There are two groups of people in this world:
1. Those who are fascinated by old-timey diseases and conditions, and
2. Those who think that those people are weirdos.
Group 1, this post is for you.
Did you ever spot the word “pellagra” on a death certificate and think “What’s that, now?”
If you have researched ancestors who lived in the southern United States around the beginning of the 20th century—particularly the poorer ones—you may have seen "pellagra" listed as a cause of death. Similar to “dropsy,” “dysentery,” or “cholera,” you likely have known absolutely no one who died of this condition if you live in a modern, developed country.
For this, you should be glad. This is a disease that you do not want to have. It’s frequently characterized by the 4 Ds: diarrhea, dermatitis, dementia and death—arguably some of the worst Ds to have.
One of the first symptoms is a sunburn-like rash anywhere your skin has been exposed to the sun, followed by darkening pigmentation and blisters. Eventually the skin on your neck, back, arms and legs begins to slough off. That's right—"slough off." Unless it's being used metaphorically, the phrase "slough off" is not one you want to hear in regards to your body.
But don’t worry. Soon, your vampire skin will be the least of your concerns. Insomnia comes next (hard to sleep, what with the blisters... and the sunburn rash... and the missing skin...) along with depression, memory loss and—the hallmark of all terrifying neurological disorders—hallucinations.
Now if that isn’t nightmarish enough for you, add diarrhea. Because there was also diarrhea. Followed by death.
In the early 1900s, pellagra was a bit of a problem. In 1928, there were over 200,000 cases of pellagra in the American South. It was one of the top ten causes of death at the time.
Initially, some thought it was contagious.
The Baltimore Sun, 24 August 1909
Despite the number of deaths and wide media coverage, some people doubted its very existence. Sound familiar?
One Mr. William Kennedy, a tobacco manufacturer from North Carolina and mental giant, told reporters that he thought the whole thing was hogwash. Mr. Kennedy said, "I have come to the conclusion that pellagra is about like malaria—always prevalent in the next town, or like good fishing, to be found half a mile upstream."¹
You weren't going fool Mr. Kennedy. No sir. Don't come around him, talking about "malaria," a deadly disease that still kills hundreds of thousands of people,² and that the ancient Chinese described as early as 2700 BC, and is referenced in Egyptian papyri, Mesopotamian clay tablets, and early Hindu texts.³ Mr. Kennedy is not putting up with your malaria malarkey or your pellagra poppycock.
Despite the Mr. Kennedys of the world, some folks were trying to sleuth it out. One theory at the time was that improperly grown or handled corn was causing pellagra. They were getting closer, but still hadn't quite figured it out.
3 June 1909, The Wilmington Morning Star
The reason pellagra became an epidemic—and to some extent was abated—in the southern United States can be summed in one word: cotton.
Cash-strapped and debt-ridden farmers turned more and more of their land to growing cotton in the early 1900s. Where before they had planted a variety of crops, now there was more and more of a cotton monoculture. Without local growers providing staples like peanuts and corn, the poorest of the poor had a diet that consisted more or less of salt pork, cornbread, and molasses. With their farms composed of all cotton, they turned to corn shipped in from the midwest that had been milled and stripped of most of its nutrients—including niacin.
It turns out that niacin is super important. Most of us don't think about our niacin intake (we'll tell you why here in minute), but your body kinda sorta really needs it.
Niacin can be found in various foods like avocados, dates, mushrooms, broccoli and asparagus. It can also be produced in the body from tryptophan, which comes from plant and animal proteins, such as eggs, turkey, seeds and peanuts. A severe niacin deficiency results in—you guessed it—pellagra.
Because the underlying cause was unknown, and the disease left untreated took years to progress, some sufferers were institutionalized when neurological symptoms began to appear. The rise of pellagra just so happened to coincide with the popularity of mental institutions. There was a publicly-supported mental institution in every state by 1890.⁴
Pellagra began to quiet down a bit into the 1930s, partly as people began to understand and accept the theory that it was caused by a poor diet, but largely due to the arrival of a notoriously fiendish pest. Boll weevils decimated cotton crops throughout the south in the early 1900s, and as they spread from Texas to the east coast, farmers began once again to diversify their crops. These periods of infestation were routinely followed by a drop in cases of pellagra several months to a year or so later.⁵
Anthonomus grandis, aka the boll weevil. Shorty had that 1/4" snout and legs with the spurs... the whole swarm was looking at her...
It wouldn’t be until 1937 that scientists definitively linked pellagra to its root cause. Laws were then passed in most states that mandated fortification of cereals, meals, and flours with niacin. Most national producers began fortifying all of their relevant products. Nowadays, most of us have more niacin than we probably need in our diet, and we don't really have to think about it.
So if you have poor ancestors who survived the early 1900s in the American South, you may have the boll weevil to thank.
Adella Moore Covington died of pellagra in a mental institution on 28 August 1924. Rest in peace, Adella.
Notes
¹ The Courier-Journal [Lousiville, Kentucky], 28 Sep 1909.
² "Malaria," World Health Organization (WHO), accessed 25 Aug 2022.
³ Cox, Francis EG, "History of the discovery of the malaria parasites and their vectors," BiomedCentral: Parasites & Vectors (1 Feb 2010), accessed 25 Aug 2022.
⁴ “Early Psychiatric Hospitals and Asylums”, National Library of Medicine at the National Institute of Health (NIH), accessed 25 Feb 2022.
⁵ Clay, K., Schmick, E., & Troesken, W. (2019). The Rise and Fall of Pellagra in the American South. The Journal of Economic History, 79(1), 32-62.
Sources
“Pellagra”, American Osteopathic College of Dermatology, accessed 25 Feb 2022.
Clay, K., Schmick, E., & Troesken, W. (2019). The Rise and Fall of Pellagra in the American South. The Journal of Economic History, 79(1), 32-62. doi:10.1017/S0022050718000700
“Pellagra”, Science Direct, accessed 25 Feb 2022).
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