on their faces, across noses. The affected peasants also suffered severe
diarrhea, lassitude, and melancholia. Dementia was common in advanced
cases. Some died from dehydration and possibly secondary, opportunis-
tic pathogens. The Spanish doctor published his record twenty years later,
with the unhappy observation that the malady was incurable. Italian peas-
ants suffering the same symptoms, meanwhile, were observed and treated
(without success, apparently) by Dr. Francesco Frapolli, who named the dis-
ease during the s. The heartbreaking malady was subsequently identi-
fied in Austria and elsewhere in Middle and Central Europe, where big corn
estates had also been established, and then, by late in the nineteenth cen-
tury, in Egypt, South Africa, and China.
Yet as late as an Atlanta physician was perplexed by a country
patient who almost certainly suffered from pellagra. The disorder—if it ap-
peared at all in American medical texts—was unfamiliar, confused with
other ills (such as beriberi) or dismissed as an inherited degenerative con-
dition. Within five years, however, U.S. doctors not only identified pella-
gra in the South but declared an epidemic. The timing was simultaneously
fortuitous and embarrassing. Hookworm (yet another ‘‘European’’ malady)
had recently been detected in the South, and the plutocrat-philanthropist
John D. Rockefeller had donated million to fund its eradication. Then
came the discovery of pellagra—another poor people’s distress, another
‘‘lazy’’ disease (to be added to malaria), and yet another peculiarly south-
ern ill. The antihookworm program certainly facilitated the long search for
a remedy for pellagra. Southern physicians became public-health-minded
and learned to recognize pellagrins (as sufferers are called), and state gov-
ernments and especially the federal Public Health Service mobilized labo-
ratory studies. The national press also took notice, sometimes with little
sympathy if not actual malice toward the region. Four and five decades after
the Civil War, southerners were still capable of presenting an embarrassing
mirror image of the prosperous, healthy United States. Articulate southern-
ers’ response was often angrily defensive, so public ad hominem exchanges
were distracting and counterproductive.
Pellagra, we know now, from early-twentieth-century research in the
southeastern United States and elsewhere, results from an extreme defi-
ciency of a B vitamin known as nicotinic acid or niacin. (Nicotinic acid was
renamed niacin in because baking companies who agreed to enrich
bread with the vitamin feared scaring consumers with a label so similar
to nicotine.) Well-off people have been known to suffer from pellagra, but
they are rare, probably victims of deranged, usually alcoholic, self-neglect.