Washington Said the South Was Starving. Twelve States Voted That It Wasn't. | Pellagra, 1914-1941

The film of this episode premieres March 23, 2027 on YouTube. The documents, the transcript and the sources are below now.

In July 1921 the United States Public Health Service estimated one hundred thousand cases of pellagra in the cotton belt that year and said ten percent would die. It used the word famine. President Harding wrote to the Surgeon General and the Red Cross the next day.

Transcript

Prove it

R001 6:15 P.M., Going home from the Arkwright Mills, Spartenberg [sic], S.C. Location: Spartanburg, South Carolina.
6:15 P.M., Going home from the Arkwright Mills, Spartenberg [sic],... · Lewis W. Hine, · Library of Congress NCLC · colorized 2026. View the original.

In 1921 Washington told the South that a hundred thousand of its people were starving. The South said: prove it.

Two weeks later the health officers of twelve Southern states voted, unanimously, that it was not happening. The government had seven years of experiments. Here is who won.

A group of workers on the mill stops, Beaumont Cotton Mill, Spartanberg, S.C., 6:30 P.M. All work and others smaller. Location: Spartanburg, South Carolina.

R002 A group of workers on the mill stops, Beaumont Cotton Mill, Spartanberg, S.C., 6:30 P.M. All work and others smaller. Location: Spartanburg, South Carolina.
A group of workers on the mill stops, Beaumont Cotton Mill,... · Lewis W. Hine, · Library of Congress NCLC · colorized 2026. View the original.

The people in the argument. Hands from the Beaumont mill, Spartanburg, South Carolina, May 1912.

D02 A group of workers on the mill stops, Beaumont Cotton Mill, Spartanberg, S.C., 6:30 P.M. All work and others smaller. Location: Spartanburg, South Carolina.
A group of workers on the mill stops, Beaumont Cotton Mill,... · Lewis W. Hine, · Library of Congress NCLC · colorized 2026. View the original.

Lewis Hine's note on the print: "All work, and others smaller."

R101 Goldberger, Dr. J.
Goldberger, Dr. J. · C. M. Bell Studio, c. 1904 · Library of Congress · colorized 2026. View the original.

And the man who did the proving. Joseph Goldberger, a surgeon of the United States Public Health Service, photographed in Washington around 1904, at thirty.

R003 The Saxon Mill, Spartenberg [sic] and Caston Hall used as school and lodge hall. Location: Spartanburg, South Carolina.
The Saxon Mill, Spartenberg [sic] and Caston Hall used as school and... · Lewis W. Hine, · Library of Congress NCLC · colorized 2026. View the original.

The photographs are federal, and were made in black and white. The color was put on by a computer, this year. A good guess, not a record. The documents are as printed.

The rash

R106 Pellagra
Pellagra · U.S. Public Health Service · National Library of Medicine · colorized 2026. View the original.

Pellagra. A rough red rash, "bilaterally symmetrical," the same on both hands. Then the bowels. Then, in the asylums, the mind.

R051 Miss Nettie Lloyd, pellagra victim, by their old well house. Orange County, North Carolina
Miss Nettie Lloyd, pellagra victim, by their old well house. Orange... · Marion Post Wolcott, 1939 · Library of Congress FSA/OWI · colorized 2026. View the original.

Miss Nettie Lloyd, by her old well house, Orange County, North Carolina, 1939. Marion Post Wolcott's caption is two words: "pellagra victim."

R105 Family eating meal of hominy grits, mush, molasses, cabbages, potatoes, and rice
Family eating meal of hominy grits, mush, molasses, cabbages,... · U.S. Public Health Service · National Library of Medicine · colorized 2026. View the original.

A family at dinner, photographed by the Public Health Service in 1920. Hominy grits, mush, molasses, cabbage, potatoes and rice. That was the diet. Nobody agreed it was the disease.

The nurses

S01
Goldberger, The Etiology of Pellagra · Public Health Reports · U.S. Public Health Service · June 26, 1914 · p. 1683. View the original.

June 26, 1914. Goldberger, newly in charge of the pellagra investigations, publishes four pages. He has not run an experiment. He has read everything, and noticed something.

S02
Goldberger, The Etiology of Pellagra · Public Health Reports · U.S. Public Health Service · June 26, 1914 · p. 1684. View the original.

In the asylums at Milledgeville, Jackson and Columbia, inmates got pellagra after twenty years inside. The nurses who lived on the wards with them never did. "If pellagra be a communicable disease, why should there be this exemption of the nurses and attendants?"

