.

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Right. So he's very, very famous. He's a tireless correspondent.

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And as soon as you attack him, the very next day, 
he's got a counterattack in some local newspaper.

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You know, he never lets up.

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JEREMY:
So that's Lombroso, super famous, super pugnacious and super wrong.

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But I'm getting ahead of myself.

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DAVID GENTILCORE:
He posits that it's tainted maize. That's the problem.

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It's infected maize, a bit like ergotism and rye, 
okay.

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In ergotism it's a fungus that attacks the rye.

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He posited something like that. He even in in his laboratory in the 
1890s,

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he claimed to have discovered something which he called pellagrosine.

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He even gave it a name and said, this is the causal agent.

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All we have to do is eliminate this fungus from maize, 
we've solved the problem.

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We just make sure that when the maize is harvested, 
it's fully ripe.

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That before it's milled, it's fully dried.

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There's no mould or anything on it.

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And then when it's made into polenta, 
we have to make sure the polenta itself doesn't go mouldy.

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JEREMY:
Lambroso is extremely convincing, not least because anyone can see 
that when poor peasants make polenta,

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what they tend to do is make a big batch once a week.

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They have a huge loaf of the stuff, 
and each meal, everyone gets a slice.

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And because polenta is pretty moist, 
by the end of the week, it is pretty green and furry.

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But the real beauty of Lombroso's idea of something toxic in the maize 
is that it lends itself to simple technical solutions.

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DAVID GENTILCORE:
So we don't have to eradicate peasant poverty.

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We don't have to worry about maize cultivation, 
production and so on.

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It won't attack the financial interests.

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JEREMY:
His view then was that it was something toxic growing on the maize.

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The alternative view, not nearly as simple, 
was that there was something missing from the diet,

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and particularly from maize.

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DAVID GENTILCORE:
There's something wrong with polenta that doesn't give people adequate 
nourishment.

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There's something deficient, something lacking.

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But the people who propounded this view did not have laboratory 
technology,

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didn't even have the language that we have to talk about, 
I don't know,

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proteins, amino acids. That's language that we develop in the early 
20th century.

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So that explanation wasn't nearly as convincing.

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JEREMY:
But here's the thing, both Lombroso and his main opponent, 
Clodomiro Bonfiglio,

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are working in insane asylums, which is where most of the really bad 
cases of pellagra ended up.

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Lombroso is in Pavia, near Milan, and Bonfiglio is director of the 
provincial asylum in Ferrara.

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DAVID GENTILCORE:
So they have this in common, you know, 
and they're both ...

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It's often, you know, it's easy to depict Lombroso as kind of the bad 
guy,

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you know, but actually both of them are really socially committed.

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They have their heart in the right place. They're really working hard 
to find a cure,

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or cause and a cure, for this disease.

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It's just that Lombroso, by insisting that his was the only possible 
explanation,

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really throws science, puts science in the wrong direction for, 
well,

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40 years I guess .

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JEREMY:
We'll come back to Lombroso and his cures.

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But there's one final twist from the Italian point of view that has 
the bizarre effect of putting science in America back 40 years.

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There's this chap, Luis Sambon. Half English, 
half Italian.

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He's originally a gynaecologist in Rome, 
but he goes to London and ends up at the London School of Hygiene and

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Tropical Medicine. There he comes under the spell of people like Sir 
Ronald Ross,

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and the idea that diseases like malaria can be transmitted by insects.

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He's also taken up by the wealthy pharmacologist Sir Henry Wellcome.

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DAVID GENTILCORE:
Wellcome hired him, Sambon, to go off looking for antiquities, 
because Wellcome was a great purchaser of anything antique,

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anything to do with the history of medicine, 
which he was fascinated by.

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And so Sambon would go on these trips to Italy, 
ostensibly to buy up books and manuscripts and

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any ancient artefacts he could lay his hands on.

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But he had this passion for pellagra at the time.

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He goes to the Roman Campagna to work on malaria with a small group.

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He's obviously a brilliant, you know, 
brilliant ideas person.

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And so he simply superimposes one map on top of another.

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You know, as an epidemiologist, he's thinking about the geographical 
spread.

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Where does pellagra manifest? Oh, look, 
there's an insect that has the same more or less the same spread.

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It's another case of it being very convincing, 
Very persuasive.

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B ut so is Sambon. He's a very ... You read his articles and you 
think.

