[Proceedings of the National Nutrition Conference for Defense] [From the U.S. Government Publishing Office, www.gpo.gov] PROCEEDINGS National nutrition CONFERENCE FOR DEFENSE MAY 26, 27, 28 1941 WASHINGTON, D. C. PROCEEDINGS OF THE NATIONAL NUTRITION CONFERENCE FOR DEFENSE MAY 26z 27z AND 28, 1941 CALLED BY PRESIDENT FRANKLIN D. ROOSEVELT FEDERAL SECURITY AGENCY OFFICE OF THE DIRECTOR OF DEFENSE HEALTH AND WELFARE SERVICES WASHINGTON, D. C. United States Government Printing Office, Washington, D. C., 1942 For sale by the Superintendent of Documents, Washington, D. C., Price 35 cents CONTENTS Page Foreword_______________________________________________________________— v Nutrition Advisory Committee to the Coordinator of Health, Welfare, and Related Defense Activities-------------------------------------- vn Recommended Allowances Proposed by the Food and Nutrition Committee of the National Research Council_____________________________ ix General Sessions, May £6 and 27________________________________________ 1 The Challenge of Nutrition, Paul V. McNutt---------------------------- 1 Mobilizing for Better Nutrition, Russell M. Wilder____________________ 10 Plans for the Conference, M. L. Wilson________________________________ 17 Nutrition in the First World War and Now, John R. Murlin-------------- 23 Adequate Nutrition and Human Welfare, Henry C. Sherman---------------- 30 Nutrition and National Defense, Henry A. Wallace------------------ 85 Agricultural Policy and National Nutrition, Claude R. Wickard____ 41 Food and Foreign Policy, Adolf A. Berle, Jr_______________________ 47 Labor’s Stake in a National Nutrition Program, Frances Perkins________ 50 Nutrition and Consumer Protection in Defense, Harriet Elliott--------- 57 National Nutrition in Relation to Selective Service, Lewis B. Hershey________________________________________________________________ 63 Discussion of Special Phases of Nutrition Problems, afternoons of May 26 and 27_______________________________________________________________ 68 Section I. Research and National Nutrition Problems___________________ 69 II. Economic Policy and Social Responsibility____________ 79 Illa. Public Health and Medical Aspects of Nutrition______ 101 Hlb. Public Health and Medical Aspects of Nutrition: Special Needs of Mothers and Children____________________ 111 IV. Nutrition for Workers in Defense Industries_______ 116 V. Methods of Education in Nutrition---------------- 130 VI. Professional Education in Nutrition________________ 146 Vila. Nutrition Problems in Distribution and Processing of Foods: Distribution________________________________ 160 VHb. Nutrition Problems in Distribution and Processing of Foods : Processing________________________________ 173 Villa. Community Planning for Nutrition: Urban Subcommittee ________________________________________________ 186 VUIb. Community Planning for Nutrition: Rural Subcommittee ________________________________________________ 197 IX. Nutrition Problems in Group Food Service__________ 208 Reports of Section Chairmen, May 28------------------------------------ 213 Concluding Addresses, May 28-----,------------------------------------- 219 The Job Ahead, Surgeon General Thomas Parran__________________________ 219 What This Conference Means to Every American, Mrs. Franklin D. Roosevelt_______________________________________________________ 226 Recommendations of the Conference to the President of the United States------------------------------------------------------------------ 230 Appendix A. Names of delegates who attended the Conference___________ 234 Appendix B. Chairmen of State Nutrition Committees___________________ 249 Appendix C. Members of the Committee on Food and Nutrition, National Research Council________________________________________________ 252 Appendix D. Members of the Committee on Food Habits, National Research Council________________________________________________________ 254 hi FOREWORD The National Nutrition Conference for Defense, called by President Franklin D. Roosevelt, convened in Washington, D. C., on May 26, 27, and 28, 1941. On the invitation of the Chairman of the Conference, Paul V. McNutt, Administrator of the Federal Security Agency and Coordinator of Health, Welfare, and Related Defense Activities, over 900 delegates met to discuss the problems of nutrition for defense and to formulate recommendations for a national program of action. The delegates included professional nutritionists, home economists, educators, physicians, public health officers, social workers, and industrial technicians. Industry, labor, and Government; the press and the radio; colleges, universities, and medical schools; farm organizations, consumer groups, processing and marketing organizations—all were represented at the first National Nutrition Conference to be called by a President of the United States. During the depression of the 1930’s, we devoted ourselves to the task of seeing that no one should starve. Through welfare programs we succeeded in assuring to low-income groups at least a minimum of subsistence. Few actually starved. But we know that a guarantee against starvation is not enough. Our nutritional goal must be commensurate with the wealth of our natural resources and with our ability to produce. The farms of America can furnish good food in abundance tor our entire population. We have rich soil, vigorous manpower, and unsurpassed farm machinery. Realizing both our needs and our ability to meet them, we started, in the middle of the past decade, to study the national problem of nutrition. Various Federal agencies, especially the Department of Agriculture, the Labor Department, and the Public Health Service, undertook tne research requisite for national planning. Studies were made of the cost of living in cities and villages and on farms; research was carried out on deficiency diseases ; and the diets of employed and unemployed workers, of school children, of pregnant women, and of other groups were studied. In 1936 the Interdepartmental Committee to Coordinate Health and Welfare Activities in the Federal Government appointed a Technical Committee on Nutrition which issued a report the following year on the work being done by various Federal agencies in the field of food and nutrition. The second half of the 1930-40 decade was marked by an expansion of governmental programs designed to make better nutrition a reality for the families in greatest need. Welfare agencies in some of the larger cities added nutritionists to their staffs to develop balanced dietaries for families receiving relief. The Federal Government initiated a number of programs of subsidized food consump- V VI FOREWORD tion for the purpose of distributing dairy products, green vegetables, and other protective foods more widely among low-income families. The first of these programs was developed by the Federal Surplus Relief Corporation which was organized in October 1933 by the Federal Emergency Relief Administration to purchase surplus price-depressing commodities for distribution among relief families. This agency was renamed the Federal Surplus Commodities Corporation in November 1935 and was transferred to the Department of Agriculture in recognition of a change in emphasis “from relief to the removal of agricultural surpluses and the encouragement of domestic consumption. During the four years 1935-39, the Corporation bought and gave to welfare agencies almost 3 billion pounds of surplus foods which were distributed to families receiving public assistance. In 1940 the dollar value of surplus foods thus distributed amounted to nearly $158 million. Other Federal programs of subsidized food consumption developed during the late 1930’s included distribution of milk at reduced prices for low-income families, free school lunches, and the Food Stamp Plan which was inaugurated by the Federal Surplus Commodities Corporation in May 1939. By Executive order the name of the corporation was changed to Surplus Marketing Administration on June 30, 1940, to indicate that its primary function was the improvement of distribution facilities. The number of areas in which the Food Stamp Plan was operating increased rapidly so that by May 1941 nearly 4 million persons in 346 areas were participating and the monthly value of surplus food stamps issued had risen to nearly $10 million. Each month more than a million undernourished urban families were in this way enabled to obtain appreciable quantities of protective foods which they could not afford to purchase at prevailing market prices. Federal programs to facilitate wider food distribution among low-income families and to promote research in nutrition had thus paved the way for more comprehensive efforts to improve nutrition. As the defense program got under way in 1939-40, the strategic importance of food became evident. On May 28, 1940, Miss Harriet Elliott was appointed Consumer Commissioner of the Advisory Commission to the Council of National Defense with broad responsibility for coordinating health and welfare activities with the program of national defense. By late August of that year, representatives from the chief Federal agencies concerned with nutrition had been appointed to an over-all Nutrition Policy and Planning Committee with Dr. M. L. Wilson, Director of Extension Work, United States Department of Agriculture, as chairman and Dr. Helen S. Mitchell, Research Professor of Nutrition, Massachusetts State College, as secretary. During the closing months of 1940, emphasis on the country’s nutritional needs received new impetus. The world situation served to stimulate public interest in food and nutrition not only as a defense measure but as part of a long-time plan for the development of a stronger, healthier nation. On November 28, 1940, the Council of National Defense, with the approval of the President, designated “The Federal Security Administrator as Coordinator ot all health, medical, welfare, nutrition, recreation, and other related fields of FOREWORD VII activity affecting the national defense.” This Executive order resulted in the transfer of responsibility for the nutrition program from the National Defense Advisory Commission to the Federal Security Agency. The over-all Nutrition Policy and Planning Committee, augmented by representatives from four national organizations concerned with nutrition, became the Nutrition Advisory Committee to the Coordinator of Health, Welfare, and Related Defense Activities, the enlarged membership including: NUTRITION ADVISORY COMMITTEE TO THE COORDINATOR OF HEALTH, WELFARE, AND RELATED DEFENSE ACTIVITIES Chairman: M. L. Wilson, Director of Extension Work, United States Department of Agriculture. Secretary: Helen S. Mitchell, Director of Nutrition, Office of the Coordinator of Health, Welfare, and Related Defense Activities. Edna P. Amidon, Office of Education, Federal Security Agency. Melva Bakkie, American National Red Cross. Margaret Batjer, Work Projects Administration, Federal Works Agency. John M. Cooper, Chairman of Food Habits Committee, National Research Council. Loda Mae Davis, Office of Price Administration and Civilian Supply, Office for Emergency Management. Martha M. Eliot, Children’s Bureau, United States Department of Labor. G. J. Hucker, Geneva, N. Y., representing Institute of Food Technologists. J. B. Hutson, Office of Agricultural Defense Relations, United States Department of Agriculture. Beula B. Marble, Chestnut Hill, Mass., representing American Dietetics Association. L. A. Maynard, Ithaca, N. Y., representing American Institute of Nutrition. E. M. Nelson, Food and Drug Administration, Federal Security Agency. Milo Perkins, Surplus Marketing Administration, United States Department of Agriculture. C. E. Rice, National Youth Administration, Federal Security Agency. W. H. Sebrell, Public Health Service, Federal Security Agency. Flora L. Slocum, Social Security Board, Federal Security Agency. Helen Stacey, New York City, representing American Home Economics Association. Louise Stanley. Bureau of Home Economics, United States Department of Agriculture. Russell M. Wilder, Chairman of Food and Nutrition Committee, National Research Council. CONFERENCE STAFF Secretary: George St. J. Perrott, United States Public Health Service. Assistant Secretary: John C. Leukhardt, United States Public Health Service. vin FOREWORD Assistant Secretary: Edith Rockwood, United States Children’s Bureau. Information: Betty Lindley, National Youth Administration. Editor: Marjorie Shearon, United States Public Health Service. While organization of Federal nutrition activities was in progress, the States began to set up their own machinery for developing local programs. At the suggestion of the Land Grant College Executive Committee, State nutrition committees were formed during the fall and winter of 1940-41. The president or dean of home economics in the land grant college usually took the initiative in calling the first meeting of each State committee. Dr. Mitchell, in her dual capacity as Director of Nutrition in the Federal Security Agency and as secretary of the Nutrition Advisory Committee, worked closely with the State nutrition committees in a consultant and advisory capacity during this formative period. Rapid expansion of defense activities early in 1941 made it evident that food and nutrition would be at least as important as metals and munitions in the national effort to marshal all our resources. Food for better health, higher morale, and greater production was an obvious necessity. Our farms and dairies would need to increase their output to meet the larger demand for protective foods, not alone for our own population but for the democracies across the seas. Since it was realized that Nation-wide interest and cooperation would be required to initiate and carry out a broad program for more food and better nutrition, the Nutrition Advisory Committee, on the authorization of President Franklin D. Roosevelt, began to develop plans for a National Nutrition Conference in the spring of 1941. Surgeon General Thomas Parran, stressing the urgency of national planning for nutrition, said: I regard this meeting as of first importance. Every State and every community in this country has citizens who do not get the food they need for proper health and vigor. This Conference must tell us how to translate our knowledge of nutrition into everyday reality for all the people. Forty percent of the American population are not properly fed. The ill-health results mean a slowing down of industrial production, a danger to military strength, and a lowering of the morale of millions. America must speed up human power as well as mechanical production. Both England and Germany have learned this lesson. So must we. I hope that this Conference will make recommendations to solve nutrition problems at national, State, and community levels as an essential part of defense and as a part of a continuing national health and welfare program. On the evening of May 25, immediately preceding the opening of the Conference, a radio forum was conducted for the purpose of presenting to the Nation a set of simple, readily understandable nutrition allowances applicable to the entire population. Dr. Russell M. Wilder, of the Mayo Clinic, Chairman of the Food and Nutrition Committee of the National Research Council, declared: It is no longer a question of a few experts in our colleges and research centers talking about vitamins and minerals. What we must do now is make people understand that nutrition is not an academic matter but a thoroughly practical consideration concerning every single person in the country—producers, processors, marketers, consumers, nutrition experts—everyone. Each meal must be planned with an eye to economy, nutrients, and palata-bility. For such planning the housewife must have diet instructions expressed in plain, everyday language. FOREWORD IX Dr. Wilder, in the radio program, announced the findings of the Food and Nutrition Committee of the National Research Council which included 28 leading experts in the field of food and nutrition. The recommendations of the Committee were embodied in the following statement on: RECOMMENDED DAILY ALLOWANCES * A guide to serve as a goal for good nutrition and as a “yardstick” by which to measure progress toward that goal has long been needed. In 1935 the League of Nations had made the only previous concerted effort to formulate such a “yardstick.” The Committee on Food and Nutrition, of the National Research Council, was set up in 1940 to advise on nutrition problems in connection with National Defense. One of its first concerns was to work out recommended daily allowances for the various dietary essentials, for people of different ages. The difficulty in such an undertaking lies in the lack of sufficient experimental evidence on which to estimate requirements for the various nutrients with any great degree of accuracy. Judgments as to requirements are necessarily based on incomplete and often conflicting reports of research and clinical findings and on data derived from work on animals. Experiments with the various vitamins also differ with regard to procedure and interpretation. These variables explain the wide divergence in “requirements” as set forth in current literature on nutrition. The Committee’s aim was to develop a table of allowances which would represent the best available evidence on the amounts of the various nutritive essentials desirable to include in practical diets. With this in view, literature on the subject was critically appraised, and in addition judgments as to the various requirements were solicited from a considerable number of nutrition authorities, representing various fields of research. On the basis of this evidence, a chart of recommended daily allowances for specific nutrients was worked out. The values as here given thus represent the combined judgment of nutrition authorities in various parts of the country. This does not mean, of course, that every contributor would fully agree with all the figures as given. It does mean, however, that the values are ones they were willing to accept tentatively, until standards derived from more exact data can be obtained. The term “Recommended Allowances” rather than “Standards” was adopted by the Committee to avoid any implication of finality (table 1). In using these recommendations, it is important that" the Committee’s purpose and general policies in formulating them should be understood: The allowances for specific nutrients are intended to serve as a guide for planning adequate nutrition for the civilian population of the United States. The vitamin figures are calculated requirements for food as eaten and do not allow for any extensive losses in cooking. The quantities as given were planned to provide a reasonable margin of safety, but it is recognized that they may not always be attainable under all circumstances. These allowances are to be 1 For the members of the Committee on Food and Nutrition, see Appendix C, p. 252. X FOREWORD distinguished from the minimum requirements recently proposed by the Food and Drug Administration for use in connection with the labeling of foods. The Committee realizes that the values proposed will need to be revised from time to time as more knowledge of nutritive requirements becomes available. In addition to the three factors of the B complex included, other members of the group, such as vitamin B6, and pantothenic acid, should be given consideration. But at the present time no specific values can be given for the amount required in the human dietary. It should be added, however, that foods supplying an adequate amount of thiamin, riboflavin, and nicotinic acid will tend to supply an adequate amount of the remaining B vitamins. Similarly diets providing adequate amounts of protein, calcium, and iron will tend to supply other needed minerals, though these are not listed. There is urgent need for continued research on the requirements for all dietary essentials, especially for children. The allowances for adults are giVen for the 70 kg. man and the 56 kg. woman at three levels of activity. They will need to be proportionately increased or decreased for larger or smaller individuals. It will be noted that the allowances for thiamin, riboflavin, and nicotinic acid are proportional to the caloric intake. This relationship has been established for thiamin, and it has been assumed to hold also for riboflavin and nicotinic acid since, like thiamin, they are part of the enzymic system involved in the metabolism of carbohydrate. The allowances for children are given by age groups, and for boys and girls separately after 12 years, since from that age the growth curves and levels of activity for the two sexes differ. The values given are in each case for the middle year in the group, and represent amounts needed for children of average size and activity. The needs for individual children may be proportionately larger or smaller depending upon size and activity. It is to be understood that these allowances are for persons in health, and that needs may vary markedly in disease. For example, in febrile conditions there is usually an increased need for calories, thiamin, and ascorbic acid. The need for these or other constituents may also be greatly altered in other diseases, especially those of the alimentary tract, which interfere with normal absorption. It should be remembered that the amounts of the various nutrients provided for in these recommended allowances, with the exception of vitamin D, can be obtained through a good diet of natural foods, including foods like “enriched” flour and bread which have been improved according to recommendations of the Committee. It is the expectation of the Committee that nutrition workers in various parts of the country will translate these allowances into appropriate quantities of foodstuffs available in their localities. Such allowances, expressed in terms of everyday foods, can then be widely used in practical nutrition work (tables 2 and 3). 3 S 3 O W Ö g Table 1.—Recommended daily allowances for specific nutrients1 Calories Protein Calcium Iron Vitamin A8 Thiamin (Bi)’ Riboflavin Nicotinic acid Ascorbic acid8 Vitamin D Man (70 kg.): Moderately active 3,000 Grams 70 Grams 0.8 Mg. 12 I. U. 5,000 Mg. 1.8 Mg. 2.7 Mg. 18 Mg. 75 I. U (*) Very active 4,500 2.3 3.3 23 2,500 2,500 1.5 2.2 15 Woman (56 kg.): Moderately active 60 .8 12 5,000 1.5 2.2 15 70 (9 3,000 2,100 2,500 1.8 2.7 18 Sedentary 1.2 1.8 12 Pregnancy (latter half) 85 1.5 15 6,000 1.8 2.5 18 100 400-800 Lactation 3,000 100 2.0 15 8,000 2.3 3.0 23 150 400-800 Children up to 12 years: Under 1 year 5 100 kg. 94 kg. 1.0 6 1,500 .4 .6 4 30 400-800 1-3 years6 1,200 1,600 40 1.0 7 2,000 .6 .9 6 35 (4) 4-6 years 50 1.0 8 2,500 1.2 8 7-9 years 2,000 60 1.0 10 3,500 1.0 10 60 1.8 10-12 years 2,500 70 1.0 12 4,500 1.2 12 75 Children over 12 years: Girls, 13-15 years 2,800 80 1.3 15 5,000 1.4 2.0 14 80 <9 Girls 16-20 years 2,400 3,200 75 1.0 15 5,000 1.2 1.8 12 80 Boys, 13-15 years 85 1.4 15 5,000 1.6 2.4 16 90 (9 Boys 16—20 years 3,800 100 1.4 15 6,000 2.0 3.0 20 100 1 Tentative goal toward which to aim in planning practical dietaries; can be met by a good diet of natural foods. Such a diet will also provide other minerals and vitamins, the requirements for which are less well known. 2 Requirements may be less if provided as vitamin A; greater if provided chiefly as the provitamin carotene. * 1 mg. thiamin equals 3331. U.; 1 mg. ascorbic acid equals 201. U. 4 Vitamin D is undoubtedly necessary for older children and adults. When not available from sunshine, it should be provided probably up to the minimum amounts recommended for infants. Source: Committee on Food and Nutrition, National Research Council. • Needs of infants increase from month to month. The amounts given are for approximately 6-8 months. The amounts of protein and calcium needed are less if derived from breast milk. ........ , . , «. - \ • Allowances are based on needs for the middle year in each group (as 2,5,8, etc.) and for moderate activity. g 4 Q W S o w Ö Table 2.—Dietary '‘Pattern” to meet the recommended allowances Milk, adults 1 pt., children 1% pts. to 1 qt. Egg, 3 or 4 times per week. Meat. 1 serving (1 oz. at 1 yr. up to 3 ozs. for adults). Vegetables, 2 servings. One green or yellow. Fruit, 2 servings. One citrus or tomato and one other, as apple, prunes, etc. Potato, one or more servings. Butter or fortified oleo (100—500 calories). .Whole grain or “enriched” cereal and bread, at least half of the intake. Sugar, fat, etc., to complete calories. Sample Low-Cost Dietary (As per Chicago Standard Budget Costing 32^ per Day) Breakfast Tomato juice Oatmeal with top milk Toast with oleo ( +A) Coffee for adults Milk for children Lunch Baked navy beans Cabbage salad Bread with oleo (-f-A) Prunes Milk Dinner Pot roast and gravy Baked potatoes and oleo Carrots Bread with oleo (+A) Gingerbread Tea or coffee for adults Milk for children Table 3.—Approximate food value of low-cost diet on preceding page Foods Amount Approximate measure Calories Protein Calcium Iron Vitamin A Thiamin (Bi) Riboflavin Ascorbic acid Orams Orams Orams Mg. I. U. Oamma1 Gamma ’ Mg. Milk 480 1 pint.. 336 15.8 0.58 0.15 528 244 1,000 6 Meat 100 J4 pound 150 21.0 .01 3.00 50 120 225 Potatoes 350 3 medium 300 7. 2 .05 3.66 144 432 162 12 Baked beans 200 1 cup 200 13.2 .09 4.00 110 235 130 Cabbage, raw 100 1 cup 25 1.1 .04 .43 88 70 72 35 Carrots 100 H cup.. 40 1.2 .04 . 64 2, 100 60 58 Tomato 200 % cup 50 2.4 .02 • 80 2,000 182 122 48 Prunes, stewed 200 % cup 250 1.4 .03 1.88 990 120 132 Oleomargarine 66 5 tablespoons 500 8.0 2.40 2,600 270 Oatmeal, cooked 300 1cups 200 .03 60 Bread, wholewheat or “enriched” 200 6 slices 500 19.0 .10 3.0 480 207 Gingerbread 75 Large piece.. 200 3. 5 .08 2.0 40 30 Sugar, jam 250 Totals Compared with recommended allow- 3,001 93.8 1.07 22.0 8,602 » 2,253 2.25 mg. »2,234 2. 23 mg. 101 ance_ 3,000 70.0 .80 12.0 5,000 1.80 mg. 2.70 mg. 11 milligram (mg.) equals 1,000 micrograms (gamma). FOREWORD XIII The Conference convened on May 26, at 10:30 a. m. in the Mayflower Hotel, in Washington, D. C., Chairman Paul V. McNutt presiding. General sessions open to the public were held on the morning and evening of May 26 and the morning and late afternoon of May 27. On the afternoons of May 26 and 27, nine sections held meetings to discuss special phases of nutrition problems and to prepare recommendations to the President. Representatives of the State nutrition committees met on the evening of May 27 and on the afternoon of May 28. While the meetings were in progress, the international situation became so grave that President Roosevelt, on May 27, declared the existence of an unlimited national emergency. This declaration gave added import to the Conference. Delegates meeting on the third and final day to hear the reports of section chairmen were clearly aware of the serious responsibility which had devolved upon them to provide leadership in quickly translating the recommendations of the Conference into realities in their several communities. Surgeon General Thomas Parran, of the United States Public Health Service, presided at the general session on May 28 when the section chairmen presented the recommendations of their respective sections. In the afternoon the Surgeon General summed up the findings of the Conference and outlined future plans in an address on The Job Ahead. The Conference closed with a speech by Mrs. Franklin D. Roosevelt on What This Conference Means to Every American. On June 10 the recommendations adopted by the National Nutrition Conference for Defense were forwarded to the President by Mr. McNutt. In the months immediately following the Conference, there was evidenced a desire on the part of both official and unofficial groups to put into effect with all possible speed the recommendations that had come out of the meetings. State nutrition conferences were held in many States and nutrition institutes were initiated for teachers, social workers, and other professional groups. Refresher courses for nutritionists and home economists were given or planned in various parts of the country under the auspices of the American Red Cross and other agencies. Industry cooperated by initiating education programs in the press and by means of posters, food charts, and pamphlets on nutrition. The necessity for closer integration of civilian and military activities relating to health and welfare resulted in a new Executive order on September 3, 1941, establishing within the Office for Emergency Management of the Executive Office of the President the Office of Defense Health and Welfare Services with the Federal Security Administrator as Director. The importance of food and nutrition in the defense program was indicated by the appointment of the Chairman of the Nutrition Advisory Committee as Assistant Director of Defense Health and Welfare Services in Charge of Nutrition. PAPERS PRESENTED AT THE GENERAL SESSIONS OF THE NATIONAL NUTRITION CONFERENCE MONDAY MORNING, MAY 26,1941 The Challenge of Nutrition PAUL V. McNUTT Administrator, Federal Security Agency; Coordinator of Health, Welfare, and Related Defense Activities; Chairman of the National Nutrition Conference We are here to discuss nutrition. We undertake the discussion for two reasons: First, new and startling facts about nutrition have become known—facts which are vital to the strength, health, and security of the United States. Second, the United States faces today one of the greatest crises in its history—a crisis of such broad significance ,that we cannot afford to compromise our national strength in any way. If we lose, our way of life will fall, perhaps forever. I have here a letter from the President of the United States. It is a letter which speaks for itself. The White House, May 23, 19^1. My Dear Governor: I am highly gratified to learn that invitations to the National Nutrition Conference for Defense have met with such generous response. It demonstrates the eager interest of the public, of educational and research centers, of medical and social sciences alike. I only regret that because of the pressure of these critical days I shall be unable to meet with you. The Conference has significant responsibilities—to explore and define our nutrition problems, and to map out recommendations for an immediate program of action. This is vital. During these days of stress the health problems of the military and civilian population are inseparable. Total defense demands manpower. The full energy of every American is necessary. Medical authorities recognize completely that efficiency and stamina depend on proper food. Fighting men of our Armed Forces, workers in industry, the families of these workers, every man and woman in America, must have nourishing food. If people are undernourished, they cannot be efficient in producing what we need in our unified drive for dynamic strength. In recent years scientists have made outstanding discoveries as to the amounts and kinds of foods needed for maximum health and vigor. Yet every survey of nutrition, by whatever methods conducted, shows that here in the United States undernourishment is widespread and serious. The Department of Agriculture has estimated that many millions of men, women, and children do not 1 2 NATIONAL NUTRITION CONFERENCE get the foods which science considers essential. We do not lack and we will not lack the means of producing food in abundance and variety. Our task is to translate this abundance into reality for every American family. I shall follow the work of the Conference with deep interest and expectantly await its recommendations. Very sincerely yours, Franklin D. Roosevelt. Not many conferences in history have been called by the President of the United States. The Conservation Conference of Theodore Roosevelt was one. The White House Conference on Child Welfare, first called by Woodrow Wilson, was another. This Conference is called because vital national issues are at stake on the nutritional front. You are here because these issues have been recognized. We need to discuss them with you who know most about them. With your help, we propose to come out of this Conference with the objectives of a national nutrition policy clearly and vigorously set forth. I would emphasize that expectation. We do not need learned or appreciative essays. We do not need wind, words, or window dressing. We need a plan for action. It is essential that this Conference lead to action. I am not asking for the details of administration. I am not asking for an outline of procedure and personnel. In the Federal Government, in the States, in the cities, in agriculture, in industry, in foundations and universities, we have the men and women who can work out the details. The how of the thing—the mechanics of management is an engineering job we can and will do. That is our job. It is the why and the what of the story—the objectives which we must attain—that are for this Conference to determine. That is your job. You are the platform committee. It is your task to create for the first time a common platform upon which the Federal Government, State and local governments, industry, and labor can stand together united for the fulfillment of definite objectives in nutrition. The other day, in answer to requests that had been made of me, I outlined seven questions of the sort that might be directed to this Conference. The are not necessarily all the questions to be answered by this Conference. Here they are in brief: 1. How much responsibility shall Government assume and what shall our national economic policy be with respect to nutrition? 2. What is the most effective way to solve the twin problems of undernutrition and of farm surpluses? 3. How can we send to Britain the food she needs and at the same time give all American families a fairly good diet? 4. Can nutritionally adequate diets for all be achieved as a result of the employment and wage increases to be expected this year and next? 5. How can we attempt to promote inexpensive methods of distribution of all basic foods? 6. What remedies can be proposed for preventing our present widespread nutritional disabilities? 7. How can public schools, colleges, and medical schools, and adult-education facilities be best mobilized to tell the story of nutrition? If these questions are to be answered, there is hard work that must be done. There are compromises with prejudices and sometimes with definite personal or economic interests. I say alike to Government McNUTT—CHALLENGE OF NUTRITION 3 agencies, professional groups, and representatives of industry: This Conference has been called to discuss a serious problem. It is no place for anybody who has come along merely for the ride. With that as an introduction, let us examine our problem. Let us see just what bottlenecks to straight thinking may stand in the way of getting our expected results. First, let us look at the facts—the new and startling facts about nutrition. There are two parts to that story—the hollow hunger and the hidden hunger. The hidden hunger story is more recent. It has, therefore, temporarily taken the center of the stage. Do not forget that your job involves looking at both problems. When America began to recover from the blitzkrieg of the great depression, it began to take stock of its human resources. It faced for the first time what would seem to be the rather obvious fact that human beings were as much worth saving as forests and minerals, streams and soil. It recognized, too, that the ways of conserving men and women were as susceptible to scientific determination and engineering solution as were our dealings with inanimate national resources. We found, for example, that a large minority of our population did not get enough to eat. Because these people did not get enough to eat, they were below par in health. They were below par in initiative and alertness. They were not the people they might have been with better food inside of them. When there was not any pinch, except the pinch of poverty and the pinch of ever-tightening, belts—when America’s industrial machine was running in a surplus labor market—nobody needed these men, nobody, that is, except their families. Efforts to do something about them were regarded as a kind of economic heresy. The Works Progress Administration, the Farm Security Administration, the National Youth Administration, the Civilian Conservation Corps, and other organizations that directed their attention to these groups were under constant attack. Do not make any mistake about it— there was a real problem. And it is not wholly gone. When a Texas county can report that “20 percent of the deaths in this county in 1938 were hastened by lack of sufficient amount and balanced diets” the job is not done. Another county in the same area reported that “malnutrition has been a contributing cause in approximately 60 percent of the deaths in this county for the past 5 years.” Texas certainly is not alone. It simply happens to have faced its facts a little squarer. Thousands of families live on sowbelly and corn. Other thousands live on tortilla and beans. Most of these should grow kitchen gardens, some say. Certainly they should, but some of the folks who urge that most loudly are also most critical of the Government expenditures for the aid and educational programs which are intended to bring about that result. And it must not be forgotten that there are other thousands— without a square foot of real estate within 5 miles of their homes in which they could put a spade—who cannot buy meal-balancing foods at the prices they would have to pay. They have not the income. 425544°—42---------2 4 NATIONAL NUTRITION CONFERENCE So, distribution is one of our problems. I would not want any nutritionist here to go home and feel complacent because the problem is recognized. This is no time for academic recognition. It is a time for action. I would not want any health officer to go back to his home town and feel smug because he set his public health nurses to advising welfare clients that what they needed were more green vegetables, fresh fruits, premium-price flour, and vitamin tablets. “Buy Better Food” is not a very helpful slogan for folks who cannot buy anything but the cheapest. I would not want any representative of industry to feel happy about the whole thing until the American system of distribution— with the skill and leadership that only the food distribution industries are now equipped to offer us—can work out a pattern of distribution that reaches everybody. Some industrial policies aim to skim off the cream of a market. Under such a policy, advertising is aimed at the 30 percent of the market that has the most money to spend. Costs and prices may be geared to that selected market. The result may be a residual market that cannot be developed economically by anybody. “Creamseparator distribution” that selects only adequate income groups may pay money dividends. But it can be a bottleneck to national health. Do not forget that for a very significant part of our population nutrition is not a nine-letter word emblazoned with men in white rampant upon a field of vitamins. It is a four-letter word—food— good food and plenty of it. Now in the pinch of defense America needs her men and women, everyone of them. We take stock of our manpower. We know that America cannot afford to take an underfed people at any income level if it is to be truly strong. We know that a lot of people who are regarded as poor prospects for jobs need food. They are set down in personnel records as lazy or dumb. In the learned language of personnel analysts, we find them marked as “slow to adjust to job situations.” What is really wrong with them is they are hungry. Well, that is the hollow hunger side of it. Not all these people are literally “hollow.” One may fill up on the wrong things because one is too poor to obtain better food. Other people, we have found, are filling up on the wrong things because tney do not know any better. It may be just habit, a sweet tooth, and a big rush that lead many a city office worker to lunch day after day on soda pop, chocolate bars, and sundaes. It may be the illusion he is a “he man” that leads the laborer to avoid vegetables and milk and confine himself to meat, potatoes, and coffee. The fallacies of those diets are obvious even to amateur critics. But recent discoveries indicate even the amateur critics may suffer from deficiencies. They indicate that some of these dietary deficiencies may show up in disorders we have been pleased to call “mental.” Stamina, intelligence, judgment, will, stability—all these may have their roots in vitamin unbalanced diets and can be treated through clinically determinable dosages of synthetic vitamins. McNutt—challenge of nutrition 5 I will not talk about the 40 necessary elements of an adequate diet. That is a point upon which others here can speak with more authority. What I need is a pattern which will suggest the manner in which these things should be translated into governmental and industrial action. There are some dramatic and convincing anecdotes along the line of nutrition in action. There are little stories of people who would ordinarily be concealed in case reports or statistics. There are little dramas of individual lives. Some tell the story of hollow hungers; some of hidden hungers. There are stories of increased industrial efficiency. There are demonstrations of the supreme importance of nutrition in the mastery of arms and the destiny of nations. In nontechnical terms they indicate to a layman that good nutrition pays. The Tennessee Valley Authority went back 40 miles behind Norris Dam to the little town of Wilder, a ghost town, a submarginal coal town. There several hundred stranded miners’ families were barely subsisting, and only the guards at the closed mines ate regularly. Bad actors, vicious, unreliable people, troublemakers, that is what they were, TVA officials were told. But TVA officials were, fortunately, pigheaded enough not to believe it. They sent a labor representative up to Wilder, signed up 40 men, put them on hard jobs with regular pay and regular food, and these men became some of the best TVA had. They were only an extreme case. In the dining halls at Norris a man could eat all he wanted for a quarter. In the early days many of them went around and around for their quarter. Five or six helpings were not uncommon. After awhile that stopped. The men caught up with their food needs. As they were fed, the level of their efficiency on the job had markedly risen. Many great industrial concerns find it good business to provide adequate and properly selected food for their employees. Whether such food is free, as in some companies, or available at cost or nominal prices, is a matter of industrial and labor union policy I need not discuss here. The essential fact remains that good food pays industrial dividends. At one of the eastern universities it was noted not long ago that many of the star athletes had unusual names. Further investigation disclosed that a more than proportionate number of these boys came from Lancaster County, Pa. There a long line of Scotch Irish and Pennsylvania Dutch had perpetuated subsistence farming and a famous tradition of good food. Perhaps there were other things besides food that those hardy forebears handed down to their sons. But it is safe to say that the average diet of the family of many a coal miner or city salesman would have long since taken that extra element out of them. Recently, I was told that a western trucking company had actually achieved a reduction of its night-accident rate by providing all its driver crews with bags of raw carrots at the beginning of every trip. Somebody had advised them who knew the effect of vitamin A on the eyesight. « One gunner in the R. A. F. has, it is said, had an extraordinary record in nailing Nazi aircraft in the darkness. His mates, who called him “Carrots” because he was constantly munching that succulent root, did not know about vitamin A but they saw the results. But 6 NATIONAL NUTRITION CONFERENCE today there is a special diet for airmen and antiaircraft gunners. The carrot stories suggest the problem of nutrition is not to be solved merely in terms of fancy processing or premium-price supplements to the diet. Vitamins may be quite prosaic. Today, we have begun to enrich our flour. Why do we enrich it? Because the consumers demanded fineness, lightness of texture, ultrarefinement. The industry joined in competitive acquiesence and further stimulated consumer demand for these superficially attractive qualities. Perhaps this Conference can aid the advertisers by adding prestige and selling power to nutritionally satisfactory appeals. But even with today’s enrichment, I am assured that the resultant flour has not achieved the nutritional level of the whole wheat. Thus, enrichment is resorted to because of limits of public acceptance. Certainly, it is important that these elements be conserved or added. But it is equally important that the consumer is not led to believe that enrichment constitutes some sort of magic wand that changes the character of bread and makes it a substitute for other necessary foods. Not even modern fortification of foods will make men live by bread alone. Certainly the food industries have real problems to face: pressures for overselective distribution, overemphasis on refinements, the exuberance of competitive copy writers. But I would want none of the consumer educators present to grow smug and self-righteous because I have suggested there is a mote in the eye of some food distributers. I suggest that the experts, too—the doctors, nutritionists, educators, home economists, and career consumers—also have forgotten a point the advertisers remember. You experts have often forgotten that eating ought to be fun. Something frequently happens to good food when its selection is distilled through the coils of an expert. Food loses its gastronomic gusto. A fellow gets the uncomfortable feeling that he is eating exactly what he ought to and he develops a sort of technological claustrophobia about it. Out in Indiana we raise and serve and eat the best food in the world—and I defy Henry Wallace to deny it tonight! Our Indiana porkers veritably fatten with honest pride at the prospect of becoming part of a Hoosier meal. An Indiana farm dinner, steaming on the kitchen table, constitutes about the best concatenation of vitamins ever strung together. And we have done it for years without ever knowing any of these vitamins by their first names—or even their initials. That kind of a dinner contains a vitamin you would not find in a laboratory—the psychological vitamin of human satisfaction. I shall name it vitamin Z, so the doctors can run theirs consecutively. Indiana food has been famous for a long time. In the days before we started to export it the difference was notable. Listen to what W. E. Wilson wrote in “The Wabash:” The Hoosier Is likely to be tall and rather lean. At one time, there was no taller civilized man in the world. Dr. B. A. Gould of the United States Sanitary Service, studying the statistics of the Civil War, discovered that “the Indiana men are the tallest of all the natives of the United States, and these latter are the tallest of all civilized countries.” The Hoosier’s height was probably the result of his diet; for the cereals of the North Central States are richer in proteins and show a larger number of heat units than the cereals of any other McNUTT—CHALLENGE OF NUTRITION 7 region of the world. In recent years, however, with standardized breakfast foods on every table and the consumption of corn, wheat, and rye no longer limited to the region in which they are grown, the Hoosier has lost the distinction of unequaled height. Wilson, you will have noted, was writing in the previtamin era. But he came out at the same place. Indiana food had what it took. The good earth of Indiana imparted life. And not the least of its virtues was vitamin Z. Food is not food for a Hoosier unless it has that. Do not think I am being facetious. I am very serious about this thing. Every first-rate dinner the world has ever seen—first-rate in rounded gastronomic satisfaction—has had those things many dietitians lace in tight unbending stays. The first-rate Italian dinner is not spaghetti and meat balls. That is just a perversion which arises from the fact that our industrialized city Italian workers have not been able to afford the abundant fruits and vegetables of their traditional diet. The good Italian dinner was not only fun—it was full of vitamins. Tortillas and beans are not any nation’s traditional food. They are only a remnant poor folks, can still afford. * * * So for schnitzels and breads three times a day. * * * I do not know the reductio ad absurdum of the Scandinavian diet, but I daresay the smorgasbord is one of the first things to disappear. You will sell your improvements more easily if you make them human. Not the tea “shoppe” but the T-bone steak should be the symbol of your progress. Public health and agriculture, government and industry, medical research and education, all these must team together if there is to be a balanced achievement as the result of this Conference. It is a great responsibility that faces you but it will pay to face it. It will pay even in terms of arithmetic. A recent Department of Agriculture study showed that if,all the families getting less than $100 a month had been able overnight to increase their income to that level, the result would be a 2-billion-dollar increase in food expenditures every year. That is dollars and cents increase. Good food is good business. If, with the help of the advertisers and the educators, the story public health and medicine have to tell could be put into such language that the great body of American people could be persuaded, American’s whole destiny would be a greater destiny than it could otherwise have been. It is up to this Conference to create the policy. It must be a clear and understandable policy. It must be a policy which will enable the housewife to find her way through a chaos of calories, salts and minerals, acids, alkalis, and vitamins. (Maybe we can get a common denominator for food needs.) It must be a policy which gives us a firm and acceptable basis for action. Let me close with reference to my administrative relationships with these problems. We have regulations and decisions to make under the law which are of interest to this Conference. We have several great bureaus, the resources .of which should contribute mightily to the ultimate success of the program that emerges from this meeting. 