From the Academy | Centennial Series| Volume 114, ISSUE 10, P1648-1662, October 2014

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History Snapshot: Dietetics Student Experience in the 1940s

Published:September 22, 2014DOI:https://doi.org/10.1016/j.jand.2014.08.001
History Snapshot: Dietetics Student Experience in the 1940s
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      To take the Continuing Professional Education quiz for this article, log in to www.eatright.org, click the “myAcademy” link under your name at the top of the homepage, select “Journal Quiz” from the menu on your myAcademy page, click “Journal Article Quiz” on the next page, and then click the “Additional Journal CPE Articles” button to view a list of available quizzes, from which you may select the quiz for this article.
      The 2017 centennial of the Academy of Nutrition and Dietetics
      Before 2012, the Academy was called the American Dietetic Association. It will be referred to as “Academy” throughout this article.
      is an opportunity to reflect on the earlier decades of the profession and consider their impact on the tremendous strides of nutrition and dietetics in the nearly 100 years since. Visually attesting to these developments is a catalogue, in the Academy’s possession, which includes photographs from Johns Hopkins Hospital that give a glimpse into an important era in dietetics education. Johns Hopkins Hospital was among the first to offer an approved training course in dietetics (in 1914) and to recognize the dietitian’s role in the national hospital system.
      The American Food Journal
      American Dietetic Association meets.
      Am Food J. 1922; 17 (Accessed July 14, 2014): 17-18
      http://books.google.com/books?id=YxLnAAAAMAAJ&pg=RA9-PA17&lpg=RA9-PA17&dq=johns+hopkins+academic+dietetics+pioneer&source=bl&ots=7Cq9IjxWuq&sig=HjkSLTEKqvB4d0Aq4GoUT5lUMo4&hl=en&sa=X&ei=QfvDU_DHNJKiyAStnIDQBQ&ved=0CC8Q6AEwAg#v=onepage&q=johns%20hopkins%20academic%20dietetics%20pioneer&f=false
      The photographs presented in this article were published in a brochure in 1946, the middle of a decade that began with international war and ended with a piqued interest in globalization. It was a decade that saw the development of key health care organizations and advancement of the profession: The first Recommended Dietary Allowances (RDAs) were released in 1941; President Harry S. Truman signed the National School Lunch Act into law in 1946, the same year the Centers for Disease Control and Prevention was founded; and the United Nations established the World Health Organization in 1948. This era represented a professional boon for dietitians and home economists, who led the way in training and careers in school foodservice and nutrition. Major recruitment blitzes to accommodate shortages were translating to new academic pathways to practice and growing interest in standardization across school curricula. Like many schools at that time, and in richly capturing these snapshots of a day in the life of dietitians and student dietitians of the time, the Johns Hopkins Hospital School of Dietetics was seeking to attract students to the profession.
      Figure thumbnail gr3
      Student dietitians sit in the ward dietitian’s office, writing special diet orders and completing food requisition forms.
      (Photo courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.)

      Nomenclature of the Day

      The term student dietitian was adopted in 1934. In 1940, in the hopes of bringing about elevated status and professional recognition for dietitians, and to ensure the distinction was made between those still in training and those who had entered practice, the term dietetic intern was approved for official use. However, use of the term student dietitian continued for several years; this was the term used in the Johns Hopkins Hospital’s 1946 brochure.
      • Cassell J.A.
      Carry the Flame.
      American Dietetic Association, Chicago, IL1990
      A definition of dietitian, determined by a committee, was also established in 1940 and emphasized the necessary educational preparation to appropriately use the designation. The definition then was simply that a dietitian “had college training in the science of nutrition and management and is proficient in the art of feeding individuals and groups.”
      • Cassell J.A.
      Carry the Flame.
      American Dietetic Association, Chicago, IL1990
      Because practitioners today are required to attain a higher standard of education and the health professions are held to a higher standard of evidence basis, the Commission on Dietetic Registration (established in 1975) created a more complex definition of a registered dietitian (RD) and allowed optional use of the registered dietitian nutritionist (RDN) credential as of 2013.

      Academy of Nutrition and Dietetics. RDN credential: http://www.eatright.org/HealthProfessionals/content.aspx?id=6859&terms=RDN%20credential. Accessed July 24, 2014.

      The standard current definition of the RD and RDN is “an individual who has met current minimum (baccalaureate) academic requirements with successful completion of both specified didactic education and supervised-practice experiences through programs accredited by the Accreditation Council for Education in Nutrition and Dietetics of the Academy of Nutrition and Dietetics and who has successfully completed the registration examination.”

