Goldberger, Waring and Willett (11), in 1915, studied the conditions which might explain the differences in the incidence of pellagra in two groups of children in an orphanage at Jackson, Miss. In this institution there were children from infancy to twelve years of age. The presence of pellagra was practically confined to the group between the ages of six and twelve years. This was correlated with differences in the diets of the two groups with respect to the content of fresh meat "and other animal protein," the older group being denied these special articles of diet. Analogous conditions were discovered at other institutions.

It was the suggestion gained from earlier studies on beri-beri which led Goldberger and his co-workers to reason from analogy that pellagra was in some way either prevented or cured by some specific substance or substances contained in fresh protein foods. With this idea in mind they instituted an experiment to test whether pellagra could be prevented or cured by a proper diet. The experiment was carried out at two orphanages and an insane asylum. It was not possible at that time to interpret as satisfactorily as can now be done, the nature of the faults in a diet. Goldberger could, therefore, do no better than to add to the institutional diets liberal amounts of each of the more important articles such as fresh meat, eggs and milk, and fresh vegetables, since the institutional diets differed from the better class American diets in the absence of these foods.

In one of the two orphanages under observation during 1914, there was no recurrence of pellagra in any of the 67 persons afflicted, who were under surveillance at least until the anniversary of their attack. Among 99 pellagrin residents of this institution who were under observation for at least a year there was not a single case of the disease after the change in the diet of the institution. At the other orphanage 105 pellagrins were observed for at least a year, including the anniversary of their attack, and there was not a single case of recurrence. Sixty-nine individuals who had not suffered from the disease were observed for at least a year and among these not a single case developed.

At the Georgia State Asylum, which was an endemic focus of pellagra, the diet of two wards was modified so as to greatly improve it, but no change was made in hygienic or sanitary conditions. In these two wards 72 patients suffering from pellagra during 1914 were kept under observation at least beyond the anniversary of their last attack, but not one of them showed any sign of recurrence. During the corresponding period 47 per cent of 32 control patients in another ward showed definite recurrences. The conclusion drawn by Goldberger and his associates was that pellagra can be prevented by an appropriate diet, even when the hygienic conditions are unfavorable.