8 NATIONAL NUTRITION CONFERENCE Tomorrow morning, in all probability, the flour standards, which have been approved, will be published in the Federal Register. Hearings have been held by the Food and Drug Administration to obtain facts upon which standards for enriched flour could be based. For many reasons which industry especially will understand, it was decided to push ahead the effective dates of the standards to January 1, 1942, instead of having them effective at the end of 90 days—as is usual. One of the requirements for enriched flour will be riboflavin. But since these hearings were held new facts have become known. We find that there is not now the productive capacity necessary to produce the riboflavin necessary for such enrichment. It is quite possible that adequate productive capacity for this and other needs may not be available by January 1, 1942. Two factors complicate this picture: The kinds of construction necessary will involve negotiation as to priorities with the Office of Production Management; we are thus not immediately in a position to know how rapidly the new facilities could be built. The amount of riboflavin and other vitamins available for the millers may depend to some extent on the requirements of Britain, which, with restricted diets, may have a more urgent need than others. The industries, which have so completely cooperated with this program, can feel assured, however, that the solution will not be one which penalizes them for events outside their control. If necessary there will be a review of this matter in the fall. These measures the Conference is considering constitute an advance in the very responsibilities of government. Let me illustrate that advance by drawing a parallel between the work of two of the bureaus of the Federal Security Agency which are represented here today. The resources of the Public Health Service—the National Institute of Health and other research centers, the able scientific personnel, the administrative machinery for cooperation with the States and with professional groups—these are at the service of this cause. Consider, however, the history of public health: First came medicine with its attention concentrated upon the treatment of disease; preventive medicine came later. .Through the instrumentalities of public health, preventive medicine is being applied to the service of every man, woman, and child. In the same way the Food and Drug Administration, in its early history, was concerned solely with dangerous foods and drugs, with things which might poison, which might maim, or destroy the person who uses them; but the Food and Drug Administration, with its new concern for standards and labeling, is assuming a positive function in the protection of the consumer. Not only must the consumer be not disfigured or killed, he must get what he thought he was getting when he read the label. As new standards for nutrition are set, as new truth about food—some of it more fantastic than fiction—becomes the substance for advertising claims, the consumer and the honest business man may be assured that these new truths will not be misused by charlatans. The Food and Drug Administration will see that enriched foods are actually enriched, that they contain the elements their manufacturers say they do. Thus, the positive health McNUTT—CHALLENGE OF NUTRITION 9 of the consumer in terms of the potency of food will receive a required protection. The Office of Education, with its facilities for bringing this story to the schools, can contribute the channels for the creation of understanding. The National Youth Administration and the Civilian Conservation Corps can help to establish for the rising generation a consciousness of what good food means to the health of a family and the life of a nation. And, on that stubborn front of low income, the experience of the Social Security Board can help us a great deal. Its experience will help show us what our requirements mean in terms of family income. The food bill must fit the family’s food budget. The Federal Security Agency, and I believe every other Government agency, is ready to act. Now it is up to you to give us the platform for action. Mobilizing for Better Nutrition RUSSELL M. WILDER, M. D. Professor of Medicine, The Moyo Foundation, Rochester, Minnesota; Chairman, Committee on Food and Nutrition, National Research Council, Washington, D. C. Evidence to be presented to this Conference should convince everyone that the Nation is faced with a serious problem of malnutrition; that despite a so-called surplus of foods a great many of our people are not receiving the fare they need for strength of mind and body. The gravity of this situation, however, is not an occasion for crepehanging and bemoaning our plight. The hopeful and challenging fact is that we now have the scientific knowledge, the means, and the national will to do something about it. The national nutrition problem is exceedingly complex, however. Its solution depends upon the mobilization of all those sources of knowledge, activity, and good will which can be utilized for the improvement of nutrition for all the people. The various fields of national endeavor represented at this Conference give evidence of the total effort we shall have to expend in mobilizing for better nutrition. Significant studies made by the Federal Government as long ago as 1936 bear witness that this mobilization comes none too soon. These surveys revealed that in 1936 more than one-third of all families were buying food which could not provide a diet rating better than “poor”—by conservative standards. Not more than 1 family in 4 secured food which would provide a diet rated as “good.” The conclusions drawn from these surveys have not been found acceptable to everyone. There are some persons who do not feel that they apply today. They maintain that times have improved since 1936—average incomes and purchasing powers are higher. Many physicians have been critical of the results set forth on the ground that none of the individuals included in the statistical totals was subjected to personal examination. However, in later studies carried out in villages of North Carolina and Tennessee, in Toronto, and in several other widely separated cities, physicians have made careful examinations of the people, and similar conclusions were reached. In considering the total problem of nutrition, there has been criticism of the physician as well as by the physician. The scientists who, for 20 years or more, have studied nutrition in animals have indulged quite frequently in caustic comment on the failure of the medical profession to come to grips with malnutrition. Practicing physicians, by and large, have been slow to act on the developments in the nutrition field. I wish to take this occasion to explain this conservatism. The past forty years and more have been a period of dramatic achievement in many fields of medical science and of marked success 10 WILDER—BETTER NUTRITION 11 in the control of diseases caused by bacteria and related organisms. The accomplishment of the average physician, in the complexity of human pathology, is highly creditable. Few persons not trained in biology are even dimly conscious of the difficulties involved in the accurate diagnosis of disease. Nor has the physician failed, except in nutrition, to recognize the predominant significance of preventive medicine. He has given freely of his time to the campaigns which have been waged with marked success against tuberculosis, syphilis, and maternal ill health. His efforts usually have been made on a purely voluntary basis. Most of the legislation to which we owe that magnificent organization, headed now by Dr. Parran, the United States Public Health Service, has come about as a result of insistence by physicians. This is equally true of the fine collateral departments of public health in our several States. The medical profession has not been tardy, either—as workers in nutrition have sometimes thought—in granting early recognition to the new in science. Salvarsan was introduced in 1910, and by 1912 was in general use for the treatment of syphilis; insulin was discovered in 1921 and by 1923 was employed the world over. The value of sulfapyridine was recognized in 1938, and patients with pneumonia received its benefit almost immediately. Fundamental knowledge in the science of nutrition is of very recent origin—in fact, it is still being sought on a dozen research fronts. Many physicians received their academic education before scientific nutrition had accumulated the body of fact which today seems so important. Moreover, the earlier investigations were made in scientific fields whose relation with medicine was not so clearly recognized as it is today. These important contributions were published in journals which the average physician did not read, and became embalmed—so to speak—in the scientific literature. As in the initial years of any new science, the early findings were indeed vague and negative. According to a popular definition, “A vitamin is something that makes you sick if you don’t get it.” It could scarcely be expected that men trained in a school of tangible causes and effects should be greatly concerned with infirmities for which only a negative causation could be suggested, nor could they find much substance in so vacuous a conception. The average office practice of most physicians and even the wards of hospitals have not revealed much disability clearly related to diet. Most persons who are malnourished are scarcely sick enough to call physicians. If they do, it is for symptoms which the doctor in the past has thought were due to mental or nervous disorders. Doctors long have recognized severe deficiency diseases. Pellagra, when it came full-blown with red, scaly skin on hands and neck, a red, sore tongue, and diarrhea, was unmistakable. But. in most places, the number of cases of pellagra has been very small. We encountered dropsy in patients with tender nerves and other symptoms simulating the disease which, in the Orient, is known as beri-beri, but such clinical pictures were very rare. Frank scurvy, with its bleeding, swollen gums and skin spotted by blood which oozed into the tissue beneath the skin, likewise has been uncommon. Rickets in children was once terribly apparent, but of late years the general dosing of infants 12 NATIONAL NUTRITION CONFERENCE with cod-liver oil has decreased the conspicuous features of rickets. When it came to the recognition of the more subtle forms of malnutrition and their relationship with the vitamins, the physicians were wary. This is entirely understandable, for it must be remembered that diet, for centuries, has been a fertile field for quackery. Food fads have come and gone by the score. Physicians are perhaps more conscious of the evils of charlatanism than others without the same training. Furthermore, the early evidence on vitamins was limited for a long time to what was learned from animal experimentation. Physicians must be careful about accepting for man conclusions based on work with lower forms of life. I beg that what I am recording will not be interpreted as lack of appreciation of work in animal nutrition. Without the basic information thus obtained, the chemists could never have proceeded. My intent is, rather, to point out that the concept of vitamin activity seemed to the physician academic, rather than practical. The earlier suggestions in nutrition that this or that vegetable or fruit was an excellent, a fair, or a poor source of this or that ill-defined activity were unconvincing to a profession becoming accustomed to methods of precision both in diagnosis and treatment. Thus, physicians demanded other evidence that the newer knowledge of vitamins applied to man. That evidence was forthcoming in the contributions of brilliant chemists who isolated or made available by chemical means the vitamins in forms which could be tasted, smelled, weighed, and measured for effect. Additional evidence came from nutritional physiologists, chemists, and clinical investigators. Methods were determined for measuring with precision the amounts of each of the several^ vitamins contained in foods. Methods of determining the amount of vitamins in blood and urine were likewise established so that diagnosis of vitamin deficiency could be made in the clinical laboratory. Physicians can now think and work in terms of micrograms of vitamins with chemical names. At least this is true for several of the vitamins. The chemical designations of these substances provide a distinct advantage, for the use of alphabetical designations—A, B, C, and so on—created much confusion. With these tools at hand, physicians have in recent years begun to display the long awaited interest in scientific nutrition. After all—as Director Wilson has remarked—in a dynamic society we cannot demand complete scientific knowledge before acting. “Greater mistakes will be made by waiting for the golden age than by acting on knowledge at hand and changing our course as newly acquired knowledge may suggest.” Another reason for the growing acceptance of nutritional science by physicians is the increasing knowledge of the actual requirement, per person, of each of the several nutrients contained in food. We know today, beyond all doubt, that the average American diet does not provide what men and women ought to have, nor what the children of today need to become vigorous citizens of tomorrow. In consequence, physicians now are even more concerned than are some of the scientists with the problems of health which malnutrition has created. Specialists in diseases of children were first to crystal WILDER—BETTER NUTRITION 13 lize their interest, but of late, discussion of some aspect of human nutrition finds a place on the program of nearly every medical gathering in the Nation. The American Medical Association organized a Committee on Foods some 15 years ago. This body, composed of a group of leading nutritional scientists and a number of physicians, undertook to inform the medical profession and the public concerning the reliability of nutritional claims made in connection with advertising and labelling of foods. This earlier Committee more recently has been renamed the Council on Foods and Nutrition. As such, it is concentrating attention on the nutritive qualities of foods in general use and on the effects of various methods of processing, distribution, and preparation on those qualities. When the President called the National Nutrition Conference for Defense, the Council on Foods and Nutrition and the Board of Trustees of the American Medical Association pledged to it their full support. They recognize the need for awakening public interest in the many problems here to be considered. They appreciate, however, that many kinds of experience are required to solve effectively the diverse problems facing us. Physicians in every community will cooperate in what needs doing, but with them must be ranged many other groups with other special training. Guidance is demanded from experts in nutrition. To provide this guidance, the Committee on Food and Nutrition of the National Research Council has been organized. ,0 Food habits offer difficulties which only experience in psycholb'gy and education will overcome. Assistance here can be looked >for from the Committee on Food Habits, now organized by the National Research Council. •••,’ »° Economics is importantly involved in any consideration0 for the improvement of national nutrition. Here the advice of the socikl economist is essential. Z"/ Very many families are unable to secure enough “protective foods?* Milk, meat, eggs, fresh vegetables, and fruits are relatively, expensive. Whole wheat bread and other whole grain cereals are perishable—a factor which adds to the cost of their distribution. The farmer in most cases can keep a cow and have a garden and an orchard; but on some poor lands, this is impossible. The city dweller, however, is always dependent on the market for the variety of foods available to him and for the amounts which his dollar will purchase. Families with incomes below a certain level must have assistance in tangible form if they are to secure the foods which provide an adequate diet. Assistance may take the form of a money dole, or it may involve the direct distribution of food. Experience has shown that money payments, as a rule, are ineffective. Distribution may be accomplished by means of tokens or stamps, good only for the purchase of food and not interchangeable. The Food Stamp Plan of the Surplus Marketing Administration has succeeded amazingly. I was told by a physician in New York that the clinical complexion of the clientele in a large dispensary changed dramatically after the Food Stamp Plan was introduced in that community. Before its adoption, almost every patient was overweight or underweight. (And I may say that overweight is as common a symptom of malnutrition 14 NATIONAL NUTRITION CONFERENCE as is underweight.) Many of the patients also presented other signs of malnutrition. After the adoption of the stamp plan, the appearance of more than half the patients decidedly improved. Indeed, one of the women patients declared, “Doctor, I’m beginning to live again!” Another way of supplementing the diets of low-income families is to distribute food in kind. This can be done by some arrangement for communal feeding. The school-lunch program, so long in operation in this country, has proved its value. Sir John Orr, Director of the Rowell Research Institute in Aberdeen and Director of the Imperial Bureau of Animal Nutrition, recently wrote from England that when the school-day diets of malnourished children were supplemented with milk and other protective foods, their ability to learn markedly improved. In a private school in Connecticut, where malnutrition had not been conspicuous before, the average grades rose 10 percent when special attention was given to the nutritional adequacy of the food served. Similar methods of improving the nutrition of industrial workers have produced encouraging results in Britain, according to Orr. The introduction of supplementary meals in factories has been followed by an increase in production and a marked reduction of accidents. A method of attack of special value is to improve the nutritional qualities of certain staples, which, because they are inexpensive, form an unduly large proportion of the diets of families with small in-comeg. It is almost impossible, even for experts, to plan nutritionally good diets costing less than 20 cents a day when the sugar, flour, rice, and edible fats have had most of the minerals and vitamins removed by methods of refining. In some foods, all of these valuable elements have been lost. < It is’here that the several food industries must mobilize. The expedient'already adopted for flour and bread has been to fortify these staples bycthe addition of iron and certain of the purified vitamins. It does not represent the ideal solution of the flour-bread problem, but neitfiej’ in my opinion does any other course available today. Brown bread has never been acceptable to more than a very small number of the population and for many persons the irritative action on the bowel of the bran contained in undermilled flours is undesirable. The miller, in time, will be able to present us with a white flour, so made that it retains most of the vitamins and mineral values of wheat. But, until he learns how to make such a flour—and that will take time—addition to plain white flour of those vitamins which the National Research Council’s Committee on Food and Nutrition has prescribed for flour and breads labelled “enriched” will do much to facilitate the planning of good diets. Many uninformed persons have blamed the food industrialist for our diet problems. The criticisms in large part have been unintelligent and grossly unfair. Modern methods of processing were developed before there was knowledge of vitamins and they have contributed importantly to improving the sanitary quality of foods. They also have provided products with better cooking qualities. In some processing methods^ the vitamins are better preserved; in others, they are lost together with other nutritive essentials. Before altering accepted procedure, the food processor, like the physician, de WILDER—BETTER NUTRITION 15 manded proof that human diets needed changing. Only recently has the evidence convinced him. Nutritionists have been aware of a shortage in diets of vitamin A, calcium, and iron. The natural food sources for these are the green, leafy vegetables, milk, and butter. Many people obtain too few pt these. Unable to purchase butter, they use in place of butter, either vegetable or animal fats which carry no vitamin A and may be lacking in other nutritional values. Something must be done to improve the nutritive qualities of the vegetable and animal fats, as now distributed. A problem the food industry must face is the need for larger distribution of milk than now obtains. The nutritional inadequacies of sugar create difficulties. Many diets are inadequate in protein. A wider distribution of lean meats and of leguminous proteins such as are contained in the peanut or the soybean would be advantageous. It would not be appropriate here to elaborate further on individual aspects of the problem. I have mentioned some of them only to illustrate that much lies beyond the physician’s sphere of activity. Success in the nutritional campaign demands leadership from many groups. The responsibility indeed is shared by all of us. Viewed selfishly, it is as much to my interest as to my neighbor’s that he and his children be well nourished—if only for the reason that today all of us need, as never before, the assurance that comes from united strength and well-being. Fortunately, an army of women, trained in schools of home economics, is already in the field. They have been there for several years, holding the front, so to speak, with almost no support and very little appreciation from the rest of us. The job of feeding the family is not woman’s work alone, as men so often have supposed. Responsibility for the health of the family is as much that of the husband as of the wife. The county agent, the Farm Security agent, and others in the agricultural service have left too much to the home demonstration people. Encouragement of home gardening and a family supply of milk and poultry is much more the responsibility of the men in these services than has been recognized. One division of the nutrition army already in the field is composed of dietitians. They are invaluable assistants to physicians. We frequently are unable to devote the necessary time to teaching patients now to put in practice what we prescribe. Dietitians receive excellent training. Their numbers need augmenting to permit their wider employment in maternal and child health centers, in community feeding projects, in dispensaries, and as teachers of nutrition in many other situations. The dental profession has been creditably active in nutrition, sometimes with greater zeal than wisdom. More emphasis on the fundamentals of nutritional physiology is desirable in schools of dentistry, as it is in schools of medicine. Nurses likewise ought to receive more training than they do in the principles of sound dietetics and nutrition. The machinery for government regulation of foods was devised to prevent the sale of spoiled, adulterated, or misbranded foods. With notable exceptions in certain bureaus of the Department of Agriculture, little attention has been given to the nutritive qualities 16 NATIONAL NUTRITION CONFERENCE of human foods. The interest in general has been more in protecting pocketbooks than health. Also unhappily some food legislation has discriminated in favor of special-interest groups with large political influence to the detriment of the public at large. Here also criticism must be tempered with appreciation of the fact that proof of damage done has only lately been presented. Our legislators and public administrators are now hearing about nutrition for the first time, and from now on a change in emphasis may be anticipated— more attention to nutritional needs by administrators and by legislators ; greater resistance to political pressures that affect unfavorably the nutritional needs of the people. Last to be named, but foremost in importance, in this army which now is mobilizing on the nutrition front, are the people in research— the pioneers with the courage and what else it takes to scout in advance of the main forces, to locate the enemy and establish outposts. Nutrition is a newcomer in the ranks of science and much remains to be learned about it. Other vitamin activities are yet to be discovered; a number of vitamins await isolation. More knowledge must be had about the chemical mechanisms involved in these activities, about the dependence of one vitamin on another, and about relationships between vitamins and the various salts. A new world awaits exploration. We are mobilizing now for a military emergency, mobilizing on many fronts. The outcome, if war is prolonged, will be determined in large measure by what we do with our foods. In summary, I again express my confidence that the physician, aware of the seriousness of the problems presented by nutrition, will cooperate in the campaign for better nutrition with the same zeal he has exhibited in other public health activity. In the application of nutritional knowledge to the treatment of disease, his leadership must be sought and recognized. The over-all problem of national nutrition is beyond the physician’s immediate sphere of action, but its solution will be the more speedily attained if his sympathetic support becomes an integral part of the program. The campaign for better nutrition is complicated by cultural, social, and economic problems. The principal battles of the army of nutrition will be fought in fields of education, economics, and industry. Guidance can be provided by research, but the success of the campaign will depend on the effort of each of the several groups with special training that now are gathering for action. Plans for the Conference DR. M. L. WILSON Director of Extension Work; Chairman, Nutrition Advisory Committee to the Coordinator of Health, Welfare, and Related Defense Activities In speaking for the committee on arrangements, I desire to emphasize by restatement two important points made in Governor McNutt’s address: First, the President of the United States calls but few national conferences, and, second, the national conferences that have been called in the past have laid the foundation stones for activities of the greatest importance to the welfare of the Nation. The Conference on Conservation, called by Theodore Roosevelt, laid the foundation for a Nation-wide consciousness of the waste of our national resources—and what to do about it. Likewise, the White House Children’s Conferences have awakened the Nation to the great importance of children in our democracy. They have greatly stimulated the thinking and actions of what we of an older generation can do to prepare the growing generation for the heavy responsibilities that will soon be theirs. This Conference has an equally heavy responsibility, the responsibility of arousing the Nation to the importance of the nutrition problem both in a period of defense and in the long vista of the future. This responsibility rests even more keenly upon us when we realize that we are representing thousands of qualified, public-spirited, and zealous men and women who could not be invited to this Conference simply because no auditorium in Washington could have held such a gathering. The decision which our executive group was forced to make—to designate this a delegate-planning conference limited to persons chosen as equitably as possible for geographic, professional, and group representation—was most difficult to make. We knew that there were hundreds of scientists, physicians, educators, welfare workers, representatives of producers, industry, distribution, and consumer groups plus the thousands of lay persons who are contributing so much to this broad program of nutrition, who were eminently qualified to come to this Conference here in Washington. We hope they understand the physical impossibility of inviting all of them as delegates. You and I pledge ourselves to represent them here to the very best of our abilities. Our executive group in planning this Conference was also faced with a difficult problem in the assignment of delegates to the various sections. We are limited by time as well as space and the over-all problem of nutrition is so vast that the number of sections into which it could properly be divided for study is many times the number we have established. This afternoon and Tuesday afternoon are to be given 17 18 NATIONAL NUTRITION CONFERENCE over to nine sectional meetings. Most of the delegates have been assigned to these sections for committee work on these two afternoons. The Conference planning committee has endeavored to organize these sections so as to give a composite rather than a narrow representation in each. In other words, we have endeavored to have represented in each section most of the various interests which are involved in this Conference. The sections are expected to bring forth their reports at the end of the Tuesday afternoon session. It is hoped that these reports will be concise and deal pretty largely with policies; “what should be done,” rather than the details of “how to do it.” In each case the recommendations should be the result of discussion and general agreement on the part of the section. The general recommendation of the Conference will be based on these section reports. The Wednesday morning program will be devoted wholly to three matters. First, such discussion as the limits of time permit of the reports and findings of the nine sections; second, short statements pertaining to the problem and what is to be done about it, to be made from the floor; and third, the recommendations to the President. We think it wise to have a rule that the Wednesday'session will be confined to the recommendations which were made by the sections and that in order for a proposal to get before the Conference as a whole, it must have originated in and received the approval of a particular section. Otherwise, we feel that the Wednesday session might easily become involved in the many detailed ramifications of matters pertaining to human nutrition. The reports of each section will be given to the public as an integral part of the Conference and will not be brought before the entire Conference for its approval. The entire Conference will express itself in the statement of what should be done, which will be presented to the President. Conferences of this kind necessarily make their recommendations to the President in the form of broad policies, policies that point out what should be done. It is also the duty of this Conference, once policies are agreed upon, to indicate the responsibilities of local, State, and Federal governments; the responsibilities of physicians, educators, producers, processors, distributors, and consumers; the responsibilities of men of science, of lay organizations, and of the individual citizen. But this second duty is a highly complicated task—it involves cooperation and teamwork, it involves understanding, and, above all, it demands a common objective. That is why, with over 900 delegates from all over the United States, representing different backgrounds and experience, it is all-important to agree on a common objective, to give to the President of the United States a set of recommendations so vital and basic that no matter what differences of opinion may arise as to methods or procedure there can never be any difference of opinion as to our purpose. For the same reason, and because of our limited time, it is important that we refrain from spending too much time in extensive excursions into areas where definite policies already exist. Tomorrow morning’s public session to which the general public is invited, will present, through the Secretary of Agriculture, the Secretary of Labor, the Assistant Secretary of State, and the Assistant Administrator of the Office of Price Administration and Civilian Sup WILSON—CONFERENCE PLANS 19 ply, the policies of their respective branches of Government as they affect the nutritional status of our people. Since those policies have already been forged out on the democratic anvil of legislation and action, we would be wise to accept them and to focus our attention on the unsolved problem of the quality of the nutrition of our fellow men. We can and should agree, for instance, that the work which we do here must be carried forward by the men and women who actually live in the homes and communities with which we are concerned. The establishment of State Nutrition Committees, with Dr. Helen S. Mitchell acting as liaison officer between them and the office of Coordinator Paul V. McNutt, has already been accomplished. Here is the framework necessary for successful application of our recommendations. Next, by recommending the calling of State and local nutrition conferences, we can impress our purpose on every home and community group in the United States. There is no limit to the aid and cooperation we can enlist if we see our problem clearly and phrase our recommendations boldly and dramatically. I especially desire to make a statement to the Conference regarding the report of the Committee on Food and Nutrition of the National Research Council, which is just released, regarding nutritional allowances. Because of the great importance of food and nutrition in defense and military activities, nutrition was quickly recognized in the organization of our great defense effort which was set in motion about a year ago. From the Federal angle, 2 important steps have taken place : 1. Nutrition was recognized early in the setup of the National Defense Advisory Commission and later in the responsibilities of the Coordinator of Health, Welfare, and Related Defense Activities. A Nutrition Advisory Committee, on which were representatives of the various departments and agencies of the Government interested in nutrition, was created for the purpose of developing coordination and planning on the national level. 2. Since many of the policies involved are of a scientific nature they should rest upon the judgments of competent people in the sciences involved. Therefore, the National Research Council, one of the functions of which is to mobilize the Nation’s science in time of need, was asked to create two scientific committees—Food and Nutrition and Food Habits. These committees are playing a prominent part in our national nutrition activities in supplying the basic scientific judgments which must underlie any effective program. We are fortunate in many ways that many activities have been going on in the last quarter of a century in relation to nutrition, which in this time of emergency bear most valuable fruit. There has been a great expansion in scientific research in this field j there have been widespread developments in the diffusion of scientific knowledge through the various agencies of education and public information. There has been the conservation and building up of fertility of the soils of the country through widespread soil conservation policies and a large reserve of feeds and cereals has been built up in the ever-normal granary. We have been getting an 425544®—42-------3 20 NATIONAL NUTRITION CONFERENCE important inventory of our nutritional status as a nation. We are fortunate that research work carried on in the past 10 years gives us some approximation as to the size and nature of the problem of insufficient human nutrition. One of the early actions of the Nutrition Advisory Committee was to request the National Research Council Committee on Food and Nutrition, under the chairmanship of Dr. Wilder, to make recommendations as to immediate emergency steps which it would be practical to take in the direction of improved national nutrition. The National Research Council Committee promptly presented the problem of the loss of vitamins and minerals through the over-refinement of certain of our staple foods. They recommended that appropriate steps be taken either to conserve the vital elements removed in the milling process or to restore to white flour the most necessary elements lost in the production thereof. Growing out of this recommendation has come the present widespread activity in connection with enriched flour and bread, which we believe to be so vital in the present situation. In this present activity science, government, industry, and consumers are cooperating in a most splendid manner. What is now going on is a fine example of what we can effectively do in a national effort. The Committee on Food and Nutrition was also asked to evaluate past and present nutritional research, and on the basis of this research and of scientific judgment, to present a statement of nutritional allowances. In the light of present scientific knowledge and scientific judgment, what should be the intake of calories, or proteins, of important vitamins and minerals in an ideal diet ? In making this request, we realized full well that science is a dynamic, developing thing, and that what seems to be valid today may be changed or modified tomorrow by the growth of scientific knowledge. We realize that such allowances are always tentative, always subject to modification and change. Yet they are extremely useful as a yardstick with which to measure the distance toward our goal. I am happy to report to this Conference that the Committee on Food and Nutrition of the National Research Council has complied with this request and has released a table of dietary allowances which has just been mimeographed and will be available to the delegates and guests at the conclusion of this session. In interpreting scientific nutritional allowances it should be made clear to all that no one is recommending a single diet or is doing anything which upsets the normal competitive relationships of our great variety of health-giving foods. The possibilities in our diets are as wide and varied as the richness and diversity of our land and individual tastes of our people. No other nation, in fact, no continent, has so rich and varied food resources. We have all the cereals and all the other foods of vegetable origin, all the milk and milk products, all the protein and mineral-supplying meats and animal products, all the fruits and vegetables from the apples of Wenatchee on the Canadian boundary to the citrus fruits and winter vegetables of our sunny winter climates. The second committee of the National Research Council—which deals with food habits—is organizing research and mobilizing judgment in an important field which parallels the biological. The more WILSON—CONFERENCE PLANS 21 light that is thrown on this whole phase, the more effective will be the educational processes involved in improvement of our food habits. We are gratified by the increasing cooperation of public and private research agencies in the field of nutrition. On behalf of the Nutrition Advisory Committee may I take this occasion to thank the National Research Council Committee for the painstaking and laborious task which it has performed in connection with the development of food allowances. The scientific modesty with which they have been presented makes us all realize the incompleteness of scientific knowledge and the great need for the expansion of research as it relates to this field. I think we can all agree with the proposition that no man, woman, or child in the United States should be allowed to starve. That is the very least this vast and fruitful land should promise its sons and daughters. But having pledged ourselves to that proposition we find we are committed to a good deal more than might be imagined. We find that starvation can be hidden, subtle, and slow, as well as desperate and dramatic. We find that science has uncovered starvation in places where it was not supposed to exist, in high and middle places as well as in the low. Call it malnutrition, call it undernourishment, call it dietary deficiency, or what you will—when men and women and children fail to eat the foods that give them full life and vigor, they are in fact starving. Here then is the challenge we must face: We are pledged to the proposition that no one in mis great democracy shall starve even with hidden hunger and we are faced with the fact that 40 percent of our people have poor and inadequate diets. There is no need to apologize for this condition, though there is urgent need to do something about it. Bad food habits, careless food preparation, the evolution of food processing explain in part the large percentage of unsatisfactory diets in the United States. As a matter of fact, our diets are as good as those of any place in the world. We are a well-fed people compared with the dietary levels in most parts of the globe. But we are not well fed in relation to the productive potentialities of our land and labor. In the totalitarian countries food is a weapon, a bait, and a lash to be used to bolster the morale of shock troops, to enlist the skill of craftsmen from other lands, or to weaken the resistance of the conquered. In America food is a boon, the gift of God’s good earth. That is why we would be criminally careless and unworthy of our heritage if we failed to dedicate ourselves to the proposition that none of us shall starve. This duty becomes especially imperative in view of the fact that we have the agricultural capacity to provide a good diet for the whole population. We have, as a matter of fact, some food to spare. We are in the twice-blessed position of being able to feed ourselves and others, a position that may prove to be all important when the starving and shattered nations of Europe gather round a barren peace table. Meanwhile during the black months or years of war that may lie ahead, we must consider the nutritional status of the Nation as a 22 NATIONAL NUTRITION CONFERENCE whole, as well as the status of its individuals. In primitive times, through a process of natural selection and survival, the people chose the best available foods. Thus nations which did not or could not make a wise choice died out. They were conquered by an enemy from within—by slow or fast starvation. We, in this great Nation, have the inestimable advantage of being able to choose wisely—if we will. And in these days of all-out national defense, when the ever-increasing demands for ever-increasing production call for optimum physical vigor and morale, it