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Mention the "Total Prof. Attend." given for "Collegium Internationale Neuro-Psychopharmacologicum" Congress?

jnjm0223

jnjm0223_p107, jnjm0223_p108, jnjm0223_p109, jnjm0223_p110, jnjm0223_p111, jnjm0223_p112, jnjm0223_p113

5,000

Neurontin Critical Congress Profiles Congresses, Sorted by Congress Specialty and Title Satellite Total Abstracts Symposia Geographic Total Prof. Specialty Congress Acronym Accepted Permitted Exhibits Target Audience % Audience % Attend. Attend. Web site American Academy of Family AAFP Yes Yes Yes Family Physicians 100 North America 99 14,886 4,500 www.aafp.org Physicians. Annual Scientific Rest of World 1 Assembly. American College of Physicians- ACP-ASIM No Yes Yes Internists 95 United States 93 10,000 7,000 www.acponline.org American Society of Internal Medicine Other 5 Rest of World 7 Annual Session. International Society of Internal ICIM Yes Yes Yes Internists 95 Japan 70 7,000 5,000 www.acponline.org/isin Medicine. Biennial Congress. Other 5 North America 10 Europe 10 Rest of World 10 Primary Medicine Today East. Pri-Med East No Yes Yes Primary Care 55 United States 100 8,000 6,991 www.pri-med.com Annual Meeting. Pediatricians 9 Other 36 Primary Medicine Today MidWest. Pri-Med No Yes Yes Primary Care 61 United States 100 5,216 5,112 www.pri-med.com Annual Meeting. MidWest Pediatricians 10 Primary Care Other 29 Primary Medicine Today South. Pri-Med South No Yes Yes Primary Care 56 United States 100 5,000 4,512 www.pri-med.com Annual Meeting. Pediatricians 8 Other 36 Primary Medicine Today West. Annual Pri-Med West No Yes Yes Primary Care 65 United States 100 9,000 8,369 www.pri-med.com Meeting. Pediatricians 10 Other 25 Society of General Internal Medicine. SGIM Yes No No Primary Care N/A North America 90 1,700 1,700 www.sgim.org Annual Meeting. Rest of World 10 WONCA Asia Pacific Regional WONCA-Asia A/R A/R A/R Primary Care N/A A/R A/R 1,000 800 www.wonca.org Conference. Annual. WONCA Europe. Annual Conference. WONCA-Europe Yes Yes Yes Primary Care N/A Europe 50 3,000 3,000 ww.wonca.org Other Rest of World 50 WONCA World Congress of Family WONCA-World Yes Yes No Family Physicians 100 North America 10 5,000 4,000 www.wonca.org Doctors. Triennial. Rest of World 90 American Academy of Child and AACAP Yes No Yes Psychiatrists 90 North America 60 3,000 3,000 www.aacap.org Adolescent Psychiatry. Annual Other 10 Europe 15 Meeting. Asia 15 Other 10 American Psychiatric Association. APA Yes Yes Yes Psychrists 90 N/A N/A 19,000 19,000 www.psych.org Annual Meeting. Other 10 Psychiatry Anxiety Disorders Association of ADAA Yes Yes Yes Physicians N/A United States 100 600 600 www.adaa.org America National Conference. Annual. Medical Students N/A Association of European Psychiatrists. AEP Yes Yes Yes Researchers N/A Europe 87 2,600 2,575 www.aep.lu Biennial Congress. Other N/A North America 4 Asia 5 Rest of World 4 A/R= Awaiting Research N/A= Not Available Medical Action Communications Information Subject to Change 31-Oct-01 107 Source: https://www.industrydocuments.ucsf.edu/docs/jnjm0223 Pfizer_LKnapp_0026113 Neurontin Critical Congress Profiles Congresses, Sorted by Congress Specialty and Title Satellite Total Abstracts Symposia Geographic Total Prof. Specialty Congress Acronym Accepted Permitted Exhibits Target Audience % Audience % Attend. Attend. Web site Collegium Internationale Neuro- CINP Yes Yes Yes Psychiatrists N/A North America N/A 5,000 5,000 www.cinp.org Psychopharmacologicum. Biennial Other N/A United Kingdom N/A Congress. European College of ECNP Yes Yes Yes N/A N/A N/A N/A 5,000 5,000 www.encp.nl Neuropsychopharmacology. Annual Congress. Institute on Psychiatric Services. IPS Yes Yes Yes Psychiatrists N/A North America 95 2,000 2,000 www.psych.org Annual Meeting. Psychologists N/A Rest of World 5 Other N/A International Conference on Bipolar ICBD Yes No Yes Psychiatrists N/A United States N/A 859 700 ww.wpic.pitt.edu Disorder. Biennial. Psychologists N/A Rest of World N/A Social Workers N/A Medical Students N/A International Congress of ICN A/R A/R A/R Psychiatrists N/A International N/A A/R A/R www.kenes.com Neuropsychiatry. Biennial. Psychiatry (cont.) International Forum on Mood and IFMAD Yes Yes Yes Psychiatrists 100 United States N/A 650 600 www.aisc.it Anxiety Disorders. Annual Meeting. Europe N/A Rest of World N/A New Clinical Drug Evaluation Unit. NCDEU Yes No No Government N/A N/A N/A 1,200 1,200 www.nimh.nih.gov Annual Meeting. Industry N/A Stress and Anxiety Research Society. STAR Yes No No Psychologists 100 Europe 52 200 200 www.star-society.org Annual International Conference. Asia 22 North America 11 Africa 7 Rest of World 8 US Psychiatric and Mental Health USPMHC Yes Yes Yes Psychiatrists 63 Europe N/A 3,000 3,000 www.cmeinc.com Congress. Annual. Psychologists 9 United States N/A Nurses 17 Social Workers 4 Other 7 World Congress of Psychiatry. WCP Yes Yes Yes Psychiatrists N/A N/A N/A 10,000 10,000 www.wpanet.org Triennial. Government N/A Other N/A A/R= Awaiting Research N/A= Not Available Medical Action Communications Information Subject to Change 31-Oct-01 108 Source: :ttps://www.industrydocuments.ucsf.edu/docs/jnjm0223 Pfizer_LKnapp 0026114 Neurontin Critical Congress Profiles Congresses, Sorted by Congress Specialty and Title Satellite Total Abstracts Symposia Geographic Total Prof. Specialty Congress Acronym Accepted Permitted Exhibits Target Audience % Audience % Attend. Attend. Web site Associated Professional Sleep APSS Yes Yes Yes Researchers 33 North America 88 4,000 3,200 www.apss.org Societies. Annual Meeting. Pulmonologists 21 Rest of World 12 Neurologists 16 Psychologists 8 Neuroscientists 8 Psychiatrists 8 Other 6 Sleep European Sleep Research Society. ESRS Yes Yes Yes Physicians N/A International N/A 950 N/A www.esrs.org Biennial Congress. Neurologists N/A Biologists N/A Psychologists N/A World Conference Sleep Odyssey. WCSO Yes Yes Yes Researchers N/A Unied States N/A A/R A/R www.wfsrs.org Quadrennial. Physicians N/A Europe N/A Rest of World N/A A/R= Awaiting Research N/A= Not Available Medical Action Communications Information Subject to Change 31-Oct-01 109 Source: :ttps://www.industrydocuments.ucsf.edu/docs/jnjm0223 Pfizer_LKnapp 0026115 DATE 29-Oct-01 REF Neurontin PSC Meeting CLIENT Pfizer MTG DATE 19-Sep-01 VENUE Pfizer PRESENT Pfizer: L Tive, E Mutisya, S Brigandi, MEDICAL ACTION S Piron, M Garcia, J Kaplan, M COMMUNICATIONS Rowbotham, L Knapp, A Fannon, A Crespo, D Probert, J Marino, C Blanckmeister, C Banta MAC: M Vinegra, S Valerio, S Steen, A Masonis, J Mierop, S Tyler COPIED TO E Shapiro, K Kennon, R Glanzman, M Ulrey, K Taylor, M Balkenhol, H Duda Racki, T Hylan, T Hsu, L Collins ACTION REPORT SUBJECT Neurontin PSC Meeting 1.0 Introduction The following action report summarizes the decisions, issues and action items discussed during the Neurontin Publications Subcommittee (PSC) meeting held on September 19. During the meeting the following topics were covered: 2002 congress presentations Issues regarding specific manuscripts Future meeting between NYHQ and Ann Arbor Key message development update Journal and congress profiling update Bibliography development update 2.0 2002 Congress Presentations Joan Kaplan (JK) initiated the discussion by informing the team that the 2001 International Conference on the Mechanisms and Treatment of Neuropathic Pain (ICMTNP) has been cancelled. However, the 2 posters scheduled to be presented at that meeting should be included in future presentation plans. The team developed the following plan for poster presentations in 2002: 2.1 American Academy of Neurology (AAN) Dosing response/exposure response (Neuropathic Pain) QOL data from the 5 pivotal trials (Neuropathic Pain) - Steve Piron SP (SP) mentioned that Brett Stacey had expressed an interest in this the Action Report: 19-Sep-01 Source: https://www.industrydocuments.ucsf.edu/docs/jnjm0223 fizer_LKnapp_0026116 type of subanalysis. SP will contact Stacey to further explore his interest. 