      Academy of Nutrition and Dietetics. Academy definition of terms list. http://www.eatright.org/scope/. Updated April 2014. Accessed July 15, 2014.

      From seeking out Medicare reimbursement for dietetics services to launching initiatives that establish how integral dietitians are to the health care team and consumers, RDNs and dietetic technicians, registered, know the Academy continues to work diligently to elevate the status of the profession.
      Figure thumbnail gr4
      Dietitians perform ward rounds with the medical and nursing staff at Johns Hopkins Hospital. Note the open window in the room. Florence Nightingale was an advocate for fresh air in hospital rooms

      Nightingale F. Notes on nursing, what it is and what it is not. 1898. Current Nursing website. http://www.nursingplanet.com/nightingale/ventilatin_and_warming.html. Accessed July 27, 2014.

      and, though the first hospital air conditioner was installed in 1906,

      American Society of Heating, Refrigerating and Air-Conditioning Engineers. History of refrigeration timeline, 1906-1939. American Society of Heating, Refrigerating and Air-Conditioning Engineers website. https://www.ashrae.org/resources--publications/history-of-refrigeration-timeline---1906-1939. Accessed July 27, 2014.

      open hospital windows were not uncommon in the 1940s. Of note, some researchers have recently advocated for a return to open windows.

      Collins N. Florence Nightingale approach ‘could help fight infection in modern hospitals.’ UK Telegraph website. http://www.telegraph.co.uk/health/healthnews/9091633/Florence-Nightingale-approach-could-help-fight-infection-in-modern-hospitals.html. Published February 20, 2012. Accessed July 27, 2014.

      , 

      Sample I. Open hospital windows to stem spread of infections, says microbiologist. The Guardian website. http://www.theguardian.com/science/2012/feb/20/open-hospital-windows-stem-infections. Published February 19, 2012. Accessed July 27, 2014.
      (Photo courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.)

      Urgent Need

      In 1942, the US Army requested that 1,000 new dietitians be available by 1943. As the US Army, US Navy, Veterans Administration, and civilian hospitals were all calling for more trained practitioners to join their ranks, the Academy published a booklet, Dietitians Are Urgently Needed, that was distributed to college students in all programs to attract them to the profession.
      • Cassell J.A.
      Carry the Flame.
      American Dietetic Association, Chicago, IL1990
      Recruitment efforts continue today, and there is now a more concerted effort, including pipeline programs, to direct much of the outreach to individuals from groups under-represented within the profession in the interest of boosting a membership composition that more closely matches the diversity of the general population.
      • Bergman E.
      Building a brighter tomorrow: Diversity, mentoring, and the future of dietetics.
      J Acad Nutr Diet. 2013; 113: S5
      Figure thumbnail gr5
      Before leaving the main kitchen to be delivered to various wards, a dietitian checks the trays.
      (Photo courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.)

      Hospital Foodservice

      With Medicare reimbursement partially tied to patient-satisfaction scores, hospital foodservice today uses technology to accommodate patient preferences in a way not possible in the 1940s. During the war years, the focus was transitioning from ward service to centralized foodservice, which was the norm in civilian hospitals with 400 beds or fewer in the late 1940s; workers in those institutions’ dietary departments worked an average 45-hour workweek in straight shifts.
      • Cassell J.A.
      Carry the Flame.
      American Dietetic Association, Chicago, IL1990
      Nurses and dietitians shared responsibility for foodservice in military general hospitals, with ward nurses frequently responsible for cooking breakfast and serving patient trays.

      Davis M. Professional services and activities of dietitians, April 1947 to January 1961. Army History website. http://history.amedd.army.mil/corps/medical_spec/chapterxvi.html. Accessed July 28, 2014.

      Military hospitals, which had long been using decentralized foodservice in which patients were fed from ward kitchens, began to take notice; in advance of a 1951 pilot program for improving foodservice operations, representatives of the Office of the Surgeon General began visiting several civilian hospitals to observe operations for a centralized system. Commercial airline equipment that had been adapted for hospital foodservice—wheeled, compartmentalized food carts insulated for keeping dishes warm or cool—were becoming more widely used then.

      Davis M. Professional services and activities of dietitians, April 1947 to January 1961. Army History website. http://history.amedd.army.mil/corps/medical_spec/chapterxvi.html. Accessed July 28, 2014.

      Carbon steel silverware had been manufactured for use in restaurants and institutions during wartime, but after the war, foodservice departments were phasing in use of china and plastic tableware.

