THE BRIEF 1948 DIET CAMPAIGN
I shall now relate an unusual experience for a physician who was personally responsible for a short, intensive, country-wide diet campaign against polio of one days duration conducted through the co-operation of the press and radio. Before I embarked on this campaign, I realized that I would be adversely criticized by many, regardless of the soundness and truth of my ideas about preventing polio. Many regard me as a seeker of publicity. I was not in a position to gain financially from the publicity because I was engaged in private practice but was a full-time federal employee. Organized medicine frowns upon such steps as mine and I endorse this attitude on general principles.
Then why did I go ahead with the campaign? The simple truth is that I felt I had something concrete to offer in the prevention of polio. For several weeks before the diet story was publicized on August 4, 1948, I felt profoundly frustrated. I felt I had a means of preventing polio but could not reach the public to tell them about it. I hoped that publication of my experiments in the medical journal in 1941 would stir public health authorities to explore the possibilities implicit in my experimental results. However, nothing ever came of the publication. The data lay buried on the bookshelf. And so I decided to assume personal responsibility by informing the public. It was a bold step and required some courage because a professional career could have been jeopardized. Looking back, I am happy I took the step.
For several years after 1941 I was faced with the problem of testing the efficacy of the diet in the prevention of polio. Experimenting with the diet on humans presented obvious difficulties. An ideal test would be to put a particular area of a city on the diet during an epidemic and compare the results with those observed in the rest of the city that was not put on the diet. Such a test can be conducted only by a public health agency. My experimental work with rabbits had been published in January, 1941, in the American Journal of Pathology. Polio has been prevalent every year since then and it reached epidemic proportions in 1944 and 1946. In the summer of 1944 I wrote to a public health agency and suggested that the people in epidemic areas be advised to adhere to a sugarless and starchless diet for the duration of the epidemic. However, no action was taken.
The summer of 1948 presented an opportunity to test the diet. I was living in the city of Asheville, N. C., which had a population of 55,000. In May and June it was evident that the state of North Carolina was headed for a major polio epidemic. A sheville was having many cases for a city its size. The number of cases increased during July. State and local health officers, after meeting with the Buncombe County Medical Society, finally recommended strong restrictive measures. Churches, theaters, swimming pools, parks, and recreation areas were closed. Public gatherings were discouraged. Children were not permitted to ride in buses. They were kept at home all day long, their activities confined to the home and front yard. Families that could do so, quit the state.
Asheville, a city that does a large tourist business, became a "ghost town." There was no panic among the citizens. There was a subdued fear and an air of helplessness in spite of restrictive measures. Quarantine has never proved of value in the control of polio and some health authorities state that it is valueless. Besides being valueless, it depresses morale.
The epidemic showed no signs of abatement. August 1 arrived, with the worst weeks ahead. I decided to approach the Asheville newspapers. I told the editors of my animal experiments and researches in diet and outlined a method of control. The editors were impressed and convinced of my claim to authority in matters of nutrition. A feature writer, Mr. James K. Hutsell, was assigned to write the news story. This was intended only for the city of Asheville and Buncombe County. On August 4, 1948, the Asheville Times, an afternoon paper, carried a detailed article telling about my experience in nutrition research and experiments with rabbits and monkeys. The following diet suggestions were printed: (See Appendix for news story.)
1. Eliminate from the diet sugar and foods containing sugar, such as soft drinks, fruit juices (except tomato juice), ice cream, cakes, pastries, pies, candies, canned and preserved fruits. Saccharin may be substituted for sugar.
2. Cut down the consumption of starchy foods, such as bread, rolls, pancakes, potatoes, rice, corn, cereals, grits.
3. Substitute for starchy foods the following: tomatoes, string beans, cucumbers, greens, lettuce, turnips, carrots, beets, cabbage, onions, soybeans, cauliflower.
4. Do not eat fruits or melons more than once daily, and then only in small quantities.
5. Eat more protective foods, such as pork, eggs, beef, fish, poultry, milk, cream, cheese.
6. Eat three substantial meals a day. Avoid exertion and fatigue because they are known to be associated with low blood sugar. Avoid swimming in cold water. Rest as much as possible.
7. The diet should be followed until the polio danger is officially declared over by local health authorities.
The story printed the following two direct statements made by me:
I am willing to state without reserve that such a diet, strictly observed, can build up in 24 hours time a resistance in the human body sufficiently strong to combat the disease. Of course, the diet must be followed throughout the period of the epidemic.
