GEORGE ROSEN, M.D., Editor BERWYN F. MATTISON, MI.D., Mlanaging Editor Editorial Board 1NIYRON E. WEGMIAN, M.).

, Chairman MARJORIE T. BEL1LOWS, MI.S.P.H.; Joii N J. HANLON, M.).; LuciLE PETRY LEONE, R.N.; JAMES WATT, M.l).; the Editor; and Managing Editor
Staff WILLIMINA RAYNE WALShI, Associate D)irector; FRANCES TOOROCK, Editorial Associate; LYDIA GARI, Editorial A ssistant

Journal of Public Health

EDITORIALS
Control of Malnutrition in Man
issuance by the American Public Health Association at the end of last year of a manual on "The Control of Malnutrition in Man" marks in a practical way the changes that have been taking place in public health. In the fall of 1917 under the guidance of Haven Emerson the Association published the manual, "Control of Communicable Diseases in Man," now in its ninth edition. Eleven years earlier, Frederick Gowland Hopkins, the British biochemist, had postulated the existence of minimal qualitative factors other than the known basic nutritional elements-protein, carbohydrate, fat, minerals. In 1912, Hopkins demonstrated in a series of convincing experiments that an animal's diet must contain minute amounts of certain essential substances other than the hitherto accepted basic nutrients if the organism was to remain in good health. He called these elements, "accessory nutritional factors." The period from 1912 to the present has been concerned with the consequences of the concept of a deficiency disease, with the elaboration of this concept, and the application of the knowledge that has been acquired as a result.
THE

This work has proceeded along several lines. A variety of accessory dietary factors, vitamins, have been isolated and associated with specific diseases. As these factors and substances became known, efforts were made to determine their chemical nature and metabolic functions. Methods have been developed to determine the vitamin content of foods, and norms have been established for optimal nutrition. Increasingly, administrative and educational tools were created to utilize this knowledge in order to improve individual and community health. As a result, public health nutrition has moved into the very forefront of health work. Haven Emerson with his conspicuous foresight had recognized the great public health significance of the food deficiency diseases, and had recommended the preparation of a companion manual to "The Control of Communicable Diseases in Man," which would provide authoritative guidance in the prevenition and control of disorders due to malnutrition. By 1956, it was clear that the time was ripe for such a manual, and a committee headed by Dr. William H. Sebrell, Jr., was appointed to deal with the task. With the assistance of a group of outstanding authorities, the Committee on
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EDITORIALS

Control of Nutritional Diseases has now made available a concise account of current knowledge on the practical control of malnutrition in man. It is naturally anticipated that this volume will require periodic revision in order to keep it up to date, but one can also anticipate that it will enjoy a long and useful life like the Association's communicable disease manual. We welcome "The Control of Malnutrition in Man," and recommend it to all public health workers. And to Dr. Sebrell and all those who have contributed to the production of this volume we wish to express our admiration for a task so well done.

Excess Mortality Due to Influenza -Protect the Aged and the Chronically III

SINCE 1957, the United States has experienced three epidemic waves of Asian influenza. The first two swept the country in the fall of 1957 and the winter of 1958, and led to 60,000 more deaths than would have occurred under normal conditions. The third wave rose abruptly during the first three months of 1960 and produced more than 26,000 excess deaths.' These epidemics have been caused by a new antigenic variant of Type A influenza virus, which has been named Type A2. Evaluation of polyvalent influenza vaccine has shown that it has value in preventing influenza. Consequently, it appears logical to try to reduce the number of excess deaths from influenza through immunization. Analysis has shown that the excess deaths from influenza have occurred

most markedly among the aged, the chronically ill, and pregnant women. In the most recent epidemic, over threefourths of the total excess deaths occurred among older persons. Furthermore, the excess deaths were overwhelmingly attributed to two groups: pneumonia-influenza (40 per cent) and cardiovascular-renal disease (46 per cent) . Clearly, those who suffer the greatest risk are older persons, and particularly those with cardiovascular disorders. For this reason, the U. S. Public Health Service recommends that influenza vaccination for the aged and the chronically ill be made as routine a medical procedure as is immunization of infants against diphtheria or whooping cough. Physicians and public health workers should carry on such a program as a regular activity and not as a mass campaign. Specifically recommended for routine immunization are persons of all ages who suffer from chronic cardiovascular, pulmonary, renal, or metabolic disorders (rheumatic heart disease, arteriosclerotic or hypertensive heart disease, diabetes mellitus, Addison's disease, chronic bronchopulmonary disease), pregnant women, and all those who are 65 years and older. Immunization of the high-risk groups should be carried on regularly and annually, no matter what the predicted incidence of influenza may be for a particular year.
1. Detailed information on excess mortality from Asian influenza will be found in "Asian Influenza 1957-1960." A descriptive brochure, Communicable Disease Center, USPHS, Atlanta, Ga. (July), 1960. "Influenza Fact Sheet" (Aug. 1), 1960, provides information on influenza vaccine, and the groups recommended for immunization.

JANUARY, 1961

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