The first part of the book shows the disease and the different theories that materialized from doctors studying it in certain populations. I did get a bit confused at one part and thought some facts were being restated, but it wasn't until later that I realized the author was showing the Thompson-McFadden Commission came up with the infectious theory and agreed with it. Many of the different hypotheses repeat others, but they were building on evidence and debunking other theories. I just thought it could have been written more clearly.
There are more than 30 vignettes that describe the suffering and horrible death of the victims. Many became suicidal or ended in insane asylums because the disease made them go mad. I felt bludgeoned by these one-paragraphs on pellegrin cases at the start. I can see many liking these individual accounts because it adds a personal touch, but it was too repetitive for me. I started to skip some because they sounded alike. It isn't until Goldberger enters the foray of finding a cure that I was able to start reading them again. The later vignettes begin to reflect the changes in doctors treatments and possible cures to the disease.
Goldberger realized that the pellegra mystery was intertwined with the South's economic and social system that became prevalent after the Civil War. The South relied on cotton that displaced farm crops. The result was that people were not getting balanced diets and most of the sufferers of pellegra lived in the South. Unfortunately, media was used in a way to not only tell people the cause of pellegra, but to put down Southerners as well for their diets and crop system. This resulted in people and doctors and politicians not listening to the facts and more people dying even after a cure was found.
This frustrated Goldberger so much that he performed some extreme and gross experiments to prove that pellegra was based on diet and not a contagious disease. Goldberger, along with his wife and other doctors conducted an experiment where they made a pill using the feces of infected patients. Can you imagine? Here dear, eat your breakfast and don't forget to take your poop pill. Even when they didn't get sick, they couldn't convince the skeptics. Some of the photos might disturb readers for they show adults and children covered in puffy, scaly skin that sometimes turns black from pellegra.
The first case of pellegra was reported in 1902 and a cure was discovered in the late 1930s; however, it wasn't until the 1940s that it disappeared when the government ordered a wartime program to address the issue. I won't tell you the cure that was found because part of the fun reading this book is how the author reveals clues that lead to the ultimate answer. The well-done notes at the back are for further reading and the layout of the book uses red inserts that give facts about pellegra and primary sources. The end has a question and answer that filled in the blanks for me. The timeline is helpful as well.
This deficiency disease does not exist today but it does in other malnourished countries. We take our rich way of life for granted and this glimpse into a past with poor immigrants is not so long ago. I know that when I go back to see my husband's grandma who is 100 years old, I'm going to ask her about this disease and find out what she has to say.