behooves us to choose wisely. MONDAY EVENING, MAY 26,1941 Nutrition in the First World War and Now JOHN R. MURLIN Professor of Physiology, University of Rochester I have rewritten this speech every time I have heard a speech today. Now, since Mr. Taft has used the figures regarding the selective service rejections, I have to rewrite it again. I am in the position of the intoxicated gent who was found sitting on the curb writing a letter. When asked to whom he was writing, he said, “To myself.” “Well, what are you saying to yourself?” his friend asked. “How do I know?” he said. “I won’t get it until tomorrow.” So I really do not know what you are going to get. The title of this paper is correctly reported to you, but the subtitle, which I scratched out, was called “Changing Emphasis in Nutrition.” Perhaps that describes it quite as well as the title announced. The two are not very different. In the development of our knowledge of foods and their values to the human body, there have been four definite phases. Following the great work of Liebig a hundred years ago there was the composition phase. The question of great interest was, of what do our roods consist ? Following the observations of the pioneer Beaumont, the first physiologist in this country and the first man ever to see digestion going on in the human stomach, and following the discovery of the digestive enzymes some years later, came the digestibility phase. The question was, what foods are most easily digested? Then came the calorie phase, when the question of greatest interest was, how much energy does the food contain, and how much does the body require? This phase, of course, began with Lavoisier 150 years ago, but was not widely prevalent until the work of Voit and Rubner in Germany and of Atwater and Lusk in this country. We are now in the phase where the subject of greatest interest is. what foods of each class are of the greatest biological value? It includes all the modem development of vitamins and biological values of proteins. Each of these phases has risen to a peak of predominant interest and left a prominent contribution, each now continues to make prominent contributions to knowledge, but has given way to the subsequent phase as the center of interest. It would not be difficult to fix an approximate time during which each of these phases was in the ascendancy. It is more important, however, for us to realize that none of them has completely died out. We still need to know what foods consist of, and this knowledge needs to be made far more particular and complete. We still need to know what foods are more digestible 23 24 NATIONAL NUTRITION CONFERENCE and why, which foods contain most energy or energy in most available form; and, more exactly, how this energy is made available for all the different physical processes, including the part played by the vitamins in these physiological processes. But the center of interest today again is quality. Why are certain foods better for us than certain others which are equally digestible and contain as much energy ? The answer is found partly in the vitamins, which do not undergo digestion at all and do not yield energy in any measurable quantity, although they contribute importantly to the release of energy from other foods, and partly in the chemical structure especially of the proteins. When the World War began we were just entering the vitamin era. McCollum and Mendel independently in the year just preceding the World War, namely 1913, had recognized the first fat-soluble, fat factor, which later became known as vitamin A. We are now riding the crest of the vitamin wave. You know it is rather precarious sometimes to be on the crest. It all depends on how the wave will behave. If it tips over and breaks, as waves do on the seashore, it may do harm, so I am trustfully living in the belief that we are going to come down off the crest of vitamins safely. The method of estimating the biological value of proteins had been introduced by Thomas in 1909. It had made no progress in this country until McCollum in 1921 and Mitchell in 1924 had clarified the issues. A few minerals were known to be important but had not yet come to full recognition, and the importance of trace elements was quite unknown. Consequently our principal interest in the first World War was energy supply, the distribution of calories to the three organic foodstuffs; general, wholesomeness of foods, with some emphasis on quality of proteins; also certain of the minerals were mentioned; and cautiously we talked about fat-soluble A and water-soluble B. My own experience at that time, as you heard, was in connection with the United States Army. Mr. Taft misspoke when he said I was chief adviser to the Government. It was only to the Army. The objectives of that division of food and nutrition in the Surgeon General’s office, were stated in the application for authorization which was addressed to the Chief of Staff and through him to the Secretary of War, a statement by the way, which was concurred in by several of my associates then on my advisory committee who are active in this Conference. The statement was as follows: That the purpose of the division [which was something entirely new in the Army] would undertake to safeguard the nutritional interests of the soldiers, first, by means of competent inspection of the food supplied to the camps with reference especially to its nutritional quality; 2nd, by seeking to improve the mess conditions with special attention to the matter of food economy, bearing in mind that palatability and proper cooking are great factors in determining the utilization of food in the physiological sense no less than in the financial sense; 3rd, by studying the suitability of the ration as a working man’s diet, tested for the proper amount and distribution of nutrients. An intelligent alteration of the rations from time to time must be based on the facts, and it is the purpose of this division to secure the facts. In contrast with the interests as they were thus outlined for the Army in 1917, there was going on at the same time, in relation to MURLIN—FIRST WORLD WAR AND NOW 25 the general population, an intensive drive for the incorporation of larger amounts of milk and other dairy products in the diet to see that there was an adequacy of this new factor called fat-soluble A as well as more calcium and phosphorus. That was one of the chief points emphasized. The Army was afraid of milk for fear the drinking of milk might develop milksop soldiers. They did not want soldiers to drink milk! This drive for greater consumption of milk had already produced an increased consumption of milk, and as we all know now the educational efforts of this pre-war period and the war period itself bore fruition in later years in much greater consumption of milk, butter, cream, and cheese. We might summarize, then, the principal nutritional interests of the first World War days, Army and civilian population included, as contained in the following expressions: Adequate calories, good quality protein (and all we could say in those days was class A proteins and whatever came below), increased milk consumption, and thereby improved mineral nutrition. The emphasis on the few vitamins not yet called vitamins very widely, but rather “accessory factors” was, of course, cautious, and wholly determined by the recency of their discovery. In the intervening years since the World War, we have seen an enormous increase in our knowledge of vitamins. First came vitamin C, so named, at least, in 1920; then vitamin D in 1922; vitamin E in 1923; the recognition of vitamin G, as it was then called, or as it has also been called, vitamin B2, as the heat-stable factor of the B complex, in 1926. More recent developments concern especially the several fractions of the B complex and the importance of vitamin K. We now have at least also four methods of determining the biological value of proteins. The agreement between those methods is reasonably good, although they do not read in the same scale. They have to be interpreted one with the other, and the agreement between observations on lower‘animals and those upon man agree also reasonably well, so much so that we are led to believe that what is good tor a rat in the way of sustaining growth of his body substance is also good for man. The figures quite often are strikingly similar. In the B complex we have not only the recognition of several new factors but an entirely new terminology growing out of the chemical identification of these factors. Six such factors are now available in chemically pure form, and without the achievements of the synthetic chemists working with the nutritionist we could not embark on the new program of vitamin enrichment of flour, shall I say for better or for worse ? I have put it that way because experiments in my laboratory have impressed me a great deal. These experiments conducted by my associate, Dr. Nas set, on dogs, have shown that when six of the synthetic factors now available are added to a diet otherwise free from B vitamins the dog is still very deficient, but when yeast is added, the deficiency at once clears up, and what seems more important, digestion is notably improved. The only one of the synthetic factors with which Dr. Nasset has had any experience that can be shown 26 NATIONAL NUTRITION CONFERENCE to have any favorable effect on digestion is pantothenic acid. On the other hand, he cannot show that any of the others is harmful. They seem to be entirely neutral in the organs where they find themselves mixed with the food. Thiamin, riboflavin, nicotinic acid—I hope for the sake of the timid that the last one will have a new name before long—ascorbic acid, calciferol, and vitamin K have been found to cure specific deficiencies in truly miraculous fashion, but we know very little about the physiological rectification by which these cures are effected. There is need for intensive effort to learn what enzyme system each vitamin fits into, because many of them are known already to fit into the tissue enzyme systems, and how they affect other organs than those exhibiting the specific lesions associated with deficiency; for example, the digestive organs, the circulatory system, and especially the nervous system. Great profits await the courageous investigator into those fields. On the recommendation of the Committee on Food and Nutrition of the National Research Council, as you have already heard, certain factors which are now available in chemically pure form are to be incorporated into white flour and bread without raising the price of bread; at least we hope it is going to be without raising the price. Why not go the whole figure and restore all the factors? Some comments have been made on this already. At the present time that can be done in only one way; namely, by producing whole-wheat flour and making whole-wheat bread. It is only fair to say that progress is being made in producing whole-wheat breads that are acceptable to people who like a little more flavor in their bread than one gets from ordinary white bread. But in the meantime people who prefer the white bread will at least get a better bread than they have been having for many years past. The two factors most needed just now to safeguard the health of this country are the ones which will be incorporated first, and as you heard this morning, no doubt riboflavin, the third, will be available by the first of the year. The Committee on Food and Nutrition is well aware that other factors than those two are needed to restore white flour and bread to the full complement of factors contained in the native wheat. Encouragement is given to every means of increasing gradually the proportion of the whole wheat obtained in the flour and hence in the bread, insofar as it can be made acceptable to the consumer. I want to say that I gave my consent to this proposal of enrichment rather reluctantly, and was greatly reassured when I knew the Committee was going to work by these other means; that is, the gradual increase of the extraction from grain of more and more nutrients. That will be a part of the program as well as the program of enrichment. No pressure is to be placed on the consumer to take a bread he does not like for the very good physiological reason that unless food is enjoyed—unless it is appetizing to the person eating it, not to somebody else—it is not so promptly digested and utilized. A great deal of work remains yet to be done to get perfectly satisfactory recommended daily allowances. As you have already heard, the ones that have been recommended to you are good guesses, but they are not final by any means. I think two speakers this morning placed emphasis on this point, and I need not say any more about it. MURLIN—FIRST WORLD WAR AND NOW 27 I wish only to add this—as a man who has had a good deal of experience with human subjects as experimental subjects, it is my experience that the species Homo laboratoriensis makes a very good rat. He knows what the experiment is about. At least he has that advantage over the rat. He gives his full cooperation willingly, and the rat has no alternative. Several citations could be made of important current work on human subjects; for example, the recent work of Williams and Wilder on thiamin on human subjects is one of the most illuminating studies we have had with that vitamin. I make this appeal for more and more experimental work on human subjects for a special reason. We all realize we can get along faster, pile up observations much more rapidly with small animals, but we are still in some doubt always as to the strict applicability of the results to ourselves. The moment we get perfectly satisfactory demonstrations of vitamin effects on man doubt is resolved at once, and more and more work on human subjects will help set the proper daily allowances. I might cite another example of a very pertinent, as it seems to me, experiment on human subjects which came to us from England not long ago. The first one I heard of was by a man by the name of Capon, who was working in a recruiting camp. He took 33 of the men who were considerably below acceptance standards, put them in a special squad by themselves, gave them remedial exercises as well as a graduated course of physical training, and fed them a diet including plenty of milk, butter, fruit, and fresh salads. The quantity of protein ana fats was high. In 6 weeks 21 of the 33 passed the examination satisfactorily, and 6 more were almost up to acceptance standards. Still more striking demonstrations along the same line have been made, as you no doubt have read in the popular press, in a reclamation camp set up by the R. A. F. to rescue men who fell below the acceptable standards and to reclaim them for service in the air. This work has been going on at Canterbury for nearly 2 years. The results have been very similar to those I gave. I hope we may see such conditioning camps set up in this country soon. Now I come to a repetition of what Mr. Taft has already told you, but I will modify it just a little bit. In spite of our knowledge oi nutrition gained in the past quarter century, the percentage of rejections in the selective service today is as high as, or higher than, it was in 1917, and the causes are substantially the same. Something needs to be done. Knowledge, as Sir Richard Gregory has said, is like energy. It is capable of doing work, but first it must be changed from the potential state to the kinetic or moving state. Knowledge is like a rock set up on a shelf. It does no harm, and it does no good, so long as it rests there, but let somebody jar the shelf and let the rock fall off, and then something happens. That is the state of things today. We know more than we are doing. We must remember also that the best diet in the world alone will not accomplish the state of physical and mental fitness we should like to see in all our people. It must be accompanied by physical training appropriate to the age and sex, and most important of all there must be the will to improve. As President Roosevelt has said to us so many times, “It can be done.” 28 NATIONAL NUTRITION CONFERENCE Bad teeth, as you have heard from Mr. Taft, constituted the most important cause of rejection. I wonder if there is not something of considerable significance in the observation of Knudsen in Denmark, who saw that the few children in that country with perfect teeth, had also perfect backs, both skeletal and muscular. We are all familiar with the poor dentition that accompanies or follows rickets. Another feature of it is the poor and shrunken, often pinched-up chest, and of course, consequently, a pinched-up and poorly constructed back. Does not muscular development promote the development of stronger bones and teeth ? I have a fear that we may be caught up in a craze for specifics. Many of us grew up without ever tasting cod-liver oil and yet developed good bones and good teeth. We never tasted any vitamin concentrate, much less a pure one. The hard work which boys and girls on the farm were required to do 50 years ago is not adequately replaced by cheering for the favorite team from the side lines. More calories from the protective foods, the foods the farm boy or girl 50 years ago got as a matter of course, together with play and work, in sunshine and fresh air, are the things that will get us along to our goal of perfect nutritional health. I repeat, the best diet in the world alone cannot do this. You can feed a person full of vitamins; but if you set him off in a corner and let him stay there, nothing happens. There must be active participation of the organs and tissues of the body. They must be exercised, both brain and brawn. As Lindhard has said, a young man who has been through a satisfactory physical training bears the stamp of controlled force. How many of our youth today, except those who have been through their training in the camps, do you see that give you the impression of controlled force? The emphasis has changed remarkably. Since the World War new knowledge has been gained, and the emphasis naturally follows the newer knowledge, because much of it interprets the old knowledge; but that is not to say that the old knowledge is no longer useful. Unlike the military establishments we do not need to scrap the old weapons. We need merely to add new ones and to rejuvenate some of the old. There is this difference, also, between our day and that day of 1914, especially from 1917 on, when we participated in the war. We have at the present time no shortage of food. You remember that we had been selling food to the allied nations for about 3 years before we became a partner of the allied nations. And that was one factor in the scarcity of food. We had war bread, and we had meatless days, and we were getting on toward the days when we were warned we must cut down on the consumption of fats. It did not actually come to amount to anything, as I recall, but we were warned it might come. In case we have a period of stringency, and of course we may have earlier than we expect, such facts as the following will be of interest: The economic saving of whole-wheat bread over the common, lean white loaf. The average per capita consumption of wheat is 4 bushels, or 240 pounds. I think that is not far off—it applied a few years ago. Deprived only of its roughest constituent, 2 percent only by weight, ground without any sifting or bolting whatever, that amount will MURLIN—FIRST WORLD WAR AND NOW 29 make 355 pounds of bread as compared with 221 pounds on a rich formula from 73 percent extraction of the grain. The 355 pounds of whole wheat, according to digestibility figures in a recent experiment on 10 men in our own laboratory, would yield 356,000 and some odd calories, compared with 240,000 and some odd calories from a white bread eaten by the same men, a saving in food of 106,000 calories, or other words, eating whole-wheat bread would save something over enough to support the average man on our diet squad 36 days. In a month’s supply of energy in the course of a year. But this is not all. The average man on our diet squad would obtain in the course of a year from the 240 pounds of whole wheat 0.24 of a pound more of calcium than if he had eaten white bread; 1.1 pound more of phosphorus; ^4 ounce more of iron; all the vitamins native to the wheat; and a protein of significantly higher biological value. We determined the biological values on seven kinds of bread, four of which were whole-wheat and three white breads. The whole-wheat breads were ahead of the white breads in quality of proteins. I was going to give figures for vitamins, but that is one of the things I had to revise since I came to this Conference. In talking with my colleagues, I developed a little doubt about the vitamin figures because the methods of determining certain of the vitamins are just now in process of modification and improvement; so I am leaving out the story of vitamins of white and whole-wheat bread. I want to conclude with this homely statement. Some of us got pretty tired of whole-wheat bread during the war. I boarded over at the Cosmos Club when I was here in Washington in the days of 1917 to 1919, and there were a lot of complaints over there about war bread. We were thoroughly tired of it, but I am sure war bread nowadays could be made much more acceptable even on the same formula they used then, and I am sure much better breads can be made or devised than have been, and I don’t think anybody need be afraid of any war bread that comes along now. Furthermore, I think we are called on now to rally to whatever program is set up. It is time for us to forget our nutritional differences, and goodness knows there have been a great number of them. In our recent conferences down at the National Research Council over these daily allowances, there have been many differences ^of opinion expressed, many points of view, but we resolved to compromise our differences and pull together, and I was the one who had to shift his point of view perhaps more than anybody else. It is time to say, “All right, we will go along with anything that is good, and if you can make me believe it is better than mine, so. much the better. This applies not merely, of course, to our nutritional activities, but also to our own foods, intimate as that is, and. it applies also to our influence on our families and on our fellow-citizens. There is no doubt in my mind that we shall begin soon to pull all together. Let our teeth and go forward with a resolution to solve these problems of whatever kind that are facing us in view of the national emergency. Adequate Nutrition and Human Welfare HENRY C. SHERMAN Professor of Nutrition, Columbia University We are told that in all nature, it is the Grand Canyon of the Colorado which most strongly challenges an artist. We are also told of the matter-of-fact man who, looking at it, said: “Evidently something has happened here.” For each of the three days of this Conference, speakers skilled and experienced in word painting have been appointed to portray the potentialities of nutrition for the improvement of human life, and the vital importance of bringing its power for efficiency into play promptly to preserve our civilization. It was thought, also, that there should be presented the perhaps more pedestrian point of view of the everyday worker whose feet are on the ground of the science of nutrition, whose pictures are as uncolored as a carpenter’s drawing or a road map, and who indulges in nothing nearer to prophecy than merely to state the strongest scientific probability in the assessment of the evidence already in hand. Speaking as well as I can for these everyday workers, I would say with that matter-of-factness just mentioned: Something has happened here. Two things, in fact, and each still growing: First, there has been not only a phenomenally rich and rapid sequence of important discoveries of facts, but also a truly epoch-making advance in the fundamental concept of the potentialities of nutrition. This is an advance of more far-reaching significance than even science could foresee, and some of it is still in process of digestion and assimilation by the scientific workers themselves. Second, there has already come the practical translation of this science into statesmanship. The present talk will deal objectively with the scientific side. In replying to an invitation to deal with meaning, I shall attempt only to summarize the meaning of some foundational facts, leaving it to others to paint the picture of the beauty and utility and importance to civilization of the superstructure of statesmanship and national welfare which our present scientific foundation is prepared to support. Obviously there is not time here to cite the evidence which supports each statement. I have been asked to discuss “what nutrition means and could mean to the welfare of the Nation.” It means the freeing of perhaps one-third of our people from ills directly or indirectly due to food conditions. It could mean, also, the building of higher health and efficiency in people who are already well and efficient. The first of these aspects is clearly aQ urgent essential of national defense, and an obvious duty to our fellow citizens. The second 80 SHERMAN—ADEQUATE NUTRITION 31 aspect can mean an advance of even more far-reaching significance. Let us consider the more obvious first. The estimate that something like one-third of our people are ill-nourished had its first scientific basis in studies of food consumption. Especially did the comprehensive data of Stiebeling and coworkers, with their interpretations in the light of the most exact knowledge of nutritional requirements, indicate an unexpectedly high incidence of deficiency of one kind or another. That the magnitude of this national ill had not been appreciated before is explained by two facts. First, for reasons largely economic, food conditions had grown worse than most of us knew. Secondly, no one could know, until now, the complexity of nutritional needs, or the great responsibility of nutrition to health, which the most recent research has revealed and is still revealing. Medicine has recently and rapidly developed a keen nutrition consciousness. It is finding in nutrition the solutions of many of its most baffling problems. It is calling upon chemistry for ever more detailed ana delicate methods of diagnosis. Partly because such methods are still in course of development, and partly because the list of diseases in which nutrition is found to be an influential factor is constantly growing, it is too early yet for anyone to know precisely what percentage of our people show, m their bodily condition2 impairments due to nutritional faults in their food. But the estimate of about one-third is finding a good deal of medical support. In a general way at least, it is supported by the numbers and causes of rejections in the draft, especially in the light of the actual demonstration in Great Britain of what right feeding can do for men thus rejected, and of King’s recent analysis of the evidence on the relation of nutrition to the condition of tne teeth. It is supported also by the findings of medical surveys of nutritional conditions in American families and school children, rural and urban, North and South. From medical data of such kinds, together with the growing volume of clinical experience and the steady progress of laboratory research, it becomes increasingly evident that the frequency of nutritional shortages in family food supplies is reflected in a correspondingly high incidence of bodily conditions of nutritional deficiency among our people. With this knowledge, what is to be done? Lord Astor put the answer in the simplest possible terms when he said: “It isn’t only that the people must have enough food; they must have enough of the right kinds of food.” And for the kinds which are most to be emphasized McCollum has given us the useful term “protective foods.” How to bring enough of the protective foods into the dietaries of all the people is both an economic and an educational problem. It is important that both these parts of the problem be clearly and frankly recognized. It is also important to emphasize that while both economic and educational efforts are needed, we are never justified in delaying one while waiting for the other. There is ample objective evidence that food habits can be improved by education in nutrition and food values, even with the purchasing power of the people as low as it now is. And it has also been clearly shown that even without further education the great majority of low-income 32 NATIONAL NUTRITION CONFERENCE families do provide themselves with nutritionally better dietaries as soon as their purchasing power is increased. Each of us who can do anything for nutrition education should do it at once and continually, and with confidence in its value, however keenly we may feel that there should also be some way found, some means provided, to improve the purchasing power of the low-income families of our Nation. Similarly each one who can do anything for direct economic betterment may do it with full expectation that it will make for improved nutrition and health, however true it may be that more or better nutrition education is also needed. And all of us may constantly plead for still fuller recognition of nutrition in all publicly supported and officially administered economic projects dealing with food, such as crop production programs and food stamp plans. A great deal of good has already been done in these ways. More can and should be done. Nutrition is too important to national welfare for us to allow the good to be enemy of the best in any phase of food economics. Granted that the best is an ideal objective which we are not prepared to define in exact quantitative terms, yet we do know the direction in which the objective lies. And the same direction of improvement of typical American dietaries and of our total food supply acts both correctively to cure the ill-nourished and constructively to build higher health and efficiency in the people who are already well. Starting with ordinary or typical American dietaries of all economic levels, the chief direction for nutritional improvement is to increase the proportion of calories taken in the form of the protective foods—fruits, vegetables, and milk in its various forms. In most low-income dietaries the place occupied by these foods is far below what anyone acquainted with the newer knowledge of nutrition can consider adequate. And recent research fully establishes the further fact that improvement in this direction need not stop at adequacy. As McCollum has so ably taught, there may be and often are very important differences between the merely adequate and the optimal in nutrition. The evidences of human experience and of laboratory experimentation consistently indicate that the larger the proportion of our needed food calories which we take in the form of the protective foods just mentioned, the better the results will be. Better growth and development, higher attainment in staminal and working efficiency, and a longer lease of healthier and more useful life, may all be realized in the same individuals through the fuller use of the newest knowledge of nutrition. Obviously there has not yet been time to study entire human life cycles directly. But the nutritional improvement of health has been studied both in children and grown people; and large numbers of controlled experiments covering entire lives (and even of successive generations) have been made with laboratory animals. Naturally we select, to serve as our deputy in such cases, a species whose nutrition is essentially like our own in respect to the factors and processes under investigation. The rat has been largely used in full-life experiments. The only known important difference between human and rat nutrition is that we are much more responsive to the ascorbic and nicotinic acid values of the food than is the rat. Thus there is definite evidence (amply convincing if one has time SHERMAN—ADEQUATE NUTRITION 33 to study it thoroughly) that the nutritional improvements shown in experiments with rats are well within the scientific probabilities of the benefits which nutrition can bring to human beings. The finding which has. perhaps, attracted most attention because it was least expected, is tne well-marked and statistically established increase in the average length of normal adult life—the life expectation of the normal adult. Previous services of science to health had not advanced this expectation. A nutritional improvement which consisted simply in changing the quantitative proportions of the natural foods used increased the life cycle by 10 percent. As already explained, this is considerably within what the same nutritional knowledge may be expected to do for human lives. A simple approximation of a sound scientific probability would be to say that the present-day science of nutrition offers an extra decade to the human life lived under its guidance. And the extra years, whatever their number may be, are not added to old age. They are best conceived as inserted at the apex of the prime of life. In fact, the real reason the life is longer is because it has been lived on a higher plane throughout; somewhat as the cannon of superior range and • power throws its projectile both higher and farther. Is the promise of increased efficiency through nutrition as valid for mental as for muscular work? Yes, I think, and for two reasons. First, no matter how brainy a man’s work may be, his ability to do it effectively depends upon the stamina of his organism. Second, nutrition affects the level of health and stamina largely by its influence upon the body’s internal environment. Here the blood is the great mediator; and the same blood circulates through all the organs of the body, carrying the fluctuations which dietary differences induce, for better or worse, to the brain, and the nerves, and the muscles, and the liver alike. There is much reason to believe, and no reason to doubt, that the same changes which so clearly improve the biological value of the ordinary American dietary will make for increased psychological efficiency as well. Undoubtedly the new concept of a more flexible internal environment than science has hitherto visualized, with our new techniques for elucidating human experience by means of laboratory experimentation, will from now on make much more objectively convincing the relationships of general stamina to mental efficiency. Of course, there is a difference between brain and brawn; between spiritual energies and mere brute force. Yet in everything in which the human spirit must use the brain as its tool the expression of the spiritual forces and of the mentality is necessarily conditioned by the internal environment of the body of which that brain is a part. That environment, which we now know to be influenced by even everyday differences of food habit, is in all probability fully as important to mental work and sound decisions as it is to muscular work and physical contest. Well-established physicochemical principles, together with the new evidence obtained from laboratory feeding experiments extending throughout entire lives of successive generations, makes us scientifically certain of the reality of the influence of dietary differences 34 NATIONAL NUTRITION CONFERENCE upon the body’s internal environment, even though in some cases present diagnostic methods may not yet be able to detect through direct analytical chemistry the difference which nutritional chemistry demonstrates clearly in the longer run. Thus recent and current developments in the concepts and methods of research are enabling nutrition to make more helpful contact with psychology in the study of mental efficiency, as also with genetics in the study of constitutional stamina. Dr. McLester’s declaration, first made in his presidential address to the American Medical Association, that science now offers man through nutrition a new degree of mastery of his fate, has been so widely quoted as not to need repeating. Sir Frederick Hopkins, using the power of understatement, says that “Nurture can assist Nature’’ to a greater extent than science has hitherto thought. We may add that so far as we know or can judge, the same superior food supply can add the benefit derivable through nutrition to whatever constitutional endowment Nature may have given any one of us. Nutrition can never be a cure-all. Handicaps may be inherited (or even acquired through bad habits) which are beyond being completely remedied by nutrition alone. So even the best of nutrition could not be expected to make all people equally vigorous and efficient. But starting with each person as he is now, what proportion of those who are already healthy could by nutritional means be improved in stamina and efficiency ? Probably such a large majority that only an extraordinary egotist would believe himself an exception after open-minded study of the evidence. Nutrition and National Defense HENRY A. WALLACE Vice President of the United States Of all conferences called by the various Presidents of the United States in recent years. I feel that this, the National Nutrition Conference meeting here in Washington at the call of President Roosevelt, is one of the most important. Food is fundamental to the defense of the. United States. If workers and management have abundant food and the right attitude, they will turn out the vast quantities of defense materials which are necessary to save us from world chaos. The President, knowing the vital importance of food, has asked us in this Conference to consider how the food resources of the United States can be used most effectively to build not only our own strength but that of the democracies we are supporting. The people in every nation today are living under great physical and nervous strain. We in the United States, to keep our nerves healthy under such conditions, need the right kinds of food as well as the right attitude. Women have long known, even better than scientists, the fundamental importance of food to health and happiness. I suspect the lady who said, “The way to a man’s heart is through his stomach,” was also the one who, when asked the question of how to make a man happy, replied, at a hard-pressed moment in a hot kitchen, “Feed the beast!” Whether it be children, whether it be workers, whether it be soldiers, the first step toward a happy, confident attitude is an abundant supply of the right kind of food. On a foundation of good food we can build almost anything. Without it we can build nothing. I am confident that this National Nutrition Conference can produce results which will affect nearly every man, woman, and child in the United States during the next 20 years. Because the knowledge of food has been growing so fast in recent years and because this knowledge has such unusual importance to everyone, there have been invited to this Conference many kinds of people. First come the experts—the doctors, dentists, nurses, home economists, social workers, the professional nutritionists, and those who have an especial interest in feeding our armed forces well. Then there are representatives of the great farm organizations, because we know that the men who produce the food are as important as those who serve and eat it. The millers, the packers, the canners, the dairymen, and all the varied wholesale ana retail food concerns are represented, because they are the channels through which food flows on its way from the farmer to the table. Land grant college professors, who live continually with the farmers and the food trades, are here. So, also, are representatives of the great national consumer organi-425544’—42-------4 35 36 NATIONAL NUTRITION CONFERENCE zations, such as union labor, women’s clubs, Negro organizations, etc. Dozens of Federal Government agencies are represented as well as a number of State and local agencies. The doctors and nutritionists are here to tell us what they have learned, which will help us to build up and maintain our health and strength during these days when we shall put forth the utmost national effort. The farm people are here to tell us just what we have in the way of food resources and how we can change, if need be, our methods of working the land in order to get the products which will best meet the needs as the experts see them. All of us at this Conference will focus on the most important job of all, which is the development of plans for action to put our modem knowledge of nutrition to practical use serving our 130 million citizens as soon as possible. In this war, thanks to the ever-normal granary and the efficiency of modern farm production, we can approach the' problem more constructively than during the last war. There seems little likelihood that we shall have meatless days, or days without sugar. Apparently, we shall not have to cut down on our own food needs in order to make sure that there is a surplus to send to our friends across the sea. The problem this time is to use our soil, our farmers, our processors, our distributors, and our knowledge to produce the maximum of abounding health and spirits—a broad foundation on which we can build all the rest of our hemispheric defense. I know this Conference can do much to build this broad foundation because I have watched for many years the development of this modern science of nutrition. Forty years ago doctors were taught very little about diet. Most of them cared less. The farmers of the country learned about scientific nutrition of livestock before the mothers of the country learned about scientific nutrition of their children. During the past twenty years, and especially during the past five years, we have found out perhaps half of those things which we should have known but did not know. The progress has been so startling that H makes those of us who have watched it carefully almost evangelical in our fervor with regard to food. The progress of the past twenty years has been largely, but not exclusively, along three lines: First, increased knowledge of different types of protein; second, more complete knowledge of the need for different types of minerals; third, and more important than everything else, a better understanding of vitamins. It was found that certain types of disease like pellagra and beri-beri could be wiped out 100 percent by proper food. We have had fairly complete knowledge about these dietary deficiency diseases for at least ten years, but there are still too many people dying fom them. Therefore, I propose as goal number 1 of the National Nutrition Conference the complete wiping out of deaths caused by dietary deficiency. We do not have yellow fever any more in the United States. Neither should we have pellagra. As goal number 2,1 would propose a great reduction in those diseases such as tuberculosis toward which insufficient food predisposes. There are several dozen diseases which are not caused directly by poor diet but for which poor diet furnishes an excellent seed-bea. WALLACE—NUTRITION AND DEFENSE 37 Undoubtedly, we can reduce the death rate from these diseases by many hundreds of thousands by adequate food. The third goal which I would suggest for this Conference excites me in some ways even more than goals number 1 and number 2. This goal is to make sure that everyone in the United States has in his diet enough energy, enough bone- blood- and muscle-building food, enough vitamins, to give that feeling of “health-plus.” We do not want merely to wipe out pellagra, rickets, and scurvy and to reduce death losses from tuberculosis, but we want to make sure that our millions are so fed that their teeth are good, their digestive systems healthy, their resistance to premature old age enhanced through strong bodies and alert minds. I listened to the radio the other day while the commentator said, “What is it puts the sparkle in your eye, the spring in your step, the zip in your soul? It is the oomph vitamin!” I hardly recognized my old friend, vitamin Bi, or thiamin chloride, ana yet what he said was to some extent true. It does seem that in the diet of a great many people in the United States the addition of the different types of vitamin B makes life seem enormously more worth living. It is clear now that the so-called devitalization of foods which the food cranks spoke about a generation ago was due very largely to the milling process removing those parts which contained the vitamins, and especially vitamin B. This is true especially of white flour and refined sugar, both of which are excellent foods, in my opinion, but both of which have actually been devitalized. We realize the need of taking care of this devitalization when we remember that in the average American diet fully 55 percent of the energy intake comes from white flour, refined sugar, and other foods containing practically no vitamins. Both molasses and the wheat grain are rich in several types of vitamin B. In some way, that which has been taken away from these foods should be put back in the diet in the most inexpensive form possible. I congratulate those in the processing trades who, during the past few months, have made an excellent beginning along these lines. They are on their way to seeing that the people of the United States are given the right to live not only with health but with “health-plus.” While undoubtedly the most striking advance in food knowledge during the past 10 years has had to do with vitamins, we cannot forget the importance of putting our knowledge of minerals in diet to better practical use. It has long been known that the soil and water in many parts of the country are deficient in iodine. In these areas many thousands of people suffer from enlarged thyroids and lack of energy because of insufficient iodine in the diet during childhood and youth. In certain parts of the United States where the soil is low in lime and the people eat very little in the way of dairy products, it is possible to tell from the skeletal structure of many individuals that their entire being has been influenced by the lack of a proper supply of the right kind of minerals. A good friend of mine once claimed that he had made a study of an area where there was considerable complaint of cattle suffering from osteomalacia. The absence of calcium and phosphorus in the soil had caused the cattle to want 38 NATIONAL NUTRITION CONFERENCE to eat bones, rotten boards, and other abnormal materials. From this same area, so my friend claimed, came the political crackpots, whose emotions were rarely clouded by any great amount of intelligence. Sooner or later, I am convinced, we