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Oh, yeah, that's that's perfectly reasonable .

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JEREMY:
Sambon's very persuasive theory, that pellagra is caused by a parasite 
spread by a blackfly,

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doesn't get much traction in Italy.

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Across the Atlantic, it's a different story.

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DAVID GENTILCORE:
When pellagra breaks out -- breaks out -- 
when it appears, first appears in the US,

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he's one of the first people they invite over because he seems to have 
the answer .

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A new disease, a new explanation. The Americans love it, 
you know.

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Oh, the Italians have had pellagra for years. They haven't been able 
to solve the problem.

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We need a new approach. It's an off the wall ...

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I mean, normally, like I say in one of my publications, 
he's normally just a footnote in history.

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I think it's fascinating that he gains a kind of notoriety for a few 
years,

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and then that's it. He has his, you know, 
whatever, 15 minutes of fame.

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And then, you know.

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JEREMY:
Of course, when the Americans say that the Italians haven't been able 
to solve the problem,

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they're being very reductionist. The solution is a better diet.

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But that isn't a good enough explanation.

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It's too fuzzy. Many Italians knew perfectly well that a better diet 
could reverse the symptoms of pellagra,

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though they did also try drugs of different kinds.

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Lombroso himself treated it with compounds of lead and arsenic, 
and he recommended bathing in salt water.

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DAVID GENTILCORE:
Can you imagine taking a salt bath when your whole, 
you know, epidermis is peeled off?

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How nice that would have been? It wasn't about treating the patients 
themselves.

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Rather, what they thought were the causes.

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But if you're saying, okay, the causes are what Lombroso says the 
causes are,

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then we need to treat the causes of tainted maize.

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We need to make sure there's no mould on the maize.

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So we set up these huge drying ovens for the kernels to dry before 
they're milled.

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Or we set up soup kitchens to ensure the peasants get other foods to 
eat.

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JEREMY:
Experimental science did get a brief look in.

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One of the places getting good results with a diet was a hospice north 
of Venice,

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where pellagra sufferers were given better food.

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Lambroso didn't think too much of that, 
so he issued a challenge.

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DAVID GENTILCORE:
The founder of this hospice and Lombroso are corresponding, 
and Lombroso says,

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here, you take 30 of my patients and half of them you treat with the 
remedies I give you,

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the arsenic, the lead and so on. Half you treat however you want.

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And so the founder of the hospital's name is Costantigris, 
he says, okay,

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I'll give them the restorative diet that I've come up with, 
and the other 15 I'll treat.

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The 15 he treated with the medicines got worse.

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His 15 were all released from hospital, 
pronounced cured.

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And he communicated this to Lombroso, 
at which point Lombroso stopped writing to him.

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So, you know, Lombroso had only one possible solution in mind, 
and it was medical.

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JEREMY:
David Gentilcore, a nd I'll be coming back to him in a while.

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But it's time to turn now to Dana Landress, 
because while doctors in Italy and other maize-

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growing areas in Europe had become familiar with pellagra by the end 
of the 19th century,

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in the U.S. i t first really becomes apparent in the summer of 1906.

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DANA LANDRESS:
It's my own view that pellagra was endemic in the US South prior to 
the first recognition in the summer of 1906.

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You have physicians who sort of retroactively write into the US Public 
Health Service and say,

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you know, I was a physician at Andersonville Prison, 
for instance, during the Civil War.

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And I saw this disease that was mysterious in 1864, 
1865.

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And we only now have the language to be able to diagnose that as 
pellagra.

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Had I known then what I know now, we would have sort of taken 
different measures amid the war to combat it.

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JEREMY:
Officials in the U.S. really weren't sure what to make of this new 
disease.

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Beginning in 1909, South Carolina hosted a series of conferences each 
year with invited international guests,

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including Louis Sambon, but five years later there was still no real 
agreement.

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Some people liked Sambon's idea that it was spread by insects.

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Others really weren't sure.

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DANA LANDRESS:
I would sort of suggest that debates over pellagra's etiology really 
actually come to symbolize the the highly contentious nature of this

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epidemic in the United States, which is to say that there is no 
consensus .

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From 1906 to roughly 1914 there are three principal theories that all 
have traction in U.S.

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medical circles. One is the corn toxin theory.

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Another is the insect vector theory.

