MrBallen’s Medical Mysteries - Ep. 32 | Scourge of the South

Episode Date: May 14, 2024

A doctor in the early 1900s is tasked with discovering the cause of a sometimes-fatal disease ravaging the American South. But in order to figure it out, he has to conduct a dangerous experiment that puts people’s lives at risk.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Hey Prime members, you can binge episodes 57 through 64 right now and ad-free on Amazon Music. Download the app today! In the spring of 1914, a cotton farmer in Milledgeville, Georgia, sat down inside of his house for lunch. He was glad to be out of the sweltering heat outside, which lately had been causing him a bunch of trouble. A few weeks ago, he'd gotten an unusually bad sunburn, which had only grown worse and turned into a very itchy rash. Scratching the rash felt like his skin was on fire. So he was glad to distract himself with a hearty meal of cornmeal cooked with bacon and drizzled in molasses. But when the farmer was done eating, he suddenly felt this wave of fatigue sweep over

him and his tongue suddenly felt prickly, making it seem swollen and strange inside of his mouth. His wife came to his side and placed a reassuring hand on his shoulder, but the farmer jolted and winced in pain. Before he could stop her, she pulled down his collar to have a look at his skin, and she gasped. His entire neck was ringed with a scaly rash. She told him he needed medical attention right now. The doctor might put him in the hospital, and then who would take care of the farm? But his wife insisted. She promised she could handle things at the farm while he was gone. The farmer nodded. He knew she was right. So he struggled to his feet and then hobbled over to their dresser

and packed a small bag of clothes. Then he hugged his wife goodbye and hiked down the road towards the nearest health care provider, the Georgia State Sanitarium for the insane. Those scenes between Cameron and Rupert Darrow, I heard that your first draft had to be toned down. This is the place for all the on-set gossip and real insight into how the world of Jilly Cooper's scandalous English county was brought to your screens, including interviews with Emily Atack, Danny Dyer and many more. Somebody needed to tell Lord Baddingham straight. There are many people on the show that does that, you know?

All episodes will be available from the 25th of October, wherever you get your podcasts. I'm Raza Jafri, and in the latest season of The Spy Who, we open the file on Sergei Skripal, the spy who Putin poisoned. When the USSR falls apart, GRU officer Skripal finds himself adrift in the new Russia. The world of espionage becomes his way out and his downfall. Once a double agent, now a pivotal figure in an

international mystery, Sergei Skripal went from a life of covert operations to a dramatic poisoning that captivated the globe. But what led to this shocking attack? And what hidden truths did Sergei uncover? Follow The Spy Who on the Wondery app, or wherever you listen to podcasts. Or you can binge the full season of The Spy Who Putin Poisoned early and ad-free and Wondery, I'm Mr. Ballin, and this is Mr. Ballin's Medical Mysteries, where every week we will explore a new baffling mystery originating from the one place we all can't escape, our own bodies. If you like today's story, please go to the Follow Buttons College graduation and right when they're about to receive their diploma, stand up and make a scene where you scream out that they cheated on all of their exams. This episode is called Scourge of the South.

On a hot, muggy morning in June of 1914, a 40-year-old physician named Joseph G. Goldberger stepped down from his horse-drawn carriage right out in front of a palatial brick building in rural Georgia. He was impressed but also confused by the grandiose architecture. It looked more like a state capital than what it really was, a mental hospital. The doctor shielded his eyes from the sun and loosened his collar and fanned his face with a stack of papers as sweat poured down his body. He had traveled all over the world in his work for the United States Public Health Service, but he couldn't remember the last time he'd felt heat this oppressive. He hoped that once he got inside, it would be a bit cooler. So Dr. Goldberger paid the carriage driver, grabbed his bags, and then marched right up the steps into the front office of the Georgia State Sanitarium for the Insane. The doctor was there on direct

orders from the United States Surgeon General to investigate a skin disease called pellagra that was ravaging the American South. The word pellagra was Italian for rough or dry skin, but that name totally understates the danger of this condition. People sometimes called pellagra the disease of the four Ds, referring to how it progresses, dermatitis, then diarrhea, then dementia, and then finally death. Until the past decade, there had rarely been a case of pellagra in the United States, but in recent years, it had arrived with a vengeance. And now it was an epidemic. In the American South alone, there were at least 100,000 confirmed cases of pellagra. The US Public Health Service had only been studying pellagra for about five years,

