The Butterfly Caste

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.