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And then, of course, you have the dietary deficiency disease, 
which is also beginning to gain traction in this period.

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And it's a bit amorphous during the first outbreak in 1906.

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But those are the primary sort of three theories.

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And I would say that there is no consensus.

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JEREMY:
Into that mess. The young US Public Health Service inserted the man 
generally accepted as the hero of the story.

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DANA LANDRESS:
Doctor Joseph Goldberger is appointed, 
beginning in the summer of 1914,

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to do essentially a tour of the southern United States, 
trying to gain preliminary epidemiological data.

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And so as part of this tour in 1914, 
he begins to track incidents of pellagra at places like state

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hospitals, orphanages and asylums.

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JEREMY:
Goldberger noted that the most severe outbreaks afflicted poor people,

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often working in cotton mill towns in the south.

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He focused on a couple of orphanages in the Deep South.

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DANA LANDRESS:
The orphanage study actually takes place at two institutions, 
two religious affiliated orphanages in Mississippi.

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And the idea here really is to design a therapeutic kind of 
intervention.

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And so Goldberger begins tracking how frequently the children are 
eating the kinds of foods they are eating.

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A rough sketch of the kind of caloric intake they're getting on a 
daily basis,

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and he quickly discovers that the food that they are eating is 
nutritionally replete.

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JEREMY:
Nutritionally replete. I had to correct my original understanding of 
the word replete.

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It means filled up, but not in a good way.

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A nutritionally replete diet is one that fills you up, 
but that doesn't offer much nourishment.

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And Goldberger is really struck by the fact that only the orphans, 
not the staff looking after them,

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get pellagra. So it's unlikely to be either a pathogen or a toxin.

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DANA LANDRESS:
And he begins to supplement their diet with leafy green vegetables, 
with lean meats,

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with legumes, peas. And he finds that this very quickly remedies the 
outbreak and that within a year,

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neither institution has any new cases of the disease.

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So this is kind of the first confirmation that Goldberger has that 
pellagra might not be infectious.

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JEREMY:
Of course, the Italian doctors could have told him that a better diet 
would work.

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But Goldberger persevered, and his next experiment was to try and 
induce pellagra by changing the diet.

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DANA LANDRESS:
This experiment is conducted with 11 white male convicts at a prison 
farm in Mississippi that is known as Rankin State Prison

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Farm. It's about 20 miles east of the capital of Jackson, 
Mississippi.

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And this is a non therapeutic experiment that is intended to produce 
pellagra's dermal lesions in convicts by feeding them a calorically

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and nutritionally replete diet.

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JEREMY:
Remember, nutritionally replete means filling but not nourishing.

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And it doesn't go well.

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DANA LANDRESS:
Unfortunately, about three months into the experiment, 
there are no clinical symptoms of pellagra that are produced among the

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convicts. And so Goldberger and his assistant doctor George Wheeler 
make the decision to actually cut back by about 500 calories,

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the amount of food that the prisoners are consuming to try and induce 
this disease.

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JEREMY:
The problem turned out to be something extremely mundane.

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DANA LANDRESS:
We now know that coffee has small trace amounts of niacin, 
and that the prisoners were actually consuming coffee once,

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sometimes twice a day.

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JEREMY:
And coffee might explain why only six of the 11 prisoners ended up 
producing definite signs of pellagra.

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But it was good enough for Goldberger and for the Mississippi state 
governor,

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who issued the pardons that were promised to the men in exchange for 
their volunteering.

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DANA LANDRESS:
In his pardon slips. Governor Brewer describes this as a pardon given 
for meritorious contributions to public health and to service of

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humanity.

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JEREMY:
Which is all fine and dandy. But a lot of the locals were incensed 
that these white-collar criminals who happened to be friends of the

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governor were now free to rejoin society after just a few months of 
deprivation.

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Leaving that aside, they did help Goldberger to prove his theories, 
and that was welcomed.

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A headline in The Watchman and Southron newspaper in December 1915 
announced A Cause and Cure of Pellagra,

248
00:24:07,730 --> 00:24:12,610
and outside the South, colleagues were quick to applaud Goldberger.

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DANA LANDRESS:
You have many individuals who praise Goldberger very widely for this 
finding.

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They believe that this is the confirmation that the medical 
establishment needed to understand the etiology of pellagra.

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Outside of the South, he is widely lauded for the success of the 
prison experiment and its implications in this kind of treating

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pellagra.

