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vs. The South
If poor diet resulting from poverty among Southern tenant farmers and mill workers was the root cause of pellagra, then the only real cure was social reform, especially changes in the land tenure system. A dramatic drop in cotton prices in 1920 and the attendant decrease in the income of many Southerners occasioned a spike in the number of reported pellagra cases. Goldberger publicly predicted dire public health consequences for 1921 when there might be as many as 100,000 pellagra cases including 10,000 deaths and even worse for 1922.
Newspaper headlines warning of famine and plague in the South caught the eye of President Warren G. Harding, who asked Surgeon General Hugh Cumming for a report and was supportive of PHS appeals for an increased budget for hospitalization and supplies. The Public Health Service called upon Southerners to provide local relief for the poor. However, the response of many in the South was the opposite of grateful and magnanimous. Enraged Southerners, led by South Carolina Congressman Jimmy Byrnes, denounced the negative characterization of their region and feared that it would discourage economic investment and tourism in the South. They believed that Southern pride and Southern prosperity were on the line.
Goldberger proved correct. There was a dramatic increase in pellagra and in the number of deaths, although not quite as many as he had predicted. The land reform that Goldberger believed necessary to eliminate pellagra was accomplished not by scientific reasoning but by the invasion of boll weevils. The insect destroyed cotton fields and forced Southerners to diversify their crops. By growing more food crops, Southerners improved their diets and suffered less from pellagra.
The Great Mississippi Flood
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