The Rise and Fall of Pellagra in the American South -- by Karen Clay, Ethan Schmick, Werner Troesken

The result of insufficient niacin consumption, pellagra caused more deaths than any other nutrition-related disease in American history, and it reached epidemic proportions in the South during the early 1900s. In this paper, we explore the forces that drove the rise and fall of pellagra. Historical observers have long-believed that pellagra stemmed from the South's monoculture in cotton, which displaced the local production of nutritionally-rich foods. To test this hypothesis, we begin by showing that, at the county level, pellagra rates are positively correlated with cotton production. We then exploit the arrival of the boll weevil--which prompted Southern farmers to begin planting food instead of cotton--to show that this correlation is likely causal. We close by studying how fortification laws passed during the 1940s helped to eliminate pellagra.