National Library of  Medicine
A family suffers from pellagra, 1920, National Library of  Medicine

Pellagra is a nutritional deficiency disease caused by inadequate intake of niacin, a B vitamin.
Pellagra was widespread in the South, particularly from the turn of the century and well into the 1930’s. In 1912 in South Carolina,  there were an estimated 30,000 cases and a mortality rate of 40%.

Alan Kraut. 1996. “Dr. Joseph Goldberger & the War on Pellagra.” National Institute for Health internet website: www.nih.gov/od/museum/exhibits/goldberger/fulltext.htm