The story of pellagra in Alabama and the Deep South is a classic tale of how improvements in the public’s health depend on the application of scientific thinking to complex public health problems. During the first decades of the 20th century pellagra ravaged poor, working class families struggling to eke out subsistence living. The death and disability caused by the disease threatened the economic and social transformation of the post Civil War South.  

The physician-scientists Joseph Goldberg and Carl Grote understood the intimate relationships between human disease and the structures – social, political, and economic – of the communities they lived and worked in. They labored against the intellectual trap of vogue thinking, which at the time saw scientists and physicians alike believing virtually every disease had an infectious cause. Grappling with the pellagra epidemic defied the logic of the day; it required the innovative thinking so characteristic of public health, drawing on many disciplines outside of and complementary to traditional medical science. Goldberg and Grote were crucial to ending the epidemic, well before the exact cause of the disease was understood.

The Reynolds [now Reynolds-Finley] Historical Library’s web presentation, “Pellagra in Alabama,” is remarkable for its beauty, historic completeness, and the lessons we are reminded of about science and public health that remain profoundly important today as we face larger and increasingly complex global health crises.  These are the “wicked problems” of grinding poverty, environmental degradation, clean water, and others Dr. John Kao discusses in his book Innovation Nation.  The public health thinking that led to the end of the pellagra epidemic in Alabama during the first part of the 20th century will guide us toward solutions for the epidemics of 21st century America.  

Max Michael, MD
Former Dean, UAB School of Public Health