Pellagra in the South

PELLAGRA IN THE SOUTH

American Outbreak

Pellagra is a disease caused by a diet deficiency of nicotinamide, a B vitamin, and results in dermatitis (inflammation of the skin), diarrhea, dementia, and often death. Today the disease is rare even in undeveloped countries. First identified in Spain in 1735 by Don Pedro Casal, physician to King Philip V, pellagra was for many years thought to be nonexistent in America. Yet from about 1900 until the 1940s an epidemic swept through the country that accounted for more than three million cases and one hundred thousand deaths.

Growing Awareness

In 1902 Dr. H. F. Harris reported a single case of pellagra in a Georgia farmer at the state's annual medical association meeting. Alabama physician George H. Searcy published in 1907 a description of eighty-eight cases at the state's insane asylum. The following year Dr. James Babcock identified cases among the insane in South Carolina. Later in 1908 the first National Conference on Pellagra was held in Columbia, South Carolina, with more than seventy physicians in attendance. The next year more than four hundred doctors attended, and Babcock was elected first president of the National Association for the Study of Pellagra. By 1924 pellagra was being reported in thirty-six states and the District of Columbia, with 90 percent of the cases in nine southern states. Four southern states known to have high disease rates did not bother to report that year.

Dietary Causes

Throughout the four-decade epidemic, pellagra was most prevalent in the southeastern United States. In that region large numbers of people subsisted on a "Three M" diet of fatty meat, cornmeal, and molasses. The disease appeared at the same time that a change in corn milling technology made the meal less prone to decay but removed vital nutrients. Southern insane asylums provided their inmates with a diet heavy in cornmeal—thus many cases developed in those institutions. Rural people who ground their own corn were much less likely to develop the dietary deficiency.

Southern Reaction

By the second decade of this century the spreading epidemic of pellagra began to panic the populace. Dr. Joseph Goldberger of the federal Hygienic Laboratory initiated a series of studies across the South and began to suspect a dietary cause for the disease. Politicians such as Georgia's senator Tom Watson and many physicians protested that a monotonous diet among southern poor could not be the cause. South Carolina Congressman James F. Byrnes branded publicity about a famine or plague in his state an "utter absurdity." Despite Goldberger's untiring efforts, pellagra persisted in the United States for more than a decade after his death in 1929.

A Familiar Pattern

The pellagra epidemic has interesting parallels with AIDS in the 1980s and 1990s. Isolated reports appeared over several years until an epidemic was finally recognized. Politics and cultural factors were also important in reactions to the disease and impediments to a cure. White political, business, and cultural leaders in the South were embarrassed that poverty among whites in their region gained national attention. State government officials were at first reluctant to act, but the continuing publicity and the eventual realization that the pellagra problem was real forced them to take action.

Sources:

Alfred Jay Bollet, "Politics and Pellagra: The Epidemic of Pellagra in the U.S. in the Early Twentieth Century," Yale Journal of Biology and Medicine, 65 (May-June 1992): 211-221;

E. W. Etheridge, The Butterfly Caste: A Social History of Pellagra in the South (Westport, Conn.: Greenwood Press, 1972);

D. A. Roe, A Plague of Corn: The Social History of Pellagra (Ithaca: Cornell University Press, 1973).