      Food Timeline. Food in 1940s. The Food Timeline website. http://www.foodtimeline.org/fooddecades.html#1940s. Accessed July 27, 2014.

      The traditional fixed-menu batch-style cooking of years past, in which a patient who has left the room for testing or physical therapy or is resting might not get a meal served fresh and warm, has given way to the modern hospital’s hotel-style room service model and à la carte food carts wheeled throughout hospital units that allow food to be plated immediately upon request. Electronic submission of food orders at any time of day from a large menu is a major transformation from foodservice of eras past, where menus were printed on paper and choice was limited.

      Galewitz P. Brought to you by Obamacare: Better hospital food. USA Today website. http://www.usatoday.com/story/money/business/2013/06/23/better-hospital-food-obamacare/2450537/. Published June 23, 2013. Accessed July 28, 2014.

      , 

      Lee J Changes on the menu. April 27, 2013. ModernHealthcare website. http://www.modernhealthcare.com/article/20130427/MAGAZINE/301049827. Accessed July 28, 2014.

      , 

      Keller M. That’s progress—Advancements in hospital foodservice. August 2009. Today’s Dietitian website. http://www.todaysdietitian.com/newarchives/072709p28.shtml. Accessed July 28, 2014.

      Expansion of Academic Dietetics Programs

      Wartime efforts within the profession, beginning in 1942, had focused on programs to aid civilians and the military branches. As noted, there was a dearth of practitioners at the time and a dire need for more dietitians serving in the US Army, so the Academy set to creating several programs to address this shortage. A program to train dietitian aides—what are now called dietetic technicians, registered—was piloted at an Illinois Veterans Health Administration hospital to help provide relief to dietitians whose lists of daily tasks just kept growing. By 1943, there were 525 dietitian aide graduates from 37 authorized courses. A plan for expediting student dietitian training was also implemented.

      Nightingale F. Notes on nursing, what it is and what it is not. 1898. Current Nursing website. http://www.nursingplanet.com/nightingale/ventilatin_and_warming.html. Accessed July 27, 2014.

      Although this accelerated dietitian apprentice program—including classes, field trips, and on-the-job training that met the Academy’s educational standards of the day—brought scores of individuals to the profession, it was limited to specific US Army and civilian hospitals. The first 6 months were spent at 1 of 4 approved US Army hospitals or 1 of 15 approved civilian hospitals, followed by 6 months at 1 of 38 approved US Army hospitals.

      Nightingale F. Notes on nursing, what it is and what it is not. 1898. Current Nursing website. http://www.nursingplanet.com/nightingale/ventilatin_and_warming.html. Accessed July 27, 2014.

      For the duration of the war, the Academy also granted students dismissal from training after 9 months to allow them to heed the call to service.
      • Cassell J.A.
      Carry the Flame.
      American Dietetic Association, Chicago, IL1990
      Another alternate pathway to practice—the qualified experience apprentice plan—was created when individuals with undergraduate degrees in other academic disciplines or with no internship experience expressed interest in serving as dietitians in the US Army medical department. This experiential apprentice plan yielded twice as many dietitians serving in the military as the student apprenticeship.
      • Hodges P.M.
      From Home Sister to Second Lieutenant: Army Dietitians in World Wars I and II.
      Catawba Publishing, Charlotte, NC2007: 40-41
      When the war was over, officer procurement objectives were nullified. Students continued with their training only if they were already on active duty as of October 1, 1945. By 1946, only one military training program for student dietitians, at Brooke General Hospital in Fort Sam Houston, TX, remained.

      Vogel EE, Manchester KE, Gearin HB, West WL. Training in World War II. US Army Medical Department website. http://history.amedd.army.mil/corps/medical_spec/chaptervi.html. Accessed July 15, 2014.

      The tradition of availing opportunities to students seeking to enter the profession has endured in the years since. Dietetics programs still welcome individuals with baccalaureate degrees in other disciplines to complete didactic coursework to pursue a degree in dietetics. Alternative routes to academic degrees today are often preferred by older students and career changers. It may be in the form of 2-year programs or something patently unheard of in the 1940s: online coursework.
      • Rhea M.
      • Bettles C.
      Future changes driving dietetics workforce supply and demand: 2012-2022.
      J Acad Nutr Diet. 2012; 112: S10-S24
      In 2012, accommodating a range of specific learner needs and college facility space constraints, 5.5 million students (across all disciplines) registered for at least one online higher-education course.