2.2 American Pain Society (APS) Efficacy data from the 5 pivotal trials - This poster was originally targeted for ICMTNP. Both the abstract and poster have been completed. MAC will provide reformatting and production support MAC as needed. 2.3 International Association for the Study of Pain (IASP) Practical dosing and titration POPP (tentative, pending subanalysis results) 2.4 American Academy of Family Practioners (AAFP) Screening tool - Stephen Valerio (SV) and Amy Masonis (AEM) of MAC both advised the team that this is a very difficult meeting in terms of acceptance of presentations. The academy has rigorous rules regarding both representation of data and pharmaceutical company funding of accepted presentations. 2.5 American Diabetes Association (ADA) Latin America diabetic neuropathy study Pooled results from the 2 diabetic neuropathy trials MAC will determine the abstract deadlines and meeting dates for ADA MAC and forward these to the team. 2.6 Other Possible Presentations In addition to the above; the following presentations will be added to the list for 2002, pending the following actions: Sleep study - MAC will contact Dr. Erhenberg to find out whether he has previously presented these data at a congress, and if not, MAC whether he would be interested in doing so. MAC will also solicit his preference as to which meeting he would like to present the data. HIV-neuropathy study - This poster was originally to be presented at ICMTNP. Elizabeth Mutisya (EM) will ask Prof. Rowbotham if he EM would prefer to present these data at American Academy of Neurology (AAN), American Pain Society (APS), or International Association for the Study of Pain (IASP). In addition, MAC will MAC follow-up with the International AIDS Conference (IAIDSC) regarding its rules for re-presentation. The team strongly felt that it would be advantageous to have these data presented at this meeting as well. Action Report: 19-Sep-01 Source: :ttps://www.industrydocuments.ucsf.edu/docs/jnjm0223 Pfizer_LKnapp_0026117 Philippine post-marketing surveillance EM will review these data to determine whether there is any EM potential for presentation material. CRPS placebo cross-over Michael Rowbotham (MR) will follow-up with Prof. Hill to find out MR whether he has any presentation plans for these data. 3.0 Manuscript Issues 3.1 Latin America Diabetic Neuropathy EM informed the team that the preliminary data have just come in and further analysis needs to be done. While the manuscript is currently targeted for the JAMA special issue, the December 31 deadline may be tight. After the data have been reviewed; MAC will distribute a MAC journal query form so that a list of potential back-up journals can be developed. Leslie Tive (LT) was identified as the lead reviewer. EM, Lloyd Knapp (LK), SP, Angela Crespo (AC) and Lingshi Tan (LT) were identified as reviewers. John Marino (JM) recommended that a Brazilian and Mexican be selected as authors. LT also suggested Klaus as an author, even though he no longer is a Pfizer employee. 3.2 Treatment of Diabetic Neuropathy Review for JAMA The team agreed that Larry Blonde and Roy Freeman should co-author this paper, with Bruce Nicholson to provide the viewpoints of an endocrinologist, an anesthesiologist, and a neurologist respectively. LK will be the lead reviewer; MR and EM will also review the manuscript. MR pointed out that the focus of the review should be to convince diabetologists that the treatment of the neuropathic pain associated with diabetes should consist of more than the underlying condition; therapy should be directed toward relieving the symptom itself. 3.3 Gabapentin Review SV reminded the team that the journal Expert Opinion on Pharmacotherapy had solicited a review from Dr. Nicholson, who then asked for Pfizer's help. It was decided that since this was an industry- focused journal, this manuscript was not a priority for the team. It was MAC decided that MAC would look into using a previous review by Nicholson as the backbone for this review and would add some new data to update it. 3.4 Dosing Manuscripts SV informed the team that he had spoken with Dr. McLean, who suggested that the 2 dosing manuscripts be combined since the fundamental issue underlying the manuscripts is the same, namely, intrasubject variability. AC and the team disagreed, arguing that the the Action Report: 19-Sep-01 Source: https://www.industrydocuments.ucsf.edu/docs/jnjm0223 Pizer_LKnapp_0026118 clinical issues associated with the 2 conditions were quite different. SV MAC suggested that he would get back to Dr. McLean and mention that Pfizer would first like to write 2 clinically focused reviews and then follow-up with a more detailed, kinetically based review next year. The team agreed to this plan. [Post-meeting note: SV has left a message for Dr. McLean and is awaiting a response.] 3.5 POPP Study The team decided that this manuscript would be placed on hold until the subanalysis is completed. The team selected The Journal of Pain and Symptom Management as the target journal with Pain Medicine as a backup. 3.6 European Journal of Pain Supplement The team was updated regarding the status of the supplement. MAC has received reviewer comments. These will be sent to Stephen MAC Brigandi (SB) who will forward them to Embryon. [Post-meeting note: SB both of these actions have been completed.] The final version will be sent to LT for final approval next week. 4.0 Meeting with NYHQ and Ann Arbor The meeting to discuss the transfer of study data and to determine whether there are studies that have not been published has been confirmed for the afternoon of October 3. The meeting to discuss the subanalyses will be arranged independently. 5.0 Key Messages Update Most of the key message meetings have taken place, and the approved list is undergoing final revisions. Corporate messages will be reviewed by a small committee via e-mail or teleconference. The entire list will be reviewed by a single committee in order to finalize it; however, the list will be revisited in the future. 6.0 Profile and Bibliography Update MAC presented the latest journal and congress profiles and reminded the team that profiling is continuing. MAC also presented the latest screen shots from the bibliography. LT requested a special meeting to discuss the bibliography, independent of other publication issues. In addition; MAC was actioned to provide a small working model to be MAC tested at the meeting. Stephen Valerio Medical Projects Director the Action Report: 19-Sep-01 Source: https://www.industrydocuments.ucsf.edu/docs/jnjm0223 Pfizer_LKnapp_0026119