One of the puzzling characteristics of polio has been its prevalence in warm weather. Many people cut down on protective foods such as meats, fish, and poultry because of a mistaken idea that a "light" diet is better for them in warm weather. And they increase the consumption of cooling foods and beverages, most of them heavily sweetened. It is this increase in consumption of sugar that produces a lowering of blood sugar and thereby a lowering of the bodys resistance to the polio virus.
The Asheville Times meanwhile had released the story on the morning of August 4 to the Associated Press and United Press wire services. In the afternoon and evening of August 4 local radio stations broadcast the diet suggestions at frequent intervals. Many afternoon and evening newspapers in distant cities printed AP or UP dispatches. Coast-to-coast newscasts carried the story all during the evening of August 4. On August 5, the Asheville Citizen, the morning paper, printed the story as it had appeared in the Times the day before. During August 5 newspapers throughout the country had either AP or UP stories. Some papers had the story on the front page. During August 5 radio stations throughout the country were still broadcasting the diet. Some newspapers did not carry the news until August 6. Thereafter several weekly publications had articles about the diet. The Asheville papers carried follow-up stories about the diet and polio for several days in order to impress the public because of the severity of the epidemic in this area. Thus a virtual alarm was carried across the country by press and radio.
The people of Asheville co-operated to an unexpected degree. They welcomed the opportunity to help themselves. The restrictive measures had been depressing. The confinement of children to home all summer was trying to all concerned. The statements about the diet were made in such strong, positive, and optimistic tone that they were readily taken up and adhered to. Since adults as well as children were being attacked by the virus, many grown-ups followed the diet.
One of the striking effects was the immediate improvement in morale. Parents felt that they were doing something constructive instead of just standing by and hoping the disease would not strike their homes. Store sales of sugar, candy, ice cream, cakes, soft drinks, and the like, dropped sharply and remained at low level for the rest of the summer. One southern producer of ice cream shipped one million fewer gallons of ice cream than usual, during the first week following the release of the diet story. Saccharin sales mounted sharply.
The Results in Asheville. Up until August 4, 1948, the city of Asheville had 55 cases of polio. If one assumes arbitrarily that the peak had been reached on that date, one could have expected about 55 cases during the decline until the end of the year, since in general during polio epidemics the number of cases following the peak is about equal to the number of cases preceding the peak. However, instead of 55 cases there were only 21 new cases in Asheville from August 4 to December 31.
Actually, however, in the southeastern United States, polio epidemic peaks are usually reached during early September. If the epidemic had been allowed to run its course without the diet story, there might have been around 75 cases in Asheville by the first week in September (a conservative estimate), with a similar number following the peak. Thus there could have been a total of 150 cases in Asheville for the entire season. Actually, there were 76 cases for the entire season, or about half the expected number.
The city of Asheville is located in Buncombe County. Both the city and the county have approximately the same population, about 55,000. The total number of cases for the county, excluding Asheville, was 102 cases for the entire year. If isolation had any effect, it should have been manifest in the county, which is largely rural with widely separated homes. Many of the county cases came from farms. Lack of contact was thus no protection against the disease.
The city of Asheville was subjected to a heavier, effective, and more sustained propaganda regarding the protective possibilities of the diet than the county. Further, the epidemic and the diet were major topics of discussion in the city during August and September. The people of the city were more alert to the dangers of the epidemic and hence more receptive to any measure which offered some degree of protection. The lack of close contact in the county rural areas could have created a false sense of security. These factors could readily account for the lower incidence in the city proper.
The Results in the Country as a Whole. The most striking effect on the course of the polio epidemic is noted in the number of cases reported from the entire country. This is clearly shown by the graph, Fig. 8, which shows the course of the 1946 and 1948 epidemics.
The graph shows that 1948 was running well ahead of 1946. The 1948 curve lies well above the 1946 curve up until the week ending July 31. For the next six weeks the 1948 curve falls below the 1946 curve, a phenomenon which has never been observed to occur in previous polio epidemics. After the week ending July 31, the 1948 curve runs a highly irregular course. The break in the 1948 curve occurred during the week ending August 7 and coincided with the release of the diet story on August 4 and 5. This immediate effect need not be surprising since it was stated "without reserve" that strict adherence to the diet would afford protection within 24 hours, because the change in diet has an immediate effect on blood sugar levels.
The graph in Fig. 9 is also very striking. It shows an immediate effect on the number of cases per week for the entire country. From the week ending May 8 through the week ending July 31, the number of cases by which 1948 was leading 1946 was climbing, so that by the week ending July 17, there were 420 more cases in 1948 than for the corresponding week in 1946. For the week ending July 31, there were 304 more cases in 1948 than in the corresponding week in 1946.