      Kolowich S. Exactly how many students take online courses? Chronicle of Higher Education website. January 16, 2014. http://chronicle.com/blogs/wiredcampus/exactly-how-many-students-take-online-courses/49455. Accessed July 15, 2014.

      A Stand for Educational Requirements

      As the Academy, the colleges, and the military were collaborating to develop programming to quickly train practitioners, while simultaneously maintaining professional standards, the strict academic requirements came into question in 1944. Because a provision in the Veterans’ Preference Act eliminated minimum academic prerequisites for certain positions, the Civil Service Commission began to inquire whether they were necessary for student dietitians. The response letter from the Deputy Surgeon General, Major General George F. Lull, detailed the duties and responsibilities of the dietitian and asserted this point of protest: “The dietitian in the Medical Department of the Army is a commissioned officer. She assists the medical officer by filling his diet prescriptions. It is, therefore, most important that the best qualified individuals be obtained for training. It is highly improbable that this type of personnel could be secured if the educational requirements are discontinued.” Thanks to Lull’s defense of the profession, the Commission rescinded its challenge.
      • Hodges P.M.
      From Home Sister to Second Lieutenant: Army Dietitians in World Wars I and II.
      Catawba Publishing, Charlotte, NC2007: 40-41
      The profession maintains its high academic standards today. Now, as then, members, educators, and the Academy are equipped to confront such challenges and assert themselves as uniquely trained among the competition.
      Figure thumbnail gr6
      Student dietitians were responsible for checking patient trays before they were delivered to the central service unit.
      (Photo courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.)

      Hospital Dietitians

      The hospital was, by far, the most common employment setting for dietetics in the 1940s. In 1947, a survey revealed that, among the 3,462 Academy members who had responded (from a total of 7,800), 68% were working in hospitals. The median salary across all dietetics positions that year, including hospital, foodservice, college/high school teaching, commercial industry, and consulting, was $3,000 a year.
      • Cassell J.A.
      Carry the Flame.
      American Dietetic Association, Chicago, IL1990

      Student Membership

      A “junior” Academy membership category was established in 1926, but in 1944 the junior category was outlined as being specifically for student dietitians.
      • Cassell J.A.
      Carry the Flame.
      American Dietetic Association, Chicago, IL1990
      Although it is not known how many students signed on for junior membership in those early years, the increasing popularity of this membership category is demonstrated by the 4,000 junior members in 1980,
      • Cassell J.A.
      Carry the Flame.
      American Dietetic Association, Chicago, IL1990
      skyrocketing to 20,730 student members in 2013–2014 (the category was rebranded as “student member” in 2003) (personal communication, Jim Weinland, Membership Director, Academy of Nutrition and Dietetics, July 2014).
      Figure thumbnail gr7
      A student dietitian explains food values to patients with diabetes in a food clinic.
      (Photo courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.)

      New Diet Recommendations

      The early war years saw rapid growth in public funding of nutrition programs, as evidence of malnutrition, past or present, was noted in 25% of those drafted to military service.
      Centers for Disease Control and Prevention
      Safer and healthier foods.
      MMWR Morb Mortal Wkly Rep. 1999; 48: 905-913
      The first RDAs and War Order Number One (a wheat flour–enriching program for vitamin and iron fortification) were established in 1941, at the National Nutrition Conference for Defense convened by President Franklin D. Roosevelt
      Centers for Disease Control and Prevention
      Safer and healthier foods.
      MMWR Morb Mortal Wkly Rep. 1999; 48: 905-913
      , 

      Welsh SO, Davis C, Shaw A. USDA’s Food Guide background and development. September 1993. US Department of Agriculture website. http://www.cnpp.usda.gov/Publications/MyPyramid/OriginalFoodGuidePyramids/FGP/FGPBackgroundAndDevelopment.pdf. Accessed July 27, 2014.

      ; the RDAs were first published in 1943. At that time, the only RDAs were for energy and nine essential nutrients—protein, iron, calcium, vitamins A and D, thiamin, riboflavin, niacin, and ascorbic acid—to address nutritional concerns related to national defense.

      Welsh SO, Davis C, Shaw A. USDA’s Food Guide background and development. September 1993. US Department of Agriculture website. http://www.cnpp.usda.gov/Publications/MyPyramid/OriginalFoodGuidePyramids/FGP/FGPBackgroundAndDevelopment.pdf. Accessed July 27, 2014.

