Burnet and Aykroyd - Nutrition in Public Health
Twenty years earlier, the technical report presented by E. Burnet and W.R. Aykroyd to the League of Nations proposed a programme of education in nutrition as a means for hastening the practical application of scientific knowledge on nutrition to public health.9
It is the task of central and local public health services, the medical profession and its ancillaries (nurses, dieticians, social workers, etc.), to instruct the public, but this cannot teach unless they have the requisite knowledge and enthusiasm. There are, therefore, two aspects of the subject: the education of those responsible for educating the public and the education of the public itself.10
During the early years in their curriculum, medical students received information about the physiology of nutrition, sometimes including practical laboratory training, but the subject was presented as a chapter of physiology and not as part of public health and preventive medicine. In practical terms, this implied that a medical practitioner learned how to manage nutritional diseases but ignored the preventive and public health dimension of nutrition. The experts demanded that nutrition be included in the curriculum of post-graduate medical schools, as scientific knowledge on diet appeared to be an important branch of public health, and therefore health administrations and public health organisations had   
to employ specialised experts and develop mechanisms for furthering work in the field. Nutrition specialists, acquainted with the latest developments in research, and capable of formulating and carrying out schemes for their practical application, were considered to be a valuable addition to the personnel of public health organisations.
Advisory committees on nutrition, made up of physiologists, practical cookery experts, medical officers and social workers, were called to work together to fulfill a useful role. Burnet and Aykroyd suggested that these committees should be attached to central public health authorities, assuming the issue of sound educational material and advising other State Departments on matters connected with nutrition among their primary duties. In most Western countries, as well as in Japan and the Soviet Union, national institutes of nutrition - or departments of nutrition in institutes of hygiene - had been created, connecting public health authorities, universities and the general population. “An ideal institute of nutrition would include laboratories, a statistical department, lecture rooms for students and the public, a cookery department, an educational department containing models, posters, diagrams etc. Such institutions or departments would obviously play a prominent part in educating nutrition workers and the public”.11 Educational material issued by responsible authorities, and containing acceptable dietary standards, were of particular value as a basis for practical action. In some cases, museums of public health took over the task of spreading knowledge and popularising new concepts, assisting the National Schools of Hygiene during the inter-war years.
While state and local authorities, expert committees and medical professionals were responsible for the initiation and support of public health nutritional work, to a large degree this was social work requiring the assistance of nutritionists, dieticians, nurses, social workers, school teachers, cooks, etc., working in private and public institutions (schools, dispensaries, prisons, hospitals, industrial canteens, etc.). Within the framework of this collaborative work the figure of the nutritionist emerged, associated with the female sex.
The nutritionist is not a scientific worker, though she often takes part in scientific enquiries. She must know how to make reliable dietary surveys. She is, in general, expected to keep up with the latest developments of her subject. Although she deals largely in matters closely associated with medicine and often works in close contact with the medical profession, she has had, as a rule, little medical or nursing training. It is only to be expected that there should be members of the medical profession who resent the intrusion of a non-medical worker into medical fields; such critics complain, rightly or wrongly, that the training and knowledge of the nutritionist is too academic, that she lacks the background necessary for the application of laboratory results to human beings. It is to be noted that the inspiration of the “nutrition” movement in the United States of America has come from distinguished scientists who are not members of the medical profession. In general, however, medical men feel that the nutritionist is a useful assistant in hospital, in the out-patient department, and in public health work of all kinds.12
A discussion was opened about the professional profile of nutritionists, particularly on whether a nurse who had received postgraduate instruction in dietetics in addition to her ordinary hospital training could successfully fulfill most of the functions of the nutritionist, and be able to deal with deficiency diseases and malnutrition. Their contribution, as well as that of health visitors, in improving dietary habits in the home was widely recognised. All those professionals were able to provide valuable assistance in campaigns against rickets, dental caries, infantile scurvy and other deficiency diseases, and supervising the diets of infants and pregnant and nursing women. Schoolteachers and social workers of all types were also able to help in the campaign against malnutrition.