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Called the sickness of the four “D’s” – diarrhea, dermatitis, dementia, and death – the first sign of pellagra was a reddening of the skin on hands, arms, feet, and face. It was often confused with sunburn or poison oak, but pellagra’s symptoms became unmistakable when reddened skin crusted over and peeled away leaving tell-tale butterfly-like lesions on the face. Accompanying the skin condition was a serious digestive disturbances and a general feeling of malaise. In severe cases depression became dementia, and victims were frequently committed as insane (Beardsley 1987:54).

Pellagra was caused by an inability “to raise or purchase those items of diet which would maintain them in health” (Roe 1973:107). Key to preventing the disease was adequate niacin in the diet. During the early years of the twentieth century, few families could afford to consistently eat niacin-rich fresh meat, fruits, vegetables, milk, and eggs. Long hours at work and small yards prevented many mill families from supplementing their diet significantly through small kitchen gardens. Intensive use of the backyards at the Front Street sites for hygiene-related activities (privies, slop holes) precluded gardens as a significant food source. By necessity, households like these relied more heavily on traditional Southern fare of “meat, meal, and molasses” (Beardsley 1987:57). The long-term effects of poor diet were catastrophic. The slow, wasting effect on the body from the onset of pellagra created a slumbering, lethargic appearance and personality that undoubtedly worked its way into misconceptions about mill worker character. “Vitamin research,” notes historian Edward Beardsley (1987:58), “was then in its infancy, and the notion that healthy people could be made sick by a deficiency of something seemed fantastic to doctors who had cut their teeth on the germ theory and the concept of insect-vectored disease.” In fact, researchers first suspected that the disease might be due to poor hygiene related to privy use (Beardsley 1987:56; Roe 1973:90). The discovery that its origin was nutritionally based instead of parasitic may have actually slowed the pace of sanitary improvements for tenants.