“Black Tongue” Takes A Toll in Cabarrus County and Across the South

15 Sep 2015

The following contains excerpts from Gail Jarrow’s book Red Madness:How a Medical Mystery Changed What We Eat and her website http://www.gailjarrow.com/pellagra.html.

Pellagra struck all age groups.
Photo: http://www.gailjarrow.com/pellagra.html

Between 1900 and 1940, at least 100,000 individuals in the South died of pellagra, or “black tongue,” a dietary deficiency disease. The accelerated rise of pellagra was especially difficult in farming and mill communities. Its effects were felt in Cabarrus County as workers struggled to feed their families during times of economic hardship. 

The July 6, 1911 Charlotte Observer reported that “Mr. J. D. Bost, a well-known and popular young man of the city [Concord], was taken to the Charlotte sanatorium this morning to be treated for pellagra. Mr. Bost’s health failed several months ago and and it became necessary for him to resign his position as book-keeper… and since that time he has been in a sanatorium for treatment but the cause of his illness was not generally known.” 
Also called Italian leprosy and Alpine scurvy, the first reported U. S. case of pellagra was in 1902 when a young Georgia farmer sought a doctor’s help. The man felt too weak to work. He vomited when he ate. His skin was covered with blisters and crusty scabs. The doctor was shocked when he realized his patient appeared to have pellagra, a dreaded disease from southern Europe. Pellagra was known for its 4-D symptoms: dermatitis (a red rash), diarrhea, dementia (insanity), and death. The affected tissue would darken, thicken, and become scaly; cases were sometimes misdiagnosed as leprosy. Symptoms would increase with sun exposure and could progress to depression, stupor, and an irrational violence.

A poor diet of hominy grits, mush, molasses, cabbages, potatoes,
and rice was the main cause of pellagra, c.1920. Photo:

Recognized in Europe since the 18th century, no one was sure what caused pellagra or how to cure it. It made its first appearance in North Carolina near Wilmington and by 1907 there was one reported case in Cabarrus.2 Physicians were worried but not yet taking it seriously. Then the federal census bureau’s death registration for 1910 reported that North Carolina led the country in pellagra mortality with 368 deaths, 263 (71.5%) of which were female. The largest numbers were in Raleigh (23); Durham (17); Charlotte (16); and Wilmington (8).3 Many went mad as the illness attacked their brain, and about 30% died. As the disease crossed the South, people panicked. 
Although there were only four reported cases in Cabarrus by 1912, nearby Mecklenburg had 156.3 As the number of cases continued to increase, concerned doctors said it was second only in importance to tuberculosis. Annual deaths in North Carolina peaked at 1,015 in 1930. The yearly total stayed well into the hundreds through the Depression and beyond; it did not fall to double digits until 1944.

Some thought it was caused by defective corn imported after the Civil War or food made from old or fermented corn. People stopped eating corn bread or anything made with corn meal. Since it seemed to run in families, was it hereditary? Was pellagra spread by an insect carrying a dangerous microbe? Was it contagious, passed from a victim to everyone around him?

Joseph Goldberger’s observations in southern mental hospitals, orphanages, and mill towns
led him to believe pellagra was not infectious, but nutritional. This theory contradicted commonly-held medical opinions, but he fought to convince critics that social reform was necessary to improve the diets of Southern tenant farmers and mill workers. Photo: http://phil.cdc.gov/phil/details.asp

The United States Public Health Service was determined to find the answers. The Surgeon General appointed a skilled epidemiologist to lead the investigation. In 1914, Dr. Joseph Goldberger headed to the South in search of clues.

Goldberger noticed more cases of pellagra among certain groups of people—sharecroppers and tenant farmers; cotton mill workers; children in orphanages; prisoners; and patients in insane asylums. After careful observations, he formed a hypothesis: Pellagra was caused by a diet high in corn and cereals and low in animal-protein foods (meat, eggs, milk).

By 1916, Goldberger had proved that pellagra was caused by a diet deficiency, but he didn’t know exactly what crucial element in food prevented the disease. Despite years of searching, he died in 1929 before anyone discovered the final solution to the mystery.

In 1937, Conrad Elvehjem, a biochemist, identified that missing element—nicotinic acid, now known as niacin or vitamin B3. Later research showed that the amino acid tryptophan, found in high-protein foods, also prevents pellagra because the body is able to change it into niacin.

Today niacin is added to bread, flour, cornmeal, and cereals. Although still common in some underdeveloped countries, Pellagra is now rare in the United States. The first year that North Carolina recorded no pellagra deaths was 1960, but during the first half of the twentieth century, more than 3,000,000 Americans became victims of the “awful and loathsome” disease, and at least 100,000 died. Sadly, many families in our area were affected. Some known deaths in Cabarrus County which were attributed to, or complicated by pellagra, include:

Pearl B. McDonald, Concord, 1914
Travis Fry, Concord, 1914
Adam Lentz, Concord, 1915
John Franklin Murph, Kannapolis, 1915
Augusta A. Robinson, Concord, 1916
William Thomas Brindle, Kannapolis, 1921
Polly Blackwelder, Concord, 1923
Charles Alexander Weddington, Kannapolis, 1926
Lottie Lemmonds Burris, Concord, 1935
Rev. Columbus Washington Beam, Kannapolis, 1943

1. Kevin Kinsella, “Changes in Life Expectancy, 1900-1990,” The American Journal of Clinical Nutrition, 1992;55:1 l96S-1202S.
2. Bulletin of the North Carolina State Board of Health, Vol 22-24, Secretary of the Board, 1907, p.93.
3. Transactions of the National Association for the Study of Pellagra: Second Triennial Meeting at Columbia, South Carolina, October 3 and 4, 1912, R. L. Bryan Company, 1914, p.33-34