Then a sudden change occurred. For the next six weeks 1948 fell behind 1946 by 1581 cases. For the week ending
This graph compares the 1946 and 1948 polio curves for the entire Note the smooth contour of the 1946 curve. The 1948 curve abruptly irregular coincident with the week ending August 7 when campaign began, and pursues an irregular course thereafter. The 1948 curve shows what the 1948 curve would have looked like if the epidemic had run its natural course without the diet campaign. The actual 1946 and 1948 curves were constructed from figures compiled by the US. Public Health Service.
August 7, there were 45 fewer cases in 1948 than in 1946. For the week ending August 14, there were 166 cases, and for the week ending August 21, there were 504 fewer cases. Since the diet campaign began on August 4 the diet was able to produce an effect during the
This graph shows the number of cases per week by which 1948 exceeded or fell behind the corresponding week in 1946. Up till the week ending August 7, 1948, the weekly number of cases in 1948 exceeded the weekly number of cases in 1946, as shown by the upright position of the solid bars on the graph.
One would have expected 1948 to maintain its lead over 1946 right through August and September when the peak is usually reached. However, 1948 suddenly falls behind 1946 for a period of six weeks, a period when polio epidemics are most severe and when one would have expected 1948 to exceed 1946 rather than fall behind 1946. Note that 1948 falls behind 1946 during the week of the diet campaign.
week ending August 7 on only three days: August 5, 6, and 7. The greater reduction in incidence during the weeks following can be explained by the fact that the diet was in effect every day of each of those weeks. Study of all previous epidemic years reveals that when one year has more cases than another year, the greater year always runs ahead of the lesser year. Thus, according to previous experience, 1948 should never have fallen behind 1946, especially during the peak weeks in August and September. From the week ending September 18 until the end of the 1948 is once more ahead of 1946, but not by as much as one would expect. If the diet campaign had been kept up all during the epidemic season, 1948 could have been kept below 1946 and thousands of cases could have prevented.
If we consider that 1948 is running ahead of 1946 or the average by 250 cases each week for the six weeks from June 26 to July 31, then the total for the six weeks August 7 to September 11, 1948, would have exceeded the total
This graph shows the dates when the epidemic peaks were reached for several states. Note that four southeastern states, North & South Carolina, Georgia, and Florida, reached their peaks during the week ending July 31, an unusually early date. The other states reached their peaks later. The North Carolina curve was closely paralleling the California curve and most likely headed for a peak date much later than July 31.
for the corresponding six weeks by 1,500 cases. Actually, the total for the six weeks August 7 to September 11, 1948, is 1,581 cases fewer than for the corresponding six weeks in 1946. Thus, one can estimate that the diet campaign prevented around 3,000 cases during the six week period August 7 to September 11, 1948. This is a conservative estimate.
ACTUAL FIGURES FOR CORRESPONDING WEEKS IN 1948 AND 1946 SHOWING ABRUPT CHANGE IN NUMBER OF CASES
|Weekending May 22 May 29 June 5 June 12 June 19 June 26 July 5 July 10 July 17 July 24 July 31 Aug. 7 Aug. 14 Aug. 21 Aug. 28 Sept. 4 Sept. 11||1948
|(more in 1948)
(fewer in 1948)
These figures were obtained from Public Health Reports of the U. S. Public Health Service.
The peak dates in various states. In past polio epidemics, peaks usually have been reached in late August or early September. The 1946 peak for the entire country was reached on September 25. Fig. 10 shows that in four southeastern states, the peak date was the same and occurred during the week ending July 31. These four states were: North and South Carolina, Georgia, and Florida. In five widely separated states the peaks occurred as follows: Texas, August 18; California, September 18; Minnesota, September 25; New York and Iowa, October 2.
The earlier peak date for the four southern states may be attributed to the fact that the press and radio publicity given the diet control plan was widespread and readily taken up by the citizens in this area because they were much concerned with the severe epidemic in Carolina. The fact that the diet plan originated in this area also served to create great interest in it. The later peak dates in the other states suggests that the publicity was not as concentrated as it was in the southeast. Observations by me indicate that practically every newspaper in the east published the story. In New York City, for example, only one newspaper, The New York Times, carried the story. Southern editors were eager to present their readers a story of prime importance and of great interest.
In summary, I would say that the diet campaign 1948 prevented 3,000 cases during the six week August 7 to September 11. Although 1948 ran ahead of1946 from the week ending September 18 until the of the year, there were not as many cases in 1948 as one would have expected. I have estimated, conservatively that 1,600 cases were prevented during the period September 18 to December 31, 1948. Thus, I estimate that the campaign of 1948 prevented about 5,000 cases August 7 and December 31, 1948.