The Rise and Fall of Pellagra in the American South

Focusing on the first half of the twentieth century, we explore the rise and fall of pellagra (a disease caused by inadequate niacin consumption) in the American South. We first consider the hypothesis that the South’s monoculture in cotton undermined nutrition by displacing local food production. Consistent with this hypothesis, a difference in differences estimation shows that after the arrival of the boll weevil, food production in affected counties rose while cotton production and pellagra rates fell. The results also suggest that after 1937 improved medical understanding and state fortification laws helped eliminate pellagra.