Two orphanages

S05
Goldberger, Waring & Willets, The Prevention of Pellagra · Public Health Reports · U.S. Public Health Service · Oct. 22, 1915 · p. 3117. View the original.

October 1915. The first test.

S06
The Prevention of Pellagra · Public Health Reports · U.S. Public Health Service · Oct. 22, 1915 · p. 3120. View the original.

Two orphanages in Jackson, Mississippi. At the first, seventy-nine children had pellagra in 1914. At the second, a hundred and thirty. It came back every spring.

S07
The Prevention of Pellagra · Public Health Reports · U.S. Public Health Service · Oct. 22, 1915 · p. 3121 · the new diet. View the original.

From September 1914 the service paid for the food. Milk twice a day, an egg at breakfast, fresh meat three or four times a week instead of once. Oatmeal for grits. The crowding, the privies and the water were left as found, on purpose.

S08
The Prevention of Pellagra · Public Health Reports · U.S. Public Health Service · Oct. 22, 1915 · p. 3123 · Results. View the original.

A year on. Sixty-seven children at the first orphanage who had pellagra in 1914: not one recurrence. A hundred and five at the second: one. "Barring recent admissions, there has been no pellagra at this institution this year."

R104 The diet laboratory where extensive research was carried out to establish that pellagra was caused by a dietary deficiency
The diet laboratory where extensive research was carried out to... · U.S. Public Health Service · National Library of Medicine · colorized 2026. View the original.

The service's diet laboratory. At the Georgia State Sanitarium, the largest asylum in the South, two wards of women were fed the same way. Seventy-two patients; none relapsed. In the wards next door, on the asylum's food, forty-seven percent did.

S10
The Prevention of Pellagra · Public Health Reports · U.S. Public Health Service · Oct. 22, 1915 · p. 3131 · Application. View the original.

Then the recommendations, which are not medical. Ownership of a milk cow. A pea patch. And: "increase wages, reduce unemployment." A government doctor had told the South its disease was its wages.

Eleven convicts

S11
Goldberger & Wheeler, Experimental Pellagra in the Human Subject · Public Health Reports · U.S. Public Health Service · Nov. 12, 1915 · p. 3336. View the original.

Three weeks later, the second paper. Preventing the disease was not proof. Causing it would be.

S12
Experimental Pellagra in the Human Subject · Public Health Reports · U.S. Public Health Service · Nov. 12, 1915 · p. 3336. View the original.

The farm of the Mississippi State Penitentiary, eight miles east of Jackson. Governor Brewer offered a pardon to any white convict who would volunteer. Eleven stayed on the diet from the nineteenth of April to the end of October, 1915, under guard day and night.

S13
Experimental Pellagra in the Human Subject · Public Health Reports · U.S. Public Health Service · Nov. 12, 1915 · p. 3337 · bill of fare, Aug. 2-8, 1915. View the original.

The bill of fare for the week of August second. Breakfast: biscuits, fried mush, grits and brown gravy, syrup. Dinner: corn bread, cabbage, sweet potatoes, grits, syrup. Supper: mush, biscuits, rice, gravy, syrup. Not an egg, not a glass of milk, not a piece of meat.

S14
Experimental Pellagra in the Human Subject · Public Health Reports · U.S. Public Health Service · Nov. 12, 1915 · p. 3338 · Results. View the original.

In September the rash appeared. Six of the eleven. Among the other convicts on the same farm, on the prison's ordinary food, not one. "Pellagra has been caused in at least 6 of 11 volunteers as the result of the restricted diet."

Seven experiments

S15
Goldberger, The Transmissibility of Pellagra · Public Health Reports · U.S. Public Health Service · Nov. 17, 1916 · p. 3159. View the original.

That should have ended it. It did not. Most doctors in the South still believed pellagra was catching. So in 1916 Goldberger tested that too, on the one animal known to be susceptible. Man.

S16
The Transmissibility of Pellagra · Public Health Reports · U.S. Public Health Service · Nov. 17, 1916 · p. 3167 · Summary. View the original.

Sixteen volunteers, thirteen of them physicians. From patients with active pellagra they took blood, and injected it. Scrapings from the rash, and swallowed them. Urine and feces, and swallowed those too.

S17
The Transmissibility of Pellagra · Public Health Reports · U.S. Public Health Service · Nov. 17, 1916 · p. 3170 · Volunteers. View the original.

The volunteers are listed by initials. "G. J., medical officer, 42 years. Participated in all seven experiments." That is Goldberger. "Housewife, 35 years. The only woman among the volunteers." His biographers say that is his wife, Mary.