so they hadn't been able to determine its cause yet, but the leading theory was that it was spread by a type of black fly that feeds on blood. And if that was true, Dr. Goldberger knew he was taking a huge risk coming here. He could get pellagra too. But Dr. Goldberger had been taking risks ever since he was a child, when his family emigrated from Hungary to New York without a cent to their name. And now, he was one of the most distinguished physicians in the U.S. Public Health Service, and he had investigated outbreaks of yellow fever, typhus, dengue fever, Schamberg's disease, and typhoid fever, just to name a few. Nearly every time, he'd caught the disease he was fighting. But Dr. Goldberger was a man on a mission. He had

to know why there was such a concentration of pellagra cases at places where people lived in large groups, like old age homes, prisons, orphanages, and mental asylums. He decided to start his research at this sanitarium in Georgia, one of the largest mental hospitals in the world with over 3,000 patients, many of which had pellagra. Once the doctor entered the vaulted four-story entrance hall, he shook hands with the head nurse and explained his plan. He wanted to interview the most advanced pellagra patients first since they had the most symptoms to study. The nurse led Dr. Goldberger out of the main building, around a fountain, and down a tree-lined road to a three-story

building. She explained that the sanitarium was segregated by gender and race. She was taking him to where the white male patients were kept. They were some of their worst Pellegra cases. The doctor followed as she led the way up some stairs and then down a long hallway lined with doors. Moans and babbling voices echoed off the stone walls. Dr. Goldberger glanced through the circular windows on each door as they passed. Patients were crowded several to a room, often with widely differing conditions, from alcoholics to senile old men to people suffering violent psychotic episodes.

Some of the patients were there voluntarily, but others were basically prisoners who had been brought against their will. Dr. Goldberger had seen plenty of human suffering throughout his career, but the misery of these men was still hard to witness. Eventually, they stopped at a heavy wooden door. The nurse removed a key from her ring, then unlocked the door and held it open for the doctor.

Inside the cramped, low-ceiling room, a tired-looking man sat on a narrow cot. The nurse said he was a local cotton farmer named Henry and he had one of the worst cases of pellagra at the hospital. Dr Goldberger flinched at the sharp smell of sweat and body odor inside the room and also at the farmer's appearance. His appearance reminded the doctor of medical photos he'd seen of leper colonies in India. The farmer's neck, hands, forearms, and feet were crusted over in this splotchy black mass. As the doctor stepped closer, he could see that the blackness

was caused by scabbed over blood from popped sores. The room was hot and stuffy, the only ventilation was a small window on the far wall. If pelllegra was contagious, this was a terrible place to visit an infected patient. But Dr. Goldberger was determined to get to the bottom of this, so he braced himself for the danger ahead and then confidently walked over to the farmer and shook the man's hand. Dr. Goldberger said hello to Henry and asked to hear his story. Henry nodded and then told the doctor that he had admitted himself to the sanitarium a few months ago. At first, Henry thought the rash on his body was just a sunburn, but the rash had continued to spread even when he was out of the sun, and then when the strange, prickly feeling

spread to his mouth, he realized this had to be something worse than just a sunburn. He was worried about his wife and his kids catching whatever he had, so he had come here. And this wasn't all. Henry now suffered from near-constant diarrhea. He couldn't sleep much or taste food, and his motor skills were deteriorating. He sighed and said he knew there wasn't anything to be done. The staff had told him that since the cause of pellagra still was not known, that meant there weren't any proven treatments. There was very little they could do to help him. Dr. Goldberger asked Henry to stand up so he could examine him. But when the farmer tried to get up, his legs were so shaky he had to immediately sit back down. Dr. Goldberger was shocked to see firsthand what this disease could do to the human body in just a few months. Henry slowly raised his head to look at

the doctor. His eyes had trouble focusing and he spoke in a cracked voice as he explained his situation. His wife was too busy with their kids to actually manage the farm and so every day Henry was here at the sanitarium was another day they were not able to tend to their crops. And if he was gone much longer, they would lose everything. Dr. Goldberger stared back at Henry and promised him that he would not stop until he discovered what caused his illness. After leaving Henry's room, Dr. Goldberger followed the nurse on a tour of the rest of the sanitarium. He interviewed dozens of men and women of different ages and races. Each case was tragic in its own way. Pellegra was relentless once it took hold. Seeing children covered in painful sores broke Dr. Goldberger's heart. It seemed like there was

