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

Perspective Chapter: Caste, Class, Race and Poverty – A Perspective from the Case of Pellagra

“…Pellagra is caused by a poor diet deficient in animal products leading to inadequate intake of the micronutrient nicotinamide (Vitamin B3). Pellagrins whether as individuals, families or groups were known collectively as the "Butterfly Caste" (referring to a characteristic exaggerated sunburn rash -"Casal's necklace") as they had acquired many degenerative features including lost cognitive and social and economic capital that appeared hereditary [1,2]. The best-known epidemics occurred in poverty ridden eighteenth century southern Italy and Spain (as first described by Casal) then in the early twentieth century "Cotton" southern states of the USA; and then in Egypt and colonial south Africa and called out as "starving on a full stomach" along with kwashiorkor.…”

The Pellagra Portraits

“…(niacin) deficiency, was one of the most pressing public health issues in the early 20th century in the US. 1 It remains a condition of malnutrition and poverty in lowerresource settings and may still manifest in higher-resource settings among patients with limited diets (eg, those with severe alcohol use disorder) or malabsorption syndromes. Pellagra manifests clinically as dermatitis-dermal plaques with hyperpigmentation, erythema, and a shellac-like desquamation known as "Casal necklace" 2 -along with diarrhea and, in severe cases, dementia and death (the "4 D's").…”