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JEREMY:
In pellagra's heartland, however, there was opposition.

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The very same edition of The Watchman and Southron, 
right next to its news of the cause and cure of pellagra,

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contained a story from a meeting of the Southern Medical Association 
that spoke of "sharp differences of opinion".

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00:24:56,470 --> 00:25:04,750
Goldberger needed to prove, beyond a shadow of a doubt, 
that pellagra was not caused by a pathogen that could be transmitted

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from person to person. And so, in the best tradition of medical 
experiments,

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he invited some colleagues to parties.

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DANA LANDRESS:
These are essentially what are known as the filth parties that are 
done in Spartanburg,

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00:25:18,630 --> 00:25:25,910
South Carolina. And so he recruits not only himself and two advisory 
clinicians from the US Public Health Service,

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but also a couple of patients who had been admitted to the hospital at 
Spartanburg,

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South Carolina. And, perhaps most famously, 
his wife, Mary Farrar Goldberger,

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who in being a very devoted spouse wanted to support her husband's 
research endeavours.

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Most essentially, the idea is to provide even more compelling evidence 
that the disease is not infectious,

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but rather caused by by dietary insufficiency.

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JEREMY:
How did they do that? The clue is in the name.

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DANA LANDRESS:
The Filth Parties.

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JEREMY:
And be warned, it gets gross.

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DANA LANDRESS:
They essentially take the scabs scraped from the dermal lesions of 
pellagra patients who had been admitted to the Spartanburg Pellagra

270
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Hospital. They take urine samples, 
they take faecal samples, and they orally ingest them.

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A nd, you know, like some of the some of the patients and some of the 
PHS clinicians report things like a headache or nausea,

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which seems fairly mild given the context of the experiment.

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E veryone is fine, you know, there are no lasting symptoms.

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And again, it's just an attempt to really try and stave away these 
recalcitrant critics that Goldberger has faced in the southern medical

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community.

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JEREMY:
I think he knew perfectly well what he was doing.

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A later newspaper headline said Scientist Risked Death to Give Mankind 
Life .

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But I'm pretty sure that by this stage, 
Goldberger was certain in his own mind that pellagra was not

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contagious. His first subject was himself, 
alone and in private, and he didn't become ill.

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So while Goldberger was praised by colleagues in the North and 
ultimately nominated for the Nobel Prize four times,

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things were not so rosy down in Dixie.

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DANA LANDRESS:
People like James Haynes, who is the state health officer of South 
Carolina,

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continue to adhere to this insect vector theory.

284
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And as late as the 1950s and 60s, you have individuals in Alabama who 
still want to suggest that pellagra is

285
00:27:33,700 --> 00:27:38,320
an infectious disease, but that maybe there's some sort of underlying 
dietary mechanism going on.

286
00:27:38,320 --> 00:27:45,040
And so in very particular kinds of circles in the Deep South, 
the insect vector theory continues to hold traction for a number of

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years.

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JEREMY:
Like I said at the outset, the way you think about the cause of a 
disease can determine the way you think about a cure.

289
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So why, when the medical evidence seemed so clear cut to everyone 
else,

290
00:28:06,680 --> 00:28:09,960
why was Goldberg's explanation rejected?

291
00:28:10,960 --> 00:28:19,600
DANA LANDRESS:
Pellagra is bad for business. Pellagra is a disease that has a strong 
connotation with regional poverty.

292
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It has a strong connotation with lethargy and laziness.

293
00:28:25,360 --> 00:28:31,000
And if you have a workforce that is plagued with a particular disease,

294
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it is much easier to introduce a kind of technical intervention, 
such as a fly trap or a screened door,

295
00:28:38,610 --> 00:28:44,650
than it is to actually have to change people's wages and the food that 
they're consuming and the landscape in which they operate,

296
00:28:44,650 --> 00:28:47,210
and the labour conditions under which they are working.

297
00:28:47,330 --> 00:28:50,690
And so the short answer is that pellagra is bad for business.

298
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JEREMY:
The fact is, economics and society at large has a huge impact on 
pellagra.

299
00:28:57,130 --> 00:29:02,250
In the US South, the boll weevil destroyed the cotton crop in the 
1920s,

300
00:29:02,730 --> 00:29:08,330
but because they weren't growing so much cotton, 
they had space for a few vegetables.