nothing anybody could do to help them. But what puzzled Dr. Goldberger the most was just how erratic this disease was. It didn't make sense to him why the pellagra hadn't spread further. In these hot, unventilated buildings, he would have thought entire wards would have caught it by now if it was contagious, but only a fraction of the residents were sick. That night, as Dr. Goldberger went over his notes in his room, he realized that the next step was to interview the staff, all 293 of them. The following morning, Dr. Goldberger was given a vacant office to conduct his interviews. He made sure the survey he would give each staff member was very thorough, how long each person had worked at the sanitarium, which ward they were stationed in, what their interactions had

been with every patient, as well as everything about their daily routine. One after another, the staff came in, introduced themselves, and patiently answered every question, and all of them were smiling and very helpful. And for some reason, something just didn't seem right to Dr. Goldberger. An hour into the process, it struck him. None of the staff were sick in the slightest. These were people who worked in buildings full of patients with pellagra, yet none of them showed even a single symptom of having caught the disease. This made Dr. Goldberger wonder, was pellagra really contagious?

The prevailing medical theory was that pellagra was an infectious bacteria carried by insects that spread the disease with their bites. If that theory was right, then why were these insects only infecting patients and not the staff? Black flies looking for blood will bite anyone. Dr. Goldberger suspected that something else besides black flies must be causing this disease. In fact, he wondered if pellagra was really an infectious disease at all. He almost laughed out loud with relief. This might be the first time in his career of fighting epidemics that he himself did not get sick. And so if this theory Dr. Goldberger was

thinking about was correct, then it was totally useless to make people sick with pellagra stay in isolation. The much more important task was trying to figure out what was sick with pellagra stay in isolation. The much more important task was trying to figure out what was causing the pellagra in all these people. Thankfully, the hospital had a telephone. Once Dr. Goldberger wrapped up his interviews with the staff, he called the Surgeon General and received permission to continue his investigation. Dr. Goldberger wanted to inspect another hotbed of pellagra outbreaks, this time at an orphanage in Jackson, Mississippi. And as Dr. Goldberger headed to his room to pack, one of the nurses pulled him aside. She said she had bad news.

Henry, the local cotton farmer, had just been found dead inside of his room. Dr. Goldberger shook his head. He wondered how many more people like Henry would die before he could figure out what was causing this horrible disease. Buried in the depths of the internet is the Kill List. A cache of chilling documents containing hundreds of names, photos, addresses, and specific instructions for their murders. Kill List is a true story of how I ended up in a race against time to warn those whose lives were in danger.

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Children who had no families to comfort them. The orphanage looked far more welcoming than the imposing sanitarium. It reminded Dr. Goldberger of a small country church, with an arched entryway and two bell towers above. Inside, the matron who ran the orphanage introduced herself and showed the doctor to his guest quarters in the visitor's wing. After putting away his things, he followed her on a tour of the building. Despite the building's friendly exterior, Dr. Goldberger realized the place needed serious maintenance. As the matron showed him around, he could see cracks in the ceiling, and the bathroom smelled swampy like they'd recently flooded or had plumbing problems. The staff

was also quite small compared to the number of kids they were caring for, but the kids were relatively well-behaved and happy. The doctor poked his head in one of the dormitories and noticed the majority of the beds were made. When they approached the hospital ward, the matron warned Dr. Goldberger to brace himself for a very unpleasant sight. The ward was a long, low room lined with narrow beds, almost like an army barracks. Fully one-third of the orphanage, 68 kids, were isolated here because they all had signs of pellagra. In some kids, the pellagra rash had spread up their neck and onto their face. As Dr. Goldberger followed the matron through the room, a particularly sad-looking girl, who looked to be about eight years old, caught his eye.

She was sitting cross-legged on her bed, holding a book. Dr. Goldberger noticed stripes of red sores creeping out beneath the cups of her sleeves. The doctor sat down next to her and asked how she was feeling. The girl said she couldn't sleep anymore because her body constantly itched all over, and whenever she scratched it, her skin burned like it was on fire. She peeled back the collar of her shirt to show him. Her neck was ringed in a dark, scaly rash. Dr. Goldberger patted her hands and told her to stay strong.

He was going to do everything he could to help her. She nodded, but she did not seem convinced. As Dr. Goldberger looked around the ward, he realized that nearly all of the kids were within a couple of years of this little girl's age. He saw almost no preschoolers or teenagers, even though the orphanage provided homes for kids from birth to age 18. Dr. Goldberger was puzzled, but he kept his thoughts to himself. Dr. Goldberger stood up and followed the matron outside to where a group of older children were helping build a storage shed. The matron explained to the doctor that that was today's chore.