Mention the "Acronym" given for "International Congress of Neuropsychiatry"?

jnjm0223

jnjm0223_p107, jnjm0223_p108, jnjm0223_p109, jnjm0223_p110, jnjm0223_p111, jnjm0223_p112, jnjm0223_p113

ICN

Neurontin Critical Congress Profiles Congresses, Sorted by Congress Specialty and Title Satellite Total Abstracts Symposia Geographic Total Prof. Specialty Congress Acronym Accepted Permitted Exhibits Target Audience % Audience % Attend. Attend. Web site American Academy of Family AAFP Yes Yes Yes Family Physicians 100 North America 99 14,886 4,500 www.aafp.org Physicians. Annual Scientific Rest of World 1 Assembly. American College of Physicians- ACP-ASIM No Yes Yes Internists 95 United States 93 10,000 7,000 www.acponline.org American Society of Internal Medicine Other 5 Rest of World 7 Annual Session. International Society of Internal ICIM Yes Yes Yes Internists 95 Japan 70 7,000 5,000 www.acponline.org/isin Medicine. Biennial Congress. Other 5 North America 10 Europe 10 Rest of World 10 Primary Medicine Today East. Pri-Med East No Yes Yes Primary Care 55 United States 100 8,000 6,991 www.pri-med.com Annual Meeting. Pediatricians 9 Other 36 Primary Medicine Today MidWest. Pri-Med No Yes Yes Primary Care 61 United States 100 5,216 5,112 www.pri-med.com Annual Meeting. MidWest Pediatricians 10 Primary Care Other 29 Primary Medicine Today South. Pri-Med South No Yes Yes Primary Care 56 United States 100 5,000 4,512 www.pri-med.com Annual Meeting. Pediatricians 8 Other 36 Primary Medicine Today West. Annual Pri-Med West No Yes Yes Primary Care 65 United States 100 9,000 8,369 www.pri-med.com Meeting. Pediatricians 10 Other 25 Society of General Internal Medicine. SGIM Yes No No Primary Care N/A North America 90 1,700 1,700 www.sgim.org Annual Meeting. Rest of World 10 WONCA Asia Pacific Regional WONCA-Asia A/R A/R A/R Primary Care N/A A/R A/R 1,000 800 www.wonca.org Conference. Annual. WONCA Europe. Annual Conference. WONCA-Europe Yes Yes Yes Primary Care N/A Europe 50 3,000 3,000 ww.wonca.org Other Rest of World 50 WONCA World Congress of Family WONCA-World Yes Yes No Family Physicians 100 North America 10 5,000 4,000 www.wonca.org Doctors. Triennial. Rest of World 90 American Academy of Child and AACAP Yes No Yes Psychiatrists 90 North America 60 3,000 3,000 www.aacap.org Adolescent Psychiatry. Annual Other 10 Europe 15 Meeting. Asia 15 Other 10 American Psychiatric Association. APA Yes Yes Yes Psychrists 90 N/A N/A 19,000 19,000 www.psych.org Annual Meeting. Other 10 Psychiatry Anxiety Disorders Association of ADAA Yes Yes Yes Physicians N/A United States 100 600 600 www.adaa.org America National Conference. Annual. Medical Students N/A Association of European Psychiatrists. AEP Yes Yes Yes Researchers N/A Europe 87 2,600 2,575 www.aep.lu Biennial Congress. Other N/A North America 4 Asia 5 Rest of World 4 A/R= Awaiting Research N/A= Not Available Medical Action Communications Information Subject to Change 31-Oct-01 107 Source: https://www.industrydocuments.ucsf.edu/docs/jnjm0223 Pfizer_LKnapp_0026113 Neurontin Critical Congress Profiles Congresses, Sorted by Congress Specialty and Title Satellite Total Abstracts Symposia Geographic Total Prof. Specialty Congress Acronym Accepted Permitted Exhibits Target Audience % Audience % Attend. Attend. Web site Collegium Internationale Neuro- CINP Yes Yes Yes Psychiatrists N/A North America N/A 5,000 5,000 www.cinp.org Psychopharmacologicum. Biennial Other N/A United Kingdom N/A Congress. European College of ECNP Yes Yes Yes N/A N/A N/A N/A 5,000 5,000 www.encp.nl Neuropsychopharmacology. Annual Congress. Institute on Psychiatric Services. IPS Yes Yes Yes Psychiatrists N/A North America 95 2,000 2,000 www.psych.org Annual Meeting. Psychologists N/A Rest of World 5 Other N/A International Conference on Bipolar ICBD Yes No Yes Psychiatrists N/A United States N/A 859 700 ww.wpic.pitt.edu Disorder. Biennial. Psychologists N/A Rest of World N/A Social Workers N/A Medical Students N/A International Congress of ICN A/R A/R A/R Psychiatrists N/A International N/A A/R A/R www.kenes.com Neuropsychiatry. Biennial. Psychiatry (cont.) International Forum on Mood and IFMAD Yes Yes Yes Psychiatrists 100 United States N/A 650 600 www.aisc.it Anxiety Disorders. Annual Meeting. Europe N/A Rest of World N/A New Clinical Drug Evaluation Unit. NCDEU Yes No No Government N/A N/A N/A 1,200 1,200 www.nimh.nih.gov Annual Meeting. Industry N/A Stress and Anxiety Research Society. STAR Yes No No Psychologists 100 Europe 52 200 200 www.star-society.org Annual International Conference. Asia 22 North America 11 Africa 7 Rest of World 8 US Psychiatric and Mental Health USPMHC Yes Yes Yes Psychiatrists 63 Europe N/A 3,000 3,000 www.cmeinc.com Congress. Annual. Psychologists 9 United States N/A Nurses 17 Social Workers 4 Other 7 World Congress of Psychiatry. WCP Yes Yes Yes Psychiatrists N/A N/A N/A 10,000 10,000 www.wpanet.org Triennial. Government N/A Other N/A A/R= Awaiting Research N/A= Not Available Medical Action Communications Information Subject to Change 31-Oct-01 108 Source: :ttps://www.industrydocuments.ucsf.edu/docs/jnjm0223 Pfizer_LKnapp 0026114 Neurontin Critical Congress Profiles Congresses, Sorted by Congress Specialty and Title Satellite Total Abstracts Symposia Geographic Total Prof. Specialty Congress Acronym Accepted Permitted Exhibits Target Audience % Audience % Attend. Attend. Web site Associated Professional Sleep APSS Yes Yes Yes Researchers 33 North America 88 4,000 3,200 www.apss.org Societies. Annual Meeting. Pulmonologists 21 Rest of World 12 Neurologists 16 Psychologists 8 Neuroscientists 8 Psychiatrists 8 Other 6 Sleep European Sleep Research Society. ESRS Yes Yes Yes Physicians N/A International N/A 950 N/A www.esrs.org Biennial Congress. Neurologists N/A Biologists N/A Psychologists N/A World Conference Sleep Odyssey. WCSO Yes Yes Yes Researchers N/A Unied States N/A A/R A/R www.wfsrs.org Quadrennial. Physicians N/A Europe N/A Rest of World N/A A/R= Awaiting Research N/A= Not Available Medical Action Communications Information Subject to Change 31-Oct-01 109 Source: :ttps://www.industrydocuments.ucsf.edu/docs/jnjm0223 Pfizer_LKnapp 0026115 DATE 29-Oct-01 REF Neurontin PSC Meeting CLIENT Pfizer MTG DATE 19-Sep-01 VENUE Pfizer PRESENT Pfizer: L Tive, E Mutisya, S Brigandi, MEDICAL ACTION S Piron, M Garcia, J Kaplan, M COMMUNICATIONS Rowbotham, L Knapp, A Fannon, A Crespo, D Probert, J Marino, C Blanckmeister, C Banta MAC: M Vinegra, S Valerio, S Steen, A Masonis, J Mierop, S Tyler COPIED TO E Shapiro, K Kennon, R Glanzman, M Ulrey, K Taylor, M Balkenhol, H Duda Racki, T Hylan, T Hsu, L Collins ACTION REPORT SUBJECT Neurontin PSC Meeting 1.0 Introduction The following action report summarizes the decisions, issues and action items discussed during the Neurontin Publications Subcommittee (PSC) meeting held on September 19. During the meeting the following topics were covered: 2002 congress presentations Issues regarding specific manuscripts Future meeting between NYHQ and Ann Arbor Key message development update Journal and congress profiling update Bibliography development update 2.0 2002 Congress Presentations Joan Kaplan (JK) initiated the discussion by informing the team that the 2001 International Conference on the Mechanisms and Treatment of Neuropathic Pain (ICMTNP) has been cancelled. However, the 2 posters scheduled to be presented at that meeting should be included in future presentation plans. The team developed the following plan for poster presentations in 2002: 2.1 American Academy of Neurology (AAN) Dosing response/exposure response (Neuropathic Pain) QOL data from the 5 pivotal trials (Neuropathic Pain) - Steve Piron SP (SP) mentioned that Brett Stacey had expressed an interest in this the Action Report: 19-Sep-01 Source: https://www.industrydocuments.ucsf.edu/docs/jnjm0223 fizer_LKnapp_0026116 type of subanalysis. SP will contact Stacey to further explore his interest. 2.2 American Pain Society (APS) Efficacy data from the 5 pivotal trials - This poster was originally targeted for ICMTNP. Both the abstract and poster have been completed. MAC will provide reformatting and production support MAC as needed. 2.3 International Association for the Study of Pain (IASP) Practical dosing and titration POPP (tentative, pending subanalysis results) 2.4 American Academy of Family Practioners (AAFP) Screening tool - Stephen Valerio (SV) and Amy Masonis (AEM) of MAC both advised the team that this is a very difficult meeting in terms of acceptance of presentations. The academy has rigorous rules regarding both representation of data and pharmaceutical company funding of accepted presentations. 2.5 American Diabetes Association (ADA) Latin America diabetic neuropathy study Pooled results from the 2 diabetic neuropathy trials MAC will determine the abstract deadlines and meeting dates for ADA MAC and forward these to the team. 2.6 Other Possible Presentations In addition to the above; the following presentations will be added to the list for 2002, pending the following actions: Sleep study - MAC will contact Dr. Erhenberg to find out whether he has previously presented these data at a congress, and if not, MAC whether he would be interested in doing so. MAC will also solicit his preference as to which meeting he would like to present the data. HIV-neuropathy study - This poster was originally to be presented at ICMTNP. Elizabeth Mutisya (EM) will ask Prof. Rowbotham if he EM would prefer to present these data at American Academy of Neurology (AAN), American Pain Society (APS), or International Association for the Study of Pain (IASP). In addition, MAC will MAC follow-up with the International AIDS Conference (IAIDSC) regarding its rules for re-presentation. The team strongly felt that it would be advantageous to have these data presented at this meeting as well. Action Report: 19-Sep-01 Source: :ttps://www.industrydocuments.ucsf.edu/docs/jnjm0223 Pfizer_LKnapp_0026117 Philippine post-marketing surveillance EM will review these data to determine whether there is any EM potential for presentation material. CRPS placebo cross-over Michael Rowbotham (MR) will follow-up with Prof. Hill to find out MR whether he has any presentation plans for these data. 3.0 Manuscript Issues 3.1 Latin America Diabetic Neuropathy EM informed the team that the preliminary data have just come in and further analysis needs to be done. While the manuscript is currently targeted for the JAMA special issue, the December 31 deadline may be tight. After the data have been reviewed; MAC will distribute a MAC journal query form so that a list of potential back-up journals can be developed. Leslie Tive (LT) was identified as the lead reviewer. EM, Lloyd Knapp (LK), SP, Angela Crespo (AC) and Lingshi Tan (LT) were identified as reviewers. John Marino (JM) recommended that a Brazilian and Mexican be selected as authors. LT also suggested Klaus as an author, even though he no longer is a Pfizer employee. 3.2 Treatment of Diabetic Neuropathy Review for JAMA The team agreed that Larry Blonde and Roy Freeman should co-author this paper, with Bruce Nicholson to provide the viewpoints of an endocrinologist, an anesthesiologist, and a neurologist respectively. LK will be the lead reviewer; MR and EM will also review the manuscript. MR pointed out that the focus of the review should be to convince diabetologists that the treatment of the neuropathic pain associated with diabetes should consist of more than the underlying condition; therapy should be directed toward relieving the symptom itself. 3.3 Gabapentin Review SV reminded the team that the journal Expert Opinion on Pharmacotherapy had solicited a review from Dr. Nicholson, who then asked for Pfizer's help. It was decided that since this was an industry- focused journal, this manuscript was not a priority for the team. It was MAC decided that MAC would look into using a previous review by Nicholson as the backbone for this review and would add some new data to update it. 3.4 Dosing Manuscripts SV informed the team that he had spoken with Dr. McLean, who suggested that the 2 dosing manuscripts be combined since the fundamental issue underlying the manuscripts is the same, namely, intrasubject variability. AC and the team disagreed, arguing that the the Action Report: 19-Sep-01 Source: https://www.industrydocuments.ucsf.edu/docs/jnjm0223 Pizer_LKnapp_0026118 clinical issues associated with the 2 conditions were quite different. SV MAC suggested that he would get back to Dr. McLean and mention that Pfizer would first like to write 2 clinically focused reviews and then follow-up with a more detailed, kinetically based review next year. The team agreed to this plan. [Post-meeting note: SV has left a message for Dr. McLean and is awaiting a response.] 3.5 POPP Study The team decided that this manuscript would be placed on hold until the subanalysis is completed. The team selected The Journal of Pain and Symptom Management as the target journal with Pain Medicine as a backup. 3.6 European Journal of Pain Supplement The team was updated regarding the status of the supplement. MAC has received reviewer comments. These will be sent to Stephen MAC Brigandi (SB) who will forward them to Embryon. [Post-meeting note: SB both of these actions have been completed.] The final version will be sent to LT for final approval next week. 4.0 Meeting with NYHQ and Ann Arbor The meeting to discuss the transfer of study data and to determine whether there are studies that have not been published has been confirmed for the afternoon of October 3. The meeting to discuss the subanalyses will be arranged independently. 5.0 Key Messages Update Most of the key message meetings have taken place, and the approved list is undergoing final revisions. Corporate messages will be reviewed by a small committee via e-mail or teleconference. The entire list will be reviewed by a single committee in order to finalize it; however, the list will be revisited in the future. 6.0 Profile and Bibliography Update MAC presented the latest journal and congress profiles and reminded the team that profiling is continuing. MAC also presented the latest screen shots from the bibliography. LT requested a special meeting to discuss the bibliography, independent of other publication issues. In addition; MAC was actioned to provide a small working model to be MAC tested at the meeting. Stephen Valerio Medical Projects Director the Action Report: 19-Sep-01 Source: https://www.industrydocuments.ucsf.edu/docs/jnjm0223 Pfizer_LKnapp_0026119

"Art will be out of town until" which day?