301
00:29:08,810 --> 00:29:14,330
Good food became more available despite a drop in incomes, 
and pellagra receded.

302
00:29:14,850 --> 00:29:23,410
In Italy too, long before, economics had the opposite effect, 
when landlords started to change their agreements with their tenants

303
00:29:23,410 --> 00:29:26,330
from sharecropping to rent in cash.

304
00:29:26,690 --> 00:29:27,570
David Gentilcore.

305
00:29:28,930 --> 00:29:36,950
DAVID GENTILCORE:
The success of maize as a cash crop brings about a transformation in 
the whole economy.

306
00:29:37,550 --> 00:29:44,421
So rather than, say, have a kind of tenant farmer arrangement that 
they made,

307
00:29:44,421 --> 00:29:54,270
that was traditional, there's a move towards paying rent in cash, 
which has a real detrimental

308
00:29:54,270 --> 00:30:04,150
effect on on peasant well-being. It essentially brings them into debt 
because in a bad

309
00:30:04,190 --> 00:30:08,750
year, your rent is ... See, in the former system of like tenant 
farming,

310
00:30:08,750 --> 00:30:12,950
if it was a bad year and you had to give over a third of the crop, 
well,

311
00:30:12,950 --> 00:30:15,590
you just gave them less, but it was still a third.

312
00:30:16,350 --> 00:30:21,910
Whereas with a set rent, if it's a bad year, 
you can't pay the rent.

313
00:30:22,030 --> 00:30:24,990
You go into debt and that just gets worse and worse.

314
00:30:25,870 --> 00:30:34,480
JEREMY:
The effects of bad years were disastrous, 
with emigration out of northern Italy to the tune of 2 million people.

315
00:30:35,040 --> 00:30:40,040
But that mass emigration actually helped with pellagra at home.

316
00:30:41,040 --> 00:30:47,600
DAVID GENTILCORE:
Ironically, it's the mass emigration that eventually contributes to 
the decline of pellagra,

317
00:30:47,600 --> 00:30:51,080
because the emigrants send back remittances.

318
00:30:51,640 --> 00:30:58,720
And that cash, that little cash that's available, 
means that you can actually choose what to eat.

319
00:31:00,120 --> 00:31:04,880
And invariably, the peasants choose not to eat polenta when given the 
choice.

320
00:31:04,920 --> 00:31:08,200
I mean, it's simply a question of wanting more variety, 
I think.

321
00:31:08,800 --> 00:31:13,920
JEREMY:
Still, while I take Dana Landress's point that pellagra was bad for 
business,

322
00:31:13,920 --> 00:31:21,280
the mill owners and the like were supported by the medical 
establishment who refused to see the obvious.

323
00:31:21,960 --> 00:31:26,000
DANA LANDRESS:
I think this is actually an instance where in some cases you have to 
follow the money,

324
00:31:26,240 --> 00:31:35,340
and many of these physicians were in professional and personal circles 
with the kind of mill managers and other kinds of owners,

325
00:31:35,340 --> 00:31:42,020
who believed that the best way to kind of alleviate regional poverty 
was to attract business,

326
00:31:42,500 --> 00:31:45,740
and that this was going to be the ultimate cure for pellagra.

327
00:31:46,100 --> 00:31:50,060
JEREMY:
The great thing about science, of course, 
is that it doesn't care what you believe.

328
00:31:53,660 --> 00:32:01,300
Pursuing what he called the pellagra preventative vitamin, 
not least because the generic better diet was too expensive for most

329
00:32:01,300 --> 00:32:07,580
institutions, Goldberger established that dried brewer's yeast 
contained plenty of it,

330
00:32:07,580 --> 00:32:13,580
whatever it was. And he put that knowledge to use .

331
00:32:13,580 --> 00:32:22,500
In the wake of the Great Mississippi Flood of 1927, 
three cents worth of dried yeast in their food saved hundreds of

332
00:32:22,500 --> 00:32:28,140
thousands of people from pellagra. The alternative, 
according to one newspaper report,

333
00:32:28,420 --> 00:32:34,800
would have been a dollar of fresh food, 
which in any case was not easily available after the flood.

334
00:32:40,040 --> 00:32:44,320
Goldberger died of kidney cancer in 1929.