As Dr. Goldberger watched these teenagers sawing and hammering planks of wood out in the sun, he was struck by the contrast between them and all the younger children inside the hospital ward. These older kids looked so happy and healthy, and none had even the faintest sign of pellagra. The doctor jotted down some observations in his notebook, and then followed the matron to their final stop, the nursery. Inside, it was loud and crowded, with infants and small children scattered all about. Some were playing with blocks and old-weathered toys, while others napped on cots. The room felt hot and chaotic,

but as Dr. Goldberger studied these kids, he couldn't see any signs of sickness. They were just maybe a bit dirty, like you'd expect active kids to be, and so it comforted Dr. Goldberger to see some signs of normalcy here. After dinner, the doctor stayed up for a while organizing his research. He was beginning to see strange patterns in who got pellagra and who didn't. At the sanitarium in Georgia, pellagra had struck people from every age group, from grandparents to young kids. But here at this orphanage, all the pellagra patients were the same age group, between 6 and 12. This was new. He'd never encountered a disease before that only affected people of certain ages.

Dr. Goldberger now felt confident pellagra was not spread by black flies, but he had a new riddle to solve. Why would infants and older kids not get pellagra, while the kids in the middle of those two groups were getting so sick. Dr. Goldberger laid in bed, thinking in circles and listening to the drone of cicadas outside. But he couldn't sleep. He just couldn't get those faces of the kids in the sick ward out of his mind. The next morning, Dr. Goldberger woke up early, gathered his notes, and called a meeting with the matron. He wanted to know every detail of how the kids at the orphanage were cared for, from daily activities to sleeping arrangements to meals. The matron explained that they tried to make the kids' lives as normal as possible, but it had grown more difficult in recent years

because of cutbacks to the orphanage's funding. The staff had been forced to ration the more expensive foods, for instance now only the youngest kids were given milk, because it was essential to their growth while all the other kids went without it. The staff had also begun assigning chores to the older kids. The orphanage needed constant repairs, but because of these cutbacks, they could no longer afford to hire outside help. And so in exchange for their labor, the older kids were given bigger and better meals, including meat and vegetables, at least once a week. By comparison, the kids in the middle, between ages 6 and 12, ate mostly cornmeal with molasses.

On rare occasions, they got whatever low-quality meat the orphanage could scrounge up. They got almost no milk or vegetables at all. Dr. Goldberger was stunned. The kids in the 6-12 group were not getting enough to eat, and they were overwhelmingly the ones getting pellagra. Of course, he knew that a bad diet could lead to health complications, but it didn't make sense that it would cause something as horrible as pellagra. The doctor then asked the matron if there were any kids in the 6 to 12 year old age range who showed no signs of pellagra. Unfortunately, almost all of the kids in that middle age group had at least some symptoms of pellagra. But then she smiled

and said actually there were a few kids in that age group who were totally healthy. They were three troublemaking 12 yearyear-olds named Charlie, Henry, and Frank. That was not what Dr. Goldberger wanted to hear. If some of the kids eating this terrible diet were not getting the disease, then food had nothing to do with who got sick. The matron led the doctor outside to a courtyard where the three troublemaking boys were running around playing tag. None of them looked sick at all, even though they lived in a facility full of kids their age ravaged by disease. So what made these three special? Dr. Goldberger walked up to the three kids and asked how they'd been feeling

lately. The boys looked at each other, confused by the question, then shrugged and ran off to continue their game. The doctor smiled. Disinterest was a normal reaction for happy, distracted kids. They clearly were not worried about their health. So the doctor thanked the matron and then headed back to his room, wondering if Charlie, Henry, and Frank held some secret to avoiding pellagra. And if they did, he desperately needed to know what it was. Dr. Goldberger stayed up late that night night trying to solve the riddle of the three healthy boys. He combed through all the existing research on pellagra, searching for an answer for

why they were not getting sick. He got so lost in thought that when he finally looked up, it was almost midnight. He decided a little breath of cool night air might help him sleep easier, so he got up and left the room. But just as he closed the door and stepped into the hallway, Dr. Goldberger heard hushed voices. In the otherwise silent orphanage, the sound echoed. He held his breath and listened. There they were again, whispers and then footsteps. The doctor tiptoed towards where the noise was coming from, and he peered around the

corner just in time to see the doors to the cafeteria's kitchen swinging shut. The doctor crept along the hallway to the cafeteria entrance, and when he got there, he put his ear up to the door, and he could hear inside the cafeteria cupboards opening and excited voices muttering. The doctor peeked through the gap between the double doors and he stifled a laugh. The three boys from earlier, Charlie, Henry, and Frank, were raiding the pantry. Dr. Goldberger was tempted to leave them be,

but he realized that whatever they were eating might explain why they had not caught Pellegra. So he slipped into the kitchen and cleared his throat. The boys instantly spun around, embarrassed looks all over their faces. They'd been caught red-handed and there was no hiding it. But Dr. Goldberger immediately assured them that they were not in trouble. In fact, he said, they could actually be a big help to him.