      , 
      Food and Nutrition Board Subcommittee on the 10th edition of the RDAs
      Recommended Dietary Allowances.
      10th ed. National Academies Press, Washington, DC1989
      http://www.nap.edu/openbook.php?record_id=1349&page=R1
      New scientific information influenced the revision of the original nine RDAs and the elevation to and demotion from RDA status of other nutrients in the decades that followed, but it was not until 50 years later, in 1993, that the Food and Nutrition Board initiated its major overhaul to the RDAs. Today the RDAs—along with Adequate Intakes, Estimated Average Requirements, and Tolerable Upper Intake Levels—are a component of the Dietary Reference Intakes, which, unlike the RDAs alone, address health benefits, toxicity levels, and role in reduction of chronic disease.
      • Kennedy E.
      • Meyers L.
      Dietary reference intakes: Development and uses for assessment of micronutrient status of women—A global perspective.
      Am J Clin Nutr. 2005; 81: 1194S-1197S
      To help individuals meet their nutrition needs during the period of required rationing during World War II, a food guide iteration for eating healthfully during wartime, the National Wartime Nutrition Guide leaflet, was published in 1943. The Basic Seven groupings were green and yellow vegetables; oranges tomatoes and grapefruits; potatoes and other vegetables and fruits; milk and milk products; meat, poultry, fish, eggs, and dried peas and beans; bread, flour cereals; and butter and fortified margarine. This guide did not provide numbers of servings, but rather alternatives in case certain types of foods were unavailable or limited during the war. However, this lack of specificity proved problematic, and an updated version of this guide with suggested servings was released in 1946 as part of the National Food Guide, after the war had ended.

      Welsh SO, Davis C, Shaw A. USDA’s Food Guide background and development. September 1993. US Department of Agriculture website. http://www.cnpp.usda.gov/Publications/MyPyramid/OriginalFoodGuidePyramids/FGP/FGPBackgroundAndDevelopment.pdf. Accessed July 27, 2014.

      After the war ended, the focus shifted from preventing nutrient deficiencies to preventing chronic disease. In fact, the landmark Framingham Heart Study, identifying the impact of diet and sedentary lifestyle on cardiovascular health, was initiated in 1949.
      Centers for Disease Control and Prevention
      Safer and healthier foods.
      MMWR Morb Mortal Wkly Rep. 1999; 48: 905-913

      Interns in Demand

      The postwar years of the 1940s saw shortages in the number of individuals becoming dietetic interns, and members of the profession collaborated to figure out ways to draw more individuals to the programs (see Figure 1). Measures to address the shortage, including a moratorium on new internships, were imposed, while a committee quickly set to work to address programming issues. An intensive study of the internship curriculum commenced in 1949, while a subcommittee investigated training dietitians for the hospital and medical school environment. In the years that followed, intern recruitment efforts intensified and a curriculum guide was published, while internships in specialty areas of practice like school lunch and pediatrics were investigated.
      • Cassell J.A.
      Carry the Flame.
      American Dietetic Association, Chicago, IL1990
      Figure thumbnail gr1
      Figure 1A session listed in the program book for the 1946 Food & Nutrition Conference & Expo (then called “annual meeting”) in Cincinnati, OH, include a panel discussion about how to let college students know about a career in dietetics.

      Standardization after the Influx

      When the Hill-Burton Act passed, and new hospitals were set to break ground across the country, it translated to a need for more practitioners in all disciplines and at all levels. Although the chief goal was no longer to staff military dietetics positions, recruitment efforts to the profession remained critical.
      • Cassell J.A.
      Carry the Flame.
      American Dietetic Association, Chicago, IL1990
      Given the array of dietetics programs and pathways to practice that developed in the war years, it became evident that standardization of application forms, evaluation procedures, and competencies was needed. A 1946 Academy committee set to work to establish minimum content requirements for hospital and administrative coursework, while other committees investigated the academic preparatory needs of dietitians working in public health and institutional management.
      • Cassell J.A.
      Carry the Flame.
      American Dietetic Association, Chicago, IL1990
      Standardized minimum competencies have long been considered an evolving work, reviewed and revised based on the demands of the science and realities of the day. Today a major emphasis is on research outcomes. In the 2010s, the leadership among academic stakeholders has examined raising the minimum academic preparation and adding research training to the minimum competency standards to prepare practitioners for participating in asserting the evidence basis of the profession.
      • Kicklighter J.R.
      • Cluskey M.M.
      • Hunter A.M.
      • et al.
      Council on Future Practice visioning report and consensus agreement for moving forward the continuum of dietetics education, credentialing, and practice.
      J Acad Nutr Diet. 2013; 113: 1710-1732
      Figure thumbnail gr8
      A student dietitian instructs an ambulatory patient in the food clinic.
      (Photo courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.)