shall find the importance of certain minerals used in connection with certain vitamins. This has already been proved true with copper and iron in the treatment of anemia. We shall also find methods of discovering just which individuals require several times as much in the way of certain minerals and vitamins as other individuals in order to live a “healthplus” life. The people of the United States, prior to 1930, enjoyed a higher average state of nutritional well-being than the people of any other large country in the world, and they still enjoy such a state. Comparing ourselves with certain nations, we find the difference so startling as to make us feel this country is truly blessed. And yet, when we study the facts cold-bloodedly and not boastfully, we find that at least three-fourths of the people in the United States do not have what can be called good diets by any reasonable standard. At least 40 million people in the United States are suffering from very bad diets. When you spend only 5 cents a meal per person for food at the grocery store, it is difficult, unless you are a trained dietitian, to buy enough food value to supply the necessary energy, let alone the proper combination of minerals, proteins, and vitamins. When we consider the inadequacy of their meals, it is not surprising that 40 percent of the young men examined for military service are being rejected because of physical disability. Not all of these rejections are for dietary deficiencies. Perhaps the examining officers would say that only a small percentage was of this nature, and yet I am convinced that it would be possible to take the men rejected and by good medical care and proper food put perhaps half of them in condition to be accepted. Moreover, proper feeding in childhood for the other half would have enabled a high percentage of them to pass the physical examination. Probably a larger number of people today are being fed properly in the United States than ever before in our history, but we have just started to do a real job. We want to see that good food gives “health-plus” riot merely to 10 percent of our people but to everyone. There are three ways of approaching this problem. First, we must shift our agriculture more and more toward producing those foods which are rich in vitamins, minerals, and the right kind of proteins. We have started producing more of these foods, such as milk, eggs, tomatoes, dried beans, pork, etc., so that we may have an abundance, not only for ourselves but for Britain, to meet every possible kind of contingency. We are using the cow, the hen, and the pig to extract from our huge supplies of corn stored in the ever-normal granary the vitamin B, the vitamin A, the good minerals, and the proteins which will furnish the nervous energy to drive us through to victory. Some people may say, “Why have the farmers not produced more of these fine protective foods before? The land and labor are available to produce twice as much of these foods. Why have the farmers not done their duty?” The reason is simple, and leads me to discuss the second line of attack. WALLACE—NUTRITION AND DEFENSE 39 Protective foods demand more hard work from the farmer than the simple energy foods. A pound of dry matter in poultry, dairy, or meat products costs 5 or 10 times as much human energy to produce as a pound of dry matter in wheat. The bottleneck has been the lack of consumer purchasing power. If all the people in the cities had been at work 8 hours a day producing the right kind of products efficiently, there would have been an incentive for the farmers to produce a lot more of these splendid protective foods. Today the total factory pay rolls of the United States in manufacturing industries are at least a third higher than they were a year ago, and the pay rolls per employed person about 14 percent higher, but the cost of living of factory workers has gone up only about three percent. This means that millions of people can now spend more on protective foods. They can pay enough for the protective foods so as to furnish the farmers an inducement to bring about that expansion which is so vitally necessary. At the same time, we must recognize that there are many millions in the cities who get paid very little and who today are getting no more than they did a year ago. We are trying to take care of these people through the Surplus Marketing Administration, the free school lunches, low-cost milk, and the Food Stamp Plan. More than 10 million people are being reached, among them 5 million undernourished children through the school lunches and about 4 million people who are getting additional quantities of butter, eggs, pork products, fruits, vegetables, flour, and cereals through the Food Stamp Plan. Yes, we have made some progress toward seeing that the city people have the purchasing power which would enable them to buy from the farmers an increased production of the protective foods. The Federal action programs have taken care of a large proportion of the 10 million people in this country who are most needy. The increased pay rolls are helping perhaps an additional 10 or 20 million. But there still are perhaps 20 million people whose diet is woefully inadequate. This brings me to the third line of attack, which has to do with education. Tens of millions of people in this country could live far more healthfully than they are living if only they had the right information about their daily food. Some people of unusual intelligence in the high-.income brackets eat improperly. A few people still make the mistake of thinking that the phrase “well-fed” means the same thing as being plump. Too much fat, especially after fifty, puts an extra strain on the heart and, therefore, in many cases, the phrase “poorly fed” should be used with reference to fat people rather than the phrase “well fed.” But when portly people, in their anxiety to reduce, cut down suddenly on their diet they are likely to reduce their intake of vitamins so greatly as to imperil their health. Thin people who are afraid to eat because they may get fat need education. So also do fat people who are trying too hard to get thin. Fortunately, the National Nutrition Conference is starting off with a very important contribution to effective planning—a set of recommendations, or nutritional standards, worked out by the Committee on Food and Nutrition of the National Research Council, which is heading up the scientific work at this Conference. Th# recommendations will tell what you need, what I need, what men and women of 40 NATIONAL NUTRITION CONFERENCE different ages need in order to keep in good physical condition—how many calories a day—how much protein—how much calcium and iron—how much of each of six different vitamins. We who are laymen can take it for granted that these recommendations are as sound as present-day knowledge can make them. The doctors and nutritionists who have prepared this information for us in such readily available form deserve our thanks. The next step is for all of us to plan together to transform these standards into the living reality of everyday food and savory meals. We want to get the information out into every household in the United States, so that the new knowledge of food may express itself in more vigor of living. One of the great purposes of this Conference is to make democratic plans for good eating just as we have made democratic plans for good farming. We have had farm committees in every county to battle with the problems of soil erosion, acreage allotment, etc. These committees have made the farmers in every township soil conservation conscious. The National Nutrition Conference proposes to make every community in the United States “nutrition conscious.” Every community should know of the families who are not getting along well. Are they eating right? Is it possible in some tactful way to help them to eat better? Does your community have any of the dietary deficiency diseases? Can you make what I conceive to be the threefold goal of this Conference a reality so far as your particular neighborhood is concerned ? Already we have made a start in our typical American democratic fashion. We have State Nutrition Committees, schools, clinics, hospitals, public health nurses, as well as the Food Stamp Plan, the school lunch program, and various other Federal programs for the distribution of food. Write to Dr. Parran of the Public Health Service for the nutrition standards which the experts have worked out. In your own way focus the agencies available to your hand so that these standards can be put into life, so that there will be no more hidden hunger gnawing at our vital organs, so that our nerves will be strong and resolute. The National Nutrition Conference has before it a program which is just as good for peace as it is for war. It is a program which will never end until the soil and the farmers of the United States are put fully and completely to work on the job of bringing the maximum of health to every individual. At the moment we are taking an especial interest in seeing that the people of Britain, as well as our own, have an adequate supply of protective foods. And I am hopeful that the day will come when we shall cooperate with the governments of Latin America to help solve the unusual problems which exist there in agriculture, population, and nutrition. This Conference is firing the opening gun in a real new order; not a new order based on fear, compulsion, and slavery, but a new order based on physical well-being, equal opportunity, and freedom of the soul. TUESDAY MORNING, MAY 27,1941 Agricultural Policy and National Nutrition CLAUDE R. WICKARD Secretary of Agriculture Everyone addressing this Conference has been emphasizing and will continue to emphasize the urgent need for better nutrition here in the United States as part of the defense effort—not only the immediate defense effort but the long-run strengthening of our democracy. So I am not going to enlarge further on that subject. But there is one thing I want to point out in the beginning about the work of this Nutrition Conference. Better nutrition does not mean soft living. It does not mean growing fat and lazy. It does not mean concentrating our attention on the fleshpots, the luxuries of life. On the contrary, it means becoming harder, more efficient, better able to work overtime whenever it is necessary, better able to do without luxuries when we have to. We do not know exactly what is ahead for us or for the world, but we do know that we are going to be called on to make sacrifices. This is all the more reason for giving attention to the whole problem of nutrition now. By applying our brains, our knowledge, and our common sense to the use of our vast resources, we can be a well-nourished and efficient people in spite of any sacrifices we may have to make. Without any further preamble, I shall come directly to my main point, which is that the existing policies of the Department or Agriculture are definitely in line with a great national nutrition program such as this gathering of scientists and laymen is considering. I say that knowing how much we still have to do. The Department has done no small amount of pioneering and spadework in the field being explored by this Conference. Farmers have been learning in these difficult years that when any large part of the population can afford nothing better than a poor diet, the market for agricultural products suffers accordingly. Farmers can fare well only if the Nation can eat well. This basic and simple truth has been recognized in some of the legislation passed by Congress to aid agriculture and in the programs of the Department. But agriculture is only one part of our national economy, and it can go only so far and accomplish only so much in advancing a program of better national nutrition. To put over such a program on any big scale, all the parts of our economy will have to pull together. If such a result comes out of this Conference, I can assure you that no one will rejoice more than the farmers. For the more thoughtful among them, it will be a dream come true. The farmer sets the na- 41 42 NATIONAL NUTRITION CONFERENCE tional dinner table, and nothing would please him better than to see everyone eating heartily. From several standpoints, our present agricultural policies furnish an excellent foundation for putting this country on a better nutritional level. I hope to show you in this brief review that these policies have an important bearing on any program this group may recommend. From the standpoint of production, it has been the national policy in the past few years to make agriculture more flexible. As a result of the long decline in foreign markets and the sharp depression of the domestic market following 1930, agriculture had to learn how to control acreage, store and hold surpluses, shift to other crops where possible, and divert products to other than the usual outlets. The alternative for farmers was a mad scramble of overproduction and soil exploitation in a desperate and vain effort to make ends meet at ruinous prices. The collapse that would have resulted from such a scramble was forestalled by the legislation that put into effect agricultural adjustment, the ever-normal granary, and soil conservation. I want to emphasize that the first step, the big step, the hard step is to achieve production adjustment on a national scale. Once this becomes a practical possibility through sufficiently widespread cooperation and adequate administrative machinery, the adjustments themselves can be made upward as well as downward according to the need. This is true of both acreage adjustments and storage. Grain stored in the ever-normal granary gives us a constant supply of food and feed that can be turned at any time into the channels of consumption to meet any emergency. Adjustments are being made upward for some products right now, in the new agricultural policy designed to furnish food for Great Britain and to safeguard our own domestic needs. Egg production is to be increased sufficiently to supply British needs and in addition furnish the United States with as many eggs as we ever used in the year of greatest egg consumption in the past. We hope to increase milk production enough to supply Britain’s needs for milk products and, in addition, maintain our own average consumption at the level of the past four years. The production of canned tomatoes is to be increased by 50 percent over that of last year, and the production of all types of dried beans by 35 percent. Pork production is to be as high as possible; the spring farrowings this year are smaller than last, but the hogs are being marketed at weights above the average, and the total supply should be larger than the average of recent years. Now these are some of the very products that we would need to produce in greater abundance, according to the nutritionists, if we set out to give everyone in the United States a satisfactory diet. In order to achieve such a goal, it has been figured that we would need to consume twice as much green vegetables and fruits as we do now (such things as cabbage, green beans, apples, and so on)—70 percent more tomatoes and citrus fruits—35 percent more eggs—15 percent more butter—20 percent more milk. All of these are “protective foods” rich in minerals or vitamins, or both. I have ho doubt, too, that a great many people in this country would be benefited by eating more meat than they can now afford. My first point, then, is that so far as production is concerned, existing national policy has given us a more flexible, more adjustable, less hap WICKARD—AGRICULTURAL POLICY 43 hazard type of agriculture. We not only have the resources to produce all our people need for better nutrition; we also have the methods. Whenever the Nation summons the will to do the job, I am sure that agriculture can meet the new demands. I do not mean to imply, however, that there is any reason to feel smug about the adjustments agriculture has accomplished so far. We still nave many problems. In particular, we still have surpluses of the three great crops produced heavily for export—wheat, cotton, and tobacco. There is no way in sight by which this country could increase its consumption of these products sufficiently to take care of the surpluses. Even a return to normal world trade would not rid us of the surplus problem with cotton and wheat. Here, then, we still need more downward adjustment. We shall have to find other uses for part of our cotton land and our wheat land. One of the best uses I can think of would be to dedicate some of this land to the products of which we do need more if we are to build up the health and strength and stamina of our people. In the South particularly, more diversification and production for home use are imperative both for nutritional and for economic reasons. So much for production. From the standpoint of distribution, existing agricultural policies are no less in line with the goal of this Conference. I would remind you that the Stamp Plan is agriculture’s baby, and agriculture is inclined to be rather proud of it. The free lunch program for school children and the low-cost milk distribution program also come under agricultural policy. By this summer the Stamp Plan will be reaching 5 million people and distributing foods worth 10 million dollars a month; and most of these foods are the protective foods especially needed by undernourished families. The free lunch program is reaching about 5 million school children. Low-cost milk is being distributed in six of our large cities. These are prime examples of practical cooperative work by city people and farmers. The city people get better diets than they could otherwise afford; the farm people find a market for their products that would not otherwise exist. The method fits the purposes of this Conference as a glove fits the hand. But as you know, this distribution of surplus foods is used almost entirely to meet the needs of people on relief, and it does not nearly meet even those needs. According to the nutritional survey recently completed by the Bureau of Home Economics (and that survey too was one of the Department of Agri-culture’s babies), at least a fourth of our families not on relief have poor diets—most of them low-income families. At least three-fourths of us do not have really satisfactory diets. And this in spite of the fact that we are the best-fed nation in the world, with the greatest food resources and with knowledge of nutrition as advanced as any in the world. So far as the fourth of our people with poor diets are concerned, the trouble is very largely a matter of distribution, which in turn depends on prices, purchasing power, income. It is the national policy that farmers shall receive enough for their products to give them a fair return; never again do we want to be faced by the specter of a ruined agriculture, with the disastrous results it would entail for all of us. Within that framework, some economies could be made by improving our marketing processes. A great deal can be accomplished for the farm and village population by extending 44 NATIONAL NUTRITION CONFERENCE home production, home and community canning, and community refrigeration. Out in Ohio, a survey was made last year among rural families in one community to see how many of them produced enough of their own food to supply their needs. Only half of them produced enough milk for themselves; only one out of ten put up enough vegetables to meet their winter needs. In fine dairy sections like New York, you find many farm families who do not keep enough milk for their own use. Why farm people should go without adequate diets when they can raise food just a few steps from their own back door is more than I can see. We can go a long way with a good home production program, and I hope this Conference will come out strongly for one. I am emphasizing this point because the Department of Agriculture is primarily concerned with farmers, and also because I am a farmer myself. I know that the nutrition problem is not confined to the cities. We have a big nutrition problem right out in the country where the food is raised, and rural people need to be awakened to the meaning of nutrition as much as city people. Now what about the part of the city population that is poorly nourished primarily because of low income, yet can receive no benefits from such devices as the stamp plan or direct relief distribution? This Conference will have to give major attention to any and all possibilities for improving the nutrition of that large group. The increased employment and better incomes resulting from the defense program will help, but there will still be plenty to do. I am sure agriculture will cooperate in any practical steps that can be taken, but this is one of the places where agriculture can do little by itself. I have mentioned production and distribution. There are two other aspects of agricultural policy that have an important bearing on the work of this Conference. The first relates to research and education. As a matter of long-standing public policy, our State and Federal agricultural agencies are engaged in research up to the hilt, as you know. And much of this research relates to food and nutrition—better handling of our soils, conservation of our soils, better crops, better livestock, more efficient farm and home management, the battle against diseases and insects that waste our resources, better nutrition for farm animals—and better nutrition for human beings. These and more are within the scope of agricultural research, which deals with social and economic problems (yes, even psychological problems) as well as with problems m the natural sciences. Here is a fertile seedbed for such an effort as this Conference is making. I will say frankly that in my opinion not only the United States but modem civilization as a whole will have to use this science of ours for the benefit of mankind much more fully, much less half-heartedly, than it has been used so far. We could feed and clothe and house the masses of our people far better than we do if we dared to turn science loose to tackle the job. But we have hesitated and sometimes this was because we have been afraid we might make a wrong move and upset somebody’s apple cart. I think it is time to be afraid that if we do not make some vigorous moves, our civilization will not have any apples to put in the carts, and it will not matter any more whether they are upset or not. WICKARD—AGRICULTURAL POLICY 45 In other words, I hope this Conference will mark a big forward step in hooking up science with the needs of common people. I should like to see this done in the United States above all places. I should like to see it done with food first of all because food is the most basic need of common people. This gathering will hear much discussion of education as an indispensable means of achieving better nutrition. Few of us know how to eat as we should but I shall leave that discussion to the educators. Here I merely want to point out that education is also an organic part of agricultural policy. It goes hand in hand with research—or at at least we try to make the two go hand in hand. We have done a good deal of educating about nutrition and about almost everything else connected with foods, from production on up, but probably we could and should do a good deal more if this Conference works out a practical program. The mention of education brings up another thought. Here in the United States we think it is a public duty to provide education for our children, and we spend a lot of money doing it. Is it not just as much a public duty—I think it is even more—to see that they have sound, healthy bodies ? In fact, if I understand the latest findings of nutrition correctly, people cannot really use their minds fully if they are suffering from undernourishment. If that is the case, then we have to begin with good nutrition for children or the money spent on their education is going to be more or less wasted. The final aspect of agricultural policy that I want to touch on is the broadest of all, and it is also the most fundamental to the work of the National Nutrition Conference. That aspect can be summed up in the term democratic planning. So far as agriculture is concerned, there is no question but that democratic planning has become definitely and I believe permanently a part of national policy. The only way farmers could save themselves from ruin back in 1932 was by trying out a policy of democratic planning on a national scale. They have greatly expanded it since then as we all learned how to do the job better. This democratic planning in agriculture now extends from the individual farm through the community, the county, the State, the region, and on up to the national government. It deals with an increasing variety of problems as farmers discover that the battles they have to fight are not isolated, single engagements but a part of a broad campaign. Soil erosion, for instance, is not just an evil that suddenly appears out of the air all by itself. It is tied in with a whole lot of economic problems, and you cannot fight it without taking on several other fights at the same time. Once again, I want to say that we cannot afford to be smug about what we have achieved in democratic planning so far. But we are over the biggest hurdle—we have made a start. The only questions now are how far we want to go and how good a job we can do. My own opinion is that we shall need to go much farther than we have, and that we will have to do a good job of it or else. * * * There is going to be planning in the modern world—either autocratic planning or democratic planning. As I look forward to the condition of the world after this war, I think we can avoid autocratic 46 NATIONAL NUTRITION CONFERENCE planning—dictatorship—only by proving that we can do a better job with democratic planning. I am absolutely certain that we can, but it is not a job that can be postponed. We need to push forward now. Democratic planning is one of those things you learn by experience. The work of this National Nutrition Conference offers a fruitful field for adding to our experience. I hope the Conference will reach down to every community in this country with recommendations for democratic planning that will help to build a better and stronger America. Food and Foreign Policy A. A. BERLE Assistant Secretary of State Let me first congratulate you for assembling, in a particularly trying time, to consider methods of improving the health of the country. Never was work more useful; and never more necessary. Your task is to consider the problems of nutrition in this country and how they must be met. That is really a problem of how effectively to distribute the huge stocks of supplies which are readily available. To me you assign a less happy subject of the policy of the Government toward nutrition outside the United States. There, due to the effects of war, blockades, and counter blockades, the problem is vastly less happy. It has been, and is, the consistent policy of the United States to make food resources available, so far as possible, to those countries which need them. In normal times we rely on commerce to take the surplus stocks of food which we have to the points where they are needed. But where normal commerce does not accomplish this result, this Government has historically supplemented the supply by sending food, at its own expense, or at the expense of American organizations. In the years following the World War, as you know, this Government through various organizations financed and sent food to Russia, Poland, Germany, Austria, Belgium, France; and sent less amounts to other countries. This process started immediately after the armistice of 1918; and it continued for several years. Only when the normal processes of reopened trade made it possible for the populations of these countries to obtain adequate food through normal channels did we cease to send relief. We did it without drawing political distinctions; and we did it on the straightforward theory that a land of plenty had a duty to humanity. During the present war, the Government has followed, so far as possible, the same policy. Naturally it has had to be modified by changed conditions, and by the exigencies of military situations which we did not create. To the extent possible, we have endeavored to send food and supplies into those countries not under actual military occupation, which were in need. We took the view that two assurances are required: first, arrangements which make sure that the supplies actually reach the people who need them preferably by distribution through the American Red Cross or agencies designated by it; and second, that the effect of such supplies will not increase hunger and want elsewhere; for, of course, nothing is accomplished by shipping food and relief into an area, if the only effect is to stimulate military seizures of other food and supplies within that area. 47 48 NATIONAL NUTRITION CONFERENCE Relief of this sort has taken various forms, depending on circumstances. In some cases—Finland, for instance—loans have been made permitting purchases of food here and its shipment abroad. Shiploads of relief have been sent to unoccupied France. Other shiploads of food have been sent to Spain. Certain movements of food have been facilitated to certain of the unoccupied French colonies. Supplies were actually on the way to Greece when she was invaded. In many cases, unhappily, the possibility of sending relief has been severely limited. The difficulties of transport and distribution have frequently been extreme. Where we have to choose, the first concern has been the sending of supplies for children, especially milk and vitamins. Only recently, arrangements were made to send two shiploads of food to Ireland. We have not felt that the policy of relief could be determined wholly by arguments over the question who is responsible for the distress. We realize perfectly that the forces of invasion and aggression are the direct cause of the want and hunger and starvation of great populations. It would be very easy to say that we ought simply to leave the problem to the people who are responsible for creating it. But that is not a complete answer. The populations of these countries still have to live; and in their children may very well lie the hope for a free and civilized Europe. Instead, therefore, of asking, “Who is responsible for this?” we have asked, “Will the relief actually do any good ? Or will it merely feed one group in one place and increase misery elsewhere by encouraging or assisting invaders or aggressors to requisition, or seize, or buy with worthless currency, or otherwise take away for themselves, food which ought to go to the populations of these countries?” If the latter happens, plainly the relief given does not assist in the slightest. The technique of modern economic warfare has developed endless ways for draining a country dry of its essential food supplies. They can be seized to feed armies of occupation; or they can be bought with currency which the occupied country is forced to print and turn over to its invaders; or its export can be required to fulfill some barter trade agreement which has been forced on tne country. In such cases, shipments of relief to the population do not assist that population unless it were possible to establish virtually an economic control system in neutral or nonbelligerent hands within the country. This is extremely difficult in time of war within military lines. There is a widespread misconception that the food difficulties in Europe are chiefly due to the allied blockade. Such information as we have indicates that the chief difficulty is due to the disturbance of crops and harvests and transport and local distribution; and to the requisitioning and economic policies pursued on the continent itself. The German Government has stated authoritatively that it does not consider that an invader has any responsibility for feeding the population of the country which it has invaded; and that it will, as a matter of course, assure that Germany will receive the benefits of whatever supplies do exist in Europe to the extent that she needs them. In tne light of this, the difficulty of carrying on any effective A BERLE—FOOD AND FOREIGN POLICY 49 policy of feeding in territory occupied within military lines must be sufficiently obvious. Let me pass, for a moment, from the very grim picture in Europe to one other subject which I nope may offer a happier aspect. It is commonly said that there are great food surpluses in the Americas; and this is true. But most of these surpluses would promptly disappear if all of the Americas were fed according to the standards which the National Nutrition Conference for Defense is here to discuss. The farmers of Canada, of the United States, and of many of the South American republics would not be worried over “overseas markets” if every family on the American continent had the food which it ought to have to improve the health of the Americans of the future. The Department of Agriculture has been giving careful thought to this Kroblem; and has been working out plans for consideration which I ope, within the not too distant future, may offer some fascinating possibilities. Although the United States is the best fed country in the world, there are millions of people who do not, and some who cannot, obtain the food that they really need. This is even more true in many of the other American republics. The problem is partly one of finance—but if it were only that I am confident we could solve it in a relatively short time. Still more, it is a problem of education. Let me say that whenever the problem of education is solved, I am confident that the economic relations between the Americas are close enough so that a solution will be found to the problem of payment. In the Americas, at least, we have passed that point. Wherever the resources are there, and the need is there, we can work out ways of getting the supply to the need. In its international aspect, the problem of proper feeding combines three great elements. The first is the scientific element—the careful analysis by groups such as yourselves of what is really needed, and the expert education of the public to insist that the need be fulfilled -The second is economic; the working out of ways and means by which the supplies, which we know do exist, can be put in the localities where they ought to be used. The third is sentimental, or if you like, moral: the feeling which everyone ought to have that the providence of God put these supplies in the world to be used for the strengthening of life; and that it is the job of everyone to see that they are so used. ■ Labor s Stake In a National Nutrition Program FRANCES PERKINS Secretary of Labor One of the hopes of this generation is to be able to make available to all our people the goods they need for satisfactory living. The most indispensable of these goods are the foods required for adequate nutrition. An answer to the problem of obtaining the foods necessary for health is vital to all of us. It is obvious that city families and rural families meet with this problem in different forms. There are some farm families who do not have adequate diets, but farm families are, on the average, able to provide as much as two-thirds of their food directly from their own gardens, orchards, or fields, and from their own milk cows, poultry, and other livestock. They have had, in addition, through the cooperative Extension Service of the Department of Agriculture, more advice on questions of nutrition than is available to the average city family. I propose, therefore, to discuss with you this morning nutrition policy primarily as it affects city workers’ families. I hardly need to say to this group that American workers have always been among the best fed in the world. We have rightly prided ourselves on the bounty of American dinner tables, and the generosity of our hospitality. When we criticize the food we have to eat, we realize at the same time that we are peculiarly fortunate in the ratio of our land resources to our population and in our knowledge of the techniques of agricultural production. As compared with most other peoples, we have an excellent diet in these United States. Our convictions on this subject are not based entirely on patriotic prejudices. Five years ago the International Labor Office made a pioneer study of the diets of urban workers and their families in different countries of the world. This was followed by reports of the League of Nations and the International Institute of Agriculture, which provided further data on the subject. These reports show that the average diet in the United States was among the best in the world, even before the catastrophes which have so greatly reduced food consumption in Europe and Asia in the last 2 years. According to the data available in the late 1930’s, only in the Scandinavian countries, Great Britain, and the British Dominions were average diets as high as in the United States. We cannot, however, be satisfied to know that average food consumption in this country is among the best in the world. In the first place, the average itself is in some respects below the standard which scientific research has set for optimum growth and health. In the second place, there are many families in the country below the average, and in the third place, a disproportionately large number 50 PERKINS—LABOR’S STAKE 51 of children are found in the families whose diets are below the average. The Department of Labor has long been concerned with this problem. There are more than 80,000,000 people in this country who depend for their living on wages and salaries, and it is one of our first tasks as a Department to assist in shaping policies which will safeguard their well-being as workers, as citizens, and as individuals. Just now the Nation is needing skilled workers, and we are told that a considerable number of the men who present themselves on jobs are not physically fit for heavy or exacting work. We must raise the question as to whether they have had the information and the income that would have made it possible for them to provide themselves with the food necessary for health and efficiency. One of the first tasks assigned the newly organized Department of Labor agency in 1888 was a study of the incomes of wage earners, and the goods available to them. Since that time, the Bureau of Labor Statistics has made periodic studies of this subject, and the Children’s Bureau has carried on intensive studies of the relation between food consumption and health. The latest survey of the Bureau of Labor Statistics was carried out among employed wage earners and clerical workers who had not been dependent on relief of any kind in 1935 and 1936. The nutritive content of the diets of these families has been calculated by the Bureau of Home Economics and shows that relatively high as they are, they nevertheless fall short of the standards which are now accepted as providing a thoroughly satisfactory margin for growth and health. In summarizing its findings, the Bureau states that there is little likelihood of deficiency in calories or protein in the diets of employed workers’ families. Most of the diets furnished an adequate amount of phosphorus. All but 5 percent furnished a fair allowance of iron, and about half a generous allowance. But these experts tell me that the consumption of calcium, and of vitamins A, B, and C was frequently inadequate. This means that some families had too little food of all kinds, but in general, that the diets were most likely to be short in the leafy vegetables, in the coarser grain products, and in such foods as raw cabbage, tomatoes, and citrus fruits. When the figures on the different types of foods were put together, it was found that about half, even of tnis group of employed urban workers, had diets which were deficient in at least one important nutrient. There is no doubt that one of the reasons why many American workers and their families do not receive a completely nutritious diet according to present-day standards, is that much of our knowledge on the subject of human food needs is so new. Dr. Murlin reminded you last night that the progress in laboratory research in this field of knowledge has been epoch-making in the last 30 years. The progress in the laboratory has been paralleled by a remarkable educational accomplishment. Average men and women in the United States today have a very fair grasp of their need for minerals and vitamins. While men still make poor selections of the food they buy at lunch counters, and women still make poor selections when they are spending the family food money, it is undoubtedly true that general knowledge of human requirements for food has been tremen- 425544°—42---------5 52 NATIONAL NUTRITION CONFERENCE dously improved in the last three decades. If you doubt the shift in emphasis in American diets, look back at the newspaper jokes of 1910 and count the proportion dealing with the “pies my mother used to make,” and compare them with the jokes about spinach in 1940. Studies of the Bureau of Labor Statistics made at the end of the last war and in the mid-1930’s provide a somewhat more exact basis for judging changes in the dietary habits of the wage-earner group. At the end of the last war Americans were just becoming aware of their need for minerals and vitamins in food and their importance in good nutrition. This new information, together with the great increase in the production of citrus fruits and their very marked decline in price, and the improvement in long-distance transportation which has made fruits and vegetables available in our cities all the year round, have combined to produce important changes in the food consumption of urban workers. Tomato juice which is almost a new food, and a very valuable one, has come onto the market. Per capita consumption or milk has also increased, as special educational efforts have been combined with methods by which low-cost milk has been made available to city families with small resources. In developing an educational program for improving nutrition, it is important to keep in mind the importance of custom in our food habits. The Labor Department’s recent studies of food consumption show the remarkable persistence of the food preferences of earlier generations in the localities studied. The tables of New Orleans still remind one of the fish, the chicken, the salads, and the greens of the French, the Bostonians still eat more beans and drink more tea than families in most other cities. In Cleveland and Milwaukee they eat more rye bread and cheese and apples and coffee. We Americans have our private ideas about good food. It is lucky for the farmers that we do like a little variety, and all these preferences must be taken into account in any program which attempts to bring diets to a point where they will adequately provide for growth and health. A national nutrition policy should plan to change foodconsumption habits only insofar as it is absolutely necessary to do so to provide all the nutrients necessary for health, efficiency, and the full enjoyment of life. Even on this basis, there is, of course, still much to do in making people aware of what constitutes good nutrition in such a way that they can apply it to their living. Those of you who are educators meet a great challenge when you face the figures recently made available which show that there are a great many city families who have enough food money, who spend it without obtaining the balanced diet necessary for the health and growth of children and the maintenance of health in adults. In my opinion, however, the fundamental problem is economic. More than one-quarter of the families surveyed by the Bureau of Labor Statistics in 1934—36 did not spend enough to secure the Bureau of Home Economics’ adequate diet at minimum cost. The literature abounds with examples of the connection between economic status and health. A Children’s Bureau study of 6- and 7-year old school girls indicated an inverse relationship between poor economic status and (1) gain in weight, (2) need for medical and dental care, (3) number of school absences. PERKINS—LABOR’S STAKE 53 The Milbank Memorial Fund has recently been making an extensive medical evaluation of the nutritional status of high-school students in New York City. It has found striking differences in the vitamin C status between the children in high- and low-income groups. Studies of gain in weight and its association with economic status by the Children’s Bureau and a study of Pittsburgh school children provide further evidence of the relationship between poor health and poor diet. Studies by the Public Health Service of the incidence of pellagra show a progressively higher incidence of the disease with decrease in family income. A relationship between poor diets, absences from school, and failure to complete the grade’s work in a year also has been found. I might go on for a long time with other examples of this sort. Indirect evidence of the results of improper diet is provided on a large scale by the beneficial effect of school lunches. The WPA reports that nourishing hot lunches fed to needy school children have improved not only general health but the quality of their school work. The proportion of our children who are found in families without adequate nutrition should be a matter of grave concern to all of us. The Bureau of Labor Statistics’ study of employed wage earners and clerical workers of which I have already spoken shows that more than 40 percent of the children in this relatively favored group live in families whose incomes are below the level necessary to provide adequate food, as well as suitable housing, clothing, medical care, personal care, union dues, carfare, newspapers, and the other sorts of recreation for which city families must pay in dollars and cents. It is a great mistake to think that a family can budget for a nutritionally adequate diet and fall far below the maintenance level in all the other goods which make up urban living. Large-city families of average size with incomes below $1,350 or $1,400 presumably distribute their funds to all categories of family needs without obtaining the best standards in any one. I know of a woman in a large northwestern city whose husband’s income was just over $1,000 in a recent year. They had 2 children, 5 and 9 years old. This meant an income of about $20 a week and they spent $8.20 a week for food. You will be interested in what they had to eat. The father and mother had black coffee, bread and butter for breakfast; the children, cereal and milk and orange or tomato juice. On Sundays they had an omelet as a special treat. Their lunch menus were regularly bread with no butter and vegetable stews, with a great many potatoes which helped to supply the energy needed by two active lads. At dinner they each had a glass of milk, meat as a rule, and one vegetable beside potato, and bread and butter. Their regular desserts were stewed fruits or simple puddings. These meals cost about 10 cents per person per meal, and my colleagues who are specialists in nutrition tell me that the family’s diet was deficient not only in the calcium needed for the children’s growth and the adults’ health, but also in the vitamins which scientists are finding make so much difference in resistance to disease, vitality, and efficiency. 