All he needed to know was what they were eating. If they told him, he'd go back to his room and this could be their little secret. The boys exchanged confused glances and then nodded to each other. They went to the pantry and pulled out the food they'd been stealing. A few peaches, a handful of peanuts, and some leftover chicken. Dr. Goldberger smiled and then, in a conspiratorial whisper, asked them if they'd done this before. The boys' faces went red, and they looked down at their feet, and then one of them quietly admitted that, yes, they had. Dr. Goldberger felt a surge of excitement. He thanked the boys for their honesty, then left them to their midnight snack.

As the doctor headed back to his room, his mind spun with activity. He knew he was close to a breakthrough. By morning, he had devised a plan to test his theory. If it worked, he could finally solve the mystery of what was causing pellagra and he could save countless lives. But Dr. Goldberger's experiment would take a little patience and more than a little danger for the people who actually took part in it. Eight months later, in February of 1915, on a pleasantly cool Mississippi morning, Dr. Goldberger stood outside of a brick building that looked just like a castle, complete with

turrets and battlements. This would be his new home for the next six months and where his grand experiment would take place, Rankin's State Prison Farm. He needed a controlled environment for his test to be scientific, and this place was as controlled as it got. To date, there had been zero cases of pellagra at this prison. But if the doctor's theory was correct, that would not be the case for much longer. Dr. Goldberger regretted what he was about to do. Pellagra killed about one out of every 30 people, and if he wasn't careful, his experiment could cost lives. But he didn't feel like he had

a choice. People were counting on him. Already dozens of his patients at the sanitarium and orphanage had died and the pellagra outbreaks at those locations were not showing any signs of slowing down. So Dr. Goldberger went inside and the warden then led him to the setting for his experiment, a prison within the prison. It was a private newly built barracks with barred cells, a cafeteria, and a small screened-in yard. Throughout the experiment, the inmates here would have no contact with the rest of the prison population, so there could be no contamination. In exchange for agreeing to be a human guinea pig for six months, the 11 prisoners in the experiment would be given full pardons, $5, and a new suit.

The warden then gave his sign to his staff, and the prisoners were brought in. 11 hardened men in pinstripe jumpsuits. Dr. Goldberger watched them file in for breakfast, taking a plate of food from the cafeteria workers, and then settling in at a long table. Everyone was tense and alert, like nobody knew what to expect. But once they began eating, the mood turned festive. They cleared their plates, went for seconds, and cracked jokes about how lucky they were. This was a vacation compared to what they were used to. But Dr. Goldberger knew that if his experiment worked, the next six months would be anything but relaxing. Because if his suspicions were correct, then these men would contract pellagra and all the horrible suffering that came with it.

Almost six months later, Dr. Goldberger woke early in his room at the prison and pulled out his calendar. It was the second week of September. The experiment's deadline was approaching fast, and he wasn't getting the results he had hoped for. In six weeks, all the funding for this would end, the barracks would be dismantled, and the prisoners would walk free. But there really was nothing Dr. Goldberger could do to make things move faster. The experiment had to move at its own pace. A few inmates had complained of some new ailments, headaches, backaches, dizziness, nausea, but they were nothing that could be pinpointed as pellagra.

Just then, a guard knocked on the door and said there'd been an incident with one of the prisoners, who was now restrained in his cell and demanding to talk to the doctor. Dr. Goldberger followed the guard to the prisoner's cell, and as soon as the inmate caught sight of the doctor, the inmate began yelling. He called Dr. Goldberger a crook and shouted that he'd rather just serve his entire sentence back inside the regular prison than stay another second in this hell. Dr. Goldberger was not surprised. The joyful mood from the beginning of this experiment had totally worn off.

