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JAMA. 1937;108(12):974. doi:10.1001/jama.1937.02780120044014.
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Despite the observation of Goldberger that pellagra could be prevented by means of an adequate diet, and his subsequent recommendations for the treatment of pellagra, there has continued to be a high mortality rate in the severe cases of endemic pellagra in the South. This high mortality rate in the hospitals (from 31 to 69 per cent), irrespective of treatment, seemed to many physicians, particularly in the South, to be inconsistent with the statement that pellagra is a dietary deficiency disease. Early in 1934 McLester published the opinion that the knowledge as to the cause and treatment of endemic pellagra was inadequate and pointed out that a high mortality rate still existed in spite of the treatment recommended by Goldberger. In 1935 Spies, working in Lakeside Hospital, Cleveland, by a more careful method of dietary control was able to reduce the death rate in Lakeside Hospital from 54 per cent


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