A third period, properly called the "hospital malnutrition" period, resulted from the involvement of Dr. Butterworth in the care of patients who often developed severe nutritional disorders while in the hospital. In 1974 a seminal paper by Dr. Butterworth, cunningly titled "The skeleton in the hospital closet," shook the medical establishment with dramatically documented observations of what became known as hospital malnutrition. This courageous disclosure led eventually to the improvement of the nutritional support of patients and to the elimination of long-established, ill-conceived hospital practices conducive to poor nutrition. The introduction of nutrition support teams, considered today to be indispensable for good patient care, can be traced to recommendations contained in this classic article. Dr. Butterworth received invaluable aid from a new recruit, Roland L. Weinsier, M.D., Dr.P.H., a young physician passionately devoted to clinical nutrition, who joined UAB in 1975. Shortly thereafter Dr. Weinsier distinguished himself by building a nutrition clinic and a nutrition support service while also developing an outstanding first-year School of Medicine nutrition course. At the time, Dr. Weinsier’s research was focused on the nutritional support of hospitalized patients in medical and surgical wards. His work attracted national attention after he reported two deaths from re-feeding syndrome after overzealous use of parenteral nutrition and a careful compilation of the complications associated with its use.
The need to objectively evaluate the nutritional status of patients had been recognized years before and had already resulted in the creation of a laboratory committed to the Biochemical Assessment of Nutritional Status. For over thirty years this laboratory functioned under the direction of Dr. Phillip E. Cornwell, a Ph.D. microbiologist interested also in folic acid and pteridine chemistry recruited in 1971 by Dr. Baugh. The results provided by this laboratory helped to unequivocally demonstrate the existence of hospital malnutrition and to convince the medical establishment of the seriousness of the problem. Howarde E. Sauberlich, Ph.D., a very prominent nutrition scientist, author of a classic book on Laboratory Tests for the Assessment of Nutritional Status, contributed his vast knowledge to the operation of Dr. Cornwell’s laboratory after joining the group in 1982.