      Rationing in the 1940s

      Rationing was the dominant—mandatory—dietary trend of the war years. Americans were required to stretch the nutrient value of restricted amounts of food from April 1942 to June 1947, while the priority for farmers and food manufacturers was feeding the military.

      Food Timeline. Food in 1940s. The Food Timeline website. http://www.foodtimeline.org/fooddecades.html#1940s. Accessed July 27, 2014.

      While gasoline rationing hindered fresh food transportation and imported foods were restricted, the majority of processed and canned items were earmarked for the US military and its allies.

      National World War II Museum. Rationing for the war effort. The National WWII Museum website. http://www.nationalww2museum.org/learn/education/for-students/ww2-history/take-a-closer-look/ration-books.html. Accessed July 27, 2014.

      Although food-ration restrictions were initially imposed on civilians, ultimately hospitals, hotels, jails, and restaurants also were subjected to a form of apportioning. These establishments were required to account for point and physical inventories of rationed foods. In 1943, rations for restaurants and other institutions were adjusted to be based per serving rather than per customer as a means to address the inequity the original system had posed for hospitals and other institutions where food was not the primary business. By 1945, however, there were claims of unfair preferential rationing given to restaurants and other foodservice industries, while many households did without staples—meat, in particular—for long stretches.

      Haller E. Rationed restaurants, just as housewives, must stretch food. February 23, 1943. Wall Street Journal:1,2.

      , 

      Grutzner C Jr. Rations asked for restaurants. September 13, 1946. New York Times 1, 3.

      , 

      Café shutdown seen with red point scarcity. July 31, 1945. LA Times 1, 2.

      Allotments of sugar were reduced for restaurants, hospitals, and other foodservice institutions in 1945, regardless of inventory, although they were also allowed to petition local boards for increased allotments of meats and canned goods.

      Grutzner C Jr. Restaurant men voice fear of further slash in rations. January 8, 1945. New York Times 1, 19.

      Sugar was by far the most restricted staple—households were seeing their sugar points voided and, in 1945, institutions and restaurants began to fear that they too would be subjected to losing unused rations. So coveted was sugar at this time that it was the last item to be removed from the rations list, in 1947.

      Food Timeline. Food in 1940s. The Food Timeline website. http://www.foodtimeline.org/fooddecades.html#1940s. Accessed July 27, 2014.

      Figure thumbnail gr9
      A medical resident presents a ward patient for a discussion about disease with dietitians and other professional staff at Johns Hopkins Hospital. Although nutrition therapy was the purview of medical staff at that time and dietitians had little direct contact with patients, medical training in that realm was minimal.

      Academy of Nutrition and Dietetics. Practice Paper: Critical thinking skills in nutrition assessment and diagnosis. November 2013. Academy of Nutrition and Dietetics website. https://www.eatright.org/Members/content.aspx?id=6442478892. Accessed July 15, 2014.

      At schools like Johns Hopkins, dietitians were often responsible for training the nursing staff in dietetics.
      (Photo courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.)

      A Need for More Hospital Beds

      After World War II, health care in the United States was in a state of transition, as home care was being phased out to a hospital care delivery system. Existing institutions were increasingly stretched to capacity: There were only 3.2 beds for every 1,000 people across the 6,000 US hospitals in 1946.
      • Sultz H.A.
      • Young K.M.
      Health Care USA: Understanding Its Organization and Delivery.
      7th ed. Jones and Bartlett Learning, Burlington, MA2001: 65-108
      The federal Hill-Burton Hospital Construction Act was passed that year to provide funding assistance toward building new hospital and clinic facilities.
      • Cassell J.A.
      Carry the Flame.
      American Dietetic Association, Chicago, IL1990
      , 
      • Sultz H.A.
      • Young K.M.
      Health Care USA: Understanding Its Organization and Delivery.
      7th ed. Jones and Bartlett Learning, Burlington, MA2001: 65-108

      Dietetic Intern Placement

      In the late 1940s, hospital, administrative, and food clinic were the only three types of internship available for dietetics students. Hospital placements were the most common (634 of 755 in 1945, 609 of 683 in 1948), followed by work in administrative roles and food clinics. The food clinics, which had fewer than 10 interns each year and, by 1949, only had 1, were clinical centers for ambulatory patients with a dietary component to their medical treatment.
      • Cassell J.A.
      Carry the Flame.
      American Dietetic Association, Chicago, IL1990
      The expansive growth of dietetics specialties in the past 40 years has yielded a much more wide-ranging field of areas for dietetic internship including sports nutrition, community health, public health, culinary entrepreneurship, and pediatrics, among others.
      Figure thumbnail gr10
      Dietitians served lunch to wards at the Harriet Lane Home for Children at the Johns Hopkins Hospital, the first children’s clinic associated with a medical school. Although the clinic closed in 1972 and the building was razed in 1974, it was relocated to the David M. Rubenstein Child Health Building when it opened in 2006. Now called the Harriet Lane Clinic, this training site for students in the medical professions provides nutrition-related services to patients.