54 NATIONAL NUTRITION CONFERENCE If the family had had the sort of diet recommended by the Children’s Bureau of Home Economics, they would have had to spend $9.40 a week, and they would have had menus something like this. Breakfast Oranges, tomato juice, or stewed fruit Cereal and milk for all and coffee for the adults Occasionally eggs Bread or toast and butter Lunch Milk for the children Vegetable stews or salads Meat twice a week or so Fresh or stewed fruit or pudding, sometimes cheese Bread and butter for all Dinner Meat or fish and one vegetable besides potatoes Bread and butter Pudding or fruit Coffee or tea for the adults Milk for the children If this family were to spend as much as $9.40 a week for food and still have enough money for the other necessities of urban living, budget specialists tell me they would need an income of $1,430 for a really satisfactory living in this particular northwestern city, in other words about $400 more for the year than they actually had. I know that many of you are thinking that the figures I have been quoting are so far out of date that they have ceased to be useful, because increases in wages and salaries have been so great since the mid-1930’s that all these dietary deficiencies will have been wiped out. This reaction will come, however, from those who did not observe that the figures on dietary adequacy which I have given you were based on data from families which had not been on relief, whose incomes were $500 or more, and in which at least one member had had employment in at least three-fifths of the weeks of the year. This group makes up what we think of as typical American city families, the middle-income group, including neither the very poor nor the rich. By 1940 average money incomes among these families are estimated to have increased by about 20 percent while living costs had risen about 3 percent since 1934-36. Such an increase in real wages and salaries has certainly permitted an improvement in the diets enjoyed by these middle-income families. For the entire group of workers, however, it is still unfortunately necessary to say that the general picture still presents a serious situation. There is still a large proportion of families in the wage earner and clerical groups whose diets are deficient in one or more nutrients. In the face of this situation, it is clear that labor has a large stake in the development of a national policy on nutrition. The figures that I have already given show that an increase in the purchasing power of families at the lower-economic levels would do much to improve the nutritional status of the wage-earner and clerical groups. The urgency and importance of such an increase should be clear to all thoughtful people. The F air Labor Standards Act is already putting a floor under wage rates so far as interstate commerce is concerned. Employment on government enterprise in connection with the defense program has already greatly increased the total wage income in the country. It is clear, however, that a change in the amount and distribution of the national income sufficient to provide PERKINS—LABOR’S STAKE 55 for entirely adequate diets for all urban workers will take a long time and presents many complicated problems. In my opinion, even while we are in the midst of the national defense program, we should be considering economic measures which will bring about improvements in the American diet. These plans should be of two types: Those for cutting the cost of bringing food from the farm to the urban consumer and plans for certain consumer subsidies. Processing and distribution costs bulk large in the Nation’s food bill. Studies of the Bureau of Agricultural Economics show that in 1940 American consumers spent about $14,800,000,000 for foods grown in this country. Of this amount the farmer got about $6,200,000,000. The remaining amount, or $8,600,000,000, went to pay the various charges for transportation, processing, and marketing. The latter costs cover services which are as real and as important as those rendered by the farmer. The charges for these services, however, may be unduly large either through inefficiency or monopoly control. The Government should continue to take whatever measures are necessary to safeguard economy of distribution. Grading and labeling regulations which encourage efficient distribution and efficient buying by the housewife should be encouraged. There are other regulations, however, taxes, and license fees which unduly raise food costs, and they should be abolished in the interest of a sound nutrition policy. Farmers’ curb markets, city pushcart markets, and low-price milk depots are needed both to serve the consumer public and to give the farmer an adequate outlet for his products. Some farmers who are located near consuming markets now peddle their products in the cities—selling directly to retailers, or even directly to consumers. Efforts should be directed toward developing varieties of direct marketing which will eliminate unnecessary cost without bringing about other unfavorable results. Food consumption subsidies became part of public policy in the United States in the years of the last depression when they seemed the best answer to the dilemma of farm surpluses of food products, on the one hand, and the many urban families without proper food on the other. The loss of foreign markets and the decline of purchasing power for a time among most city families resulted in the wastage of unmarketable food surpluses on the farms. The surplus marketing program was at first developed as a temporary measure, but there is much to be said for incorporating some of its best features into a national policy on nutrition. The school-lunch program seems a particularly valuable addition to American institutions. In most parts of the United States, school books have been provided without charge to the students for a number of years. The provision of free school lunches seems an even more important part of the public responsibility. More than 4,000,000 children in our schools have received free lunches during the current fiscal year. There are about 30,000,000 school children in the entire country. If all the children who now have inadequate diets were to be reached by the school-lunch program, it is unlikely that there would be many schools without some children having a free lunch. It thus seems clear that the extension of this 56 NATIONAL NUTRITION CONFERENCE program to all school children would have, in addition to its other advantages, a very sound psychological basis. It would also provide for children whose parents had not taught them sound food habits, and give practical lessons in what constitutes a nutritionally adequate noon meal. Provision for additional adult education in nutrition for city mothers, and very likely for city fathers, too, should be part of a national nutrition policy. We need to make available to the adults of today the newer knowledge of nutrition which wasn’t taught when they were in school. We should make it as easy as possible to translate human needs for calories, proteins, minerals, and vitamins into terms of breakfast, lunch, and supper' menus. We must make it easy for average men and women to protect themselves from the unscrupulous who wish to exploit the current interest in what constitutes an adequate diet. Government agencies are, of course, working to protect consumers in this matter. Rather recently, I understand, one of our Government departments had reports of a concern selling synthetic vitamins advertised to make permanent waves stay in longer, and to keep polish from chipping off from fingernails. The regulatory agencies dealt with this case of obvious fraud, and they will do their best in other cases of this sort but they must be assisted by an informed public. City families need more education facilities than are now available in this field. Many suggestions have been made for the extension of the Food Stamp Plan to all families which have been certified for public assistance, and in addition to independent families with incomes under $1,000. Such an increase in the program would require careful planning and a considerable increase in agricultural production, but it might yield such substantial dividends in morale as well as in health that it should be incorporated as part of a national policy on nutrition. Planning for improved nutrition should also include improvement of proper nutrition standard meals in factory lunchrooms and canteens. Arrangements should be made to provide nutritionally adequate and palatable meals at cost to men and women at the place of work with due regard for the preferences and the food consumption habits of the group to be served. Too often factory workers find it difficult to secure digestible and attractive meals near their work without paving excessive prices. This proper food will greatly increase their working efficiency as well as personal appearance. Developing a national nutrition policy for the United States is not a simple task. It involves a delicate balance of the interests of producers, distributors, and consumers, of farmers and urban workers. Labor, whether agricultural labor, factory labor, labor in mines, on trains, or on waterfronts, has a great stake in a nutrition program, because good nutrition is fundamental to good health, and the cooperation of healthy workers is fundamental to the development of any important national policy. This problem is one that involves individual action and social action, and I believe that we may look forward with confidence to finding its solution on a democratic basis. Nutrition and Consumer Protection in Defense HARRIET ELLIOTT Assistant Administrator in charge of the Consumer Division, Office of Price Administration and Civilian Supply The problem of national nutrition cannot stand alone. It is set in a framework of individual and national resources, of individual, group, and national customs, of business practices, economic institutions, and public policies. Above all it is set today in the framework of a great national defense effort. It is, in fact, an integral part of that effort. I want to discuss briefly the characteristics of that framework in order that you may know the related policies and programs for consumer protection with which to integrate your plans for meeting the nutritional needs of the American people. National defense, it must never be forgotten, means total defense. As such it has two major parts; first, military preparedness and aid to the democracies; second, and equally essential, the strength of our own people. These two parts of the defense effort were recognized by the President when he set up the National Defense Advisory Commission and assigned to it the double responsibility, not only for achieving military production but for keeping the American economy in effective operation and safeguarding the interests of the civilian population. This dual task continues to be evidenced by the present administrative set-up which has taken the place of the Advisory Commission. On the one hand, the Office of Production Management is responsible for production of the essentials for military defense. Parallel to it, the Office of Price Administration and Civilian Supply is responsible for maintaining economic stability and meeting civilian needs. Both parts of the defense program affect the framework within which planning and action for adequate nutrition take place. This Nation is committed to an all-out program of military preparedness and all-out aid to the democracies. We are committed to whatever sacrifices such an all-out program may entail. But we are not committed to indiscriminate sacrifice regardless of necessity or cost. To defend our democracy we must strengthen, not undermine it, in the defense process. For this, we must not call upon our people to make unnecessary sacrifices—sacrifices which could be avoided by careful planning or the setting aside of certain private advantages. We are committed to the principle that the burden of necessary sacrifices must fall on those best able to bear that burden, not upon those already struggling to maintain a level of living for their families that is consistent with our national resources, our democratic purpose, and our democratic faith. It requires constant effort to make this principle effective in our society where so many of our institutions and traditional practices make those who can least afford it bear the burdens of insecurity and social adjustment. But such constant effort must be made. 57 58 NATIONAL NUTRITION CONFERENCE All this means careful planning of military production and supplies not only to achieve the maximum military result but to do so in the way least burdensome to the civilian population. It means placing the needs of the democracies for food and other supplies alongside the needs of the American people and- choosing those ways of meeting their needs which are most consistent with meeting our own. It means, in effect, making the program of food for our armed forces, for the British people, and for our own people a single integrated program. Let me give a few concrete illustrations. The Army’s decision to feed fresh milk to the boys in camp has required planning to make milk from outside of the local milkshed available for the civilian population in the vicinity of cantonments. The British needs for concentrated foods which can be transported with a minimum of cargo space have so increased the demand for cheese, evaporated milk, and powdered milk that much larger shifts in our own milk utilization are now required. In applying priorities for aluminum, special allowance was made in the past month for the pressure cookers needed in the Farm Security Administration program to permit food conservation and the raising of nutritional levels of low-income rural families. Illustrations could be multiplied but these are sufficient to indicate what is involved in adjusting our military aid program in order to limit the burdens placed upon American consumers to those which are necessary. The Nation is committed to the second part of our defense program, positive steps to strengthen our democracy, no less than to all-out military preparedness and aid. But this part is far less visible, less dramatic, and less the focus of our concentrated national energy. This Nutrition Conference is an important step toward making our effort on the home front as truly an all-out effort as our program of military preparedness and aid. There are three essential aspects of defense through democratic strength—(1) increasing our economic efficiency, (2) strengthening the health and effectiveness of our people, and (3) maintaining and strengthening our democratic procedures. We cannot achieve our goal of democratic defense with anything less than full efficiency in the use of our economic resources—efficiency in our homes, efficiency in the market place, efficiency in the community, and efficiency in the Nation. Efficiency in our homes calls for a new assumption of responsibility by consumers as economic citizens. Efficiency in the market place means wise buying by consumers and methods of selling which permit consumer discrimination and economy. More than that, it means the degree of price stability essential for efficiency through the economy. Like a sword of Damocles hanging over our head is the memory of the first World War with its sharp and disruptive spiral of skyrocketing prices, living costs, wages, and yet higher prices again. We cannot let such a spiral happen now. We have the machinery to prevent it from happening, and the determination to use that machinery to prevent a price run-away. During the first World War, price controls were introduced only after prices had already shot way up. Today, Mr. Henderson, the Price Administrator, tries to act before the prices rise alarmingly. He set a ceiling on steel lest a jump there start the whole price structure climbing; he held coal in ELLIOTT—CONSUMER PROTECTION 59 line lest the temporary lack of production during the coal strike give rise to a price boost; his recent ceiling on combed cotton yarns. 20 percent below the market price, was designed to pull that price back from a speculative level. By these means a disruptive price spiral can be avoided. This does not mean that no price increases will occur. Some prices have risen and will rise, but these increases must not be regarded as the launching of a price spiral, or panic consumers into buying practices that force prices higher in the process. Greatly increased demand for food growing out of increased consumer purchasing power, Army needs, and shipments under the lease-lend program, have been pushing food prices up from the low point at which most foods were when the war began. Efforts to achieve parity prices for farmers have recently added to the upward trend of food prices. This inevitably means higher costs of some food to American consumers. It is our policy and our determination, however, that these prices shall not run away but shall be held within reasonable bounds In spite of the sharp increases in food prices in recent months, the Bureau of Labor Statistics index of retail food prices is still five percent below th? level of 1937. But every increase in food prices places a burden on the low-income consumer. The food price increases occurring at the present time constitute a burden which must be lightened by redoubled efforts to make possible wise buying, assist consumers to know and use the less expensive foods, and to promote special programs which put food of high nutritive value within reach of low income families. Increased food prices make particularly significant Dr. Wilder’s suggestions for insuring proper nutrition by enriching the staple, low-cost foods. They make imperative the much wider use of quality standards and grades to enable consumers to compare products, stretch their food pennies, and make their food purchases fit their needs. Price itself is meaningless without quality. Living standards are dependent, of course, upon quality, as well as quantity. Economic efficiency cannot be achieved with ignorance in the market place. Price controls cannot be administered unless a price applies to a specific quality. In the food field, minimum quality standards for health and safety are set by the Food and Drug Administration, and the quality characteristics of certain products are defined. These provide a very essential bottom below which quality may not fall, and the extension of such minimum standards is needed more than ever now. But these minimum standards are not enough. They do not provide the necessary basis for economic efficiency as do standards and grades for products at different quality levels. Such grades exist for some meat, eggs, canned goods, and fresh products. The prompt extension of the use of these grades in all retail markets is essential. As rapidly as possible, usable standards and other quality designations must be developed for products for which such standards do not now exist. I have spoken of food prices and food standards because those most closely touch the problem of nutrition which we are here to discuss. But prices and quality standards for other items in the consumer 60 NATIONAL NUTRITION CONFERENCE budget have a direct bearing as well, since expenditures for these items crowd the food budget and cut down the amount available to purchase good nutrition. Next to food, the largest item in the consumer budget is rents. In many communities congested by defense activity, sharp rent increases have occurred. In order to remedy this situation and prevent further increases, the Office of Price Administration and Civilian Supply is assisting local communities to set up fair rent committees and to hold rents as close as possible to pre-de-fense levels for the duration of the emergency. Clothing economy is dependent on recognition of quality, and the need for the development of textile and clothing standards is pressing. I recently saw a statement in a trade paper that a difference of 18 percent in the cost of a certain type of cotton cloth involved a 68 percent difference in quality. The consumer who could not tell that the wearing quality of the material had been reduced not only could not guard her own pocketbook but could not do her part in contributing toward national efficiency. Goods bought for purposes which they do not serve, clothes that wear out and have to be replaced, mean waste and inefficiency in home and Nation. Our all-out effort must overcome this type of waste. It must overcome, too, those obstructions and inefficiencies in methods of production and distribution which check the flow of goods and raise costs to the consumer. Toward this end, the Attorney General recently notified Mr. Henderson that priority will be given to pending antitrust investigations of practices which appear likely to interfere with the price stabilization program. The Antitrust Division last winter started to investigate monopolistic practices in the processing and distribution of a number of foods. Tnese investigations will be given special attention where the evidence indicates that such practices impair the economy and efficiency needed for the defense effort at the present time. Many other types of waste which burden the economy will be attacked by the program of simplification and standardization undertaken in the Office of Price Administration and Civilian Supply. Such a program will reduce the wastes of false and misleading advertising, of multiple and confusing packages and can sizes, and other practices which raise the costs of distribution. The most fundamental approach to economic efficiency, and incidentally to problems of price, is to produce and make available an adequate supply. This is the only real means of consumer protection, moreover, for there is no substitute for the actual things that go to make up the consumer’s standard of living. For most of the basic things which go into the American standard of living there are resources and materials and available manpower to produce them. Shortages exist, and priorities are being established on some imported products, and on others where expansion of defense demand has outstripped expansion of productive capacity. But many of these shortages can and must be overcome, and we must, therefore, work for the maximum in needed production which our resources, our effort, and our organizational ability can produce. This is particularly true in the matter of food. Our agricultural plant is tremendous. The resources for producing all the rood which we need are here. We must encourage and secure the production of that food. The Secretary of Agriculture has already pointed out the ELLIOTT—CONSUMER PROTECTION 61 additional volume of agricultural production which would be required were the American people to be fed at levels of adequate nutrition. The foods needed for export are in many instances the same as those needed for adequate nutrition in this country. We should secure the prompt production of these foods by all means consistent with fair and adequate protection to the farm population. The Department of Agriculture’s plan announced April 3, to support the prices of hogs, dairy products, chickens, and eggs, had the concurrence of my office and Mr. Henderson’s on the ground that it was a practical measure to secure the added production of these foods which is needed at the present time. It is not enough for all-out defense that we take these steps to promote economic efficiency. National defense requires fitness and strength for all our people. We know that there are many who live below the safety line. I need not repeat the evidence which you have heard and discussed and which is familiar to all of you. Our national defense program requires the support of Federal, State, and local programs and of private efforts to meet the needs of low-income consumers and to find means to raise their levels of living to the point of strength and fitness. Many of the specific programs have been mentioned by other speakers today. School lunches, Food Stamp Plan, the cooperative canning of local surpluses are but a few of the many ways in which low-income families may be aided toward adequate health and safety standards. We shall not achieve our program of defense until the level of all our people has been raised above the minimum. And we must not only maintain but make increasingly effective the services of Federal, State, and local governments and the cooperative activity of private agencies and individuals toward this end—necessary resources, for instance, to enlarge for school lunch and food stamp programs, to extend and speed up the grading and inspection services of the Agricultural Marketing Service and the Food and Drug Administration, and to carry forward the investigations of the Antitrust Division of the Department of Justice. We cannot set the defense program on one side and our “social gains” on the other side and ask how many of our social gains we must sacrifice for the sake of defense. Our social gains, those instruments of social protection which we have forged, are an essential part of our national defense. So, too, is our democratic method. Defense cannot be wholly for the people; it must be by people. Consumer protection must be achieved by an educational process leading to tne goal of effective economic citizenship. Aid to consumers to permit ana encourage their wise buying; market information through press and special publications ; knowledge of how to judge quality and to plan use, or to save by paying for plain foods in bulk instead of for fancy packaging; suggestions for activities to promote consumer welfare; these are all means by which consumers may gain understanding and carry their economic responsibility. Local market news broadcasts in many cities guide housewives to those things which are plentiful in the market, help to absorb local surpluses and add to individual and national efficiency. Democratic defense thus rests upon an educational process and broad participation of people throughout the country in matters affecting their welfare. 62 NATIONAL NUTRITION CONFERENCE This, then, is the framework of defense into which the national program of nutrition fits—an all-out effort on the home front as well as the military sphere; economic efficiency, human strength, democratic processes. In the total picture, nutritional standards occupy an important place, for they supply necessary criteria in terms of which efficiency may be gauged, and a guide to those adjustments in consumption to meet defense conditions which are, and those which are not, consistent with defense itself. One final word: As we develop a program of total defense today we must face not only the present but the future, and must lay the foundations on which a strong America can be built when the emer-fency is past. We entered the defense emergency after years of epression. We look back to the post-war periods of the past and see them marked by economic collapse. But we cannot let tear of a post-war slump stand in our way today, for we must, at our peril, avoid such a collapse when the emergency is past. No nation which cannot effectively order its own economy can expect to survive in the world of tomorrow. The framework within which we build sound nutrition for strong defense today extends forward to the only future which can give meaning to our present effort—one in which health, security, and opportunity are the birthright of all our people. Selective Service and Its Relation to Nutrition BRIGADIER GENERAL LEWIS B. HERSHEY, Deputy Director, National Headquarters, Selective Service System The Selective Service System appreciates an opportunity to participate in a conference of this kind and at this time. Selective Service is vitally interested in any measures which look to the betterment of the health of our people. Selective Service is ready, willing, and anxious to participate to the limit of its capacity in the means by which disabilities are prevented, as well as the steps which may be taken to correct those already developed. Selective Service was created “to provide for the common defense by increasing the personnel of the armed forces of the United States and providing for its training.” It must accomplish these purposes without unnecessarily interfering with the many other activities so essential to an all-out defense. To accomplish the missions given by Congress brings the Selective Service System into the every day lives of millions of our people. This contact with the lives of our people brings into the foreground basic facts about our people. Selective Service is a decentralized operation. It is an operation which makes available to the people of a community facts about the people of that community. It has made of record—it has inventoried—the capacities, the skills, and the physical conditions of many of our citizens. It has focused the attention of all of us upon conditions which we may have vaguely suspected but which we preferred to overlook. I hope that it has produced and will continue to produce facts about our physical condition as a people which will force us to take action to prevent the occurrence of these disabilities and to correct wherever possible those which are already in existence. Let us briefly review the information which has come to us during the past several months about the physical condition of the men of America. Under the present practices the registrant who has been placed in class I by his Local Board is initially examined by the Medical Examiner of the Local Board. The men who are deferred because of dependency, because of occupation, or because of any one of several reasons are not physically examined at the present time. Approximately a million registrants have been examined by the medical examiners of the Local Boards. Of this number approximately 200,000 have been rejected as unsuited for military service. One hundred twenty thousand have been placed in I-B, which means normally one of two things—either they are temporarily unfit for general service, or they are permanently unfit for general military service but are fit for certain types of military service where physical qualifications are not as rigid. . The registrants who are passed by the local medical examiners as fit for general military service are sent to Army induction stations as 63 64 NATIONAL NUTRITION CONFERENCE they become due for induction. Here they are examined by a board of medical examiners. These examiners may be medical officers of the Army of the United States. The board may be composed of a few medical officers, the remainder contract surgeons. Here another physical examination of the registrant is held—about 560,000 have taken this examination. Of this number 500,000 were found fit for general service, 55,000 for limited military service, and 5,000 were wholly rejected. In tnis connection I should like to comment on the situation created by the dual examinations and the problem of those who are accepted by the first, and then rejected by the second. This has been the cause of some hardship to rejected registrants and the basis of well-founded criticism. The basic causes of this situation lie in the fact that the final examination is given by the service into which the registrant is to be inducted. The fact that the final examination is given just prior to induction compels the registrant to settle his affairs prior to reporting for induction. This step is most unfortunate if the medical board at the induction station disagrees with the finding of the local board examiners. It is not surprising that differences of opinion developed between examiners as to the fitness of the registrant as a soldier. Our World War experience seems to indicate that 8 percent variation is a fair average in deviation in opinion between examiners. It must be remembered that in the beginning practically all medical examiners were inexperienced in work of this nature. It should also be borne in mind that the medical examiners of the Selective Service System served without pay and that the long hours which they have given have been a patriotic contribution. Experiments are now under way whose purpose is to perfect a system which will enable registrants to be physically examined finally by an Army examining board at a reasonable time prior to the induction date. By this method each individual registrant should know sufficiently in advance of his successful passage of the physical examination to enable him to make preparations for his induction into the armed forces. I have said that out of a million examined by Selective Service and about 560,000 examined by the Army a total of 380,000 have been found unfit for general military service under present standards. What have been the causes for rejecting these individuals? There are many and I shall name the few which account for the largest number. Teeth account for nearly 20 percent of the rejections; eyes and cardiovascular 10 percent each; 9 percent are rejected as being generally disabled for three or more reasons; musculoskeletal disabilities account for 8 percent; 7 percent are obviously unfit even to the nonprofessional; nervous and mental rejections take 6 percent; ear, nose, and throat fail 5 percent; lungs, hernia, and those over or underweight each reject 4 percent; gonorrhea and syphilis take out 3.5 percent, and feet 3 percent. It is not my purpose to attempt to fix the causes for these disabilities. Many suggestions are advanced. Foods undoubtedly play a very considerable part whether it be because of a lack of a proper amount, or because the food was of an improper kind. It has been estimated that perhaps one-third of the reactions were due either directly or indirectly to nutritional deficiencies. In terms of men, the Army today HERSHEY—SELECTIVE SERVICE 65 has been deprived of 150,000 men who should be able to do duty as soldiers. This is 15 percent of the total number which have been physically examined by the Selective Service System. It is perhaps of little use to speculate on what should have been done by our schools, by parents, by health bodies, or by the Government. Probably the depression years left their marks. Undoubtedly the automobile and the cash it required for monthly payments and for gas, oil, and tires, has cost us as a people in physical fitness. Whatever the causes, this is the condition in which we find ourselves. Whether we are worse off physicaly than we were in 1917-18 is undoubtedly controversial. That our physical standards are higher now, let us admit. The fact remains that while we may be no worse now than twenty-four years ago we seem certainly to be no better. Better or worse or the same, we are physically in a condition of which we nationally should be thoroughly ashamed. It is a condition we should recognize as dangerous and which we should take immediate, positive, and vigorous measures to correct. There are some facts to indicate that there is a definite relationship between age and physical disability, an indication which would be assumed on general observation. A study of 8,000 cases chosen generally from all sections of the country indicated that the rejections in the age group 18-21 was less than 6 percent; 21-25,25 percent; 26-30, 36 percent; and 31-36, 52 percent. To what extent later disabilities have their causes in the earlier ages is a matter for conjecture. The fact that all of those examined between 18 and 21 were volunteers may well be one of the reasons for the extremely low rejection rate, if we are to assume that those who had disabilities were aware of it and have not offered their services. However, our information from this study and from a study of those examined by the Army Induction Station in Chicago indicates that there are twice as many physical rejections in the 31-36 group as there are in the 21-25. In this connection it should be noted that this may not be an exact indication of the physical condition of the two groups because Selective Service, so far, has confined its physical examination to those who had no reasons for deferment, and it may be true that the individual in the upper age group who has no dependent or skill or who has in no other way made himself a necessary man is not representative physically of his group. We are faced with the question—What can we do to improve the physical condition of our people ? Undoubtedly prevention is always better than cure; far-reaching results will follow basic changes which develop our people physically. This is a long-range program in which schools, parents, and Government must each bear a part. To be successful there must be a thorough-going system of education as to what the situation is, what steps are necessary for its correction, and the individual part that each citizen must play in making these measures operative. In the long range picture I believe the most fundamental step must be a basic change in our conception of the nature of our educational system. We must place a decided emphasis on physical training and physical education. The ancient Greeks had a conception about the development of the human body to which we should give serious consideration. Our first long step m building a physically strong America 66 NATIONAL NUTRITION CONFERENCE is to recognize physical fitness as even more important than mental fitness. This recognition must be on a plane above the recreational level. Today we pay our tribute to outstanding athletes, but only as they entertain us. Our educational system must place the youth who has developed a perfect, healthy body on a plane above the scholarship giant who in reaching his goal has ruined his eyes, his digestion, and is health in general. Once we have set up an educational objective of a well-developed body, we must organize our curriculum to secure it. This establishment of an ideal of bodily development is basic and necessary, but it is a long-range planning item. What can we do now ? I shall omit any reference to those unregistered or to those placed by local boards in deferred classifications. I shall concern myself with two general categories—those who have not been classified and those who have been classified, examined, and rejected. The individuals who have not yet been classified owe a duty to their government for service. That obligation calls for the service of a whole man—a man entirely alive—a healthy, strong, well-developed man. It is the duty of the registrant faced with this responsibility to use every means available to make himself fit to serve. To accomplish this end will require the coordinated efforts of the medical profession, State and governmental agencies, and an enlightened and energetic public opinion. If there is an effort on the part of all, there can be thousands of men made acceptable for service in the armed forces. I turn to the next category—those registrants who have been physically examined by Selective Service and rejected, or have been accepted by Selective Service and rejected at the Army induction station. This group numbers somewhere in the neighborhood of 400,000, with about one-half rejected for any military service and the remainder judged satisfactory for limited military service. Of course, every effort should be made to correct every correctible defect in this group, but the 200,000 who are fitted for limited military service create a special problem. Many of these individuals have every appearance of an able-bodied man. They are known in their communities as individuals capable of performing physical labor, or of participation in activities that require a reasonable amount of physical proficiency. With this group will be an increasing number of individuals who have been rejected for mental deficiencies. I do not believe our people will continue indefinitely to accept avoidance of military obligations by the class to which I have just referred. If this assumption is accurate, we are confronted with the necessity for rehabilitation for the members of this group where it is possible to better their physical condition, and to attempt to discover an efficient place in national defense for those with uncorrectible disabilities. Some of these rejected registrants will attempt to correct their physical disabilities without urging; some additional ones will do so if persuasion is used; many will be content to continue as they are. I believe that it will be necessary to place the responsibility for the rehabilitation of these individuals directly upon the Government. Whatever methods may be used for the correction of physical disabilities in the general public, this group must be utilized in a manner which will not permit them to escape military obligations because of their physical conditions. I realize that there are agencies in the HERSHEY—SELECTIVE SERVICE 67 Government at the present time which might be modified to serve as rehabilitation agencies—their part in the rehabilitation of the general public may or may not be feasible, but for this group liable tor military service voluntary methods will not suffice, In the interest of public morale these individuals should be compelled to render service to the Nation. In the public interest they should be improved physically while they are performing this national service. I realize the tremendous task which has been placed upon the War Department by the necessities of the past year; I am aware of the task which the induction of one or two hundred thousand limited service men would impose upon an already over burdened agency; I am aware of the financial responsibilities which may accrue to the Government by the acceptance of below-standard men. On the other hand, there seem to be no other agencies capable of carrying out this task in a manner which will insure that the Government shall require service from the individual, while at the same time effective measures are undertaken to improve the physical condition of the individual. In addition there is work which can be done by limited service men that will relieve combat units from tasks which must be done, but whose doing interferes seriously with the training programs of these units. There is an additional advantage to be gained by having these men inducted into service, for as they become rehabilitated physically and mentally they can take their places in combat units. In summary, Selective Service has examined physically a million. The results or these examinations should be disturbing to us as a people—they should energize us to immediate and positive action. Approximately 400,000 have been found unfit for general military service—probably one-third of these are suffering from disabilities directly or indirectly connected with nutrition. At least two hundred thousand can be used for limited military service, with perhaps one hundred thousand of these capable of rehabilitation to the point where they can do full military service. The non-induction of the limited service group constitutes a grave moral problem which will tend to increase. Measures must be taken to require service of these individuals and their development to a physical condition where they can do full physical duty if inducted. In general this cannot be accomplished by the voluntary efforts of the individuals concerned. There is national work which they can do while their rehabilitation is in process. America must be strong, but she cannot be strong when one-half of her sons are substandard physically. America needs whole men, not half men. She must develop vigorous and healthy youths; she must prehabilitate those whose defects are slight; she must rehabilitate those examined and found deficient. The task before us, like all tasks in a democracy, is the duty and responsibility of each and every citizen. The Selective Service System by its very nature will play a vital part in the solution of this all important problem. It dedicates itself to a participation in the movement for better and healthier bodies for all the citizens of America. 425544°—42---------6 DISCUSSION OF SPECIAL PHASES OF NUTRITION PROBLEMS On the afternoons of May 26 and 27, section meetings were held to discuss special phases of nutrition problems and to prepare recommendations to the President. Sections III, VI, VII, and VIII were divided into two parts presided over by cochairmen. Each section appointed a drafting committee to prepare a brief report on the main points brought out in the two afternoons of discussion and to draw up recommendations to be presented on the final day of the Conference. The work on special phases of nutrition problems was discussed in the following sections: Section I. Research and National Nutrition Problems. Chairman: E. V. McCollum. Secretary: J. Ernestine Becker. Section II. Economic Policy and Social Responsibility as Related to Nutrition. Chairman: Lucy H. Gillett, Cochairman: Hazel Kyrk. Secretary: Hazed K. Stiebeling. Section III. Public Health and Medical Aspects of Nutrition. Chairman: James S. McLester. Cochairman: Richard M. Smith. Secretaries: W. H. Sebrell and Katherine Bain. Section IV. Nutrition for Workers in Defense Industries. Chairman: Frank G. Boudreau. Secretary: Carroll E. Palmer. Section V. Methods of Education in Nutrition. Chairman: G. Dorothy Williams. Cochairman: Mildred W. Wood. Secretaries: Miriam Birdseye and Edna P. Amidon. Section VT. Professional Education in Nutrition. Chairman: Lydia J. Roberts. Cochairman: John H. Musser. Secretaries: Thelma Porter and Marjorie M. Heseltine. Section VH. Nutrition Problems in Distribution and Processing of Foods. Chairman: Hector Lazo. Cochairman: L. V. Burton. Secretaries: Frederick V. Waugh and R. S. Hollingshead. Section VIII. Community Planning for Nutrition. Chairman: Howard Y. McClusky. Cochairman: H. C. Ramsower. Secretaries: Margery Vaughn and B. W. Allin. Section IX. Nutrition Problems in Group Food Service. Chairman: Katharine Ansley. Cochairman: Alberta MacFarlane. Secretary: Melva B. Bakkie. 