Pellagra, a disease caused by a dietary deficiency in vitamin B (niacin), was seen in the southern United States after the Civil War (1861-65). In the early 1900s it was thought to be an infectious disease, but studies conducted by public health physician Joseph Goldberger at the Milledgeville State Hospital (later Central State Hospital) in Georgia showed that it was related to diet. Death statistics indicate that pellagra may have been one of the most severe nutritional deficiency diseases ever recorded in the United States. Symptoms include dermatitis, diarrhea, inflammation of the mucous membranes, and even dementia. Pellagra can flare in strong sunlight. Left untreated, the condition results in death.

Joseph Goldberger
Joseph Goldberger

Courtesy of Centers for Disease Control and Prevention

The incidence of pellagra increased greatly in the early twentieth century, during the Progressive Era. In 1909 more than 1,000 estimated cases were reported from thirteen states. By 1911 pellagra was reported in all but nine states, and the number of cases increased ninefold. From 1906 to 1940 approximately 3 million cases and 100,000 deaths were attributed to this disease. It was most prevalent in the southern states, where income level was low and most of the available land was used for such cash crops as cotton and tobacco rather than food crops. By 1920 pellagra had became a serious illness in Georgia, where 432 deaths were attributed to the disease. During 1928-29, at its peak incidence, pellagra was the eighth or ninth leading cause of death besides accidents in the South.

Economic recovery and the enrichment of flour with niacin improved diet and health in areas where pellagra had been common. This made possible the elimination of pellagra by the end of the 1940s.

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Joseph Goldberger

Joseph Goldberger

After observing mill towns, mental hospitals, and orphanages in the South, epidemiologist Joseph Goldberger determined that malnutrition was the cause of pellagra. Goldberger's work led other doctors to discover the exact cause of the disease, a niacin deficiency.

Courtesy of Centers for Disease Control and Prevention