Joseph Goldberger of the Public Health Service, and his colleagues eventually eradicate what turns out to be a nutritional deficiency disease through dietary changes and the addition of nicotinic acid, or niacin, to flour. Jarrow treads in the medical gumshoes’ footsteps, tracking clues down blind alleys of poverty and contagion, and follows medical reasoning from hypotheses to human experimentation (that would never be allowed by today’s standards) while examining the political contentions that caused public health setbacks even after effective treatment had been discovered. When it reached epidemic proportions in early twentieth-century America, doctors took notice, and the hunt was on for the culprit and a cure. The illness was already known among rural populations in Europe and named “pellagra” (rough skin) by the Italians. By the time it was diagnosed, the patient had often reached a state a dementia and was weeks or even days from death. The rash could pass for sunburn, except for the predictable patterns in which it presented. It started with three symptoms: rash, diarrhea, fatigue.
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