Seven mill villages

S19
Goldberger, Wheeler & Sydenstricker · Public Health Reports · U.S. Public Health Service · Nov. 12, 1920 · p. 2673. View the original.

In the spring of 1916 the service went into the cotton-mill villages of Spartanburg County and stayed three years.

R004 Some of the smallest spinners at the Beaumont Mill. Location: [Spartanburg, South Carolina]
Some of the smallest spinners at the Beaumont Mill. Location:... · Lewis W. Hine, · Library of Congress NCLC · colorized 2026. View the original.

Hine had photographed the same villages four years before. Beaumont, Saxon, Spartan, Arkwright, Drayton. Some of the smallest spinners at the Beaumont mill.

S21
Seven Cotton-Mill Villages of South Carolina · Public Health Reports · U.S. Public Health Service · Nov. 12, 1920 · p. 2678. View the original.

Seven villages, each a company town around one mill. About 4,160 people in about 750 households. The few Black families, who lived apart, were left out. The study is of white mill hands only, and says so.

Twin spinners in Saxon Mill, Spartenberg [sic], S.C. Joe and Pearl Steading, 75 William St., make 44 cents a day each. Another sister works. Mother a widow. Location: Spartanburg,

R005 Twin spinners in Saxon Mill, Spartenberg [sic], S.C. Joe and Pearl Steading, 75 William St., make 44 cents a day each. Another sister works. Mother a widow. Location: Spartanburg, South Carolina.
Twin spinners in Saxon Mill, Spartenberg [sic], S.C. Joe and Pearl... · Lewis W. Hine, · Library of Congress NCLC · colorized 2026. View the original.

And they took the mill payrolls. Hine's note on the twins: Joe and Pearl Steading, seventy-five William Street, "make 44 cents a day each. Another sister works. Mother a widow."

S23
Seven Cotton-Mill Villages of South Carolina · Public Health Reports · U.S. Public Health Service · Nov. 12, 1920 · p. 2711 · conclusion 4. View the original.

Conclusion four. "Pellagra incidence was found to vary inversely according to family income. As the income fell, the incidence of the disease rose." In the best-paid households, still under a thousand dollars a year, it all but disappeared.

S24
Seven Cotton-Mill Villages of South Carolina · Public Health Reports · U.S. Public Health Service · Nov. 12, 1920 · p. 2709. View the original.

The paper was finished on the last day of August 1920, with cotton falling through the floor. Pellagra follows hard times, it said, "and as there is some reason to fear may again be observed in the spring of 1921 if the present depression, especially in the price of cotton, continues."

Famine

R009 Noon hour. Saxon Mill. Location: Spartanburg, South Carolina.
Noon hour. Saxon Mill. Location: Spartanburg, South Carolina. · Lewis W. Hine, · Library of Congress NCLC · colorized 2026. View the original.

It continued. By July 1921 cotton had collapsed and laborers were being laid off. Noon hour at the Saxon mill, nine years before. The service's men reported more cases in Mississippi, Tennessee and South Carolina. Washington issued a statement.

One hundred thousand cases of pellagra in the cotton belt that year, it estimated, and ten percent would die. It used the word famine.

President Harding wrote to the Surgeon General on July 25. "Famine and plague are words almost foreign to our American vocabulary, save as we have learned their meaning in connection with the afflictions of lands less favored." He asked the Red Cross to prepare relief.

Seven states denied it in a day. The Georgia Senate passed a resolution. Louisiana counted five new cases that week. Florida said pellagra was on the decline. North Carolina, Arkansas, Alabama, Tennessee: no increase.

South Carolina's health officer, Dr. James Hayne, in the language of 1921: the whole thing "seems to have been hatched for the purpose of casting reflections on the South," and, he said, to make it appear that Black Southerners were not being treated fairly.

Senator McKellar of Tennessee: "I respectfully ask the President not to include Tennessee."

Then something odd. Congressman Byrnes of South Carolina sent the President telegrams to prove there was no famine, and the President quoted one back to him. The editor of the Spartanburg Herald, who had watched Goldberger's men work in his town: "the government's study of pellagra stopped just at the time it should have been continued."

On August 4 the health officers of twelve Southern states met the Surgeon General. Their report, adopted unanimously: they "deplore the fact that an impression has been created that famine conditions exist in the south."

On August 15 the Surgeon General reported back. Conservative estimate: five thousand deaths and a hundred thousand cases in 1921. Famine, he conceded, only "in a scientific, restricted sense."

