[Skip to Content]
[Skip to Content Landing]
January 1, 1973

The Butterfly Caste: A Social History of Pellagra in the South

JAMA. 1973;223(1):84. doi:10.1001/jama.1973.03220010070041

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.


Pellagra, now a rare disease, was a serious health problem in the United States half a century ago. Although well known in Spain and Italy since 1735, pellagra was not diagnosed in this country until 1902. But in the next few years, more and more cases appeared of the "3-D disease"— diarrhea, dementia, and dermatitis (including the ugly facial butterfly, from which this book derives its title).

In 1921 more than 2,500 Americans died of pellagra. Meanwhile, Joseph Goldberger, an officer of the Public Health Service, was patiently demonstrating that dietary deficiency was the cause. Obviously, improved diet could prevent and cure the condition, but improving the diet of impoverished sharecroppers and millworkers involved tremendous economic and social difficulties.

The rise and fall of pellagra, the disputes about its cause, and the social and political struggles form a fascinating story, well told by Elizabeth Etheridge. She is a historian, not