      The Harriet Lane Home for Invalid Children. Medical Archives of the Johns Hopkins Medical Institutions. http://www.medicalarchives.jhmi.edu/harrietlane.html. Accessed July 17, 2014.
      (Photo courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.)

      Why Hold a Meeting During War?

      Although the government’s request that all “nonessential” conventions be postponed in 1942 led to talk of the Academy holding no annual meeting (now called the Food & Nutrition Conference & Expo), the criticality of accelerated training for student dietitians and recruitment efforts were among the chief reasons the annual meeting went on as planned in Detroit, MI (see Figure 2).
      • Cassell J.A.
      Carry the Flame.
      American Dietetic Association, Chicago, IL1990
      Figure thumbnail gr2
      Figure 2A sampling of the education-focused sessions offered at the 1942 annual meeting (now called Food & Nutrition Conference & Expo) from the event’s original program book.

      Infant Feedings in the 1940s

      Breastfeeding in the 1940s was on the decline. From 1946 to 1950, only 50% of first-born infants were breastfed, only 20% up to age 6 months, compared with slightly less than 70% in the early 1930s. The increased use of infant formula was just beginning to get the attention of the US Food and Drug Administration, which had only first referred to infant formulas among foods for specialty dietary purposes in its federal regulations in 1938, and required that these product labels display nutrient information as of 1941. Hospitals at that time prepared newborn and infant formula in-house. The process was performed in specially equipped, labor-intensive laboratories with exceptional demands for quality control. It required a mixture of water and powdered milk engineered to mimic human milk’s chemical composition. For children allergic to cow’s milk, soy flour–based and meat protein–based powders were available. Because of greater understanding of nutrient requirements, as well as advances in sanitation and a safe water and milk supply, the general public and most physicians then thought formula feeding to be comparable to breastfeeding in terms of safety and satisfaction. Acceptance of concentrated, commercially prepared liquid formula was not far off, however, as it gained market ground in the next decade.
      • Fomon S.J.
      Infant feeding in the 20th century: Formula and beikost.
      J Nutr. 2001; 131: 409S-420S
      Figure thumbnail gr11
      Student dietitians learned formula preparation at the Johns Hopkins Hospital Harriet Lane Home for Children.
      (Photo courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.)
      Today, the Academy promotes breastfeeding as a public health strategy for improving the health of the mother and infant. The Academy has published a position that identifies exclusive breastfeeding up to 6 months and breastfeeding with complementary foods from 6 to 12 months as the ideal infant-feeding pattern to attain optimal nutrition and health protection.
      Position of the American Dietetic Association: Promoting and supporting breastfeeding.
      J Am Diet Assoc. 2009; 109: 1926-1942
      Figure thumbnail gr12
      A meal is served to a dietitian at a Johns Hopkins Hospital cafeteria for dietitians, nurses, and other professional groups.
      (Photo courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.)

      What Were They Eating in the 1940s?

      Rationing in the 1940s led to some changes in the overall diet. For example, to compensate for the scarce canned and fresh foods available, cereals, spaghetti, and noodles were used as filler in dishes in households and in some eating establishments, so casseroles were fairly popular in the 1940s.

      Food Timeline. Food in 1940s. The Food Timeline website. http://www.foodtimeline.org/fooddecades.html#1940s. Accessed July 27, 2014.

      , 

      National World War II Museum. Rationing for the war effort. The National WWII Museum website. http://www.nationalww2museum.org/learn/education/for-students/ww2-history/take-a-closer-look/ration-books.html. Accessed July 27, 2014.

      Although its price remained higher than those for beef and pork through World War II, chicken began its ascent to becoming a more popular meat choice in 1942.

      US Department of Agriculture, Economic Research Service. Food availability and consumption. US Department of Agriculture, Economic Research Service website. http://www.ers.usda.gov/data-products/ag-and-food-statistics-charting-the-essentials/food-availability-and-consumption.aspx#.U9lt2fldXbM. Accessed July 30, 2014.

