SAMA HOOLE: Dr. Joseph Goldberger figured it out in 1915. It wasn't infectious. It wasn't genetics. It was the corn-based diet that poor Southerners had been forced into after the Civil War.

American South, 1900-1940. Mysterious disease killing poor Southerners by the thousands. Skin lesions, dementia, diarrhea, death.

They called it pellagra. Nobody knew the cause. Some thought it was infectious. Others blamed bad sanitation. It ravaged poor white and Black… pic.twitter.com/FY6bPjWUBZ

— Sama Hoole (@SamaHoole) January 6, 2026

American South, 1900-1940. Mysterious disease killing poor Southerners by the thousands. Skin lesions, dementia, diarrhea, death.

They called it pellagra. Nobody knew the cause. Some thought it was infectious. Others blamed bad sanitation. It ravaged poor white and Black communities alike. Dr. Joseph Goldberger figured it out in 1915. It wasn't infectious. It wasn't genetics. It was diet. Specifically, it was the corn-based diet that poor Southerners had been forced into after the Civil War. The pre-war South, for all its evils, had more dietary diversity. Even enslaved people typically received salt pork, occasionally fish, some dairy. Poor whites ate more varied diets with access to hunting and fishing. Post-war poverty meant survival on the cheapest calories available: corn. Cornmeal, corn grits, corn bread, hominy. Three meals a day, seven days a week. Some molasses and fatback if you were lucky. Minimal meat, minimal dairy, minimal vegetables. Corn lacks niacin in bioavailable form. Without niacin, you get pellagra. Traditional Native American preparation methods used alkali processing (nixtamalization) which makes the niacin available. The Southern poor were just boiling or baking corn without this treatment. The disease killed 100,000 people between 1900 and 1940. The solution was known: add meat, eggs, milk, or properly processed corn to the diet. But the Southern poor couldn't afford it. The irony is that pellagra was rare in the South before the Civil War despite the poverty. Why? Because even minimal animal protein prevents it. The post-war corn dependency was so complete that people weren't getting even that minimal amount. Goldberger proved this by triggering pellagra in prison volunteers by feeding them exclusively corn-based diets, then curing them by adding meat. The experiment was brutal but definitive. The disease vanished in the 1940s not because of medicine but because economic conditions improved and people could afford to eat something besides corn. As soon as the Southern poor got access to animal protein again, pellagra disappeared. One hundred thousand people died because they were trapped on a corn-based diet. Not by choice. By poverty. The plant food couldn't sustain them. The moment they could afford meat, they stopped dying.