The count

S25
Vital Statistics Rates in the United States, 1900-1940 · Bureau of the Census, 1943 · Table 15 · death rates per 100,000, 1921-1927. View the original.

The argument in the death tables, afterward. Pellagra deaths per hundred thousand, in the states that reported to the census. 1921: two point seven. 1924: two point two. Then up. 1927: four point eight.

S26
Vital Statistics Rates in the United States, 1900-1940 · Bureau of the Census, 1943 · Table 15 · pellagra, 1928-1940. View the original.

1928: six point zero. The worst year in the table, seven years after the South said there was nothing to see. Then down, every year, to one point six in 1940.

S27
Vital Statistics Rates in the United States, 1900-1940 · Bureau of the Census, 1943 · Table 15 · pellagra by race, 1928-1940. View the original.

By race, 1928. White: two point nine. Everyone the census listed as "all other races," in the South meaning Black Southerners: thirty-three point eight. Nearly twelve times the rate.

Nurse Shamburg gives Viola Pettway instructions and help about her diet in treatment of pellagra. She has been sick about four years and is a little better now. Her mother has thir

R061 Nurse Shamburg gives Viola Pettway instructions and help about her diet in treatment of pellagra. She has been sick about four years and is a little better now. Her mother has thirteen children and twenty-five dollars a month for all. Table top is made from cheese box. Gee's Bend, Alabama
Nurse Shamburg gives Viola Pettway instructions and help about her... · Marion Post Wolcott, 1939 · Library of Congress FSA/OWI · colorized 2026. View the original.

Gee's Bend, Alabama, 1939. Nurse Shamburg gives Viola Pettway instructions about her diet, in treatment of pellagra. Sick about four years, Wolcott wrote, and a little better. Her mother had thirteen children and twenty-five dollars a month for all of them.

The conqueror

January 17, 1929. Goldberger died at the Naval Hospital in Washington, at fifty-four, of an illness his own colleagues could not name. The Star called him the pellagra conqueror.

A milk cow

R067 Unbalanced diet, new rehabilitation family. Coffee County, Alabama. Beans and biscuits
Unbalanced diet, new rehabilitation family. Coffee County, Alabama.... · Marion Post Wolcott, 1939 · Library of Congress FSA/OWI · colorized 2026. View the original.

Coffee County, Alabama, 1939. Wolcott's caption: "Unbalanced diet, new rehabilitation family. Beans and biscuits."

R069 Helms family working out farm and home plan with FSA (Farm Security Administration) supervisor. Coffee County, Alabama
Helms family working out farm and home plan with FSA (Farm Security... · Marion Post Wolcott, 1939 · Library of Congress FSA/OWI · colorized 2026. View the original.

The Helms family working out a farm and home plan with a Farm Security Administration supervisor. The plan is Goldberger's 1915 recommendations, more or less line by line, twenty-four years late.

Balanced diet at Helms family supper: roast beef (home canned) turnip greens, potato salad, stuffed eggs, lima beans, rice, pear pickles, biscuits, cornbread, butter, milk, peaches

R071 Balanced diet at Helms family supper: roast beef (home canned) turnip greens, potato salad, stuffed eggs, lima beans, rice, pear pickles, biscuits, cornbread, butter, milk, peaches, cake. Coffee County, Alabama
Balanced diet at Helms family supper: roast beef (home canned) turnip... · Marion Post Wolcott, 1939 · Library of Congress FSA/OWI · colorized 2026. View the original.

"Balanced diet at Helms family supper: roast beef, home canned; turnip greens, potato salad, stuffed eggs, lima beans, rice, biscuits, cornbread, butter, milk, peaches, cake."

Mrs. Watkins has two milk cows. She sells eight to ten pounds of butter each week. FSA (Farm Security Administration) borrower, Coffee County, Alabama

R073 Mrs. Watkins has two milk cows. She sells eight to ten pounds of butter each week. FSA (Farm Security Administration) borrower, Coffee County, Alabama
Mrs. Watkins has two milk cows. She sells eight to ten pounds of... · Marion Post Wolcott, 1939 · Library of Congress FSA/OWI · colorized 2026. View the original.

"Mrs. Watkins has two milk cows. She sells eight to ten pounds of butter each week." Recommendation one, sub-paragraph a, 1915: ownership of a milk cow.