      According to the Meal Planning Guide of the Home Economics Institute, published in 1943, a typical breakfast at that time may have included any combination of tomato juice, prepared whole-grain or enriched-grain cereal with whole milk, buttered white toast, applesauce, and cornmeal pancakes or waffles with syrup. Lunch could have included kidney beans, pickled beets, raisin bread, bean and barley soup, cottage cheese and prune salad, buttered enriched white bread, a gelatin fruit dessert, or orange slices.

      Food Timeline. Food in 1940s. The Food Timeline website. http://www.foodtimeline.org/fooddecades.html#1940s. Accessed July 27, 2014.

      A buffet, according to Good Housekeeping in 1944, might consist of dishes like baked beans, frankfurters in toasted rolls, veal paprika, noodles with poppy seeds, creamed oysters, eggs with mushrooms, buttered rice, mustard pickles, mixed vegetable salad, assorted cheeses, peas in French dressing, jellied tomato and potato salad, velvet pie, orange mint julep, and mints.

      Food Timeline. Food in 1940s. The Food Timeline website. http://www.foodtimeline.org/fooddecades.html#1940s. Accessed July 27, 2014.

      Military needs also brought some new products to market. M&Ms (Mars, Inc) and Tootsie Rolls (Tootsie Roll Industries) were developed in 1941 and 1942, respectively, to accommodate the need for heat-resistant chocolate that could be shipped overseas.

      Food Timeline. Food in 1940s. The Food Timeline website. http://www.foodtimeline.org/fooddecades.html#1940s. Accessed July 27, 2014.

      , 

      A history of American snack foods, from waffle cones to Doritos. December 17, 2012. Bon Appétit website. http://www.bonappetit.com/restaurants-travel/article/a-history-of-american-snack-foods-from-waffle-cones-to-doritos. Accessed July 28, 2014.

      And thanks to military research, some convenience products, such as instant coffee, frozen orange juice, canned meats, and cake mix, entered the market in the late 1940s.

      Food Timeline. Food in 1940s. The Food Timeline website. http://www.foodtimeline.org/fooddecades.html#1940s. Accessed July 27, 2014.

      Figure thumbnail gr13
      The dietitians had their own residence across from Johns Hopkins Hospital. Here, they are relaxing during off-duty hours in the living room of their quarters.
      (Photo courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.)
      Figure thumbnail gr14
      A handful of dietitians in one of the bedrooms of the dietitians’ residence across from Johns Hopkins Hospital.
      (Photo courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.)

      The Dietitian Dress

      Perhaps today it would seem more typical to see off-duty RDNs in more comfortable clothing, like jeans. But jeans did not become part of casual fashion until the early 1950s, and even from then until the 1960s, it was mostly considered emblematic of counterculture.

      Hegarty S. How jeans conquered the world. February 28, 2012. BBC News website. http://www.bbc.com/news/magazine-17101768. Accessed July 27, 2014.

      Slacks for women were gaining acceptance in the 1940s, but the most popular women’s wartime fashion—utility clothes to accommodate rationing—mostly comprised tailored suits, knee-length skirts, and blouses with squared or padded shoulders. After the war, rounded shoulders, more shapely bust lines, skirts to the calves, and waist-defining clothing gained popularity.

      1940s women’s clothing. University of Vermont website. http://www.uvm.edu/landscape/dating/clothing_and_hair/1940s_clothing_women.php. Accessed July 29, 2014.

      But while on duty, a student dietitian considered “well dressed” wore a regulation nursing uniform, including a slip, petticoat, white hose, and white shoes with rubber heels.
      • Cassell J.A.
      Carry the Flame.
      American Dietetic Association, Chicago, IL1990

      Celebrating the Parallels of Past and Present

      Although it was a challenging decade, the 1940s proved to be crucial to the academic and professional development of dietetics and quite different from the current era, yet bears many similarities. The public’s ever-growing interest in nutrition and health has sustained the need for practitioners and maintained the high value of a dietetics education. As the centennial nears, it is something to celebrate that each time there are challenges, whether in the 1940s or 2010s, whether in academics or practice, the profession at large has always emerged with elevated recognition for its diligent work in serving its practitioners, its country, and the public.

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      Article info

      Publication history

      Published online: September 22, 2014

      Footnotes

      This article was written by Karen Stein, MFA, freelance writer, Traverse City, MI, consultant editor for the Nutrition Care Manual, and a former editor of the Journal.

      Identification

      DOI: https://doi.org/10.1016/j.jand.2014.08.001

      Copyright

      © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

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