khgl0226

khgl0226_p0, khgl0226_p1, khgl0226_p2

Thursday

Mr. Placé: Art will be out of town until Thursday, I learned today when I called for an answer to your letter. I did not mail your letter (although I like the way you stated your case and your attitude to the board) as I was not sure whether or not you wanted to wait for Art's possible criticism of your letter. CJB Source: https://www.industrydocuments.ucsf.edu/docs/khgl0226 esß gray be in Washington so 3'll learn this will you to mail if it is ok was are et " leate repeaters?? 1/25/re or ? https:fiwwwindusaydocuments.ucsf.edu/docs/khgl0226 Mr. Placé: Nothing has been accomplished so far with the Union joining in the work of the United War Chest. I have been speaking to Lowedl about this and they realize the situation and still expect to be able to do something from the top. Do you want to apply to NY for our company contribution! The drive starts the week after next. CJB Source: https://www.industrydocuments.ucsf,edu/docs/khgl0226

Who wrote the letter?

khgl0226

khgl0226_p0, khgl0226_p1, khgl0226_p2

CJB

Mr. Placé: Art will be out of town until Thursday, I learned today when I called for an answer to your letter. I did not mail your letter (although I like the way you stated your case and your attitude to the board) as I was not sure whether or not you wanted to wait for Art's possible criticism of your letter. CJB Source: https://www.industrydocuments.ucsf.edu/docs/khgl0226 esß gray be in Washington so 3'll learn this will you to mail if it is ok was are et " leate repeaters?? 1/25/re or ? https:fiwwwindusaydocuments.ucsf.edu/docs/khgl0226 Mr. Placé: Nothing has been accomplished so far with the Union joining in the work of the United War Chest. I have been speaking to Lowedl about this and they realize the situation and still expect to be able to do something from the top. Do you want to apply to NY for our company contribution! The drive starts the week after next. CJB Source: https://www.industrydocuments.ucsf,edu/docs/khgl0226

Provide the receipt number printed at the left top corner of the receipt?

sggl0226

sggl0226_p0, sggl0226_p1

12135

12135 Amerinan Jnr. Washington, D. C., July 16, 1943 We gratefully acknowledge receipt of your contribution listed below, to be expended in carrying on the activities of the American Taxpayers Association, Inc. Receined nf Louis V. Place, Jr. the sum of $.5.00 W. J. McCahan Sugan Refining & Molasses Company Philadelphia, Pa. 101 S. Front St. Secretary Source: https:/lwww.industrydocuments.ucst. edu/docs/sggl022 AMERICAN TAXPAYERS ASSOCIATION, INC. MUNSEY DUILDING WASHENOTON, D.C. June, 1943 Office of the Treasurer Mr. Louis V. Place, Jr. W. J. McCahan Sugar Refining & Molasses Co. 101 S. Front St., Philadelphia, Penna. TO CONTRIBUTION $ 5.00 Source: ttps://www.industrydocimasts.ucsf.edu/docs/sggl0226 1000

Which "Association" has given the receipt?

sggl0226

sggl0226_p0, sggl0226_p1

AMERICAN TAXPAYERS ASSOCIATION, INC., AMERICAN TAXPAYERS ASSOCIATION, American Taxpayers Association, Inc.

12135 Amerinan Jnr. Washington, D. C., July 16, 1943 We gratefully acknowledge receipt of your contribution listed below, to be expended in carrying on the activities of the American Taxpayers Association, Inc. Receined nf Louis V. Place, Jr. the sum of $.5.00 W. J. McCahan Sugan Refining & Molasses Company Philadelphia, Pa. 101 S. Front St. Secretary Source: https:/lwww.industrydocuments.ucst. edu/docs/sggl022 AMERICAN TAXPAYERS ASSOCIATION, INC. MUNSEY DUILDING WASHENOTON, D.C. June, 1943 Office of the Treasurer Mr. Louis V. Place, Jr. W. J. McCahan Sugar Refining & Molasses Co. 101 S. Front St., Philadelphia, Penna. TO CONTRIBUTION $ 5.00 Source: ttps://www.industrydocimasts.ucsf.edu/docs/sggl0226 1000

Who has given $ 5.00?

sggl0226

sggl0226_p0, sggl0226_p1

LOUIS V. PLACE, JR., Louis V . Place, Jr.

12135 Amerinan Jnr. Washington, D. C., July 16, 1943 We gratefully acknowledge receipt of your contribution listed below, to be expended in carrying on the activities of the American Taxpayers Association, Inc. Receined nf Louis V. Place, Jr. the sum of $.5.00 W. J. McCahan Sugan Refining & Molasses Company Philadelphia, Pa. 101 S. Front St. Secretary Source: https:/lwww.industrydocuments.ucst. edu/docs/sggl022 AMERICAN TAXPAYERS ASSOCIATION, INC. MUNSEY DUILDING WASHENOTON, D.C. June, 1943 Office of the Treasurer Mr. Louis V. Place, Jr. W. J. McCahan Sugar Refining & Molasses Co. 101 S. Front St., Philadelphia, Penna. TO CONTRIBUTION $ 5.00 Source: ttps://www.industrydocimasts.ucsf.edu/docs/sggl0226 1000

Mention the amount given by "Louis V . Place, Jr."?

sggl0226

sggl0226_p0, sggl0226_p1

$ 5.00, $5.00

12135 Amerinan Jnr. Washington, D. C., July 16, 1943 We gratefully acknowledge receipt of your contribution listed below, to be expended in carrying on the activities of the American Taxpayers Association, Inc. Receined nf Louis V. Place, Jr. the sum of $.5.00 W. J. McCahan Sugan Refining & Molasses Company Philadelphia, Pa. 101 S. Front St. Secretary Source: https:/lwww.industrydocuments.ucst. edu/docs/sggl022 AMERICAN TAXPAYERS ASSOCIATION, INC. MUNSEY DUILDING WASHENOTON, D.C. June, 1943 Office of the Treasurer Mr. Louis V. Place, Jr. W. J. McCahan Sugar Refining & Molasses Co. 101 S. Front St., Philadelphia, Penna. TO CONTRIBUTION $ 5.00 Source: ttps://www.industrydocimasts.ucsf.edu/docs/sggl0226 1000

Who has signed the receipt?

sggl0226

sggl0226_p0, sggl0226_p1

SECRETARY, Secretary

12135 Amerinan Jnr. Washington, D. C., July 16, 1943 We gratefully acknowledge receipt of your contribution listed below, to be expended in carrying on the activities of the American Taxpayers Association, Inc. Receined nf Louis V. Place, Jr. the sum of $.5.00 W. J. McCahan Sugan Refining & Molasses Company Philadelphia, Pa. 101 S. Front St. Secretary Source: https:/lwww.industrydocuments.ucst. edu/docs/sggl022 AMERICAN TAXPAYERS ASSOCIATION, INC. MUNSEY DUILDING WASHENOTON, D.C. June, 1943 Office of the Treasurer Mr. Louis V. Place, Jr. W. J. McCahan Sugar Refining & Molasses Co. 101 S. Front St., Philadelphia, Penna. TO CONTRIBUTION $ 5.00 Source: ttps://www.industrydocimasts.ucsf.edu/docs/sggl0226 1000

Which date is receipt given?

sggl0226

sggl0226_p0, sggl0226_p1

July 16, 1943, JULY 16, 1943

12135 Amerinan Jnr. Washington, D. C., July 16, 1943 We gratefully acknowledge receipt of your contribution listed below, to be expended in carrying on the activities of the American Taxpayers Association, Inc. Receined nf Louis V. Place, Jr. the sum of $.5.00 W. J. McCahan Sugan Refining & Molasses Company Philadelphia, Pa. 101 S. Front St. Secretary Source: https:/lwww.industrydocuments.ucst. edu/docs/sggl022 AMERICAN TAXPAYERS ASSOCIATION, INC. MUNSEY DUILDING WASHENOTON, D.C. June, 1943 Office of the Treasurer Mr. Louis V. Place, Jr. W. J. McCahan Sugar Refining & Molasses Co. 101 S. Front St., Philadelphia, Penna. TO CONTRIBUTION $ 5.00 Source: ttps://www.industrydocimasts.ucsf.edu/docs/sggl0226 1000

Where is "American Taxpayers Association, Inc." located?

sggl0226

sggl0226_p0, sggl0226_p1

Washington, D.C., WASHINGTON, D.C.

12135 Amerinan Jnr. Washington, D. C., July 16, 1943 We gratefully acknowledge receipt of your contribution listed below, to be expended in carrying on the activities of the American Taxpayers Association, Inc. Receined nf Louis V. Place, Jr. the sum of $.5.00 W. J. McCahan Sugan Refining & Molasses Company Philadelphia, Pa. 101 S. Front St. Secretary Source: https:/lwww.industrydocuments.ucst. edu/docs/sggl022 AMERICAN TAXPAYERS ASSOCIATION, INC. MUNSEY DUILDING WASHENOTON, D.C. June, 1943 Office of the Treasurer Mr. Louis V. Place, Jr. W. J. McCahan Sugar Refining & Molasses Co. 101 S. Front St., Philadelphia, Penna. TO CONTRIBUTION $ 5.00 Source: ttps://www.industrydocimasts.ucsf.edu/docs/sggl0226 1000

How many women say eating too much meat is harmful?

lpdl0226

lpdl0226_p16, lpdl0226_p17, lpdl0226_p18, lpdl0226_p19, lpdl0226_p20, lpdl0226_p21, lpdl0226_p22, lpdl0226_p23, lpdl0226_p24, lpdl0226_p25, lpdl0226_p26, lpdl0226_p27