Mother and child. This woman, wife of an ex-farmer now living on relief, had pellagra in an advanced stage. She has had some treatment and shown great improvement but there were st

R056 Mother and child. This woman, wife of an ex-farmer now living on relief, had pellagra in an advanced stage. She has had some treatment and shown great improvement but there were still evidences of mental disturbances. She was the mother of twelve children. The child in her arms has malaria as have probably the entire family. Jefferson, Texas
Mother and child. This woman, wife of an ex-farmer now living on... · Russell Lee, 1939 · Library of Congress FSA/OWI · colorized 2026. View the original.

Jefferson, Texas, 1939. Russell Lee: "This woman, wife of an ex-farmer now living on relief, had pellagra in an advanced stage." Twelve children. The child in her arms has malaria.

Enriched

S28
Federal Register · Tuesday, May 27, 1941 · Enriched Flour · findings of fact · 6 F.R. 2577. View the original.

May 27, 1941. The Federal Register.

S29
Federal Register · Tuesday, May 27, 1941 · Enriched Flour · findings of fact · finding 33 · 6 F.R. 2576. View the original.

The Food and Drug Administration was writing the legal definition of a word. Its findings: "The deficiencies are more prevalent in the case of persons with low incomes."

S30
Federal Register · Tuesday, May 27, 1941 · Enriched Flour · findings of fact · finding 34 · 6 F.R. 2576. View the original.

"Among the most serious and widespread deficiencies, in children as well as adults, are those of vitamin B1, riboflavin, nicotinic acid, and iron." Nicotinic acid prevents pellagra. From then on, flour sold as "enriched" had to carry it.

[Untitled photo, possibly related to: Mrs. Lloyd, ninety-one year old mother of Miss Nettie Lloyd, who is a pellagra victim. Mrs. Lloyd was born and reared in Orange County; has li

R054 [Untitled photo, possibly related to: Mrs. Lloyd, ninety-one year old mother of Miss Nettie Lloyd, who is a pellagra victim. Mrs. Lloyd was born and reared in Orange County; has lived on this spot since her marriage sixty-nine years ago. It is on a new road leading off from left of Route number 54, about four miles west of Carrboro, Orange County, North Carolina]
[Untitled photo, possibly related to: Mrs. Lloyd, ninety-one year old... · Marion Post Wolcott, 1939 · Library of Congress FSA/OWI · colorized 2026. View the original.

It is on nearly every sack of white flour and loaf of white bread in the country, still. Nobody reads it. That is the trace the disease left.

Group of mill boys going to church Sunday morning. Beaumont Mill Settlement, Spartanberg, S.C. All work. The front row left hand and Elish Putnam been working 3 or 4 years. Middle

R016 Group of mill boys going to church Sunday morning. Beaumont Mill Settlement, Spartanberg, S.C. All work. The front row left hand and Elish Putnam been working 3 or 4 years. Middle Bryson Hemmett working 3 months. Right hand George Powell, six months working. Location: Spartanburg, South Carolina.
Group of mill boys going to church Sunday morning. Beaumont Mill... · Lewis W. Hine, · Library of Congress NCLC · colorized 2026. View the original.

Beaumont mill settlement, Spartanburg, Sunday morning, 1912. Hine: "All work."

R024 6:15 P.M., Going Home from the Arkwright Mills, Spartenberg [sic], S.C. Location: Spartanburg, South Carolina.
6:15 P.M., Going Home from the Arkwright Mills, Spartenberg [sic],... · Lewis W. Hine, · Library of Congress NCLC · colorized 2026. View the original.

If your people lived on corn bread, molasses and fat meat, they lived where this happened. If any of them ever said the word pellagra at the table, write it down below. And if the machine got the colors wrong, say so.