68 SECTION I RESEARCH AND NATIONAL NUTRITION PROBLEMS Presiding, ELMER VERNE McCOLLUM, M. D., Professor of Biochemistry The Johns Hopkins University Chairman AGENDA I. Nutritional Requirements and Standards for Normal Individuals at Different Age and Maturity Levels and in Pregnancy and Lactation. A. For vitamins. B. For minerals including “trace” elements. C. For other nutrients. 1. Protein. , 2. Fat. 3. Carbohydrates. D. Interrelationships between nutrients and the possibility of imbalance. II. Nutritional Aspects of Special Problems. A. Dental caries and gingival health. B. Constitutional inefficiency. C. Suboptimal nutritional status and convalescence. III. Nutritive Value of Foods as Affected by Genetic and Production Factors, Processing, Preparation, and so forth. A. Variety, environmental, and cultural factors in plants. B. Breed and feeding practices in animals. C. Milling, sterilizing, freezing, pasteurizing, and drying. D. Methods of preparing and cooking. E. Influence of aging, storage, and shipping. IV. Nutritional Status. A. Gross appraisal. 1. Physical examination. a. Need for standardization of clinical items as to both techniques and interpretation. 2. Anthropometric measurements. a. Need for further data on individual growth and evaluation of influencing factors. b. Relative value of both static and functional measurements. 69 70 national nutrition conference 3. Roentgenographic assessments. a. Skeletal development: need for further work on standards of skeletal development and its relation to physiological maturity. b. Bone density : significance and interpretation of findings. 4. Physical-performance tests. 5. Inquiries concerning dietary habits and economic level. B. Appraisal with respect to specific factors. 1. Nutrients. a. Proteins. b. Minerals. Iron and copper. Calcium and phosphorus. c. Vitamins. A. The B vitamins. C. p. 2. Hematological procedures. 3. Basal metabolism. C. Interrelationships between specific factors and their value in the appraisal of nutritional status. V. Design and Technique of Experiments on Human Nutrition. VI. Methods and Effects of Changing Food Habits. A. Importance of habit as an influence preventing the widespread utilization of nutrition knowledge. B. How food habits are established. C. Factors of major importance in bringing about changes in food habits. D. Group and age differences in willingness to change habits. SUMMARY OF DISCUSSION The discussion in section I dealt with all the principal lines of inquiry in the nutrition field and was directed toward clarifying the problems which present themselves most urgently for further immediate investigation. It is clearly recognized that, with few exceptions, the fundamental knowledge which we possess concerning the number and nature of the chemical substances which constitute the essential nutrients, their distribution in our ordinary foods, and the pathological effects of their underprovision, was derived from animal experiments. Our knowledge is still incomplete in all these fields of inquiry, but it is sufficiently extensive to be of outstanding value in making possible the formulation of adequate dietaries at several cost levels: for recognizing several specific types of malnutrition; for conserving nutrients in foods ; and, in the case of several of the vitamins, the utilization of synthetic products to supplement dietaries. Since our information on all these matter^ depends upon chemical tests and physiological and clinical techniques for assessment of the status of the individual, it is agreed upon by the specialists who RESEARCH AND NUTRITION 71 participated in the discussions that the need for further research is urgent in the following fields : (1) Improvement of presently known chemical and biological procedures for estimating the amounts of the essential nutrients in foods and their physiological availability. (2) More refined techniques for the detection of nutritional deficiency states, especially in the subclinical degrees of intensity. (3) More precise determination of the optimum and minimum requirements of human subjects for each of the nutrients, as influenced by age and physiological status (including pregnancy and lactation) and those factors which affect their utilization. (4) Study of problems relating to the nutritional needs of the individual as influenced by constitutional inefficiencies, by suboptimal nutrition, by disease and convalescence. (5) Studies toward clear definition of the physical status of the individual. (6) Study of all factors affecting the nutritive value of foods and their preservation during the interval between production and consumption. (7) Study of methods of preparation of foods for consumption so as to avoid losses of nutrients. (8) Food habits and methods and effects of changing them. DISCUSSION The section on Research and National Nutrition Problems considered the principal lines of investigation in the field of nutrition and discussed the problems most urgently in need of immediate research. The meeting opened with a discussion of the available sources of vitamin A. Dr. C. E. Bills (Mead Johnson Co., Evansville, Ind.) pointed out that high potency fish oils are not available in sufficient amounts to supply the Nation’s needs for this vitamin. He recommended the importation of West African palm oil which is a good source of vitamin A and which can be used in enriching margarine. He also suggested investigating the feasibility of applying molecular distillation to low potency fish oils that are available in large amounts. This would be a means of obtaining vitamin-A-rich concentrates. Since the reliability of existing methods for detecting incipient vitamin A deficiency is still controversial, critical comparison of the existing techniques was recommended in order accurately to evaluate the various methods for determining the physiological status of the individual as respects vitamin A reserves. Research for new procedures of detecting the earliest evidences of vitamin A deficiency was also urged. In the discussion of thiamin, Dr. Elvehjem (University of Wisconsin, Madison, Wis.) emphasized the need of direct studies on human subjects for the estimation of man’s requirement for this nutrient. Because of the lack of sufficiently accurate and rapid 72 NATIONAL NUTRITION CONFERENCE methods for estimating thiamin content, refinement of existing methods and the discovery of new ones are needed. Studies of the quantitative distribution of the thiamin content of food should be carried on extensively and as soon as possible, since this type of data is rather scarce. Similar work is needed on riboflavin, nicotinic acid, pyridoxine (vitamin B8), and pantothenic acid in order to determine the human needs for these nutrients in different physiological conditions, such as age, pregnancy, lactation, etc. The following lines of investigation were recommended in the discussion of vitamin C by Dr. C. G. King (University of Pittsburgh, Pittsburgh, Pa.) : (1)' Inquiry into the functions of vitamin C in tne body and the increased need during convalescence and during periods when the body is recovering from injury; (2) devising of means for insuring adequate vitamin C during infancy and childhood; (3) evaluation of the significance of moderate vitamin C deficiency during infancy and childhood in relation to (a) the later incidence of dental caries and (b) other problems in tne field of public health. Discussion of the relation of vitamin D to the prevention of rickets in infants and children was led by Dr. E. A. Park (Harriet Lane Home, the Johns Hopkins Hospital, Baltimore, Md.). He was of the opinion that studies are needed to show whether activated 7-dehydro-cholesterol is of the same order of potency as calciferol. Research directed toward the clarification of the role of vitamin D in protecting skeletal development is essential. The adult requirement for vitamin D also merits investigation. In the discussion of the mineral elements in nutrition, it was concluded that more information is needed in order to formulate reliable standards for human calcium requirements. There is also need for information from human studies to determine the significance of the calcium and phosphorus ratio in the diet. Iron and copper metabolism as well as the physiology of other so-called trace elements were considered. The following suggestions for research in this field were made : 1. Investigation of the utilization of, and requirements for, calcium and phosphorus by the adolescent. 2. Investigation of the utilization of, and the requirements for, calcium and phosphorus by the pregnant and lactating woman. 3. Study of the utilization of, and the requirements for, calcium and phosphorus in old age. 4. Study of bone growth and calcification during early infancy in relation to the type of milk fed, that is, mother’s, cow’s, etc. 5. Investigation to determine whether sufficient iron and copper will be furnished by a diet from natural foodstuffs which is adequate with respect to all other known dietary essentials for normal individuals at different age and maturity levels and in pregnancy and lactation. 6. Investigation to determine the factors which influence availability of the iron and copper in various foodstuffs. In these studies, consideration should be given to the influence of other nutrients. RESEARCH AND NUTRITION 73 7. Investigation of the possibility that deficiency of one or more of the trace elements might occur in case the Nation should come to use what are termed “enriched” foods to a great extent. 8. Investigation of the danger that may arise from the annual repetition of spraying of food-producing plants with insecticides containing lead and arsenic. 9. The study of the possible deleterious effects of dosage with massive amounts of iron m the treatment of anemias. In the discussion of the research on the proteins in nutrition, study of the following subjects was proposed: 1. The amino acid composition of the proteins in our common foods. 2. The chemistry and nutritional significance of the essential amino acids in the human body. 3. The effect of cooking and preservation practices upon the digestibility and the utilization of various proteins in our common foods. 4. New and better substitutes for the more expensive proteins from meat. 5. Development of better technique for determining the qualitative and quantitative protein requirements during the period of growth. The dietary need of fats was considered and it was decided that the human requirements for the essential unsaturated fatty acids be further and more accurately determined. Also the interrelationships existing between fat and vitamin metabolism should be studied. Experimentation to establish the extent to which the fat-soluble vitamins are dependent upon the presence of fat for their absorption was recommended. Investigation is also needed to determine the relationship between fat intake and the bulk and satiety value of diets. Dr. John R. Murlin (University of Rochester, Rochester, N. Y.), who led the discussion on the role of carbohydrates in man’s diet, suggested that studies on human subjects should be undertaken to demonstrate clearly the superiority of whole grain cereals in the maintenance of physical fitness for muscular work. This is particularly urgent during the national emergency, especially since certain studies made in Switzerland seemed to show that soldiers living on whole-wheat bread maintained their fitness better than soldiers living on white bread. Research on the interrelationships between nutrients and the possibility of imbalance was recommended, particularly to determine: 1. Whether there are nicely balanced oxidative or other metabolic processes which may be fatally overturned by the administration of large amounts of only one of the participating indispensable nutrients. 2. Whether the bacterial flora of the intestines is so modified or stimulated by the ingestion of imbalanced nutrients as to change the composition of the absorbable nutrients. 3. At what level of intake, if at all, the prescribed vitamins precipitate symptoms due to other latent diet deficiencies. 4. What is the optimum dose and the optimum ratio of each of the known vitamins in relation to all the others ? 74 NATIONAL NUTRITION CONFERENCE It was suggested that systematic experiments, upon several species of animals, need to be made at once in various laboratories to answer these questions. Cautious use of human subjects may be possible. Consideration was also given, during this session, to the nutritional aspects of the etiology of dental caries. Because an extremely high percentage of draft selectees have been rejected on account of dental defects, and because of the marked controversy among dental specialists on the problem of the causes of dental disease, investigation is urged on this subject. Dr. Isaac Schour (University of Illinois, Dental College, Chicago, Ill.)? pointed to the great need for research on the influence of nutrition on the developing teeth and supporting structures. Experimental production of caries and paradontal disease is essential to aid in the solution of this problem. Standards of assessment of caries and paradontal disease are also needed. Suboptimal nutritional status and nutritional status in convalescence were discussed next. It was pointed out that a study should be carried on to establish criteria for the accurate recognition of states of suboptimal nutrition, and also to establish the necessary increase in intake of nutrients in such conditions, in disease, and during convalescence. Investigations of constitutional inefficiencies which will yield to diet adjustment or supplementation were also advocated. The discussion on the nutritive value of foods as affected by genetic and production factors, processing, preparation, etc., was conducted by Dr. L. A. Maynard (Cornell University, Ithaca, N. Y.), who recommended that in order to establish procedures that will produce a food supply of the highest possible nutritional quality, research in the production of food crops should emphasize yields of available nutrients, rather than yields of the crops in tons or bushels per acre and that research be carried on to learn more specifically about the genetic, environmental, and cultural factors which cause food crops to vary in nutritive value. Better methods of feeding and management are required to improve the nutritive value of animal products. Consequently further research on (1) cheaper sources of protein supplements to replace expensive protein concentrates; (2) a better hygienic and nutritional program for preventing losses of young animals; (3) and a conservative program for animal production, with a long view to the future, should be carried on. Prevention of the high mortality among young chicks and unthriftiness among grown birds should be studied. Further information on the extent to which essential nutrients are destroyed by sterilization methods are needed. Investigations to show how these losses may be minimized should be performed. Investigation on drying methods for fruits, vegetables, meats, eggs, milk, etc., is needed as well as are data concerning the deterioration in food value caused by the procedures practiced at the present time. There is urgent need, particularly at this time, to acquire information on the nutritive values of dried or desiccated foods. More information on the loss of nutritive value in foods as a result of preparation and cooking is also essential. RESEARCH AND NUTRITION 75 Dr. E. M. Nelson (Food and Drug Administration, Federal Security Agency, Washington, D. C.) opened the discussion on the influence of aging, storage, and shipping, on the nutritive value of foods. He was of the opinion that further investigation is necessary on the following problems: 1. Losses of vitamin C in fresh vegetables kept under different conditions and practical methods of reducing such losses to a minimum. 2. Loss in vitamin content of dried vegetables and fruits. 3. Importance of deterioration of the nutritive value of proteins of cereals to persons whose diets are restricted largely to cereals. 4. Losses of vitamins in canned fruits and vegetables under1 pro longed storage. In the discussion of the appraisal of nutritional status, it was revealed that there is a great deal of confusion concerning what is meant by nutritional status. It was pointed out that there is urgent need for improving and integrating present methods of assessment including the clinical examination; laboratory procedures; tests for physical performance; growth standards including anthropometric and roentgenographic procedures; and dietary histories. There is a definite need for more carefully planned studies of human nutrition in order to insure definitive answers and to exclude the effects of factors other than the one being studied. In addition, sufficient observations to answer satisfactorily the question being studied are needed to permit efficient utilization of these observations. Further and more detailed studies of individuals followed over a considerable period of time, with an adequate evaluation of their intake, the efficiency of its utilization, and the resulting evidences of adequate or inadequate nutritional status should be conducted. More study and greater care and thoroughness in such studies are needed so that the physical examination may be made a useful tool in appraising nutritional status. In order to determine whether anthropometry can be useful in appraisal of nutritional status, study is urged of anthropometric data on a group of individuals followed over a considerable time period, and followed from dietary, anatomical, physiological, and psychological aspects as well as those of health. It was brought out in the discussion that several years of research in roentgenographic assessments have demonstrated that there is a very close relationship between skeletal development and physiological status. Continuation of longitudinal studies such as those conducted and discussed by Dr. A. H. Washburn (Denver, Colo.) was recommended. It was urged that skeletal norms, regardless of their source, should not be emphasized. There is need for more precise information about the limitations of existing standards of skeletal developement, particularly with reference to the degree of variability in skeletal status at various ages which is compatible with adequate physical growth and development. Longitudinal studies in which the skeletal development of individual children is followed over a period of years was suggested. Skeletal data were to be supplemented with other evidences of child’s growth such as developing its health history. Studies to include children of various social and national groups are to be encouraged in order to evaluate the data on skeletal develop 76 NATIONAL NUTRITION CONFERENCE ment. Recommendations were made for further research in the appraisal of bone density with particular reference to establishing a standard region or regions for making the smallest number of tracings possible which will give an objective and valid measure of skeletal density in human beings and to developing a series of standards for different ages of the two sexes. The appraisal of the nutritional status with respect to specific dietary factors was considered. It was pointed out that there is need ror better and more practical methods of determining protein standards and physiological nitrogen environment. Research to reevaluate and redetermine normal hemoglobin values, especially for women, should be encouraged. Investigations should also be made to determine what dietary factors other than iron influence hemoglobin values and consequently what a hemoglobin value may reflect concerning nutritive status in respect to dietary factors other than iron. There is also a need for methods for assessing the nutritive status of the body in relation to copper. Since there are no standards at present whereby the nutritional status of an individual in respect to calcium and phosphorus can be assessed, experimentation is required to establish standards for assessing the status of the individual to determine whether he is getting sufficient calcium and phosphorus to keep him in maximum physiological efficiency. In the discussion oi the vitamins, the need for more specific, cheap, simple, and objective study of the usefulness of the existing criteria of incipient or of more marked deficiency of vitamin A was urged in order that quantitative procedures may be worked out for detecting these states. Basic experimental studies on animals are indicated to determine the actual function of vitamin A in physiological processes. Fundamental researches to extend our knowledge of the absorption and utilization of both vitamin A and carotene were recommended. Investigation of the chemical changes which accompany thiamin deficiency was suggested by Dr. R. R. Williams (Bell Telephone Co., N. Y.). Researches should be encouraged for determining the role of vitamin Bi, thiamin, in the body. One necessary line of study is a collection of data regarding the quantitative occurrence of each of the several B vitamins in each of the body tissues and fluids. This ought to be applied widely first to animal tissues and then to human tissues from individuals of varying ages of both sexes and from those succumbing to a wide variety of diseases, and particularly from accident cases, so as to establish values normal for human beings free from disease. Since vitamin C, ascorbic acid, is one of the many factors fundamental to the development of good teeth and to the incidence of dental caries in both the young and the old. the vitamin-C intake during infancy and early childhood in relation to the normal development of the bones and teeth should be investigated extensively in order to study what contribution marginal vitamin-C deficiency has made to the present widespread evidence of dental caries. The degree to which marginal or severe vitamin-C deficiency may affect constitutional inefficiency needs to be determined. Vitamin C appears to have an active function in the cells of glandular tissues. RESEARCH AND NUTRITION 77 Consequently, the correlation between vitamin-C intake and glandular function is of importance. Further experimental and clinical studies are needed to extend our knowledge of the significance of marginal deficiency of vitamin C. Since both experimental and clinical studies have demonstrated that bacterial toxins and injections cause an increased demand for vitamin C, reasonably generous levels of this vitamin would be desirable from the standpoint of protection against injury in case infections occur. Specific provision for adequate supplies of vitamin C as a part of the National Defense Program should be recognized also because (1) the vitamin is an important factor in the process of wound healing; (2) a regular intake of the vitamin is necessary to maintain normal health and efficiency; and (3) the vitamin is extremely sensitive to destruction in stored food supplies and requires special consideration when there is a restricted intake of fresh fruits and vegetables. In case of vitamin D, some chemical method by which we could appraise the vitamin-D concentration in the body fluids, particularly the blood, would be of considerable aid in evaluating the status of vitamin D. In the discussion of basal metabolism in relation to nutritional status, the desirability of an extensive program including observations on cases of mild deficiencies of each of the essential nutrients to determine the extent to which these states influence metabolic rate was recommended. Standardized techniques for this purpose are to be sought in order that the data of different investigations may be compared. More information on the total energy requirements of human subjects and the factors influencing basal outputs is needed. In addition, more attention should be given to both the younger and the older age groups in respect to this problem. Dr. Sarah S. Deitrick of the Cnildren’s Bureau, Department of Labor, Washington, D. C., discussed the subject of interrelationships between specific factors and their value in the appraisal of nutritional status. How far skeletal maturity is related to physiological maturity, and how far it is reliable in evaluating the nutritional condition should be investigated. The use of physical performance tests in the evaluation of the individual’s physical efficiency was recommended. More emphasis should be placed on providing a satisfactory diet before proceeding to assess the nutritional status. In carrying on research of nutritional status, a complete history of the child as respects growth and development, together with tests of physical performance and a full medical history, are essential. Growth and development should be considered in relation to the child’s own previous record rather than to a scale which is the average of a variety of growth patterns. Careful inquiry into the dietary habits of the child should be a part of such programs. Methods and effects of changing food habits were considered. It was recommended that available research findings dealing with cultural patterns should be brought together with particular reference to the problem of how food habits can be changed. Research was recommended to determine what motives and appeals for use with mass methods will prove most effective in reaching individuals. It 78 NATIONAL NUTRITION CONFERENCE was recommended that methods which alter the food habits of those whose diets are most in need of change should be studied. Research is required to learn which available foods are preferred relative to taste and custom by the different groups whose diets now are deficient. Research is also needed to determine the actual and potential influence in the change of food habits which is exerted by misinformation, superstitions, accurate nutritional knowledge, folkways, prestige, and concern about the national emergency and also how each can be used most effectively in furthering the National Defense Program. There is need of evaluating the various educational programs in schools, and in society in general, that are now being used in attempts to change food habits. At the conclusion of the discussion of the section, Dr. Murlin (University of Rochester, Rochester, N. Y.), suggested that the existing facilities be used for the research recommended by this section, at least at first. It might be more effective to start with coordination of existing agencies, each laboratory known to be competent in a certain field to be asked to do a certain part in this general program. He also recommended that we proceed to make a survey or existing facilities in all universities and agricultural and land-grant colleges of the country fitted to carry out substantial portions of the general research program outlined by the section. In this survey an estimation of additional funds should be included which may be necessary to effect promptly and efficiently the execution of these researches. Dr. Murlin’s recommendation was put into a motion and was accepted to be incorporated into the report. RECOMMENDATIONS After a report summarizing the discussion and conclusions of the section had been adopted, the following motion was passed: Resolved, that section I of the National Nutrition Conference appoint a committee to survey existing facilities in all the universities, agricultural and land-grant colleges, or other laboratories of the country, fitted to carry out substantial portions of the general research program outlined in the report as adopted, and include in this survey an estimation of additional funds which may be necessary to effect promptly and efficiently the execution of these researches. SECTION II ECONOMIC POLICY AND SOCIAL RESPONSIBILITY Presiding, LUCY H. GILLETT, Director of Nutritional Work, Community Service Society, New York City, Chairman; HAZEL KYRK, Ph. D., Consulting Specialist, Bureau of Home Economics, United States Department of Agriculture, Cochairman AGENDA I. Certain assumptions must underlie economic policy or social responsibility for the improvement of nutrition. These facts are generally agreed upon: A. Malnutrition exists in this country to an unnecessary extent. B. For many families, especially those with children, incomes are too low to buy nutritionally adequate diets at current retail prices without great change in food habits and lowering of standard of living in other respects. C. The changes in income that accompany the defense effort will not eliminate malnutrition. D. Not all the nutritionally inadequate diets are found among low-income groups. E. The kinds of foods that should be consumed in greater quantities by low-income families in this country are dairy products, eggs, leafy, green, and yellow vegetables; other vitamin-C-nch vegetables and fruits, whole-grain, lightly milled, or enriched forms of flours and cereals, and in some sections more lean meat and fish. II. Increased consumption of the requisite foods among low-income and relief families would presumably result from such changes as those listed below. The methods suggested are not alternatives. The promotion of all or any group of them could constitute the social program. Pertinent questions to determine which proposal to approve or to emphasize would be: What improvement in nutrition would be achieved by this method? How speedily? Which proposals are most feasible? The most desirable socially? 79 80 NATIONAL NUTRITION CONFERENCE A. Higher incomes: 1. Increased employment and higher wage rates among low-income village and city groups. 2. Increased farm incomes (including suitable programs of food production for family use). 3. More adequate relief allowances covering not only food but all essentials for those dependent on society for support. B. Decreased processing and distribution costs of essential foods: 1. Promotion of inexpensive methods of distribution of all basic foods. 2. Production and marketing of low-cost forms of nutritionally desirable foods, as dry skim milk, soybean, and peanut products, etc. 3. Elimination of laws that discriminate against desirable foods and increase their cost of distribution. 4. Elimination of excise taxes on food. 5. Elimination of price-maintenance measures and other restraints upon trade. C. Changed scale of values governing family expenditures, giving more prominence to food. D. Provision oi essential foods wholly or in part at community expense. 1. Free lunches for all school children. 2. Participation in the stamp plan by all families with children. 3. Low-priced milk for all families with children. 4. Suitable lunches at cost to workers in industry. III. The resources of many families in the lower-income groups are inadequate to provide nutritionally satisfactory diets in present circumstances, but not all of the inadequate diets of this country are found among low-income groups. To what extent should we undertake the improvement of diets at all income levels through education in careful food preparation, wise selection of food purchased, and by suitable programs of home production, especially in villages and on farms? A. What progress is possible through more effective education in food selection and preparation adapted to needs of the various population groups and coupled with timely market information ? B. How important is home food production in rural areas in a program designed to improve nutrition ? C. To what extent can home-food production programs be promoted through: 1. Fostering more satisfactory owner-tenant relationships, including land leasing arrangements that will permit more extensive food production for family use? ECONOMIC POLICY 81 2. Developing of attitude that a suitable home-food production program is not a side-line of the farm enterprise, but an integral part of the whole? 3. Promoting long-time planning for food production on individual and community basis? 4. Providing more adequate community facilities, such as cold-storage and freezer lockers, canning kitchens, drying ovens ? IV. Inasmuch as educational processes tend to work slowly, and changes in power to purchase food do not bring marked and speedy results in dietary adequacy, would it be economically feasible and socially desirable to undertake certain public health measures : A. Fortification of all staple foods with minerals and/or vitamins ? B. Development of low-cost complete-ration mixtures of foods to supplement customary diets? SUMMARY OF DISCUSSION The delegates invited to consider and make recommendations to the Conference on the question of economic policy and social responsibility included persons with very diverse viewpoints and interests— economists, social workers, nutritionists, teachers, extension workers, homemakers, and representatives of farm, labor, and “professional” consumer groups. To insure some common understanding of the problem, time was taken at the first session to present briefly certain factual material against which the discussion of the agenda might be focussed. These included a statement of the dietary situation in the United States, and some factors affecting it, by Dr. Hazel K. Stiebeling, of the United States Bureau of Home Economics ; a summary of the outlook for income and prices, by Dr. Faith Williams of the United States Bureau of Labor Statistics; and the significance to nutrition of food processing and distribution costs, by Dr. Donald Montgomery, Consumers’ Counsel, United States Department of Agriculture. The recommendations, hammered out in true democratic fashion by debate, discussion, motion, and vote, were presented in full to the Conference in assembly. To do less would be to resort to meaningless generalities, since the topic assigned was extremely broad— in fact, there might well have been as many sections on this one topic as were set up for considering all other aspects of nutrition. No single delegate would subscribe in full to all details in the statement. There was difference of opinion as to the relative importance, feasibility, and desirability of many of the specific recommendations. Nevertheless, there was unanimity of opinion that the recommendations as a whole reflect the sense of the section meeting. The section recognized that to combat malnutrition there must be increased production and consumption of the foods that are rich in those nutrients now consumed in less than adequate quantities. This implies increased power to purchase and produce foods for family use. To this end the section indicated several steps that 82 NATIONAL NUTRITION CONFERENCE might be taken to increase the real incomes of the lower economic groups in villages, cities, and on farms. Suggestions were also made for increasing the supply of essential foods. Measures were pointed out for the reduction of costs of processing and distribution and changes needed in the market to increase the efficiency of the consumer in selection. Direct consumer subsidy in the form of free school lunches5 the Food Stamp Plan, penny milk for school children, and “nickel” milk for families were believed to have an important place in correcting malnutrition. There was a recognition, however, that high food expenditures alone will not guarantee adequate nutrition. Education is needed not only in the choice and preparation of food but also in food buying and home production. It was also agreed that provision for systematic research should be made as a basis for developing economic policy and social programs for the improvement of nutrition. The discussion indicated diversity of viewpoint on detail, but agreement in general on the recommendations as a whole. The set of recommendations must be considered as a serious report by a lay group on the impact of our economic and social organization on nutrition coupled with suggestions for improving the situation. DISCUSSION The Dietary Situation in the United States Hazel K. Stiebeling1 We here in the United States have been used to thinking that we have a relatively high level of nutrition. This comes from comparing conditions in this country with those prevailing over large areas of our globe. Compared with the standards set by modern science, however, our level of nutrition is far from high. A large proportion of families here have food supplies that fail to furnish the quantities of nutrients recommended by the National Research Council’s Committee on Food and Nutrition. This is shown by comparing these allowances with the nutritive value of diets studied in the two large-scale studies made during the last 7 years by Federal agencies. These studies indicate, for example, that the diets of only one-fourth of the village and city families and about one-half of the farm families probably would meet the suggested calcium standard of 0.8 gram per man per day, and even fewer would have diets furnishing (in the uncooked food) as much as 1.8 milligrams vitamin Bi or 2.7 milligrams of riboflavin, the recommended allowances. Local dietary studies give much the same picture. Unfortunately we have no large-scale clinical studies to give us direct evidence of the prevalence of malnutrition, but the small-scale studies that have been made corroborate this. Furthermore, we have the opinion of qualified medical authority that the prevention and treatment of nutritional diseases constitute one of the greatest medical problems. 1 Bureau of Home Economics, U. S. Dept. Agriculture ECONOMIC POLICY 83 Many families with grossly inadequate diets recognize that they would fare better were their diets improved. But a large proportion of the millions of families with moderately poor diets are unaware that food could make a difference, and that their strength, alertness, working efficiency, and joy in living could be enhanced through improved nutrition. To raise levels of nutrition in this country, it is necessary to have (1) a widespread appreciation of the importance of adequate diets, (21 a working knowledge of what constitutes an adequate diet, and (3) economic resources that would enable people to acquire adequate diets. Illustrating these points is the accompanying chart (Fig. 1) showing grade of diet as related to food expenditures and food choices. The amount spent for food per person per week is plotted on the horizontal axis; percentage of families on the vertical axis. GRADE OF DIET AS RELATED TO MONEY VALUE OF FOOD NONREUEF VILLAGE FAMILIES IN THE NORTH ANO WEST, 1936-37 Figure 1.—Source; Stiebeling, Hazel K. “You Too Need Better Food, Land Policy Review, Vol. 4, No. 6, June 1941. Bureau of Agricultural Economics, U. S. Department of Agriculture. The upper curve shows how nonrelief white native-born families living in villages of the North and West were distributed by expenditure for food. It is obvious that, of the nonrelief families, very few spent less than $2 a person a week for food, and few, more than $4. The great majority of families spent between $2 and $4 a week for the food of each person. The shadings in the area of the chart bounded by the frequency distribution curve and the horizontal axis indicates quality of diet— black areas indicate diets classed as poor; medium gray, the fair; and white, diets that were classed as good. The chart shows that among families affording $4 or more a week for the food of each 425544*—42---------7 84 NATIONAL NUTRITION CONFERENCE family member, practically none had diets rated poor, but by no means did all of these families have diets that could be rated good. In the in-between section—that representing the families spending between $2 and $4 a person a week for food—all three shadings appear, i. e., some families selected diets that could be rated good; others had diets that were only fair; and still others, diets that had to be classed as poor. That section of the chart representing families spending less than $2 a person a week for food is almost entirely blank, i. e., the diets of almost all of these families were rated poor. About $2 per man per week could buy a fully satisfactory diet at the time this study was made (and can at present prices). You will notice that some few families succeeded in getting good diets for this outlay—still others got fair diets. But you also will notice that half of the families with poor diets in this nonrelief group were among those spending enough for food—not merely to buy a fair diet, but enough—had they known how and wished to—to buy a diet that would really be excellent in nutritive value. Some families spend too little to obtain an adequate diet.—None of the village or city families in the North and West succeeded in obtaining good diets when they spent for food less than $2 per adult unit per week (in terms of 1936 prices). In the Southeast, however, a small proportion of the white families did get good diets for sums slightly under this amount. Naturally, this group includes a large proportion of families on relief, and of those in the low-income brackets generally—many Negro families, the foreign-born, the unskilled workers fall in this class. Large families spend less for the food of each verson than small.— At a given income small families are relatively better off than large families and can afford to spend more for the food of each person. For example, among white families with incomes of $500 to $1,000 in cities and villages, median food expenditures per adult food expenditure unit per week in families of different size were as follows: Median food expenditure per unit per week Husband and wife only__________________.____________________$2. 80 Husband, wife, and 1 or 2 children under 16_________________ 2. 30 Husband, wife, 1 person 16 or older, and 0 to 3 others______ 2.00 Husband, wife, 1 child under 16, and 2 to 5 others__________ 1. 70 But at any given income level there is a wide range in food expenditures even among families of the same size and composition.—This may be seen in table 4 which gives the food expenditures per adult unit per week below which were one-fourth, one-half, and three-fourtns of the village and small-city families. This variation helps to explain the difference in the quality of diets among families similar as to income and family composition. Many families spend enough but do not obtain an adequate diet.— It is estimated that about three-fourths of the nonrelief families in villages and cities included in the Consumer Purchases Study spent more than $2 a person a week—about enough to obtain fully adequate diets if care is taken in food selection and preparation. With food expenditures above a certain minimum, families may have good, fair, or poor diets, according to the wisdom with which ECONOMIC POLICY 85 Table 4.—Food expenditures of village and small-city families in relation to family composition and income: Estimated food expenditures per adult unit per week below which were one-fourth, one-half, and three-fourths of white and Negro village and small-city families,1 1936-37 [Nonrelief families that include a husband and wife, both native-born] Family composition and Income class (dollars) White families Negro families Food expenditures per adult unit2 per week below which were— Food expenditures per adult unit2 per week below which were— One-fourth of families One-half of families Three-fourths of families One-fourt h of families One-half of families Three-fourths of families Husband and wife and: No others: 0-499 $1.70 $2.30 $2.90 $1.20 $1.50 $1.90 2.70 500-999 2.30 2.80 3.40 1.90 2.30 1,000-1,499. 2.70 3.40 4.00 2.40 2.90 3.30 i; 500-1,999 3.10 3.70 4.50 2.80 3.40 3.90 2,000-2,999.. 3.30 4.00 4.90 3.000 or over 3.50 4.30 5.20 1 or 2 children under 16: 0-499 1.50 1.90 2.50 1.00 1.20 1.50 500-999 1.90 2.30 2.80 1.30 1.70 2.00 1,000-1,499 2.30 2.70 3.20 1.80 2.00 2.40 i; 500-i; 999... 2.60 3.00 3.60 2.10 2.40 2.70 2,000-2,999 2.90 3.30 4.00 3,000 or over 3.20 3.60 4.30 1 person 16 or older and 0 to 3 others: 0-499 1.20 1.50 2.00 .80 1.00 1.20 500-999 1.60 2.00 2.40 1.10 1.40 1.70 1,000-1,499 2.00 2.40 2.80 1.30 1.70 2.10 1,500-1,999. 2.20 2.70 3.10 1.60 2.10 2.40 2,000-2,999.. 2.50 3.00 3.50 3,000 or over 1 child under 16, and 2 to to 5 others: 0-499 2.60 3.20 3.80 1.00 1.30 1.60 .60 .80 1.00 500-999 1.40 1.70 2.00 .90 1.20 1.40 1,000-1,499 1.80 2.10 2.40 1.20 1.60 1.80 1,500-1^999 2.00 2.40 2.70 1.50 1.90 2.20 2,000-2,999 2.30 2.70 3.00 3,000 or over 2.50 2.90 3.20 i Source of data: Food-estimate schedules. Consumer Purchases Study. 2 Food-expenditure unit. For scale of relative expenditures for food among persons differing in age, sex, and activity, see page 372, United States Department of Agriculture Mise. Pub. 405. their food dollar is invested (table 5). Of course, the less there is to spend, the greater is the need for skill in meal planning, in food buying, and in meal preparation. As incomes go up, food expenditures go up, although at a slower rate than do expenditures for other goods and services. With more money for food, more of the relatively expensive dairy products, meats, vegetables, and fruits are bought—foods that tend to provide nutrients most frequently lacking in low-cost diets. Poor diets are more likely to he found in villages and cities than on farms.—Among the nonrelief families included in the Consumer Purchases Study, 35 percent of those in cities and villages had poor diets as compared with 25 percent on farms. The superiority of many farm diets may be ascribed to the large share (an average of about two-thirds) or their food supply which is farm furnished. These home-produced foods include chiefly milk, eggs, and vegetables, nutritionally important foods that tend to be used in relatively small quantities by low-income groups in villages and cities. 86 NATIONAL NUTRITION CONFERENCE Table 5.—Grade of diet in relation to family composition and income; percentage of households having diets of specified grades, village and city families in 2 regions,1 1936-^7 [Households of white nonrelief families that include a husband and wife, both native-born] Family composition and income class (dollars) North and West1 Southeast Households Proportion of households with diets graded3— Households Proportion of households with diets graded *— Good Fair Poor Good Fair Poor Husband and wife and: No others: Number Percent Percent Percent Number Percent Percent Percent 600-999 89 19 48 33 15 13 60 27 1,000-1,499. 106 34 43 23 21 52 24 24 1,500-1,999. —. 