335
00:32:44,680 --> 00:32:54,400
In 1937, Doctor Conrad Elvejhem at the University of Wisconsin finally 
identified what he'd been calling vitamin G --

336
00:32:54,400 --> 00:32:58,720
for Goldberger. It was vitamin B3, 
niacin.

337
00:32:59,800 --> 00:33:03,880
So you can say pellagra is caused by lack of niacin.

338
00:33:04,240 --> 00:33:07,920
You can also say it's caused by industrial capitalism.

339
00:33:08,240 --> 00:33:13,440
And to that mix, you can add that it was caused by Eurocentric 
arrogance.

340
00:33:16,480 --> 00:33:24,640
The indigenous people of the Americas, 
who subsisted on corn for centuries never showed any signs of anything

341
00:33:24,640 --> 00:33:28,240
resembling pellagra, even in times of want.

342
00:33:30,330 --> 00:33:35,810
And that's because they learn to process their maize with an alkaline 
solution,

343
00:33:36,050 --> 00:33:41,730
often by soaking the kernels in water containing dissolved lime or 
wood ash.

344
00:33:44,650 --> 00:33:48,370
That process is called nixtamalisation.

345
00:33:48,770 --> 00:33:56,290
After the Nahuatl words for lime ashes and uncooked corn dough, 
the same word that gives us tamales.

346
00:33:56,650 --> 00:34:05,290
The Europeans who adopted maize as a cash crop with glee simply 
ignored indigenous techniques like nixtamalisation.

347
00:34:05,650 --> 00:34:10,290
Even Cesare Lombroso threw out the evidence available to him.

348
00:34:10,570 --> 00:34:17,410
DAVID GENTILCORE:
In fact, Lombroso in one of his studies, 
does mention the Indios, he says,

349
00:34:17,410 --> 00:34:20,690
of Mexico. He says, well, you know, 
they don't get pellagra.

350
00:34:21,250 --> 00:34:26,450
Why not? And his answer was, well, 
obviously the maize there is a better quality.

351
00:34:26,450 --> 00:34:28,890
It doesn't get mould. He's still ...

352
00:34:28,930 --> 00:34:31,470
You know, in a circular argument like that, 
you can't win.

353
00:34:31,470 --> 00:34:39,470
He's always got the answer. And yet, 
if they had observed maize in its place of origin,

354
00:34:40,310 --> 00:34:47,230
you know, we have early descriptions where the Spanish conquistadors 
are writing these accounts of discovery.

355
00:34:47,830 --> 00:34:51,510
They described traditional ways of producing.

356
00:34:51,510 --> 00:34:56,750
But Europeans aren't interested. They just want to turn it into flour.

357
00:34:57,030 --> 00:35:05,190
There's this obsession we have in Europe with bread, 
with milling, means that they can only see maize in this one way.

358
00:35:05,190 --> 00:35:08,230
They have to, yeah, treat it like wheat.

359
00:35:09,790 --> 00:35:17,190
JEREMY:
Goldberger's experimental approach squarely demonstrated that pellagra 
was caused by a dietary deficiency,

360
00:35:17,430 --> 00:35:20,790
regardless of what actually caused the deficient diet.

361
00:35:21,350 --> 00:35:24,510
But did it have any impact back in Italy?

362
00:35:25,310 --> 00:35:27,150
DAVID GENTILCORE:
No, because people knew that already.

363
00:35:27,190 --> 00:35:32,400
I mean, the hospital doctors all knew, 
and they write this on the records quite clearly.

364
00:35:32,840 --> 00:35:38,480
Oh, so-and-so is cured, but he'll go back to his diet and we'll see 
him again before long.

365
00:35:38,920 --> 00:35:45,720
Even before they knew about about niacin, 
hospital doctors simply knew from experience,

366
00:35:45,720 --> 00:35:52,840
give them a decent diet. The one thing that determines this, 
though, is if they can stop the diarrhoea.

367
00:35:53,720 --> 00:35:56,200
And there's no way in this period to stop diarrhoea.

368
00:35:56,680 --> 00:36:02,720
So if the patient gets better, can keep the food down, 
can digest it,

369
00:36:02,760 --> 00:36:09,640
they get better. Quite simple. So even before Goldberger, 
they know that as a reality.

370
00:36:10,360 --> 00:36:14,480
By Goldberger's time, in Italy pellagra has practically disappeared.

371
00:36:14,520 --> 00:36:17,520
Nobody's really investigating it anymore.