Many of the inmates were grouchy and irritable, and he was getting yelled at a lot. Dr. Goldberger watched the prisoner thrash against his restraints and howl, when suddenly the doctor caught a glimpse of something through a tear in the prisoner's shoulder seam. The doctor called for the guards to come open up the cell, and then once they had, Dr. Goldberger rushed in and stretched that rip in the prisoner's shoulder even wider. And when he did, boom, there it was. A scaly rash stretching along the prisoner's shoulder blades and up around the base of his neck. Dr. Goldberger then pulled up the prisoner's shirt, and the man's torso was a trail of blackened rashes and pimply sores. There was no doubt this man had pellagra, and he didn't catch

it from another prisoner or from the guards. This man must have gotten pellagra from Dr. Goldberger's experiment. Dr. Goldberger asked the guards to please send all the other inmates back to their cells. The doctor wanted to do a full-body checkup on each of them. Once all the prisoners were ready, Dr. Goldberger slowly walked along the cell block, scanning each prisoner from head to toe, and as he did, his pen was a blur in his notebook, furiously scribbling detailed descriptions. The doctor couldn't believe what he was seeing. His hands were shaking. Five more men had clear symptoms of pellagra, meaning six out of the eleven volunteers had caught the deadly disease.

Dr. Goldberger dashed back to his office and quickly sent word to the governor. His experiment had worked. Now it was time to tell the world. What Dr. Goldberger had discovered was shockingly simple. Pellagra was not caused by black flies transmitting a virus or bacteria, and pellagra was not contagious. Pellegra was not caused by black flies transmitting a virus or bacteria. And pellegra was not contagious. Pellegra was caused by food. Specifically, it was caused by the traditional American Southern diet in poor households. Salt pork, molasses, and cornmeal. If that was all somebody ate, it was highly likely they would get pellagra. And people who supplemented this traditional southern diet with things like milk and vegetables and fresh meat would not get pellagra.

Once these results were published, there were mixed reactions from the scientific community. Some wanted to nominate Dr. Goldberger for a Nobel Prize, but just as many doubted the experiment's results. In particular, doctors and officials who lived in the American South. They felt like this northern doctor was criticizing their entire way of life. Dr. Goldberger was frustrated that people were questioning his discovery. After all, he had proven it with the experiment he ran at the prison. The prisoners who had volunteered to be a part of it had followed a strict diet of biscuits, gravy, cornbread, grits, rice, syrup, collard greens, and yams. They could eat as much of these foods as they wanted, but no other types of food.

And this diet is what caused half of the prisoners to develop pellagra, just like the residents of the Georgia State Sanitarium for the Insane and the children between the ages of 6 and 12 at the orphanage. They all got pellagra from their diet. Still, while Dr. Goldberger had proven that a better, more varied diet was enough to prevent pellagra, he had not actually figured out why that was. It would take another 20 years until scientists actually proved what caused pellagra. It is caused from a deficiency of vitamin B3, also known as niacin. The traditional post-Civil War southern diet of dried meat, molasses, and cornmeal severely lacked this nutrient,

which is why the region was hit so much harder than other areas in America. But once people started adding niacin back into their diet, mostly in the form of enriched flour, the disease no longer manifested and almost everyone already suffering from it recovered. All told, over 100,000 people died of pellagra between 1900 and 1940 until it disappeared with the identification of niacin. Sadly, Dr. Goldberger died before this discovery of an unrelated and extremely rare form of cancer. However, Dr. Goldberger will always be remembered because he was the one who cracked the riddle of pellagra

and saved tens of thousands of lives. From Ballin Studios and Wondery, this is Mr. Ballin's Medical Mysteries, hosted by me, Mr. Ballin. A quick note about our stories. We use aliases sometimes because we don't know the names of the real people in the story. And also, in most cases,

we can't know exactly what was said, but everything is based on a lot of research. And a reminder, the content in this episode is not intended to be a substitute for professional medical advice, diagnosis, or treatment. This episode was written by Britt Brown. Our editor is Heather Dundas. Sound design is by Ryan Potesta. Coordinating producer is Sophia Martins. Our senior producer is Alex Benidon. Our associate producers and researchers are Sarah Bytack and Teja Palakonda. Fact-checking was done by Sheila Patterson.

For Ballin Studios, our head of production is Zach Leavitt. Script editing is by Scott Allen and Evan Allen. Our coordinating producer is Matub Zare. Executive producers are myself, Mr. Ballin, and Nick Witters. Thank you. executive producers are Aaron O'Flaherty and Marsha Louis for Wondery. From the award-winning masters of audio horror. I see a face right up against the window, bleach white, no hair, black eyes, a round hole for a mouth. It's flat, Taylor. It's completely flat. I don't know what that is. I don't know what kind of a head is flat. Comes the return of Dark Sanctum. Look. What is that coming under the door?

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