Sources

Joseph Goldberger, "The Etiology of Pellagra: The Significance of Certain Epidemiological Observations With Respect Thereto," Public Health Reports, vol. 29, no. 26, June 26, 1914, pp. 1683–1686 — https://archive.org/details/sim_public-health-reports_1914-06-26_29_26 - p. 1684: inmates at the Georgia State Sanitarium, the Jackson, Miss. asylum and the South Carolina State Hospital developed pellagra after 10 to 20 years' residence; "no case, so far as I was able to learn, has developed in a nurse or attendant." "If pellagra be a communicable disease, why should there be this exemption of the nurses and attendants?" - p. 1685: the nurses "have the privilege—which they exercise—of selecting the best and the greatest variety for themselves"; quoting Wait (Office of Experiment Stations Bull. 221): "Except in extreme cases, the city poor * * * appear to be better nourished than the mountaineers" of Tennessee. - p. 1686: "I would urge the reduction in cereals, vegetables, and canned foods … and an increase in the fresh animal food component, such as fresh meats, eggs, and milk."
Goldberger, Waring and Willets, "The Prevention of Pellagra: A Test of Diet Among Institutional Inmates," Public Health Reports, vol. 30, no. 43, Oct. 22, 1915, pp. 3117–3131 — https://archive.org/details/sim_public-health-reports_1915-10-22_30_43 - p. 3120: orphanage "M. J.," 79 cases in 1914 up to Sept. 15; orphanage "B. J.," 130 cases; both in Jackson, Miss. "At the very outset it was requested that no change be made in hygienic and sanitary conditions." - p. 3121: milk "at least twice a day" for every child under 12, one egg at breakfast, fresh meat "three or four times a week" instead of once; oatmeal for grits; syrup excluded for some weeks. The January 1–7, 1915 menu is printed. - p. 3123: 67 of the 79 at "M. J." completed the anniversary of their attack, no recurrence; 105 of the 130 at "B. J.," one recurrence. "In other words, barring recent admissions, there has been no pellagra at this institution this year." - pp. 3123–3126: two wards at the Georgia State Sanitarium, "the largest in the South"; 72 patients (36 and 36), no recurrence; the control groups (32 women) recurred at 47 percent. - p. 3130, conclusion 9: "pellagra may be prevented by an appropriate diet without any alteration in the environment, hygienic or sanitary." - p. 3131, the recommendations: "a. Ownership of a milk cow"; "b. Poultry and egg raising"; "d. … an adequate pea patch"; "e. … butcher shops"; "2. … a. Improve economic conditions; increase wages, reduce unemployment."
Goldberger and Wheeler, "Experimental Pellagra in the Human Subject Brought About by a Restricted Diet," Public Health Reports, vol. 30, no. 46, Nov. 12, 1915, pp. 3336–3339 — https://archive.org/details/sim_public-health-reports_1915-11-12_30_46 - p. 3336: the farm of the Mississippi State Penitentiary "about 8 miles east of Jackson"; 12 white convicts volunteered "accepting the offer of a pardon made them by Gov. Brewer"; one released July 1 for prostatitis; 11 on the diet from noon April 19 to Oct. 31, 1915, "strictly segregated and under guard day and night." - p. 3337: the bill of fare for the week ended Aug. 8, 1915, printed day by day; 2,952 calories per man per day; "No vegetable fats entered into the diet." - p. 3338: "Of the 11 volunteers, not less than 6 developed symptoms, including a 'typical' dermatitis"; first noted between Sept. 12 and 24; "No person in the 'camp' not of the volunteer squad has presented evidence justifying even a suspicion of pellagra." - p. 3339: "The conclusion is drawn that pellagra has been caused in at least 6 of 11 volunteers as the result of the restricted diet."
Goldberger, "The Transmissibility of Pellagra: Experimental Attempts at Transmission to the Human Subject," Public Health Reports, vol. 31, no. 46, Nov. 17, 1916, pp. 3159–3173 — https://archive.org/details/sim_public-health-reports_1916-11-17_31_46 - p. 3160: 16 volunteers, 13 physicians, one woman. - p. 3167: "Blood was administered by intramuscular or subcutaneous injection; secretions by application to the mucosa of the nose and nasopharynx; scales and excreta by mouth." Seven experiments at Washington, Columbia, Spartanburg and New Orleans. "None has developed evidence justifying a diagnosis of pellagra." - p. 3170: "G. J.—Medical officer, 42 years … Participated in all seven experiments." "G-MHF.—Housewife, 35 years. Resides at Washington, D. C. The only woman among the volunteers." The identification of G-MHF as Mary H. Farrar Goldberger, his wife, is the biographers' (Alan Kraut, Goldberger's War, 2003); the document gives initials only. "willing participation in a trying ordeal."