(18), 18

Question 6a: Are there any foods you don't eat at all because you are afraid they are too fattening? Total Men Women Total Respondents (506=100%) (2119=100%) (25%==1UUY) Yes 15% 8% 21% No 85 92 79 Question 6b: If yes, which foods? Total Men Women Respondents who have (506=100%) (2114=100%) (257=100%) quit eating certain foods Fats - animal or vege- 6% 3% 8% table butter, cream, whipped cream, whole milk, fat meat, fried foods Desserts, pies, pastries, 5 2 7 cake, cookies, pudding, ice cream. Sugar 4 3 5 Potatoes 4 3 4 Bread, rolls 2 2 1 Candy 1 * 2 Starches, macaroni, spag- 1 * 2 hetti, noodles, etc. Sweets, sweet food 1 1 2 Liquor, soft drinks * - 1 Beans, corn * * * All other 2 2 2 Less than 0.5% Source. htps://www.industrydocuments.ucst.edu/docs/lpdl022 Question 7a: Do you think the general health of people is harmed more by : eating too much sugar; eating too much salt or by eating too much meat? Total* Men* Women* Total Respondents (506=100%) (249=100%) (257=100%) Eating too much sugar 53% 52% 54% Eating too much salt 34 29 40 Eating too much meat 6 5 7 Don't, know 9 12 7 None of these 11 10 11 *Adds to more than 100% because some respondents gave more than one answer. Question 7b: Why do you say that? Those who say eating too much sugar Total* Men* Women* is harmful, (268=100%) (130=100%) (138=100%) Reasons: Fattening, makes one fat, causes overweight 32% 32% 33% Causes diabetes 31 28 33 Bad for teeth 16 14 18 Bad for blood, gets in blood stream, thins blood, blood turns to water 7 8 7 Causes overweight which in turn causes ailments, affects organs 6 8 4 Bad for general health, causes ailments 4 2 7 Causes heart trouble, hard on heart 4 2 6 Not necessary, can get along without it, not much food value, no protein 3 4 1 Causes rash, skin blemishes 2 2 2 Causes high blood pressure 1 2 1 Causes acid condition 1 2 1 Too much isn't good, too much of anything isn't good 9 7 11 All other 2 2 1 Don't know 2 4 - *Adds to more than 100% because some respondents gave more than one answere Question 7b Continued Source: Question 7b (Cont'd) Why do you say that? Total* Men* Women* Those who say too much salt is harmful (174=100%) (71=100%) (103=100%) REASONS: Retains water in body, upsets water balance 21% 15% 25% Causes high blood pressure 21 20 21 Fattening, creates fat 16 8 21 Causes heart trouble, bad for the heart 16 18 15 Causes hardening of the arteries, bad for arteries 11 11 11 Bad for blood, acts on blood 6 4 8 Makes one drink too much water 5 3 7 Just bad for you 5 6 4 Bad for kidney 3 4 3 Causes bloating, swelling 2 1 3 Has no food value, no protein 2 4 - Too much isn't good, too much of anything isn't good 10 10 11 All other 9 10 8 Don't know, no answer 6 8 4 Adds to more than 100% because some respondents gave more than one answer. Question 7b Continued Source: https://www.industrydocuments.ucsf.edu/docs/lpdl0226 Question Tb why do you say that? Those who say eating too much meat Total* Men* Women* is harmful (31) (13) (18) Reasons: Doesn't balance diet, eat too much meat not other foods, too much protein (5) (3) (2) Fattening (5) (2) (3) Most people eat more than body requires, eat too much meat (4) (4) (-) Causes high blood pressure (4) (1) (3) Can harm blood (3) (1) (2) Harmful to body (2) (-) (2) Hurts stomach (1) (-) (1) Causes heart trouble (1) (-) (1) Too much just isn't good (7) (3) (4) Don't know (1) ( ) (1) Actual numbers are shown rather than percentages since totals are too small to express in percentage form. Question 8: Have you ever heard of "Saccharine"? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Yes 91% 90% 92% No 9 10 8 Question 9: Have you ever used "Saccharine"? Total Men Tomen Respondents who have ever (460=100%) (224=100%) (236=100%) heard "Saccharine" Yes 35% 33% 37% No 65 67 63 Question 10: Are you currently using "Saccharine"? Total Men Women Respondents who have used (161=100%) (74=100%) (87=100%) " Saccharine" Yes 24% 28% 20% No 76 72 80 Source: https://www.industrydocuments.ucsf.edu/docs//pdl0226 Question 11: Have you ever heard of "Sucaryl"? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Yes 54% 45% 62% No 43 49 37 No answer 3 5 1 Question 12: Have you ever used "Sucaryl"? Total Men Women Respondents who have ever used (274=100%) (115=100%) (159=100%) 11 Sucaryl" Yes 25% 21% 27% No 75 78 73 Don't know * 1 - Question 13: Are you currently using "Sycaryl"? Total Men Women Respondents who have used (67=100%) (24=100%) (43=100%) "Sycaryl" Yes 45% 42% 47% No 54 58 51 No answer 1 - 2 *Less than 0.5% Source: Question 14a: Have you ever been on a reducing diet? Total Men Women Total Respondents (506-100%) (249=100%) (257-100%) Yes 26% 16% 35% No 74 84 65 Question 14b: What did your diet say about how much sugar you should use? Total Men Women Respondents who have been on (132=100%) (41=100%) (91=100%) reducing diet Comments: No sugar at all, cut it out eventually, use only saccharine 30% 24% 33% Limit amount, cut down usage, use as little as possible, just enough to sweeten beverages 24 24 24 Sugar not specifically mentioned by doctor, just cut down on sweets, fats, starches, eat less of every- thing, certain calorie count 21 32 17 Cut down to 1/2 to 1 teaspoon a day 11 7 12 Cut down to 2 or 3 teaspoons a day 2 - 3 Put self on diet, own diet, not Doctor's orders 10 13 8 Don't know - No answer 2 - 3 Source: https://www.industrydocuments.ucsf.edu/docs/lpdl0226 Question 15: Do you drink Coffee or Tea? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Drink: Coffee 22% 24% 20% Tea 6 4 9 Both 66 68 64 Neither 6 4 7 Question 16: Do you use sugar with the Coffee or Tea you drink? Total Men Women Respondents who drink coffee: (446-100%) (229-100%) (217-100%) Yes 54% 65% 41% No 46 34 59 No answer * 1 - Total Men Women Respondents who drink tea, (367-100%) (179-100%) (188-100%) Yes 57% 63% 52% No 42 36 47 No answer 1 1 1 * Less than 0.5% Question 17: How many teaspoons of sugar do you use with coffee? With tea? Respondents who use sugar in Total Men Women coffee: (239=100%) (149=1C0%) (90=100%) Use: Less than 1 teaspoon 26% 26% 25% 1 teaspoon 40 47 39 l 1/2 teaspoons 4 4 3 2 teaspoons 29 27 32 More than 2 teaspoons 1 2 - No answer * - 1 Total Men Women Respondents who use sugar in tea: (210=100%) (112=100%) (98=100%) Use : Less than 1 teaspoon 30% 29% 30% 1 teaspoon 37 36 37 1 1/2 teaspoons 2 3 2 2 teaspoons 28 27 29 Over 2 teaspoons 2 2 2 No answer 1 3 - * Less than 0.5% Source. https://www.industrydocuments.ucsf.edu/docs//pdl0226 Question 18a: Do you ever eat candy? b: Would you say you eat it frequently or just occasionally? c: If not frequently - Is it because you don't like it, or because you think it is fattening, or do you have another reason? Total Men Women Total Respondents (506-100%) (249-100%) (257-100%) Eat candy 85% 84% 86% Do not eat candy 15 16 14 Total Men Women Respondents who eat candy (430-100%) (208-100%) (22-100%) Eat it occasionally 76% 76% 76% Eat it frequently 24 24 24 Respondents who do not eat Total* Men* Women candy frequently (326-100%) (158-100%) (168-100%) Reasons: Don't like it 40% 47% 33% Think it is fattening 29 16 40 Don't creve sweets, don't care for it too much, can take it or leave it, no special desire, don't care for it too often 11 13 10 Don't buy often, just don't have it around to tempt, doesn't last long 8 11 5 Hard on teeth, bad for teeth 6 3 8 Not good for me, doesn't agree with me 3 2 5 Diet - diabetic 9 1 1 All other 4 6 2 *Adds to more than 100% because some respondents gave more than one answer. Source: htps.//www.industrydocuments.ucsf.edu/docs//pdl0226

How many men say eating too much meat is harmful?

lpdl0226

lpdl0226_p16, lpdl0226_p17, lpdl0226_p18, lpdl0226_p19, lpdl0226_p20, lpdl0226_p21, lpdl0226_p22, lpdl0226_p23, lpdl0226_p24, lpdl0226_p25, lpdl0226_p26, lpdl0226_p27

13, (13)

