The present study might well be said to have begun in 1930, when I realized that persons with deficiency diseases were unbelievably weak and listless. The first six years were spent in the careful study of 278 patients in Ohio, selected because they had lesions typical of pellagra, beriberi or scurvy.1 In 146 of these patients the nutritional deficiencies were secondary to organic diseases which interfered with the proper ingestion, absorption or utilization of a good diet; in 115 patients they followed chronic alcoholic addiction which interfered with the ingestion of an adequate diet; in the other 17 patients they were of the endemic type which follows the habitual consumption of a diet poor in essential nutrients. All the 278 patients were severely ill and were admitted to the hospital for careful clinical study. Invaluable aid in carrying out these studies was given from time to time by Drs.
SPIES TD. NUTRITIONAL REHABILITATION OF ONE HUNDRED SELECTED WORKERS FOR INDUSTRY. JAMA. 1943;122(14):911–916. doi:10.1001/jama.1943.02840310003002
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