Goldberger, Wheeler and Sydenstricker, "A Study of the Relation of Family Income and Other Economic Factors to Pellagra Incidence in Seven Cotton-Mill Villages of South Carolina in 1916," Public Health Reports, vol. 35, no. 46, Nov. 12, 1920, pp. 2673–2714 — https://archive.org/details/sim_public-health-reports_1920-11-12_35_46 - p. 2678: "seven representative cotton-mill villages situated in the northwestern part of South Carolina"; none over 800 or under 500 people; "the few Negro families present and living somewhat apart were not considered"; executives, store managers and clerks excluded; "about 4,160 people, included in about 750 households." - p. 2679: "a systematic biweekly house-to-house search for cases"; "only cases with a clearly defined, bilaterally symmetrical dermatitis were recorded as pellagra." - p. 2709: "as there is some reason to fear may again be observed in the spring of 1921 if the present depression, especially in the price of cotton and cotton-textile manufacturing, continues." Submitted for publication Aug. 31, 1920 (p. 2673, note 1). - p. 2711, conclusion 4: "pellagra incidence was found to vary inversely according to family income. As the income fell, the incidence of the disease rose … reduced almost to the point of practical disappearance in the highest of our income classes, although the income enjoyed by this class was comparatively quite low" (p. 2708: "but few had annual incomes of over $1,000"). - p. 2707: sanitation and hygiene checked village by village; food availability (fresh meats, fresh milk, green vegetables, fresh fruits) "the only one in connection with which significant evidence of such relationship was found." - That the Spartanburg County villages were the site: the 1916 paper names the "United States Pellagra Hospital, Spartanburg, S.C." and Spartanburg County Farm patients (pp. 3170–73), and the Spartanburg Herald's editor described the study in his July 1921 telegram (below).
Evening Star (Washington, D.C.), July 26, 1921, p. 2 — https://www.loc.gov/resource/sn83045462/1921-07-26/ed-1/?sp=2 - "SOUTH DISCOUNTS PELLAGRA REPORT — Seven States Deny Fear of Famine"; the state health officers of South Carolina, Louisiana, Arkansas, Georgia, Tennessee, Alabama and North Carolina quoted; President Harding's July 25 letter to Surgeon General Cumming: "Famine and plague are words almost foreign to our American vocabulary, save as we have learned their meaning in connection with the afflictions of lands less favored"; his letter to Dr. Farrand of the Red Cross.
New-York Tribune, July 27, 1921, p. 1 and p. 3 — https://www.loc.gov/resource/sn83030214/1921-07-27/ed-1/?sp=1 - p. 1 headline: "South Denies Plague as U.S. Speeds Relief." - p. 3: Dr. James A. Hayne, South Carolina state health officer: "The whole plan behind this reported pellagra epidemic seems to have been hatched for the purpose of casting reflections on the South and to make it appear that the negro is not being treated fairly." Georgia Senate resolution; Atlanta Chamber of Commerce; Louisiana five cases in the week ended July 23; Florida "distinctly on the decline."
Evening Star, July 27, 1921, p. 2 — https://www.loc.gov/resource/sn83045462/1921-07-27/ed-1/?sp=2 - The service's estimate of "about 100,000 persons"; "at least 100,000 persons in the southern cotton belt would have pellagra and that 10 per cent of them will die"; Goldberger's method (a ratio of deaths to cases, from census deaths and the reporting states); Clark Howell's telegram: the reports "does great injustice to Georgia."
Evening Star, July 29, 1921, p. 9 — https://www.loc.gov/resource/sn83045462/1921-07-29/ed-1/?sp=9 - The President's letter to Representative Byrnes quoting Charles O. Hearon of the Spartanburg Herald: "the government's study of pellagra stopped just at the time it should have been continued … the experts predicted at the time it might recur in any period of depression"; Senator McKellar: "I respectfully ask the President not to include Tennessee in using any Red Cross or government agencies"; the conference called for August 4.
The Washington Herald, July 31, 1921, p. 2 — https://www.loc.gov/resource/sn83045433/1921-07-31/ed-1/?sp=2 — the full text of Harding's letter to Byrnes, including Byrnes's "utter absurdity."
Evening Star, Aug. 5, 1921, p. 1 — https://www.loc.gov/resource/sn83045462/1921-08-05/ed-1/?sp=1 - "FAMINE IN SOUTH, PLAGUE RESULTING, STOUTLY DENIED"; the report adopted unanimously by the health officers of "a dozen southern states": they "deplore the fact that an impression has been created that famine conditions exist in the south"; the struck clauses, and Dr. Rankin of North Carolina on charity being "a reflection on the south."