Question 6a: Are there any foods you don't eat at all because you are afraid they are too fattening? Total Men Women Total Respondents (506=100%) (2119=100%) (25%==1UUY) Yes 15% 8% 21% No 85 92 79 Question 6b: If yes, which foods? Total Men Women Respondents who have (506=100%) (2114=100%) (257=100%) quit eating certain foods Fats - animal or vege- 6% 3% 8% table butter, cream, whipped cream, whole milk, fat meat, fried foods Desserts, pies, pastries, 5 2 7 cake, cookies, pudding, ice cream. Sugar 4 3 5 Potatoes 4 3 4 Bread, rolls 2 2 1 Candy 1 * 2 Starches, macaroni, spag- 1 * 2 hetti, noodles, etc. Sweets, sweet food 1 1 2 Liquor, soft drinks * - 1 Beans, corn * * * All other 2 2 2 Less than 0.5% Source. htps://www.industrydocuments.ucst.edu/docs/lpdl022 Question 7a: Do you think the general health of people is harmed more by : eating too much sugar; eating too much salt or by eating too much meat? Total* Men* Women* Total Respondents (506=100%) (249=100%) (257=100%) Eating too much sugar 53% 52% 54% Eating too much salt 34 29 40 Eating too much meat 6 5 7 Don't, know 9 12 7 None of these 11 10 11 *Adds to more than 100% because some respondents gave more than one answer. Question 7b: Why do you say that? Those who say eating too much sugar Total* Men* Women* is harmful, (268=100%) (130=100%) (138=100%) Reasons: Fattening, makes one fat, causes overweight 32% 32% 33% Causes diabetes 31 28 33 Bad for teeth 16 14 18 Bad for blood, gets in blood stream, thins blood, blood turns to water 7 8 7 Causes overweight which in turn causes ailments, affects organs 6 8 4 Bad for general health, causes ailments 4 2 7 Causes heart trouble, hard on heart 4 2 6 Not necessary, can get along without it, not much food value, no protein 3 4 1 Causes rash, skin blemishes 2 2 2 Causes high blood pressure 1 2 1 Causes acid condition 1 2 1 Too much isn't good, too much of anything isn't good 9 7 11 All other 2 2 1 Don't know 2 4 - *Adds to more than 100% because some respondents gave more than one answere Question 7b Continued Source: Question 7b (Cont'd) Why do you say that? Total* Men* Women* Those who say too much salt is harmful (174=100%) (71=100%) (103=100%) REASONS: Retains water in body, upsets water balance 21% 15% 25% Causes high blood pressure 21 20 21 Fattening, creates fat 16 8 21 Causes heart trouble, bad for the heart 16 18 15 Causes hardening of the arteries, bad for arteries 11 11 11 Bad for blood, acts on blood 6 4 8 Makes one drink too much water 5 3 7 Just bad for you 5 6 4 Bad for kidney 3 4 3 Causes bloating, swelling 2 1 3 Has no food value, no protein 2 4 - Too much isn't good, too much of anything isn't good 10 10 11 All other 9 10 8 Don't know, no answer 6 8 4 Adds to more than 100% because some respondents gave more than one answer. Question 7b Continued Source: https://www.industrydocuments.ucsf.edu/docs/lpdl0226 Question Tb why do you say that? Those who say eating too much meat Total* Men* Women* is harmful (31) (13) (18) Reasons: Doesn't balance diet, eat too much meat not other foods, too much protein (5) (3) (2) Fattening (5) (2) (3) Most people eat more than body requires, eat too much meat (4) (4) (-) Causes high blood pressure (4) (1) (3) Can harm blood (3) (1) (2) Harmful to body (2) (-) (2) Hurts stomach (1) (-) (1) Causes heart trouble (1) (-) (1) Too much just isn't good (7) (3) (4) Don't know (1) ( ) (1) Actual numbers are shown rather than percentages since totals are too small to express in percentage form. Question 8: Have you ever heard of "Saccharine"? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Yes 91% 90% 92% No 9 10 8 Question 9: Have you ever used "Saccharine"? Total Men Tomen Respondents who have ever (460=100%) (224=100%) (236=100%) heard "Saccharine" Yes 35% 33% 37% No 65 67 63 Question 10: Are you currently using "Saccharine"? Total Men Women Respondents who have used (161=100%) (74=100%) (87=100%) " Saccharine" Yes 24% 28% 20% No 76 72 80 Source: https://www.industrydocuments.ucsf.edu/docs//pdl0226 Question 11: Have you ever heard of "Sucaryl"? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Yes 54% 45% 62% No 43 49 37 No answer 3 5 1 Question 12: Have you ever used "Sucaryl"? Total Men Women Respondents who have ever used (274=100%) (115=100%) (159=100%) 11 Sucaryl" Yes 25% 21% 27% No 75 78 73 Don't know * 1 - Question 13: Are you currently using "Sycaryl"? Total Men Women Respondents who have used (67=100%) (24=100%) (43=100%) "Sycaryl" Yes 45% 42% 47% No 54 58 51 No answer 1 - 2 *Less than 0.5% Source: Question 14a: Have you ever been on a reducing diet? Total Men Women Total Respondents (506-100%) (249=100%) (257-100%) Yes 26% 16% 35% No 74 84 65 Question 14b: What did your diet say about how much sugar you should use? Total Men Women Respondents who have been on (132=100%) (41=100%) (91=100%) reducing diet Comments: No sugar at all, cut it out eventually, use only saccharine 30% 24% 33% Limit amount, cut down usage, use as little as possible, just enough to sweeten beverages 24 24 24 Sugar not specifically mentioned by doctor, just cut down on sweets, fats, starches, eat less of every- thing, certain calorie count 21 32 17 Cut down to 1/2 to 1 teaspoon a day 11 7 12 Cut down to 2 or 3 teaspoons a day 2 - 3 Put self on diet, own diet, not Doctor's orders 10 13 8 Don't know - No answer 2 - 3 Source: https://www.industrydocuments.ucsf.edu/docs/lpdl0226 Question 15: Do you drink Coffee or Tea? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Drink: Coffee 22% 24% 20% Tea 6 4 9 Both 66 68 64 Neither 6 4 7 Question 16: Do you use sugar with the Coffee or Tea you drink? Total Men Women Respondents who drink coffee: (446-100%) (229-100%) (217-100%) Yes 54% 65% 41% No 46 34 59 No answer * 1 - Total Men Women Respondents who drink tea, (367-100%) (179-100%) (188-100%) Yes 57% 63% 52% No 42 36 47 No answer 1 1 1 * Less than 0.5% Question 17: How many teaspoons of sugar do you use with coffee? With tea? Respondents who use sugar in Total Men Women coffee: (239=100%) (149=1C0%) (90=100%) Use: Less than 1 teaspoon 26% 26% 25% 1 teaspoon 40 47 39 l 1/2 teaspoons 4 4 3 2 teaspoons 29 27 32 More than 2 teaspoons 1 2 - No answer * - 1 Total Men Women Respondents who use sugar in tea: (210=100%) (112=100%) (98=100%) Use : Less than 1 teaspoon 30% 29% 30% 1 teaspoon 37 36 37 1 1/2 teaspoons 2 3 2 2 teaspoons 28 27 29 Over 2 teaspoons 2 2 2 No answer 1 3 - * Less than 0.5% Source. https://www.industrydocuments.ucsf.edu/docs//pdl0226 Question 18a: Do you ever eat candy? b: Would you say you eat it frequently or just occasionally? c: If not frequently - Is it because you don't like it, or because you think it is fattening, or do you have another reason? Total Men Women Total Respondents (506-100%) (249-100%) (257-100%) Eat candy 85% 84% 86% Do not eat candy 15 16 14 Total Men Women Respondents who eat candy (430-100%) (208-100%) (22-100%) Eat it occasionally 76% 76% 76% Eat it frequently 24 24 24 Respondents who do not eat Total* Men* Women candy frequently (326-100%) (158-100%) (168-100%) Reasons: Don't like it 40% 47% 33% Think it is fattening 29 16 40 Don't creve sweets, don't care for it too much, can take it or leave it, no special desire, don't care for it too often 11 13 10 Don't buy often, just don't have it around to tempt, doesn't last long 8 11 5 Hard on teeth, bad for teeth 6 3 8 Not good for me, doesn't agree with me 3 2 5 Diet - diabetic 9 1 1 All other 4 6 2 *Adds to more than 100% because some respondents gave more than one answer. Source: htps.//www.industrydocuments.ucsf.edu/docs//pdl0226

How many people in total say eating too much meat is harmful?

lpdl0226

lpdl0226_p16, lpdl0226_p17, lpdl0226_p18, lpdl0226_p19, lpdl0226_p20, lpdl0226_p21, lpdl0226_p22, lpdl0226_p23, lpdl0226_p24, lpdl0226_p25, lpdl0226_p26, lpdl0226_p27

31, (31)

