The Butterfly Caste

Book excerpt: This book is a medical detective story of the search for a killer. Pellagra, the disease of the four Ds: diarrhea, dermatitis, dementia, and death, was epidemic in the Southern United States in the early part of this century. The often fatal disease was characterized by the dramatic stigmata of an ugly red "butterfly" across the nose and a symmetrical skin rash on the extremities. Although it has been described and studied by European physicians as early as 1735, and pellagroid symptoms had long been identified in this country, pellagra was not acknowledged as a discrete disease until 1907. In that year an epidemic broke out in an asylum in Alabama. Reports of other cases quickly followed, and within a few years pellagra was pandemic in the South. The search for the killer was on, but it would be many years before the cause could be isolated and a cure found. In 1914, Dr. Joseph Goldberger, a United States Public Health Service physician, became director of the PHS pellagra research program. This book traces his efforts to identify the culprit responsible for this disease and ultimately to find the cure in 1937 that would help to eliminate it.