The Independent (Elizabeth City, N.C.), Aug. 5, 1921, p. 4 — https://www.loc.gov/resource/sn83025812/1921-08-05/ed-1/?sp=4 - Editorial: "In the rural South thousands die of pellagra because they don't get enough fresh fruits and green vegetables, milk and eggs … and too few farmers keep a cow"; "I suspect that down-right laziness is responsible"; "If the landlords are responsible … legislation should be enacted."
Evening Star, Aug. 16, 1921, p. 4 — https://www.loc.gov/resource/sn83045462/1921-08-16/ed-1/?sp=4 - The Surgeon General's report to the President, summarized by the White House Aug. 15: "Conservative estimates indicate 5,000 deaths and 100,000 cases of pellagra in the country in 1921"; famine "in a scientific, restricted sense"; "In Mississippi, the only state having trustworthy statistics, the incidence of the disease in the first six months of the present year was about double that in the corresponding period last year."
Vital Statistics Rates in the United States, 1900–1940, by Forrest E. Linder and Robert D. Grove, Bureau of the Census, 1943, Table 15, "Specific Death Rates for Selected Causes … Death-registration States," and the companion table by race — https://archive.org/details/sixteenthcensuso00unit - Pellagra (except alcoholic), both sexes, per 100,000: 1921 2.7; 1922 2.7; 1923 2.3; 1924 2.2; 1925 3.0; 1926 3.4; 1927 4.8; 1928 6.0; 1929 5.7; 1930 5.2; 1931 4.2; 1932 3.0; 1933 3.1; 1934 2.9; 1935 2.8; 1936 2.9; 1937 2.5; 1938 2.5; 1939 1.8; 1940 1.6. Earlier: 0 through 1908; 1.1 in 1915; 4.0 in 1917 and 1918. - By race, 1928: white 2.9; all other races 33.8. 1940: 1.1 and 6.3. - ⚠️ The death-registration area grew across the period as states were admitted to it; the rates are for the states reporting in each year, and the episode says so.
Evening Star, Jan. 17, 1929, pp. 1–2 — https://www.loc.gov/resource/sn83045462/1929-01-17/ed-1/?sp=1 - "PELLAGRA CONQUEROR DIES, VICTIM OF STRANGE DISEASE"; died at the Naval Hospital "of a disease which attending physicians have been unable to diagnose"; born Austria-Hungary July 16, 1874; yellow fever, typhus and dengue contracted in the course of his work; "the vitamine 'PP,' or pellagra preventative … contained in dried yeast"; "During the height of the Mississippi flood two years ago … several carloads of yeast cakes"; "pellagra practically has been erased from the list of dread diseases."
Photographs of Goldberger: C. M. Bell Studio glass negative, "Goldberger, Dr. J.," between Dec. 1903 and Mar. 1905, Library of Congress LC-DIG-bellcm-18685 — https://www.loc.gov/pictures/item/2016706124/ ; "Joseph Goldberger," Library of Congress LC-USZ62-121029 — https://www.loc.gov/pictures/item/98510205/
Federal Register, vol. 6, Tuesday, May 27, 1941, pp. 2574–2582, Food and Drug Administration, "Flour, self-rising flour, and related products … definitions and standards of identity," findings of fact — https://archive.org/details/sim_federal-register-find_1941-05-27_6_103 - Finding 33 (p. 2576): "in many cases the food consumed does not furnish sufficient amounts of certain necessary nutritional elements to maintain health. The deficiencies are more prevalent in the case of persons with low incomes." - Finding 34: "Among the most serious and widespread deficiencies, in children as well as adults, are those of vitamin B1, riboflavin, nicotinic acid, and iron."
"'Enriched' Flour and Bread," USDA Press Service, digest of Market Basket for March 19, 1941 — https://archive.org/details/enrichedflourbr1941unit_0 — "nicotinic acid (pellagra-preventive factor)."
Lewis Wickes Hine for the National Child Labor Committee, South Carolina, 1908–1912, Library of Congress NCLC collection (LC-DIG-nclc-01409 through -04243); each plate's credit carries Hine's own caption. Spartanburg, May 1912: Arkwright, Beaumont, Saxon, Spartan and Drayton mills. Also Lancaster, Newberry, Chester, Clinton and Dillon, 1908.
Farm Security Administration / Office of War Information, Library of Congress: Marion Post Wolcott, Orange County, N.C. and Coffee County, Ala., 1939; Gee's Bend, Ala., 1939; Russell Lee, Jefferson and San Augustine County, Texas, 1939; Arthur Rothstein, Gee's Bend, 1937. Captions on screen are the photographers' own.
U.S. Public Health Service photographs, National Library of Medicine Digital Collections (each record: "The National Library of Medicine believes this item to be in the public domain"): the Pellagra Hospital, Spartanburg (101446104); the diet laboratory (101446807); a family eating "hominy grits, mush, molasses, cabbages, potatoes, and rice," 1920 (101447549); pellagra hands (101448007).
The photographs were made in black and white and colorized with DDColor in 2026; a gray-patch audit (tools/spotfix.py) was run on every frame used. The color is a computer's estimate.

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