Question 6a: Are there any foods you don't eat at all because you are afraid they are too fattening? Total Men Women Total Respondents (506=100%) (2119=100%) (25%==1UUY) Yes 15% 8% 21% No 85 92 79 Question 6b: If yes, which foods? Total Men Women Respondents who have (506=100%) (2114=100%) (257=100%) quit eating certain foods Fats - animal or vege- 6% 3% 8% table butter, cream, whipped cream, whole milk, fat meat, fried foods Desserts, pies, pastries, 5 2 7 cake, cookies, pudding, ice cream. Sugar 4 3 5 Potatoes 4 3 4 Bread, rolls 2 2 1 Candy 1 * 2 Starches, macaroni, spag- 1 * 2 hetti, noodles, etc. Sweets, sweet food 1 1 2 Liquor, soft drinks * - 1 Beans, corn * * * All other 2 2 2 Less than 0.5% Source. htps://www.industrydocuments.ucst.edu/docs/lpdl022 Question 7a: Do you think the general health of people is harmed more by : eating too much sugar; eating too much salt or by eating too much meat? Total* Men* Women* Total Respondents (506=100%) (249=100%) (257=100%) Eating too much sugar 53% 52% 54% Eating too much salt 34 29 40 Eating too much meat 6 5 7 Don't, know 9 12 7 None of these 11 10 11 *Adds to more than 100% because some respondents gave more than one answer. Question 7b: Why do you say that? Those who say eating too much sugar Total* Men* Women* is harmful, (268=100%) (130=100%) (138=100%) Reasons: Fattening, makes one fat, causes overweight 32% 32% 33% Causes diabetes 31 28 33 Bad for teeth 16 14 18 Bad for blood, gets in blood stream, thins blood, blood turns to water 7 8 7 Causes overweight which in turn causes ailments, affects organs 6 8 4 Bad for general health, causes ailments 4 2 7 Causes heart trouble, hard on heart 4 2 6 Not necessary, can get along without it, not much food value, no protein 3 4 1 Causes rash, skin blemishes 2 2 2 Causes high blood pressure 1 2 1 Causes acid condition 1 2 1 Too much isn't good, too much of anything isn't good 9 7 11 All other 2 2 1 Don't know 2 4 - *Adds to more than 100% because some respondents gave more than one answere Question 7b Continued Source: Question 7b (Cont'd) Why do you say that? Total* Men* Women* Those who say too much salt is harmful (174=100%) (71=100%) (103=100%) REASONS: Retains water in body, upsets water balance 21% 15% 25% Causes high blood pressure 21 20 21 Fattening, creates fat 16 8 21 Causes heart trouble, bad for the heart 16 18 15 Causes hardening of the arteries, bad for arteries 11 11 11 Bad for blood, acts on blood 6 4 8 Makes one drink too much water 5 3 7 Just bad for you 5 6 4 Bad for kidney 3 4 3 Causes bloating, swelling 2 1 3 Has no food value, no protein 2 4 - Too much isn't good, too much of anything isn't good 10 10 11 All other 9 10 8 Don't know, no answer 6 8 4 Adds to more than 100% because some respondents gave more than one answer. Question 7b Continued Source: https://www.industrydocuments.ucsf.edu/docs/lpdl0226 Question Tb why do you say that? Those who say eating too much meat Total* Men* Women* is harmful (31) (13) (18) Reasons: Doesn't balance diet, eat too much meat not other foods, too much protein (5) (3) (2) Fattening (5) (2) (3) Most people eat more than body requires, eat too much meat (4) (4) (-) Causes high blood pressure (4) (1) (3) Can harm blood (3) (1) (2) Harmful to body (2) (-) (2) Hurts stomach (1) (-) (1) Causes heart trouble (1) (-) (1) Too much just isn't good (7) (3) (4) Don't know (1) ( ) (1) Actual numbers are shown rather than percentages since totals are too small to express in percentage form. Question 8: Have you ever heard of "Saccharine"? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Yes 91% 90% 92% No 9 10 8 Question 9: Have you ever used "Saccharine"? Total Men Tomen Respondents who have ever (460=100%) (224=100%) (236=100%) heard "Saccharine" Yes 35% 33% 37% No 65 67 63 Question 10: Are you currently using "Saccharine"? Total Men Women Respondents who have used (161=100%) (74=100%) (87=100%) " Saccharine" Yes 24% 28% 20% No 76 72 80 Source: https://www.industrydocuments.ucsf.edu/docs//pdl0226 Question 11: Have you ever heard of "Sucaryl"? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Yes 54% 45% 62% No 43 49 37 No answer 3 5 1 Question 12: Have you ever used "Sucaryl"? Total Men Women Respondents who have ever used (274=100%) (115=100%) (159=100%) 11 Sucaryl" Yes 25% 21% 27% No 75 78 73 Don't know * 1 - Question 13: Are you currently using "Sycaryl"? Total Men Women Respondents who have used (67=100%) (24=100%) (43=100%) "Sycaryl" Yes 45% 42% 47% No 54 58 51 No answer 1 - 2 *Less than 0.5% Source: Question 14a: Have you ever been on a reducing diet? Total Men Women Total Respondents (506-100%) (249=100%) (257-100%) Yes 26% 16% 35% No 74 84 65 Question 14b: What did your diet say about how much sugar you should use? Total Men Women Respondents who have been on (132=100%) (41=100%) (91=100%) reducing diet Comments: No sugar at all, cut it out eventually, use only saccharine 30% 24% 33% Limit amount, cut down usage, use as little as possible, just enough to sweeten beverages 24 24 24 Sugar not specifically mentioned by doctor, just cut down on sweets, fats, starches, eat less of every- thing, certain calorie count 21 32 17 Cut down to 1/2 to 1 teaspoon a day 11 7 12 Cut down to 2 or 3 teaspoons a day 2 - 3 Put self on diet, own diet, not Doctor's orders 10 13 8 Don't know - No answer 2 - 3 Source: https://www.industrydocuments.ucsf.edu/docs/lpdl0226 Question 15: Do you drink Coffee or Tea? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Drink: Coffee 22% 24% 20% Tea 6 4 9 Both 66 68 64 Neither 6 4 7 Question 16: Do you use sugar with the Coffee or Tea you drink? Total Men Women Respondents who drink coffee: (446-100%) (229-100%) (217-100%) Yes 54% 65% 41% No 46 34 59 No answer * 1 - Total Men Women Respondents who drink tea, (367-100%) (179-100%) (188-100%) Yes 57% 63% 52% No 42 36 47 No answer 1 1 1 * Less than 0.5% Question 17: How many teaspoons of sugar do you use with coffee? With tea? Respondents who use sugar in Total Men Women coffee: (239=100%) (149=1C0%) (90=100%) Use: Less than 1 teaspoon 26% 26% 25% 1 teaspoon 40 47 39 l 1/2 teaspoons 4 4 3 2 teaspoons 29 27 32 More than 2 teaspoons 1 2 - No answer * - 1 Total Men Women Respondents who use sugar in tea: (210=100%) (112=100%) (98=100%) Use : Less than 1 teaspoon 30% 29% 30% 1 teaspoon 37 36 37 1 1/2 teaspoons 2 3 2 2 teaspoons 28 27 29 Over 2 teaspoons 2 2 2 No answer 1 3 - * Less than 0.5% Source. https://www.industrydocuments.ucsf.edu/docs//pdl0226 Question 18a: Do you ever eat candy? b: Would you say you eat it frequently or just occasionally? c: If not frequently - Is it because you don't like it, or because you think it is fattening, or do you have another reason? Total Men Women Total Respondents (506-100%) (249-100%) (257-100%) Eat candy 85% 84% 86% Do not eat candy 15 16 14 Total Men Women Respondents who eat candy (430-100%) (208-100%) (22-100%) Eat it occasionally 76% 76% 76% Eat it frequently 24 24 24 Respondents who do not eat Total* Men* Women candy frequently (326-100%) (158-100%) (168-100%) Reasons: Don't like it 40% 47% 33% Think it is fattening 29 16 40 Don't creve sweets, don't care for it too much, can take it or leave it, no special desire, don't care for it too often 11 13 10 Don't buy often, just don't have it around to tempt, doesn't last long 8 11 5 Hard on teeth, bad for teeth 6 3 8 Not good for me, doesn't agree with me 3 2 5 Diet - diabetic 9 1 1 All other 4 6 2 *Adds to more than 100% because some respondents gave more than one answer. Source: htps.//www.industrydocuments.ucsf.edu/docs//pdl0226

How many men get fattened due to eating of meat ?

lpdl0226

lpdl0226_p16, lpdl0226_p17, lpdl0226_p18, lpdl0226_p19, lpdl0226_p20, lpdl0226_p21, lpdl0226_p22, lpdl0226_p23, lpdl0226_p24, lpdl0226_p25, lpdl0226_p26, lpdl0226_p27

2, (2)

