Goldberger (Figure 1-4), Waring, and Tanner studied the mode of transmission
of pellagra, conducting an important classic experimental study in 1914. Pellagra is
characterized by diarrhea, dermatitis, dementia, psychomotor disturbances, and sensitivity
to light and can be fatal. Pellagra was initially believed to be a communicable
disease because of the high incidence and prevalence rates noted in the United States.
Despite treatment, there was no improvement in disease symptomology. The growing
spread of this disease was identified as a public health emergency, with quarantine
and isolation implemented for those affected or exposed. However, isolation and
quarantine of such a large number of individuals began to drain public health resources,
also impacting the nation’s economic productivity.
U.S. Public Health Service officials conducted a study at both an orphanage and a
sanatorium to better understand the disease and identify prevention strategies. The
subjects’ diets were slightly modified to replace grits (maize or corn) with protein
products such as milk and meat. Within a year researchers noticed that the signs and
symptoms associated with pellagra disappeared completely. The subjects were followed
for second and third year, with the disease recurring only in those who revertedto eating corn products. In those who continued to consume a diet high in protein,
pellagra was not noted again. Sanitation, isolation, and other preventive measures did
not help the subjects (Laguna & Carpenter, 1951).