372
00:36:18,400 --> 00:36:24,000
JEREMY:
The Italian government ignored social factors and took Lombroso's 
advice to heart.

373
00:36:24,400 --> 00:36:32,980
In 1904, they passed the first law to combat pellagra, 
which mandated big drying ovens in maize growing areas.

374
00:36:33,780 --> 00:36:38,922
Cases had in any case, started to decline a decade or so before .

375
00:36:38,922 --> 00:36:42,060
Peasants began to organise and demand better conditions.

376
00:36:42,300 --> 00:36:48,180
And of course, there were the remittances sent home by the millions of 
Italians who emigrated.

377
00:36:48,540 --> 00:36:51,860
Italy had quietly vanquished pellagra.

378
00:36:52,740 --> 00:36:54,700
DAVID GENTILCORE:
Ultimately, it's the First World War.

379
00:36:54,780 --> 00:36:59,260
And then there's another paradox. You would think, 
oh, conditions would get worse during the war.

380
00:36:59,700 --> 00:37:05,820
But no, the Italian government buys in lots of wheat from abroad in 
1915,

381
00:37:05,980 --> 00:37:09,980
which essentially subsidizes the price of bread.

382
00:37:10,540 --> 00:37:13,300
And so these peasants, finally they can afford bread.

383
00:37:13,740 --> 00:37:16,660
So naturally they they opt for that.

384
00:37:17,300 --> 00:37:24,620
Mussolini, in 1927, he's celebrating five years of fascist rule.

385
00:37:25,100 --> 00:37:31,070
And he's very smug. He's able to say, 
we've solved this problem, the Americans haven't.

386
00:37:31,790 --> 00:37:35,390
Meaning, by his time, pellagra was history.

387
00:37:36,470 --> 00:37:39,470
The government had nothing to do with it, 
it has to be said.

388
00:37:39,830 --> 00:37:42,190
Medical science had very little to do with it.

389
00:37:42,190 --> 00:37:46,350
It was simply improving peasant conditions that were behind that.

390
00:37:46,950 --> 00:37:56,510
So it wasn't politics. And it wasn't really a medical intervention 
because there was no treatment for

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pellagra aside from an improved diet.

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And even Lombroso said, we can't improve the peasants' diet.

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That's that's not our job. We're doctors.

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JEREMY:
Well, whose job is it, then? For pellagra, 
the answer is quite easy.

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Governments said that some foods have to be fortified with added 
niacin,

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and that solved the problem. Today we look back on pellagra as a 
distant memory.

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Will we one day be able to do the same for, 
say, type two diabetes?

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00:38:34,370 --> 00:38:40,050
With current ill health linked to food, 
where the whole point of food manufacturers is to get us to eat more,

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00:38:40,570 --> 00:38:43,290
which kind of cause do you focus on?

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00:38:43,770 --> 00:38:47,890
Biochemical, Economic? Societal?

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I don't have answers, but I'd love to know what you think.

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00:38:56,810 --> 00:39:03,810
You can email me -- Jeremy @eat this podcast.com -- 
or leave a comment on the website at eatthispodcast.com .

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00:39:05,930 --> 00:39:13,130
My profound thanks to Dana Landress and David Gentilcore for their 
help in making this episode.

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00:39:13,970 --> 00:39:17,810
I'm taking a break over the summer; 
back in a couple of months.

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00:39:18,290 --> 00:39:23,650
There are more than 300 episodes in the archive in case you miss the 
show.

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00:39:23,890 --> 00:39:29,500
And be sure to subscribe wherever you get your podcasts so you don't 
miss the return.

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00:39:31,940 --> 00:39:38,020
If you're already subscribed to Eat This N ewsletter, 
then that will alert you when the podcast is back.

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00:39:38,020 --> 00:39:43,660
And in the meantime, I'll continue to share interesting stuff that I 
find every week.

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00:39:43,900 --> 00:39:51,900
If you want to sign up for that, head over to 
eatthispodcast.com/subscribe and you'll find a link at the bottom of

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00:39:51,900 --> 00:40:00,460
the page. My thanks again to supporters for allowing me to make 
everything freely available,

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00:40:00,460 --> 00:40:03,980
including written transcripts and subtitles.

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00:40:06,740 --> 00:40:11,500
For now though, from me, Jeremy, surface and Eat This podcast.

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Goodbye and thanks for listening.