62 35 49 16 15 40 33 27 2,000-2,999 67 37 50 13 14 21 58 21 1 or 2 children under 16: 500-999 - 125 23 38 39 37 19 32 49 1,000-1,499 219 23 50 27 35 37 43 20 1,500-1,999 - 225 27 58 15 41 32 32 36 2,000-2,999 173 31 56 13 26 53 35 12 1 person 16 or older and 1 or no others: 500-999 - 56 16 46 38 9 0 44 56 1,000-1,499 104 17 51 32 27 30 26 44 1,500-1,999 93 16 59 25 15 40 47 13 2,000-2,999 112 24 57 19 23 26 57 17 1 child under 16 and 2 to 5 others: 500-999 45 7 46 47 22 5 27 68 1,000-1,499- 111 5 45 50 20 25 35 40 1,500-1,999 96 9 52 39 28 25 57 18 2,000-2,999 133 12 59 29 36 31 38 31 i Source of data- Food records, Consumer Purchases Study. s New England, Middle Atlantic and North Central, Plains and Mountain, and Pacific regions. 8 Excellent diets meet in all respects the specifications of the liberal standard described below. Good diets exceed the minimum standard by at least a 50-percent margin but by less than 100 percent in the case of vitamins. Fair diets meet the minimum standard in all respects but exceed it by less than a 50-percent margin. Poor diets fail to meet the minimum standard in 1 or more respects. Because there were relatively few excellent diets those graded excellent and good have been classed together in this table. Quantities per man per day of— Protein Calcium Phosphorus Iron Vitamin A Thiamin Ascorbic acid Riboflavin Gm. Gm. Gm. Mg. I. U. Mg. Mg. Mg. Minimum standard 60 0.45 0.88 10 3,000 1.0 30 0.9 Liberal standard 76 .68 1.32 15 6,000 2.0 60 1.8 Source: U. S. Department of Agriculture, Bureau of Home Economics, May 14,1941. The question is frequently asked: “What income will support the level of food expenditures needed for an adequate diet?” There is no simple answer to this question as can readily be seen from the foregoing discussion. For village and city, table 6 gives some idea of the kind of diet purchasable for the amounts of money generally allotted to food by families differing in size and income. This table indicates, for example, that at 1938 price levels, families of two persons with incomes of $500 to $1,000 could purchase either the low-cost or the moderate-cost good diets described in “Planning for Good Nutrition,” Yearbook of Agriculture, 1939. However, families of five to eight persons probably would require incomes of $1,500 to $2,000 to enable them to purchase the same ECONOMIC POLICY 87 kind of diet. Among farm families, fully as much depends on success in home production as well as purchases of family food needs as upon cash incomes. We in this section are then faced with the task of considering the problems of, and drafting recommendations for action that will concern: (1) Families with inadequate resources. What economic arrangements and social programs could be devised to benefit these? What population groups are included in this category? (2) Families making unwise use of their resources. Is education the sole social measure needed ? Or are there others ? Table 6.—Diets purchasable (1938 prices) for sums generally allotted to food by families differing in size and income Family-income class (dollars) 2 persons2 Diets 1 purchasab 3 or 4 persons3 e by a family of— 3 to 5 persons4 5 to 8 persons8 500-999 1,000-1,499 1,500-1,999 2,000-2,999 3,000-4,999 Low cost or moderate cost good diet. Moderate-cost or expensive good diet. do do do Economical fair diet or low-cost good diet. Low-cost or moderate-cost good diet. do. Moderate-cost or expensive good diet. do Economical fair diet or low-cost good diet. do Low-cost or moderate-cost good diet. do Moderate-cost or expensive good diet. Poor or economical fair diet. Economical fair or low-cost good diet. Do. Low-cost or moderate-cost good diet. Do. 1 For a description of diets, see “Planning for Good Nutrition” (Yearbook of Agriculture, 1939) pp. 321-340. ’ 2 adults. 8 2 adults and 1 or 2 children under 16 years of age. 4 2 adults, 1 person 16 years of age or ever, and <• to 3 other persons. 8 2 adults, 1 child under 16 years of age, and 2 to 6 other persons. Source: U. S. Department of Agriculture, Bureau of Home Economics, May 12,1941. Statement by Dr. Faith M. Williams 1 I know that you must have been thinking as you listened to Miss Stiebeling’s figures on the nutritional content of customary diets in 1936 that incomes have improved considerably since that time and that diets must have improved along with tnem. It is, of course, true that there has been a marked improvement in the Nation’s income since the low point in 1932. The total national income (income paid out) in 1932 was 39 percent below the 1929 level. Since that time marked changes have occurred in the operation of our economy. There was a gradual recovery in both employment and income from 1932 to 1937 when levels comparable to those prevailing in 1930 were attained, followed by a sharp drop in 1938, and a gradual improvement in the spring and summer of 1939. Since the fall of 1939, increases in employment and income have been sharply accelerated, and we now find ourselves at levels equal to, and in some industries surpassing those prevailing in 1929. From August 1939 to March of this year employment has increased by about 2^ million. In March of this year the total number of wage and salary workers in nonagricultural employment was somewhat above 31 million as compared with an employment of less than 28 1 Chief of Division of Cost of Living Studies, U. S. Department of Labor. 88 NATIONAL NUTRITION CONFERENCE million in March 1939 and an average of less than 31 million for the year 1929. Employment in manufacturing, in March, was somewhat above 11 million, the highest ever recorded. These new levels of employment have not, however, eliminated unemployment. Estimates of the number of persons seeking work in the month of March 1941 averaged from 7% to 9 million. There has been a very great increase in the labor force in the interval since 1929, a greater increase than would be regarded as normal for a population the size of that of the United States, because of the particular age composition of our population. At the present time, there are more young people coming from schools and colleges who want to go into offices and factories and jobs of other types than ever before. There is no current official estimate of unemployment. The latest official figure is that of the Census for April 1940, 8,450,000. Employment in business and industry has increased since that time by more than 2 million, but our labor force has also increased in the interval. The number of young men taken into the defense training camps has been somewhat greater than the normal increase in the labor force, but meanwhile employment in the WPA has been decreasing. The number employed on WPA projects for the fiscal year 1940-41 averaged 1,700,000; in May 1941 there were 1,500,000 and by June it will oe down to 1,350,000, and the estimate for the coming year places it at a considerably lower figure. The total national income in the period to which Miss Stiebeling’s figures on nutritional content of diets apply was about 64 billion dollars, a decline of about 16 billions from the 1929 figure. Not all the decline in the dollar income figure can be estimated to be a decrease in the production of goods, as prices fell off rapidly during the period and the Bureau of Labor Statistics’ cost of living index in 1936 was 18 percent below its 1929 level. By 1940 income had increased to almost 70 billion dollars, and there had occurred at the same time an increase in the living costs of large city families of only about 2 percent since 1936. The last 6 months of 1940 witnessed a sharp rise in income which is still continuing. In terms of the national well-being, it is much more accurate to think in terms of per capita rather than in terms of aggregate income, remembering that our population is still increasing and to take account of changes in the purchasing power of money. It is impossible to define exactly the changes which have occurred in the purchasing power of the dollar of the average family in the United States. There are large segments of the population for which we do not have cost-of-living indices, but the material at hand for large city and for farm families indicates that the per capita real income receipts in March of this year may have been above the 1929 level. When we ask ourselves what effect this increase in income will have on the diets of American families, we must first examine changes in food prices as compared with changes in other prices. Food prices dropped more than other prices in the period from 1929 to 1932 and they have risen more than other prices in the period since that time. In view of the complexities and uncertainties of the entire world situation, it is impossible to prophesy price movements very far into the future. The Bureau of Labor Statistics recently estimated that ECONOMIC POLICY 89 living costs would probably increase by as much as 3 percent between March of this year and the early autumn. Our study of recent increases in wholesale prices of clotning and house furnishings intended for fall delivery, and probable increases in food prices and in rents leads us to believe that increases in food prices in this period will, on the average, be larger than increases in average prices of goods and services of other types. The analysis which I have been able to make of distribution of families according to income leads me to believe that the income increases which have occurred since 1936 and those which are likely to occur this year will not be great enough to wipe out the problem of malnutrition in the United States. In spite of the increases which are occurring in production and in income, there will be, for various reasons, large numbers of unemployed in the next year and large numbers of low-income families among the employed. As regards the employed families whose incomes have been increasing, when we talk about how much families spend for food and how much we can expect food expenditures to increase with increases in income, we cannot proceed until we have in mind all the other things that city people must spend money for. It not infrequently happens that family spending is planned on the basis of food budgets which provide all the nutrients necessary for an adequate diet along with much less adequate provisions for other aspects of family living. However, pressures upon the money incomes of families living in American cities at the present time are tremendous. Certain expenditures for clothing, housing, commercial recreation, and personal services have become essential if a family is to be well-adjusted in its community, however much we might wish the situation were different. According to a study of employed wage earners and clerical workers in 1934r-36, more than 40 percent of total family expenditures went to food at the lower economic levels; less than 30 percent at higher levels; about 26 percent for housing at both the lower and higher levels; the proportion spent for clothing was larger at the higher economic levels; that for medical care slightly larger; the proportion for automobile was considerably larger at the higher economic levels; that for household operation was also larger, but that for personal care was about 2 percent at all levels. There are obviously many things of this sort we must consider when we talk about the economics of food consumption. Dr. Stiebeling’s chart on differences in the purchases of different kinds of food at given income levels provides as good an estimate as we have of the effect on food purchases of higher incomes since we do not have data which show what families do with their money when their incomes are increased. We know something about what they would do from things that happened in the retail markets. Family expenditures for all goods and services at successive income levels give a clue as to what expenditures will be when incomes rise. Chart—Fig. 2 shows the difference between expenditures of urban families with incomes of $600-$900 and $2,700-$3,000. The bars are arranged in the order of the magnitude of the proportional differences. The greatest difference between the 2 income groups was in gifts and contributions which were almost 9 times as great at the higher income level as at the lower level. Expenditures for vocation 90 NATIONAL NUTRITION CONFERENCE Figure 2.—Source: “Expenditure Habits of Wage Earners and Clerical Workers,” Monthly Labor Review, December 1939, Vol. 49, No. 6. ECONOMIC POLICY 91 and education were 7 and 9 times as great at high as low. Transportation was 6 times as great with much larger expenditures for automobiles, 5^ or 6 times as much for automobile purchase and operation by families at the higher than at the lower levels, but the food expenditures were only about 2% times as great at the higher income level. One reason for this is that the families at higher income levels were smaller families. Another reason is the pressure on the incomes of urban families for other goods and services that make living more attractive and which compete with increases in food expenditures. In my opinion all these figures reinforce other data which indicate that we should develop a program which will decrease the cost of bringing food from producer to consumer, which will educate con sumers as to food values and the importance of adequate diets, and which will actually subsidize the consumption of protective foods by certain groups within the population. Processing and Distribution Costs D. E. Montgomery1 Gains toward better nutrition largely must be made among low-income families. If the processing and distributing trades are to contribute to that result, it is clear that their contribution must lie in the direction of promoting greater economy for the low-income food buyer. Needy consumers must be able to get more nutritive value for their money, which means that a larger part of their food money must be spent for actual food and the nutritive quality that goes with it. A smaller part must be spent for the supplementary services and quality distinctions that lack nutritive value. Educators will be able to give attention to the whole range of family needs and may urge in some cases that a larger share of the family income be spent for food; it is doubtful that food processors and distributors can safely exert similar pressure without knowledge of the non-food needs of their customers. Therefore, we are here concerned with what processors and distributors can do to help limited funds go further in buying more and better nutritive value in the form of foods. Without considering whether retail costs of food have been, or are likely to be, affected more by changes in farm prices than by changes in the processing and distribution margin, it may be noted that this margin in 1940 accounted for 60 percent of the consumer’s retail food cost. On prepared cereals and canned goods it took 70 to 80 cents of the consumer’s food dollar. On meats and eggs it ordinarily takes less than 50 cents. Obviously the margin is, on the whole, an important part of the consumer’s final food cost. In recent years there have been processing and distribution developments that tend toward greater economy for the food buyer, and there have been developments in the contrary direction. Larger retail stores; self-service; better physical handling of fruits and vegetables 1 Consumers’ Counsel, U. S. Dept, of Agriculture. 92 NATIONAL NUTRITION CONFERENCE over long distances; better methods of processing and packaging; increased use of grade labeling; and new methods of pricing and selling milk, all appear to be moves toward greater economy. In the other direction, there has been a trend toward costly packaging of staple foods; increased emphasis on fancy quality; promotion of expensive forms of processing; multiplication of high-priced specialties in cereals, dairy products, and meats; expansion of price-fixing activities through legislation and privately; and employment of discriminatory legislation against various forms of retailing. Under each of the subheads outlined in the prepared agenda, I suggest some of the possibilities of greater economy indicated by experience to date. (1) Fluid-milk prices can be lowered by wider use of economies already put to use in some markets. Store sales cost less than home delivery, but in only 137 of 250 cities surveyed by our office last fall could consumers buy milk more cheaply at stores than at the doorstep. Half-gallon and gallon containers are saving consumers an average of 2 cents a quart at stores, 3 cents a quart delivered, where they are being used; but nearly 200 of the 250 cities are not using them. Stores and chains specializing in the handling of l^rge quantities of milk and dairy products appear to effect real savings in the relatively few cities where they have been developed for that purpose. It seems likely that sales direct to consumers at pasteurizing plants might effect substantial saving in many localities. Only 23 of the 250 cities reported such sales. Better terminal-market facilities for the wholesale handling of fruits and vegetables might cut food costs in many cities. Too often the facilities now used are relics of a past day, unsuited to present needs, unfit for handling of human food, overcrowded, insanitary, and inefficient. For low-cost retailing of fruits and vegetables more public attention might be given to the possibilities of farmers’ markets, push-cart markets, municipal markets. For the better handling of perishable products in large cities, it is possible that surplus marketing facilities commercially or municipally operated might dispose of excess supplies at special prices. The bulk shipment of some fruits and vegetables deserves attention as a means of reducing handling costs at both ends. Oranges for juice consumption, for example, can be carried and marketed at less cost than oranges for table use. (2) Dry skim milk is given in your outline as an example of a food providing high nutrition at low cost. It has not been widely distributed as a staple article of food. The sale of fluid skim milk was reported to us in only 36 of the 250 cities in our milk-price survey, but where sold it was priced (usually in gallon lots) at an average of 4% cents a quart? some 7 cents less than the store price of whole milk in the same cities. Generally speaking, the market for lower grade foods does not seem to be receiving the attention it deserves, both for better nutrition and for larger farm income. Grade labeling of such foods would serve as a guarantee of suitably low prices, and develop a steady reliable source of supply for great numbers of economy buyers. ECONOMIC POLICY 93 Chain stores are experimenting with grade-labeled canned goods, but with one noteworthy exception are widely omitting the label on the ?rade C quality. Consumer cooperatives are handling all grades. know of no important use that is being made of Government grades on meats below the good grade, although well over half of all beef, for example, falls below that grade. Egg customers are more eagerly solicited for the premium grades at premium prices, although it has been found that grade B will regularly outsell grade A when both are described. Many large retailers do not sell eggs by grade at all. Ability to identify lower grades is especially important to consumers when, as now, food prices go up, because the increase usually is much less on the lower grades. From August 3 to December 7, 1940. top grades of live steers went up $3.70 per hundredweight, while medium and common grades went up only 90 cents per hundredweight. Between April and November 1940, best white eggs in New York went up 18 cents a dozen, lower grades 6 cents. There was a saving on the lower grade of 11 cents a dozen in April and of 25 cents in November. Widespread use of grade labels on many kinds of foods would enable low-income consumers to concentrate their purchases on brands that are found to stand for economy as well as reliability. Today they must be guided largely by guess or by reputation. Both are likely to be expensive. Such food grades as are now available need to be examined with respect to their value as guides to better nutrition. Some of them emphasize superficial characteristics which acquire market value in part because essential values are not known. The possibility of processing and salvage operations to assure consumption of the lower grade fruits and vegetables now frequently withheld from market both by private action and by State and Federal regulation, needs attention. (3) Discriminatory laws and regulations erect trade barriers across the lines of distribution for many foods. Trucking restrictions, license fees and taxes directed against special types of retailers, from push-cart peddlers to giant markets and interstate chains, may and often do have the purpose of restricting the flow of foodstuffs into consumer hands. Milk and cream sanitary regulations in many areas favor the locally produced product on the ground of greater protection of health. Restrictions in many areas probably go beyond what is necessary to protect health. Such restrictions add to the cost of milk, hold up its price, and contribute to the inability of many families to buy the milk they need. There is no national system of standards and inspection by which all communities might assure themselves of perfectly wholesome milk and cream and yet be able to buy it on the most economical basis. Margarine is legislatively the most put upon of all food products. The Federal Government levies special license fees on manufacturers, ■wholesalers, and retailers on this product. Sixteen States add fees of their own. The Federal Government and 9 States levy excise taxes on all margarine; 15 others tax some kinds of margarine. In at 94 NATIONAL NUTRITION CONFERENCE least 5 States the burden is such that sale of the product is to all intents and purposes prohibited. (4) The excise tax levied by the Federal Government on uncolored margarine is % cent per pound; on colored margarine, 10 cents per pound. The excise tax on all uncolored margarine is 5 cents a pound in three States, 10 cents a pound in four, and 15 cents a pound in two. In States taxing only certain kinds of margarine the taxes are 10, 12, and 15 cents a pound. Sales taxes of from 1 to 3 percent, mostly 2 percent, are levied on all foods sold at retail in 18 States; on all but 5 foods in 1 State; and on all but 10 foods in another. (5) In 33 States unfair sales laws have been enacted prohibiting sale of foods by distributors at less than cost. In many of them distributors must add a specified percentage to actual invoice cost. Experiments in economy methods of distribution are not encouraged by this type of legislation. In Colorado and Connecticut Federal grand juries have recently voted indictments of groups of retailers for using such laws to fix prices privately agreed upon. Milk is widely price-fixed by law. The Federal Government fixes prices paid to producers in 20 markets. Twenty States fix producer prices; 18 of them also fix the price at which milk distributors sell to consumers. Fluid milk prices are too high for many low-income consumers. Nutrition of the population suffers if prices are fixed higher than necessary to maintain adequate supplies of good milk. Fixed producer prices are not always confined to that purpose. It is doubtful that fixed distributor prices ever contribute to that end or are likely to promote better nutrition. In several States, consumers are complaining that margins are too high, when distributors’ prices are fixed by the State. The full force and effect of private monopoly in food processing and distribution is now under examination. The Department of Justice is rapidly obtaining indictments in these fields as a result of its food investigations. Final effect of these actions upon the cost of food to consumers will depend upon success of the cases in court and upon the extent of action permitted by the funds available to the Antitrust Division. The whole subject is. of course, vitally important to a national program for better nutrition. To summarize: if processing and distribution are to contribute to better nutrition among families that most need it, that contribution is most likely to be made through: 1. Greater attention to finding and using economy measures suited to the needs of the low-income buyer: 2. Wider distribution and better marketing of low-cost types and grades of foods; 3. Elimination of discriminatory and restrictive measures imposed by law and by private combinations and monopoly; 4. In addition, the possibility on the one hand off Government assistance and on the other of consumers cooperation in promoting new economies also deserve your consideration. ECONOMIC POLICY 95 RECOMMENDATIONS I. Improved Incomes for Low-Income Families. In order to obtain higher incomes for city and village groups, there must be higher wage rates and increased employment in many sectors of our economy. In spite of the great increases in employment since 1939, several million persons are still seeking work and many millions more are receiving incomes insufficient to supply nutritionally adequate diets as well as other necessaries of life. A large and continuing expansion of industrial production is needed to provide employment. In view of the extent of unemployment at the present time and the low level of relief allowances, we oppose reduction in Federal nondefense expenditures for employment and relief in the coming fiscal year. Relief allowances to cover not only an adequate food supply but also other items necessary for family living should be provided m all communities for those dependent wholly or in part on society for support. Long-range planning for public and private employment is needed to complement and offset fluctuations in economic and defense activity. The conclusion of the present emergency and the consequent decline in production of war materials will require extensive readjustments before normal production is resumed. Plans for public and private employment, that can be put into effect as the occasion requires, are therefore particularly important in order that health may be maintained as the emergency effort is completed. Real income is threatened by price advances due to increased demand for and scarcity of consumer goods. As long as there are unemployed workers and surpluses, increased production of consumer goods should be encouraged—with Government subsidies if necessary to the extent that this does not hazard the Nation’s defense effort. Labor organization affords a democratic method of improving the level of living of wage earners. Free collective bargaining must be maintained and extended among all workers, including those at the lowest income levels. The coverage of the Federal Fair Labor Standards Act should be extended to those groups presently excluded. Workers in intra-State employment should be protected by State legislation which would be correlated with the Federal Act and would provide similar standards. Equality of opportunity, which is the essence of our democracy, requires elimination of barriers against the employment of Negroes and other minority groups whose nutritional problems now are acute because of very low incomes. Federal, State, and municipal governments should be in the forefront of such progress. Inequitable taxation bears with disproportionate emphasis on low-income families and further lowers their ability to purchase protective foods and other necessaries of life. As a defense against malnutrition the tax burden on the lower income groups should be decreased. No taxes should be levied on incomes insufficient to provide an adequate family diet. Sales and other excise taxes on food and other necessaries of living of low-income groups should be eliminated. Programs for increasing farm incomes should emphasize raising the incomes of the families at the lower economic levels. Increased 96 NATIONAL NUTRITION CONFERENCE opportunities should also be provided for supplementary earnings by farm workers with proper safeguards for labor standards. Although farm families tend to have better diets than other occupational groups, there is, nevertheless, considerable malnutrition among persons living on farms. The programs for increasing production of foods needed for home use of the Extension Service, Farm Security Administration, and other groups should be maintained and extended. The coverage of the Social Security Act should be extended to include domestic and agricultural workers, especially those employed on commercialized and factory-type farms. There should be provision for benefits to workers temporarily or permanently disabled on account of sickness or accident. II. Increased Supply of Protective Foods and Reduced Costs of Processing and Distribution. We believe it is essential to increase the supply of foods and nutrients, and to accomplish this we recommend : A. That the Government and industry, including agriculture, should give increased attention to trends in consumer demand and to the supply of foods needed to insure an adequate diet for all families. Government programs should continue to minimize disorganization in agriculture, and at the same time, seek to eliminate idle resources. From time to time the Federal Government may find it necessary to put a floor under the wholesale price of some foods in order to get necessary expansion. It is recognized that the program of desired expansion may necessitate the Government’s subsidizing either consumption or production or both. B. That surpluses on hand, including so-called unmarketable grades or sizes of fruits and vegetables, should be saved for consumption by suitable processing or distribution in fresh form, by means of Government subsidies if necessary. C. That the Government should take the initiative in encouraging industry to bring on the market low-cost, highly nutritious foods in forms acceptable to consumers, such as soybean, peanut, and milk products. No milk nutrients should be wasted. Skim-milk products, dry and fluid, are vitally needed and should be put on the market at low price. D. We recommend that dietary essentials be secured from properly planned meals of natural food materials. Fortification of foods with minerals and vitamins should be undertaken only to the extent that scientific research indicates that such practice is in the public interest and provides an economical method of improving nutrition. E. We favor the following methods of increasing efficiency in market selection : 1. The extension of grade labeling of foods and the revision of Federal grades of fresh fruits and vegetables to reflect differentials in nutritive value. 2. The simplification of size and shape of container in order to reduce consumer difficulty in comparing prices per unit. ECONOMIC POLICY 97 3. The provision of more information in advertising to facilitate the identification and comparison of the quality of food and size of container. 4. The provision of information on food labels in simple standard terms as needed to identify and compare quality and quantity of contents even beyond that required by present Federal law. 5. The provision by retailers in stores of more information on the relative economy of foods. 6. Increased attention to food and drug advertising by the Federal Trade Commission to check all forms of misrepresentation, which may take money needed for food under false pretenses. 7. Development and increased use of consumer standards and grade in retail sale of clothing and other consumer goods in order that consumer’s real income may be increased. To further the end we recommend a Government Bureau of Consumer Standards to set up minimum standards for consumer goods. 8. Action by local organizations to check misrepresentation in sale of food including weights and measures. F. In order that the interests of low-income consumers can be better served, we urge the food industries to avoid every unnecessary expense and to seek and develop more efficient and cheaper methods in the processing and distributing of foods. 1. Every effort should be made to reduce the spread between the farm and retail prices of fluid milk. 2. Fruit and vegetable marketing facilities should be adapted to modern methods of mass distribution. Special types of markets for perishable foods should be developed to meet the needs of economy buyers. Surplus perishables that might otherwise be wasted should be moved rapidly through direct outlets at prices to make them accessible to low-income consumers. 3. Special-interest groups, through private combinations and pressure on public authority, have erected interstate or regional trade barriers which reduce the opportunity for efficient distribution of foods into consumers’ hands, such as discriminatory administration of milk ordinances. We recommend elimination of such restraints. 4. We oppose the following State or Federal legislation : (a) Laws which discriminate against wholesome nutritive foods, such as taxes on colored and uncolored margarine; (b) laws or regulations which favor food products according to the locality in which they are produced, such as laws which permit eggs to be labeled as fresh only if they are produced within a certain area; (c) special taxes to place 98 NATIONAL NUTRITION CONFERENCE special kinds of retailers at a disadvantage with others; (d) excise, sales, and processing taxes on foods; (e) price maintenance and unfair sales laws which permit and encourage private price-fixing without public control; (f) State marketing or prorate acts which tend to increase monopoly control and raise prices of foods to consumers. 5. We believe that regulations to fix retail prices of milk perform no service to milk producers since they discourage economy in the handling and sale of this essential food and protect inefficiency and restrict consumption. We recommend repeal of these laws. 6. We recommend that adequate funds and authority be assured to the Antitrust Division of the Department of Justice to permit it to continue investigations and prosecutions of monopoly in the processing and distribution of foods. We also recommend that the appropriations of the Food and Drug Administration be increased to enable better consumer protection by closer watching of quality and economic practices. 7. We strongly support consumer cooperatives as a means of helping low-income families and producers’ cooperatives as a method of decreasing marketing costs. III. Provision of Essential Foods Wholly or in Part at Public Expense. To insure the consumption of essential foods by children and by those families with most limited power to purchase or produce for themselves, we recommend the provision of certain foods wholly or in part at community expense: A. Provision of free school lunches in low-income areas. Wherever free school lunches are provided they should be available to all children; the foods provided should be selected on the basis of the nutritive needs of the children and the educational opportunity thereby offered for the formation of sound food habits be fully utilized. B. Extension of the Food Stamp Plan in all communities to all relief families and to other families whose incomes are insufficient to furnish adequate diets. The foods included should be chosen on the basis of the nutritive needs of the consumers. To the end that this be accomplished we urge that no less than 235 million dollars be appropriated to the Surplus Marketing Administration for the fiscal year 1942, and in the future such appropriations as may be necessary. C. Federal-local programs to provide penny milk for school children and “nickel” milk to needy families should be extended to more people and more markets wherever reduced producer prices and competitive bids from handlers are obtainable. ECONOMIC POLICY 99 IV. Education as a Method for Improvement of Diets at All Income Levels. Federal and State governmental agencies and other institutions responsible for educational policies should undertake the improvement of diets at all income levels through education in good food habits and in the principles of wise food selection and preparation, and through promotion among rural people of home food-production programs suited to the area and type of farming. To make this policy effective in the long run, certain aspects of the program need emphasis: A. Equalization of educational opportunity through Federal aid to the States; otherwise areas most in need and least able to pay will be relatively neglected. B. Suitable teaching of good food habits should be given in the schools at all levels and to both sexes. The teaching should be adapted to the needs of various population groups and to the economic situation of the family. The educational pos-sibilitites of the school lunch should be utilized. C. For adult groups especially, the teaching should be coupled with timely market information and with information on measures designed to protect the consumer of foods. To facilitate the provision of such information there should be at least one Government agency devoted solely to the interest of consumers and divorced trom regulatory powers with respect to food supplies and prices. D. The education of nutritionists and others concerned with the improvement of food habits should include such work in economics and the other social sciences as to enable them to understand the economic factors in the problem of malnutrition. E. Education for home food production among rural people must deal with the following aspects of the program: 1. Improvement of soils in certain areas where diversified production is now unsuccessful. 2. Seeds and cultivation practices adapted to local conditions. 3. Landlord-tenant relationships that encourage home food production among tenants. 4. Planning for suitable home food production not as a sideline but as an important farm enterprise. 5. Provision of more adequate community facilities for processing and conserving foods, such as community-owned and cooperatively owned cold storage and freezer lockers, canning centers, drying ovens, curing houses, etc. V. Research Programs. Action programs should include provision for research in order to provide the needed basic information. For example, education in food choice should be based upon knowledge of food preferences and prejudices; family food production should be promoted with knowledge of possible advantages to families; spot surveys should be made from time to time to supplement the basic data on food 425544*—42-------8 100 NATIONAL NUTRITION CONFERENCE consumption and dietary levels provided by the Consumer Purchases Study. To this end we recommend that an increase be made in Government appropriations for economic research bearing on nutrition in the Federal bureaus and in the experiment stations of land-grant colleges ; and that private research foundations give increased attention to research bearing on economic and psychological factors affecting food consumption. Such investigations should be directed to the improvement of nutrition status. Members of Drafting Committee: Chairman of Steering Committee: Hazel Kyrk, Bureau of Home Economics. Faith M. Williams, Bureau of Labor Statistics. Hazel K. Stiebeling, Bureau of Home Economics. Lucy H. Gillett, Community Service Society, New York, N. Y. Mildred Fairchild, Bryn Mawr College, Pa. Dr. Morris Raskin, Medical Advisor, Automobile Union. Norma E. Boyd, Chairman, Nonpartisan Council on Public Affairs, Wasnington, D. C. Helen Hall, Henry Street Settlement, New York, N. Y. Mary Taylor, Consumers’ Counsel Division, Agricultural Adjustment Administration. Lazare Teper, International Lady Garment Workers, New York, N. Y. Margaret G. Reid, Iowa State College, Ames, Iowa. Mrs. Fay Stephenson, National President, U. A. W. A., Cleveland, Ohio. Ada M. Moser, Winthrop College, Rock Hill. S. C. Sue E. Sadow, Department of Welfare, New York, N. Y. Adelaide Spohn, Elizabeth McCormick Memorial Fund, 848 North Dearborn Street, Chicago, Ill. Donald Montgomery, Consumers’ Counsel Division, Agricultural Adjustment Administration. Ellen LeNoir, Baton Rouge, La. Leone Nutting, Extension Worker, Maine. SECTION Hid PUBLIC HEALTH AND MEDICAL ASPECTS OF NUTRITION Presiding, JAMES S. McLESTER, M. D., Professor of Medicine University of Alabama, Birmingham, Ala. Chairman AGENDA !• Presentation of evidence of extent of medical aspects of the nutrition problem in the United States. A. In a joint session with subsection on relation to maternal and child health statements will be submitted by: 1. Dr. H. D. Kruse of the Milbank Memorial Fund. 2. Dr. D. F. Milam of Duke University. 3. Dr. J. H. Ebbs of Toronto (maternal problem). 4. Dr. Horton Casparis of Vanderbilt University Medical School (field study). 5. Colonel John W. Meehan, Chief, Statistical Division, Surgeon General’s Office, U. S. Army. II. Subjects to be discussed by the section and on which suitable recommendations are to be submitted. A. Is there need for unity of effort in cooperation between medical and public health groups with other agencies interested in nutrition ? B. Is there need for more training in nutrition in schools of medicine and public health with special attention to the economic aspects of adequate nutrition? (Detailed recommendations to be submitted by a subcommittee on this phase of nutrition education.) C. What remedies can be proposed for preventing widespread nutritional disabilities ? 1. Need for wider distribution of inexpensive foods of high nutritive value, such as skim-milk solids, peanut, soy, and cotton seed flour, dried eggs, etc.? 2. Encouragement of home production of protective foods? 3. Improvement of nutritive quality of staple foods other than flour and bread? 101 102 NATIONAL NUTRITION CONFERENCE D. Is there need for stimulating greater interest in nutrition among general practitioners? How can this be best accomplished ? 1. Possibly post-graduate training in connection with nutrition clinics established in medical school dispensaries? 2. Should physicians give greater attention to the economic aspects of the nutrition problems of their patients? 3. Possibly further extension of therapeutic diet clinics already being conducted in a few large medical centers ? E. What part can the practicing physician play in the nutrition program ? 1. Need for support in State and community planning? 2. Desirability of representing organized medical societies on State and community nutrition committees? 