Skip to main content

The Butterfly Caste

May 2024
1min read


Daniel Akst’s article “The Forgotten Plague” (December) took me back to my days as a graduate student at the University of Georgia in the 1960s. I needed a dissertation topic, and my major professor had been looking for someone to work in medical history. I seemed a likely prospect. Because I was studying social history, I decided to investigate an endemic rather than an epidemic disease in the hope that it would act as a mirror to the culture. Since I lived in the South and had little money for travel, I narrowed the choices to two: hookworm or pellagra. I did not think I could bear to spend months reading and writing about latrines and privies, so by default, I opted for pellagra.

It was a serendipitous choice. Dr. Goldberger’s work and that of the Public Health Service unfolded like a detective story. I called my dissertation “The Strange Hunger: A Social History of Pellagra in the South,” but when I expanded it into a book several years later, I changed the title to The Butterfly Caste , which referred to the butterfly-shaped rash that often covered a pellagrin’s face. Pellagrins were shunned like lepers, and when Dr. Goldberger linked the widespread occurrence of pellagra to the South’s poverty, this stigma was transferred to the region as a whole. No wonder Southerners were outraged.

Dr. Goldberger’s work did more than just rid the South of a pestilence. His study of the 24 South Carolina mill villages definitively linking disease to economics is a classic in epidemiology and has often been used in the training of epidemiologists.

I am glad that Dr. Goldberger’s wonderful story has reached a new and larger audience and that my effort to tell that story three decades ago has stood the test of time.

We hope you enjoy our work.

Please support this magazine of trusted historical writing, now in its 75th year, and the volunteers that sustain it with a donation to American Heritage.

Donate