3. Need for a nutrition section in State medical societies ? F. Should the distribution of vitamin pills or concentrates to the general public be encouraged or discouraged ? G. Is there need for greater activity in the field of nutrition by State and city health departments; if so, what direction should this activity take in fields other than maternal and child health ? H. Should health department laboratories provide physicians with laboratory diagnostic service for deficiency diseases ? I. Is there need for greater attention to therapeutic problems in nutrition especially where nutritional conditions are secondary to other diseases? SUMMARY OF DISCUSSION Practicing physicians, health officers, and faculty members of medical schools discussed the disturbing prevalence of nutritive failure in this country, the part to be played by public health and similar agencies in preventing such failure, cooperation between these agencies, the necessity for increasing the time allotted to nutrition in the medical schools, and the leadership in this field asked of the practicing physician. Reports were submitted on studies made to appraise the nutritional status of different groups in the population, such as school children, residents in a southern mill town, and pregnant women. It was pointed out that while the existence of deficiency diseases has been known for years, there is still a need for definite methods of measurement so that the extent of malnutrition in the entire population may be determined. There was considerable discussion of the advisability of distributing vitamin pills to the general public, and it was agreed that good nutrition was a matter of supplying enough of the right kind of food rather than of furnishing pills. The advisability of adding vitamins to various foods was questioned because of nutritional imbalances that might result. A distinction was made between enrichment of foods which had been devitalized in processing, as in the case of flour, and fortification of foods beyond their normal nutritive level. The latter type of enrichment was not recommended. PUBLIC HEALTH AND MEDICAL ASPECTS 103 The role of health officers and of practicing physicians was discussed. It was pointed out that the medical profession must be part of any public health program and that professional groups must be represented in community planning for nutrition. The responsibility of practicing physicians was particularly stressed inasmuch as they are in a strategic position to recognize evidences of latent malnutrition and to advise patients about diets that will aid in curing and preventing deficiency diseases. DISCUSSION This section opened at 2 p. m. on May 26, meeting jointly with section Illb, at which time there was a presentation of evidence of the extent of the medical aspects of the nutrition problems in the United States. Dr. H. D. Kruse of the Milbank Memorial Fund stated that 30 to 40 percent of the population are improperly fed. He pointed out that the actual amount of malnutrition as determined by examinations of individuals is not known, because past methods of detectiing malnutrition have been unsatisfactory. Convincing evidence has been adduced that much of the unsatisfactory nutrition manifests itself in specific deficiency diseases and that their earliest or mildest stage is represented by the latent or subclinical state. Entirely satisfactory methods for detecting the subclinical state of deficiency diseases have not been evolved, but enough information is available to make a start in ascertaining the amount, nature, and distribution of malnutrition. A joint study has been conducted by the United States Public Health Service, the Departments of Preventive Medicine and Pediatrics of the Cornell University Medical College, the New York City Department of Health, and the Milbank Memorial Fund on approximately 2,150 public high school pupils, and 350 private high school pupils. The Work Projects Administration has contributed heavily to this study and 130 members of their personnel were also examined. Of the children from high-income families, only 1 percent had low hemoglobin values; 6 percent had low plasma ascorbic acid levels; and 2 percent showed definite signs of riboflavin deficiency. Four percent of the children from low-income families had low hemoglobin values; 47 percent had low plasma ascorbic acid levels; and 75 percent of 512 of the children in this group showed signs of riboflavin deficiency. Dr. Kruse mentioned the desirability of more extensive application of these methods to find out the Nation-wide prevalence of malnutrition. It was his opinion that such information could be of inestimable value in the various approaches to the problem of nutrition, particularly in the present national emergency. He indicated that it could become the basis for plans to raise the national nutritional level by focusing activities on the malnourished. It would be helpful in formulating the program to improve the nutritive value of staple processed foods, and would be particularly pertinent to any program of intensive therapy for the rapid nutritional rehabilitation of the malnourished unemployed. Dr. D. F. Milam of Durham, N. C., presented a report on the appraisal of nutritional status of a North Carolina community in 1940. This project was set up as a cooperative effort by Duke University, 104 NATIONAL NUTRITION CONFERENCE the North Carolina State Board of Health, and the Rockefeller Foundation, with the aim of using all the methods now available in arriving at some appraisal of the actual nutritional status of the population. The study was started in a small mill village of 400 residents and expanded to include a rural district of some sixty square miles. The spring survey of March-April 1940 revealed that 61 percent of the population had a plasma ascorbic acid level which was very low and that only 13 percent of the population had what is considered a normal blood level of vitamin C. Similar findings were found with reference to vitamin A. It was also found that in addition to a low caloric intake, there was evidence of deficiency in riboflavin, thiamin, iron, calcium, and proteins. When the survey was extended to other seasons and included the rural area, it was observed that the whole population was at a much higher nutritional level in the fall than in the spring. No great abnormality was found in the hemoglobin. The results indicate that in this typical rural community the nutritional level leaves much to be desired. While the defects are to a great extent made up in the diet of the garden season, there is still undoubtedly great health injury done in the winter. It was Dr. Milam’s opinion that some improvement in-educational procedures is indicated, especially with nutritional work in the schools and through the health departments. Dr. J. H. Ebbs of Toronto presented a most interesting report on the influence of prenatal diet on the mother and child. Dr. Ebbs studied a group of pregnant women in the Toronto General Hospital and followed the babies up to the age of 6’ months. He was able to show that by improving defects in prenatal diets through the addition of simple foods, the whole course of pregnancy keeps improving. During the prenatal period, during labor, and during convalescence, the mothers on a good prenatal diet enjoyed good health and had fewer complications than those on an inferior diet. There were many more miscarriages, stillbirths, and complications at birth, and more deaths before six months of age in those babies born of mothers on a deficient prenatal diet. Babies born of mothers on a good or a supplemental-good diet enjoyed better general health and suffered fewer illnesses up to the age of 6 months. Dr. Ebbs stated that while it is recognized that there are more important factors in the successful outcome of pregnancy, his studies suggest that nutrition can play a very large part in the course of pregnancy in mothers who receive a deficient diet. Dr. Casparis of Vanderbilt University Medical School stated that the conditions found in Tennessee were much the same as those reported by Dr. Milam for North Carolina. He indicated that we must have definite methods of measurement so that we can clearly demonstrate the extent of the nutrition problem in the whole population. He pointed out that we have known for years that deficiency diseases exist, but that it is difficult to get this before the whole population and the great problem is how to correct these deficiencies by adequate diets. He indicated that nutrition should be woven into the fabric of the individual and that we should lay plans for an enduring program, Following these presentations section Illa then proceeded to a discussion of the subjects on the agenda. The first subject discussed PUBLIC HEALTH AND MEDICAL ASPECTS 105 was the question of need for unity of effort in cooperation between medical and public health groups with other agencies interested in nutrition. Dr. Abercrombie, State health officer of Georgia, mentioned the county demonstration being carried out in his State and indicated that cooperative efforts were already under way in Georgia. Dr. Markwith, State health officer of Ohio, indicated that they have already planned extensive cooperative work with agricultural groups as well as local health agencies. He expressed the opinion that there should be a sectional approach within the State and that the whole program must be approached as a joint endeavor. Dr. Williams, State health officer of Tennessee, set forth the fundamentals involved in a well-rounded nutrition program: (1) Production, (2) preparation, (3) preservation, (4) distribution, (5) practice. Dr. Williams pointed out that the work of the home demonstration group has been largely with individuals of higher economic levels and not with the lower income groups who are in greatest need of health. Dr. Williams indicated that he was interested in the provision of scholarships this summer for teachers to go to the University of Tennessee for the specific purpose of working out a nutrition guide which would be distributed to elementary and high schools in the State. He agreed that there was a definite need for cooperation which was already under way. Dr. Rice, New York City health officer, felt that cooperative effort was necessary and expressed the opinion that the local health department should head such efforts. Other discussion indicated the approval of cooperative efforts by all agencies concerned, and it was suggested that the nutrition councils should indicate the leaders for the effort. The next subject to be discussed was the distribution of vitamin pills or concentrates to the general public. Dr. Morris Fishbein pointed out that vitamins are just a part of the nutrition program and that we should get enough food, avoiding too much stress on vitamin pills, which are the third largest item sold by drug stores. Only a small portion of the 100-million-dollar vitamin business represents products prescribed by physicians. Dr. Fishbein pointed out that the nutrition problem is that of supplying the right food to the people who need it and not vitamin puls, and that we will never answer our nutrition problems by prescribing vitamins. As he sees it, the problem is first, one of educating people as to what is proper nutrition, and second, providing them with food and budget analyses to see if they are spending too much on items other than food. He pointed out the need of attacking the vitamin pill problem by cooperative study and action and indicated that the Council on Foods of the American Medical Association is endeavoring to settle the question of which vitamins will meet the deficiencies now prevalent in this country. Miss Frances Stern expressed the view that doctors prescribe vitamin pills rather than food, because it is too much work to calculate properly the food values, and that patients read about vitamins and insist that they be given a prescription for them. She pointed out the need of physicians to prescribe vitamins in terms of food. Dr. McLester said that we should teach people to eat an abundance of good food and vitamins. The section then went on to discuss the need for more training in nutrition in schools of medicine and public health, with special at- 106 NATIONAL NUTRITION CONFERENCE tention to the economic aspects of adequate nutrition. Dr. Barborka indicated that efforts have been made for a long time to awaken a more definite interest in nutrition by young doctors and that very little educational work, particularly in the economic phases of nutrition, has been done in the medical schools. He stated that our medical schools are making efforts to improve the teaching of nutrition, and in his opinion, most medical schools would welcome the development of more centralized effort. Dr. Leavell also stated that medical students can get a great deal of this type of education by working in health clinics and with well-child conferences. Dr. Mackie followed up Dr. Leavell’s suggestion in regard to undergraduate teaching and clinical application and pointed out the importance of cooperation between different teaching departments, especially between the clinicians and the public health teachers. Miss Sterns added that she thought a medical social worker should participate in medical school teaching of nutrition. The next subject was remedies which may be proposed for preventing widespread nutritional disabilities. Dr. Mackie stated that there was no question of the desirability of making available to the general public foods which will bring them large amounts of specific food factors at the lowest cost. He felt that one of the precise answers to this question in rural districts is the encouragement of the home production of foods and preserving them for the winter. He also mentioned the fortification of peanut butter by the addition of brewers’ yeast and indicated the need for serious consideration of questions such as this. Miss Margaret Moore pointed out the large waste in skim milk and the advisability of using rice polishings in areas in which rice is produced in large quantities. Dr. Ira Manville called attention to milk being sold in California to which a number of vitamins are being added at an increased cost of 5 cents a quart. Dr. McLester called attention to the seriousness of attempting to add various substances to milk. Dr. Fishbein pointed out the difficulty in educating people to eat new cheap foods of high nutritive value when you call them by such unattractive names as skim milk, soybean flour, and the like. He indicated the desirability of using more attractive names for such products. Dr. Williams of Tennessee again emphasized the importance of the home production of food and indicated that proper methods of canning should be taught in such a program. Dr. Markwith mentioned the necessity for cooperation in this field also. He indicated that low-income families who plant gardens and raise food may sometimes be cut off from relief, and expressed the opinion that this should not be done, but that the individual should be further encouraged to produce his own food supply. Dr. Leavell pointed out the desirability of providing suitable implements for the cultivation of gardens. Dr. McLester, in discussing the enrichment of flopr, indicated that in this particular case it was an effort to put into the flour some of the elements lost in milling and that the Council on Foods of the American Medical Association will not permit fortification of any food beyond its normal nutritive level. He expressed the opinion that it would be unwise to add thiamin to sugar and that it is a mistake to try to make a food something different from its natural composition. Dr. McLester discussed oleomargarine as a substitute for butter and in PUBLIC HEALTH AND MEDICAL ASPECTS 107 dicated that the Council of the American Medical Association has recommended its fortification with fish-liver oils, in order to improve its vitamin-A content. Dr. Fishbein stated that Great Britain has made it illegal to sell oleomargarine which is not fortified with vitamin A. He also pointed out that since people in many States live by the production of dairy products, any efforts to promote the sale of oleomargarine should be made in such a way as not to affect adversely the incomes of those in the dairy industry. Dr. Helen S. Mitchell stated that one-third of the oleomargarine is now being fortified with vitamin A and that in experimental areas where oleomargarine is being produced, it has not replaced the sale of butter, and we should not assume that this will harm the sale of dairy products. Dr. Barborka mentioned the advisability of encouraging the program for the enrichment of flour. The need for stimulating greater interest in nutrition among general practitioners was then discussed by the section. Dr. Giddings discussed the question from the point of view of an internist and indicated the need for stimulating greater interest in nutrition. He pointed out the necessity for getting doctors in rural communities and interesting them in nutrition. Dr. Tisdall of Toronto mentioned the lack of knowledge about nutrition by physicians and the necessity for encouraging interest in nutrition among practitioners. Dr. Pollack thought that the general practitioner should be taught nutrition while in medical school rather than waiting until after graduation. He also called attention to the lack of specific knowledge among general practitioners. Dr. Godfrey, State health officer of New York, also indicated the need for education in nutrition in medical schools and pointed out that the Health Department and the State Medical Society in New York are approaching the problem in a practical way. Nutrition must be taught by people who know how to teach. Dr. Fishbein mentioned the lag of 5 to 10 years in getting scientific findings applied by the general practitioner. He expressed the opinion that this is a good thing in that it allows time for inaccuracies to be corrected. Dr. Mackie stated that the proper teaching of nutrition would reveal the magnitude of the problem and that the medical schools will become more interested. Dr. Coombs pointed out that physicians must pay attention to the economic aspects of the nutrition problem, because it is of paramount interest in the care of the patient. Other discussion indicated that careless statements by physicians may frequently undo a lot of good teaching; that the physician does not have time to give detailed dietary instruction, and that more thought should be given to the use of dietitians and nutritionists by physicians; that nutritionists can help doctors by showing them how a family c?n live adequately on a very low income; and that patients can be taught a great deal about dietetics, and the need for teaching physicians to do dietetics. Mr. Trescher pointed out that Johns Hopkins has had a diet clinic for about 10 years and that this clinic more than pays for itself by keeping diabetics out of the hospital. Dr. Pollack thought that dietetic clinics are a necessity. Dr. Barborka discussed the Mayo food clinic and its development into a fine means of teaching with great advantage to the patient. He felt that the food clinic is an essential part of medical school teaching. The patients are taught the proper 108 NATIONAL NUTRITION CONFERENCE foods to be eaten in the various diseases. This information seems to stick. The section closed at this point and was taken up at 2 p. m. on the following day, May 27. At this time Dr. A. N. Baggs, representing Colonel Rowntree of the Selective Service, stated that selective service examinations showed nutritional defects in the manpower. Of the 800,000 men so far examined, over 1,000 have been refused for nutritional defects and diseases intimately associated with nutrition. He especially pointed out the necessity for conditioning men before they come up for selective service examination, and expressed the need for educating the men of this age group to do this. The section then discussed the part which the practicing physician can play in the nutrition program. There was discussion from several individuals on community planning and cooperative efforts involving the physician. It was pointed out that in any plan the scientific and technical side, as well as the administrative side, should be sound, and in order to have the technical side sound, professional groups must be represented in planning the program. Dr. Coombs mentioned the many cases of subclinical scurvy which he has seen in his practice and the need for getting the doctor interested in the problem of preventing the deficiency diseases. It was pointed out by others that the medical profession must be a part of any such public health program. It was suggested that the state medical societies form committees, speakers’ bureaus, or in other ways take part in disseminating a knowledge of nutrition among their members. Dr. Mackie brought up the point of the possibility of establishing a nutrition section in the American Medical Association, and also that the Journal of the American Medical Association be requested to establish an abstract service of appropriate current literature in the field of nutrition. He then mentioned the desirability of having a part of a section of the State medical society devoted to this problem and further suggested that the matter be brought to the attenion of the State medical societies, and that they be encouraged to have symposia on nutrition. Dr. Godfrey expressed doubt as to the advisability of the American Medical Association having an additional section. Several others held this same noint of view. The next item to be discussed was the question of the need for greater activity in the field of nutrition by State and city health departments, and what direction such activity should take. General discussion which followed indicated that there is no question of the need for greater activity in this field by State and city health departments. The point of view was expressed that greater educational efforts are indicated; that it means something more than just sending a nutritionist out to talk to lay meetings. The question of demonstration areas was also discussed and their value pointed out as a means of education. Dr. Bunting discussed the food element in dental caries and expressed the point of view that sugar is a large factor in the production of dental caries. Dr. Rice discussed the role of State health departments in nutrition programs and pointed out the difficulty in obtaining money and stimulating interest in public health work. He mentioned the large distribution of free lunches and the school-milk program in New York City. He felt that there is need for more personnel in the health department on the nutrition problem. PUBLIC HEALTH AND MEDICAL ASPECTS 109 The question of whether health-department laboratories should provide physicians with laboratory diagnostic service for deficiency diseases was next brought up and general discussion by several members of the section indicated that this was certainly a desirable function of health-department laboratories, when approved tests are made available. It is too early at the present time to recommend any specific tests which should be made available by health department laboratories. The final problem which the section discussed was need for greater attention to therapeutic problems in nutrition, especially where nutritional conditions are secondary to other diseases. Dr. Allen Butler discussed the nutritive status of the patient, particularly where the therapy or the disease interferes with the digestion and the normal diet. The general discussion brought out the need for complete diagnosis, including secondary dietary deficiencies, and an appreciation of the pathologic processes which increase the need of vitamins and interfere with their utilization. There is great need for the physician to recognize these basic factors. On the basis of the discussion the following recommendations were read and approved, separately, by vote of the section. RECOMMENDATIONS I. That departments of public health recognize that they have.a large responsibility in the nutrition programs in their respective communities. II. That closer cooperation between medical and public health groups and other agencies interested in nutrition be established, and in order that effective local action may be taken, it is urged that the need for this cooperation be called to the attention of organized medical and public health groups everywhere. III. That efforts be made to stimulate greater interest in nutritional problems among general practitioners and with this in view that opportunity for post-graduate training in nutrition be made more widely available. IV. That the establishment of therapeutic diet clinics in connection with hospitals and medical centers be actively promoted. V. That additional training in nutrition be given in schools of medicine and public health, with special attention to teaching the economic aspects of adequate nutrition. The section concurs in the more detailed recommendations on this subject made by section VI of the Conference. VI. That medical societies, dental societies, and health authorities be represented in all State and community nutrition committees, and that medical groups take an increasingly active part in organizing, sponsoring, and cooperating in nutrition programs. VII. That medical societies be asked to form nutrition committees for the purpose of disseminating nutrition information through symposia, speakers’ bureaus, exhibits, motion pictures, and similar methods. VIII. The recognition that robust health should be preserved by the use of adequate diets where available and that vitamin pills and concentrates of adequate potency be used only to supplement diets 110 NATIONAL NUTRITION CONFERENCE which are necessarily inadequate and by physicians for the treatment of deficiency diseases. IX. That as soon as acceptable diagnostic methods of proven value are developed in the field of nutrition, such service be made available by departments of health to the practicing physician. X. That both city and State health departments take a greater interest in nutrition with a view primarily of aiding practicing physicians in the diagnosis and treatment of nutritional disorders. XL The wider distribution and utilization of inexpensive foods of high nutritive value and the home production and use of larger amounts of protective foods, in order to assist in preventing deficiency diseases. The section endorses the action of the Food and Nutrition Committee of the National Research Council in sponsoring the enrichment of flour and bread. SECTION lllb PUBLIC HEALTH AND MEDICAL ASPECTS OF NUTRITION SPECIAL NEEDS OF MOTHERS AND CHILDREN Presiding, RICHARD M. SMITH, M. D. Assistant Professor of Pediatrics and Child Hygiene Harvard Medical School and School of Public Health Cochairman SUMMARY OF DISCUSSION Following a brief joint meeting with section Illa, section Illb began its deliberations on the special needs of mothers and children. Dr. Smith outlined the ground to be covered and emphasized the obligation of the section to confine itself to subjects on the agenda, since other sections were taking up other matters. Though various people had been asked to discuss certain points, free discussion by all members of the group was to be encouraged. A committee to draw up recommendations growing out of the discussion was appointed by Dr. Smith, consisting of Dr. Casparis, chairman, Mrs. Bertha Burke, and Dr. Amy Hunter. The first subject for discussion was the food allowances set up by the Committee on Food and Nutrition of the National Research Council. It was recognized that these allowances are tentative and will need to be modified. There was considerable discussion in regard to vitamin D, and some members felt the allowance of 400 to 800 units too low. The group suggested that the committee consider the advisability of continuing D through the growing period and of including vitamin K for the newborn infant, or for the mother during labor. An attempt was made to translate these allowances into simple diets. The diet for the breast-fed infant was outlined and again the question of the advisability of the administration of vitamin K arose. It became clear that our present knowledge is not sufficient to allow a positive statement on the value of K in the prevention of hemorrhage. Various members of the group discussed vitamin D in some detail, considering the form administered and the time of starting. There was a general agreement that it should be started early and that the form used should be fish oil, since vitamin A also would be provided. The time for starting egg was given considerable discussion because 111 112 NATIONAL NUTRITION CONFERENCE of the possibility of allergic manifestations. For the artificially fed baby it was stated that milk should be used in the amount of at least iy2 ounces per pound of body weight, and that we should emphasize the necessity for pasteurization or boiling when liquid milk is used. The equal suitability and the cheapness of evaporated milk and of dried milk was pointed out. In outlining the diet for the child the group considered the daily check list given in the Children’s Bureau folder, Well-Nourished Children, and agreed to accept it as adequate with a few modifications (see appended food lists). There was general agreement that properly milled grain is to be preferred to improperly milled flour which is fortified. In recommending cereals or bread the descriptive expressions “whole grain” or “properly milled” should be used. The value of cheap foods, such as peas, beans, and unpolished rice was stressed. The mention of the use of sugar brought out a lively discussion between the proponents of various theories concerning the causation of dental caries. It was pointed out that another section, section I, was charged with the responsibility for reviewing research and would undoubtedly take up this question. For the pregnant and lactating woman the Children’s Bureau folder, The Expectant Mother, was used, and also the folder, Daily Diet During Pregnancy, prepared by the Department of Child Hygiene, Harvard School of Public Health and Boston Lying-In Hospital. This last folder was accepted as adequate by the group. It was emphasized that the diet of the pregnant woman is frequently too low in protein, iron, and vitamin C. Under the heading of Availability of Foods, several people spoke about sectional problems and problems of low-income groups. It was again pointed out that another section, section II, was considering economic problems. The utilization of foods was taken up first from the standpoint of psychological factors, including food habits and racial and cultural factors, and then from the standpoint of physiological factors. The adjustment of the dietary recommendations to the total family situation was discussed from the standpoint of the nutritionist engaged in both teaching medical students and serving patients in a large city clinic. This completed the first day’s discussion. On the second day the public-health aspects of the problem were considered. The role of the physician was brought out, the role of the clinic, and the role of public-health services. There was some discussion on specific ways of making knowledge available, but it was recognized that a section of the Conference was dealing with problems of education, both popular and professional. The need for further education of workers, physicians, nurses, and nutritionists was emphasized. The roles of the public-health nurse and of the nutrition consultant and of the medical social worker were all considered. Various members of the group entered into the discussion bringing out their particular problems in the public health field and how these problems were being met. Examples of successful programs were presented. Emphasis was placed on the need for recognition of nutrition as a public-health responsibility, and the importance of having a nutritionist on the staff of a State health department. It NEEDS OF MOTHERS AND CHILDREN 113 was suggested that there be representation of the health department on the State Nutrition Committee. This section recommended the following food lists for infants, children, and pregnant and lactating women: Foods the infant needs daily: Milk: Breast milk if possible for the first 6 months of life from a mother receiving an adequate diet. If the baby is artificially fed a minimum of 1^ ounces of milk per pound body weight. , Fish oil: Fish oil supplying vitamins D and A beginning at 2 weeks of age. Orange juice: Orange juice beginning at 2 weeks. Additional foods beginning at 4 months or soon after: Properly milled whole grains. Egg yolk. Vegetables. Fruit. Foods the growing child needs daily: Milk: 1% pints to 1 quart daily adequately pasteurized, boiled, dried, or evaporated. (Evaporated milk is of equivalent food value to whole milk.) Properly milled whole grains: In the form of cereal or bread: 2 servings. Lean meat or fish: Once a day if possible. Eggs: One a day for each child if possible. An orange or its equivalent in tomato juice: Or some other adequate source of vitamin C. Green leafy or yellow vegetable and a potato. Fish oil: Fish oil containing vitamins D and A. Other foods such as dried or fresh fruits and dried peas and beans may be used. Foods the pregnant and lactating woman needs daily: Milk: 1 quart (adequately pasteurized, boiled, dried, or evaporated). Properly milled whole grains as bread or cereals. Meat. Egg- Citrus fruit, or Its equivalent in tomato juice, or some other source of vitamin C. Other fruit, dried or fresh. Green leafy or yellow vegetables and potato. Fish oil containing vitamins D and A. RECOMMENDATIONS Section Illb has been concerned with the nutrition of pregnant and lactating women and of children. We have studied the daily allowances of nutrients released by the Committee on Food and Nutrition of the National Research Council and have accepted these allowances as a working basis. We recommend that this committee investigate vitamin K and consider the desirability of adding this vitamin as an essential nutrient for women during the late period of pregnancy, or for new-born infants within the first 24 hours of life. This section has indicated how the essential nutrients may be translated into foodstuffs and has indicated the kinds and quantities of fqod needed to establish adequate nutrition of pregnant and lactating women, and of children of differing ages. These food lists are appended as an integral part of this report and we recommend their wide distribution. 114 NATIONAL NUTRITION CONFERENCE It is the opinion of this section that all the essential nutrients can and should be provided through natural foods. Great progress is being made in the proper milling of grains so as to retain their full nutrient value. Pending further developments in this field, fortification of flour may be acceptable. Vitamin D in most instances will be provided by fish oil. We recommend this source of vitamin D since it also augments the intake of vitamin A. We have taken cognizance of geographic and economic considerations which influence the availability of these natural foods. We look forward with interest to the report of other sections which have given particular consideration to these matters. The utilization of an adequate diet by children is significantly affected by food habits. We are not in this report making specific recommendations with reference to habit formation or to the methods of preparing and serving food so that it is attractive and palatable, but we wish to record our appreciation of the extreme importance of psychological factors. The food lists which have been recommended are for normal children and should be applied on an individual basis. Certain children, such as the premature infant, the diabetic or allergic child, and others with developmental or pathologic variations require special consideration. We recommend that in the general nutrition program increased emphasis be placed on the importance of the nutritive requirements of pregnant and lactating women. In providing adequate food for pregnant and lactating women we appreciate the necessity for taking into consideration the whole family situation and the limitations of the family budget. Ways and means should be found to provide a satisfactory diet for the pregnant and lactating woman without reducing the food available to the other members of the family. To make effective a program for better nutrition, it is essential that the technical workers who will interpret the facts to the general public should be themselves well grounded in the fundamentals of good nutrition. Among those in this category are included physicians— those in training, in private practice, and in public health positions— dentists and dental hygienists, nurses, nutritionists, dietitians, home economists, teachers, and social workers. We recommend that a definite program be developed to assure to these groups adequate education in nutrition and in its practical application. In extending the knowledge of nutrition to the individuals of the country, full utilization should be made of all available or potential resources in the community and of the most effective means of education. The official health agencies at the Federal, State, and local levels should assume greater responsibility in the field of nutrition. As an aid to this it is recommended that the services of persons especially trained in the field of nutrition be made available to communities, Such persons should give expert advice and assist in the training of other personnel concerned in the furthering of good nutrition for mothers and children. NEEDS OF MOTHERS AND CHILDREN 115 It is essential in order to accomplish the ends in view that all agencies in the community, public and private, be coordinated in a single effort to improve nutrition. Members of the Drafting Committee: Chairman: Dr. Horton Casparis, Vanderbilt University Medical School, Nashville, Tenn. Mrs. Bertha S. Burke, Harvard School of Public Health, Boston, Mass. Dr. Amy Louise Hunter, Chief, Bureau of Maternal and Child Health, State Board of Health, Madison, Wis. 425544°—42-------------9 SECTION IV NUTRITION FOR WORKERS IN DEFENSE INDUSTRIES Presiding, FRANK G. BOUDREAU, M. D. Executive Director of the Milbank Memorial Fund, New York City Chairman AGENDA I. The Labor Recruit. As the demand for defense workers intensifies, the supply of the skilled and experienced will become exhausted and recourse will be had to young men and women who have never had working experience, and to older men and women who have been unemployed for long periods. Many of the young men who have been rejected for service with the armed forces will enter defense industries. A comparatively large proportion of these men will be suffering from physical defects associated directly or indirectly with malnutrition, such as underweight, general debility, defective teeth, and low-grade chronic infections. Results of selective service and army medical examinations will give a fair idea of the health of labor recruits of similar ages. There is some evidence that a large proportion of WPA workers are malnourished (Milbank Memorial Fund Study of Nutrition in New York City) and that those on other forms of relief or in similar income groups are even worse off. II. Workers in Newly Established Plants and Communities. To meet the needs of the national defense program, plants for the manufacture of munitions and other defense products are being established in new localities, where it is sometimes necessary to build up completely new community facilities to meet the needs of the workers. Older plants which are being rapidly expanded may bring so many new workers to an established community that the normal facilities become inadequate. New and expanding plants are likely to be supplied in large part with new workers or workers who have been unemployed for longer or shorter periods. All of these conditions present special hazards to the workers’ nutrition. Moreover, certain industrial processes associated with volatile or toxic products peculiar to munitions plants require special nutritional measures. 116 NUTRITION FOR WORKERS 117 It is evident that in new or rapidly expanding plants, particularly where such plants are established in new localities without adequate community facilities, special attention and care are required to safeguard the health and nutrition of the worker. III. How Adequate Is the Defense Workers’ Diet? There is very little precise information available on the nutrition of workers as distinct from other classes in the community. Studies of the United States Department of Labor and of the Bureau of Home Economics of the United States Department of Agriculture have shown that a large but varying proportion of employed workers’ families in the different regions of the country consume diets which are below the margin of safety as regards essential nutrients. Adequacy of the diet varies roughly with the level of family income, although among families in the same income group there are wide variations in the quality of the diet, demonstrating the importance of education. While nutritional deficiency diseases are fairly common in this country, it is probable that latent malnutrition is far more common and much more important. Poor diets are usually inadequate in several nutrients ; mild forms of malnutrition are apt to be the result of several deficiencies. Individuals with latent forms of malnutrition are liable to break down under strain. Heaviest strains on human nutrition are associated with infancy, adolescence, pregnancy, arduous physical work, and war. IV. Concern of the Industrial Plant in the Workers’ Nutrition. The capacity of workers whose diet is inadequate may be increased by the right kind of supplemental food. Moreover, this method is said to reduce the number of industrial accidents, and may lessen absenteeism, although this problem requires further investigation. Experimental diets deficient in thiamin cause cheerful, cooperative, industrious young adults to become morose, noncooperative, and indifferent. When adequate amounts of thiamin are restored to the diets, these same young adults return to their normal selves. As there is reason to believe that dietary deficiency in thiamin is widespread in this country, authorities believe that some forms of labor unrest may be due to this cause. No one concerned with production for defense can remain indifferent to these facts. In many plants attempts are being made to improve workers’ diets. The plant which is concerned with the most efficient production, the smallest number of accidents and illnesses, and the least friction between management and labor has a large stake in the nutrition of its workers. V. Suggestions for Improving the Working Efficiency of Labor (and Labor Recruits) in Industrial Plants Concerned with Defense by Improved Diets and Additional Nutrients. The report of the Subcommittee on Nutrition in Industry of the Committee on Food and Nutrition of the National Research Council has been adopted by the Committee on Food and Nutrition and by the Subcommittee on Industrial Health and Medicine of the Health 118 NATIONAL NUTRITION CONFERENCE and Medical Committee. The report includes a series of recommendations on: 1. The nutritional conditioning of classes of the population which are likely to become industrial workers. 2. The need for special attention to the nutrition of defense workers. 8. Supplemental feeding in factories. 4. The need to demonstrate the influence of diet on health, working capacity, incidence of accidents, absenteeism, and the psychological state by carefully controlled studies. VI. Federal, State, and Local Programs for the Improvement of the Nutrition of Defense Workers. In order to obtain good results, there must be appropriate organization and action on the Federal, State, and local levels. It is desirable to define the type of program best suited to each level. The problem might also be approached in another way, as follows: Responsibility of the medical officer of an industry or plant. Responsibility of the community department of. health. Responsibility of the State (nutrition committee and departments of health and education). Responsibility of the Federal Government. VII. Need for Further Studies and Investigations as Regards the Diets and Nutrition of Defense Workers. So little is known concerning the diets and nutritional states of defense workers, that there is urgent need for further studies and investigations. This need is referred to briefly in the report mentioned under item V. SUMMARY OF DISCUSSION The members of this section discussed the nutrition needs of all workers in industry, especially of those directly concerned with national defense efforts. Data presented on the diets of employed workers’ families indicated that economic situation and availability of various foods appeared to exert the most important influence on adequacy of diet. Although several studies of the diets of employed workers were cited, it was pointed out that little precise information on the subject is available and that research in this field is urgently needed. In considering the health and nutrition of labor recruits it was stated that many of the men rejected by the Selective Service would eventually become recruits for industry. It was proposed that nutritional deficiencies responsible for certain dental defects and for other adverse health conditions in rejected selectees and in other labor recruits should be corrected as quickly as possible through education and the supplementation of diets of workers entering defense industries. The migration of workers to areas where facilities for NUTRITION FOR WORKERS 119 housing and for the preparation of nutritious meals are inadequate was discussed. The need for quick action was stressed. While long-time studies should be undertaken, the results of such research will not be available at once to aid in the emergency now confronting us. It was recommended that immediate action be initiated at the Federal level to secure the cooperation of industry and labor in carrying out a nutrition program for workers. It was generally agreed that the Office of Production Management, working with other Government agencies, might well assume leadership in (1) gaining the help of trade groups, manufacturers’ associations, the United States Chamber of Commerce, and other organizations, and (2) in securing the cooperation of medical divisions and of other groups and individuals in industrial plants who could provide supervision for a nutrition program for workers. In this section, as was the case in other Sections of the Conference, extension of the Food Stamp Plan was urged so that “protective foods,” such as milk, enriched bread, and vegetables might be made available at reduced cost to families of low-income whether they were on relief or not. DISCUSSION I. The Worker. In his opening remarks the chairman drew the attention of the section to the mimeographed agenda for section IV and to the report of the Subcommittee on Nutrition in Industry of the Committee on Food and Nutrition of the National Research Council. He stated that the section was expected to formulate recommendations for presentation to the whole Conference, and suggested that the subcommittee’s report which had been accepted by the Subcommittee on Industrial Health and Medicine be considered as the basis for such recommendations, with such amendments or other additions as the section might decide to make. Dr. Esther F. Phipard then presented a discussion (illustrated with the attached charts, figs. 3-7) of a study of the diets of employed workers’ families. The data were collected in 1934-37 by the Bureau of Labor Statistics of the Department of Labor and analyzed by the Bureau of Home Economics of the Department of Agriculture. The analysis had to do with the amounts of food purchased and those used in a single week by each of 4,000 families of industrial workers in various sections of the country. The sample included representation of both large and small cities and was not selected by income level. Considering the gross quantities of food consumed by each family during the week and with certain assumptions of median values for nutrient constituents, including mineral, protein, and vitamins, each family’s diet was classified as good (definitely above the safety line), fair (doubtful or close to the safety line), or poor (definitely below safety line). As regards adequacy of diet, it is recognized that many of the values used would be considered inaccurate in the light of present-day knowledge but it is also believed that the resulting estimates tended to be high rather than low so that the charts of “adequacy of diet” are more optimistic than they ought to be. 120 NATIONAL NUTRITION CONFERENCE One reason for this is that no allowance was made for waste and at the time there was a very incomplete basis for computing loss in cooking. No attempt was made in this study to appraise the diets of individuals of the family although it was observed that the mother was generally less well nourished than either the father or the children. There was little observable differentiation in adequacy as between occupational groups, if the cost factor remains constant. Similarly, there is little significant difference in adequacy associated with educational opportunity. Both caloric content and vitamin sufficiency vary directly with the dollar expediture per family per week. Figure 3.—North Atlantic families : Distribution by expenditures for food a person a week, and proportion obtaining diets graded poor, fair, and good. Source : ü. S. Department of Agriculture, “Diets of Employed Workers,” Circular 507, p. 75. In answer to questions by the chairman and Drs. Harris, Palmer, and Cowgill, Dr. Phipard stated that the economic situation, coupled with the availability of various foods, appeared to exert the most im-portant influence on adequacy of diet. Furthermore, present foodconsumption habits influence in important ways individuals’ willingness to accept adequate but unpalatable diets. At this point Dr. Henry Borsook reported on a small survey in which the diets of 50 families were analyzed, with findings quite similar to those reported by Dr. Phipard. He spoke in particular of a Pennsylvania Quaker family in which, even with low income, through unusual interest in food and by very careful shopping, the housewife had been able to Figubh 4.—East North Central families (above). Figure S.—Pacific families : Distribution by expenditure for food a person a week, and proportion obtaining diets graded poor, fair, and good. Source: U. S. Department of Agriculture, “Diets of Employed Workers,” Circular 591, p. 76. Figure 6.—East South Central white families (above). Figure 7.—Southern Negro families : Distribution by expenditure for food a person a week, and proportion obtaining diets graded poor, fair, and good. Source : U. S. Department of Agriculture, “Diets of Employed Workers,” Circular 5