Question 6a: Are there any foods you don't eat at all because you are afraid they are too fattening? Total Men Women Total Respondents (506=100%) (2119=100%) (25%==1UUY) Yes 15% 8% 21% No 85 92 79 Question 6b: If yes, which foods? Total Men Women Respondents who have (506=100%) (2114=100%) (257=100%) quit eating certain foods Fats - animal or vege- 6% 3% 8% table butter, cream, whipped cream, whole milk, fat meat, fried foods Desserts, pies, pastries, 5 2 7 cake, cookies, pudding, ice cream. Sugar 4 3 5 Potatoes 4 3 4 Bread, rolls 2 2 1 Candy 1 * 2 Starches, macaroni, spag- 1 * 2 hetti, noodles, etc. Sweets, sweet food 1 1 2 Liquor, soft drinks * - 1 Beans, corn * * * All other 2 2 2 Less than 0.5% Source. htps://www.industrydocuments.ucst.edu/docs/lpdl022 Question 7a: Do you think the general health of people is harmed more by : eating too much sugar; eating too much salt or by eating too much meat? Total* Men* Women* Total Respondents (506=100%) (249=100%) (257=100%) Eating too much sugar 53% 52% 54% Eating too much salt 34 29 40 Eating too much meat 6 5 7 Don't, know 9 12 7 None of these 11 10 11 *Adds to more than 100% because some respondents gave more than one answer. Question 7b: Why do you say that? Those who say eating too much sugar Total* Men* Women* is harmful, (268=100%) (130=100%) (138=100%) Reasons: Fattening, makes one fat, causes overweight 32% 32% 33% Causes diabetes 31 28 33 Bad for teeth 16 14 18 Bad for blood, gets in blood stream, thins blood, blood turns to water 7 8 7 Causes overweight which in turn causes ailments, affects organs 6 8 4 Bad for general health, causes ailments 4 2 7 Causes heart trouble, hard on heart 4 2 6 Not necessary, can get along without it, not much food value, no protein 3 4 1 Causes rash, skin blemishes 2 2 2 Causes high blood pressure 1 2 1 Causes acid condition 1 2 1 Too much isn't good, too much of anything isn't good 9 7 11 All other 2 2 1 Don't know 2 4 - *Adds to more than 100% because some respondents gave more than one answere Question 7b Continued Source: Question 7b (Cont'd) Why do you say that? Total* Men* Women* Those who say too much salt is harmful (174=100%) (71=100%) (103=100%) REASONS: Retains water in body, upsets water balance 21% 15% 25% Causes high blood pressure 21 20 21 Fattening, creates fat 16 8 21 Causes heart trouble, bad for the heart 16 18 15 Causes hardening of the arteries, bad for arteries 11 11 11 Bad for blood, acts on blood 6 4 8 Makes one drink too much water 5 3 7 Just bad for you 5 6 4 Bad for kidney 3 4 3 Causes bloating, swelling 2 1 3 Has no food value, no protein 2 4 - Too much isn't good, too much of anything isn't good 10 10 11 All other 9 10 8 Don't know, no answer 6 8 4 Adds to more than 100% because some respondents gave more than one answer. Question 7b Continued Source: https://www.industrydocuments.ucsf.edu/docs/lpdl0226 Question Tb why do you say that? Those who say eating too much meat Total* Men* Women* is harmful (31) (13) (18) Reasons: Doesn't balance diet, eat too much meat not other foods, too much protein (5) (3) (2) Fattening (5) (2) (3) Most people eat more than body requires, eat too much meat (4) (4) (-) Causes high blood pressure (4) (1) (3) Can harm blood (3) (1) (2) Harmful to body (2) (-) (2) Hurts stomach (1) (-) (1) Causes heart trouble (1) (-) (1) Too much just isn't good (7) (3) (4) Don't know (1) ( ) (1) Actual numbers are shown rather than percentages since totals are too small to express in percentage form. Question 8: Have you ever heard of "Saccharine"? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Yes 91% 90% 92% No 9 10 8 Question 9: Have you ever used "Saccharine"? Total Men Tomen Respondents who have ever (460=100%) (224=100%) (236=100%) heard "Saccharine" Yes 35% 33% 37% No 65 67 63 Question 10: Are you currently using "Saccharine"? Total Men Women Respondents who have used (161=100%) (74=100%) (87=100%) " Saccharine" Yes 24% 28% 20% No 76 72 80 Source: https://www.industrydocuments.ucsf.edu/docs//pdl0226 Question 11: Have you ever heard of "Sucaryl"? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Yes 54% 45% 62% No 43 49 37 No answer 3 5 1 Question 12: Have you ever used "Sucaryl"? Total Men Women Respondents who have ever used (274=100%) (115=100%) (159=100%) 11 Sucaryl" Yes 25% 21% 27% No 75 78 73 Don't know * 1 - Question 13: Are you currently using "Sycaryl"? Total Men Women Respondents who have used (67=100%) (24=100%) (43=100%) "Sycaryl" Yes 45% 42% 47% No 54 58 51 No answer 1 - 2 *Less than 0.5% Source: Question 14a: Have you ever been on a reducing diet? Total Men Women Total Respondents (506-100%) (249=100%) (257-100%) Yes 26% 16% 35% No 74 84 65 Question 14b: What did your diet say about how much sugar you should use? Total Men Women Respondents who have been on (132=100%) (41=100%) (91=100%) reducing diet Comments: No sugar at all, cut it out eventually, use only saccharine 30% 24% 33% Limit amount, cut down usage, use as little as possible, just enough to sweeten beverages 24 24 24 Sugar not specifically mentioned by doctor, just cut down on sweets, fats, starches, eat less of every- thing, certain calorie count 21 32 17 Cut down to 1/2 to 1 teaspoon a day 11 7 12 Cut down to 2 or 3 teaspoons a day 2 - 3 Put self on diet, own diet, not Doctor's orders 10 13 8 Don't know - No answer 2 - 3 Source: https://www.industrydocuments.ucsf.edu/docs/lpdl0226 Question 15: Do you drink Coffee or Tea? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Drink: Coffee 22% 24% 20% Tea 6 4 9 Both 66 68 64 Neither 6 4 7 Question 16: Do you use sugar with the Coffee or Tea you drink? Total Men Women Respondents who drink coffee: (446-100%) (229-100%) (217-100%) Yes 54% 65% 41% No 46 34 59 No answer * 1 - Total Men Women Respondents who drink tea, (367-100%) (179-100%) (188-100%) Yes 57% 63% 52% No 42 36 47 No answer 1 1 1 * Less than 0.5% Question 17: How many teaspoons of sugar do you use with coffee? With tea? Respondents who use sugar in Total Men Women coffee: (239=100%) (149=1C0%) (90=100%) Use: Less than 1 teaspoon 26% 26% 25% 1 teaspoon 40 47 39 l 1/2 teaspoons 4 4 3 2 teaspoons 29 27 32 More than 2 teaspoons 1 2 - No answer * - 1 Total Men Women Respondents who use sugar in tea: (210=100%) (112=100%) (98=100%) Use : Less than 1 teaspoon 30% 29% 30% 1 teaspoon 37 36 37 1 1/2 teaspoons 2 3 2 2 teaspoons 28 27 29 Over 2 teaspoons 2 2 2 No answer 1 3 - * Less than 0.5% Source. https://www.industrydocuments.ucsf.edu/docs//pdl0226 Question 18a: Do you ever eat candy? b: Would you say you eat it frequently or just occasionally? c: If not frequently - Is it because you don't like it, or because you think it is fattening, or do you have another reason? Total Men Women Total Respondents (506-100%) (249-100%) (257-100%) Eat candy 85% 84% 86% Do not eat candy 15 16 14 Total Men Women Respondents who eat candy (430-100%) (208-100%) (22-100%) Eat it occasionally 76% 76% 76% Eat it frequently 24 24 24 Respondents who do not eat Total* Men* Women candy frequently (326-100%) (158-100%) (168-100%) Reasons: Don't like it 40% 47% 33% Think it is fattening 29 16 40 Don't creve sweets, don't care for it too much, can take it or leave it, no special desire, don't care for it too often 11 13 10 Don't buy often, just don't have it around to tempt, doesn't last long 8 11 5 Hard on teeth, bad for teeth 6 3 8 Not good for me, doesn't agree with me 3 2 5 Diet - diabetic 9 1 1 All other 4 6 2 *Adds to more than 100% because some respondents gave more than one answer. Source: htps.//www.industrydocuments.ucsf.edu/docs//pdl0226

How many women get fattened due to eating of meat ?

lpdl0226

lpdl0226_p16, lpdl0226_p17, lpdl0226_p18, lpdl0226_p19, lpdl0226_p20, lpdl0226_p21, lpdl0226_p22, lpdl0226_p23, lpdl0226_p24, lpdl0226_p25, lpdl0226_p26, lpdl0226_p27

(3), 3

Question 6a: Are there any foods you don't eat at all because you are afraid they are too fattening? Total Men Women Total Respondents (506=100%) (2119=100%) (25%==1UUY) Yes 15% 8% 21% No 85 92 79 Question 6b: If yes, which foods? Total Men Women Respondents who have (506=100%) (2114=100%) (257=100%) quit eating certain foods Fats - animal or vege- 6% 3% 8% table butter, cream, whipped cream, whole milk, fat meat, fried foods Desserts, pies, pastries, 5 2 7 cake, cookies, pudding, ice cream. Sugar 4 3 5 Potatoes 4 3 4 Bread, rolls 2 2 1 Candy 1 * 2 Starches, macaroni, spag- 1 * 2 hetti, noodles, etc. Sweets, sweet food 1 1 2 Liquor, soft drinks * - 1 Beans, corn * * * All other 2 2 2 Less than 0.5% Source. htps://www.industrydocuments.ucst.edu/docs/lpdl022 Question 7a: Do you think the general health of people is harmed more by : eating too much sugar; eating too much salt or by eating too much meat? Total* Men* Women* Total Respondents (506=100%) (249=100%) (257=100%) Eating too much sugar 53% 52% 54% Eating too much salt 34 29 40 Eating too much meat 6 5 7 Don't, know 9 12 7 None of these 11 10 11 *Adds to more than 100% because some respondents gave more than one answer. Question 7b: Why do you say that? Those who say eating too much sugar Total* Men* Women* is harmful, (268=100%) (130=100%) (138=100%) Reasons: Fattening, makes one fat, causes overweight 32% 32% 33% Causes diabetes 31 28 33 Bad for teeth 16 14 18 Bad for blood, gets in blood stream, thins blood, blood turns to water 7 8 7 Causes overweight which in turn causes ailments, affects organs 6 8 4 Bad for general health, causes ailments 4 2 7 Causes heart trouble, hard on heart 4 2 6 Not necessary, can get along without it, not much food value, no protein 3 4 1 Causes rash, skin blemishes 2 2 2 Causes high blood pressure 1 2 1 Causes acid condition 1 2 1 Too much isn't good, too much of anything isn't good 9 7 11 All other 2 2 1 Don't know 2 4 - *Adds to more than 100% because some respondents gave more than one answere Question 7b Continued Source: Question 7b (Cont'd) Why do you say that? Total* Men* Women* Those who say too much salt is harmful (174=100%) (71=100%) (103=100%) REASONS: Retains water in body, upsets water balance 21% 15% 25% Causes high blood pressure 21 20 21 Fattening, creates fat 16 8 21 Causes heart trouble, bad for the heart 16 18 15 Causes hardening of the arteries, bad for arteries 11 11 11 Bad for blood, acts on blood 6 4 8 Makes one drink too much water 5 3 7 Just bad for you 5 6 4 Bad for kidney 3 4 3 Causes bloating, swelling 2 1 3 Has no food value, no protein 2 4 - Too much isn't good, too much of anything isn't good 10 10 11 All other 9 10 8 Don't know, no answer 6 8 4 Adds to more than 100% because some respondents gave more than one answer. Question 7b Continued Source: https://www.industrydocuments.ucsf.edu/docs/lpdl0226 Question Tb why do you say that? Those who say eating too much meat Total* Men* Women* is harmful (31) (13) (18) Reasons: Doesn't balance diet, eat too much meat not other foods, too much protein (5) (3) (2) Fattening (5) (2) (3) Most people eat more than body requires, eat too much meat (4) (4) (-) Causes high blood pressure (4) (1) (3) Can harm blood (3) (1) (2) Harmful to body (2) (-) (2) Hurts stomach (1) (-) (1) Causes heart trouble (1) (-) (1) Too much just isn't good (7) (3) (4) Don't know (1) ( ) (1) Actual numbers are shown rather than percentages since totals are too small to express in percentage form. Question 8: Have you ever heard of "Saccharine"? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Yes 91% 90% 92% No 9 10 8 Question 9: Have you ever used "Saccharine"? Total Men Tomen Respondents who have ever (460=100%) (224=100%) (236=100%) heard "Saccharine" Yes 35% 33% 37% No 65 67 63 Question 10: Are you currently using "Saccharine"? Total Men Women Respondents who have used (161=100%) (74=100%) (87=100%) " Saccharine" Yes 24% 28% 20% No 76 72 80 Source: https://www.industrydocuments.ucsf.edu/docs//pdl0226 Question 11: Have you ever heard of "Sucaryl"? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Yes 54% 45% 62% No 43 49 37 No answer 3 5 1 Question 12: Have you ever used "Sucaryl"? Total Men Women Respondents who have ever used (274=100%) (115=100%) (159=100%) 11 Sucaryl" Yes 25% 21% 27% No 75 78 73 Don't know * 1 - Question 13: Are you currently using "Sycaryl"? Total Men Women Respondents who have used (67=100%) (24=100%) (43=100%) "Sycaryl" Yes 45% 42% 47% No 54 58 51 No answer 1 - 2 *Less than 0.5% Source: Question 14a: Have you ever been on a reducing diet? Total Men Women Total Respondents (506-100%) (249=100%) (257-100%) Yes 26% 16% 35% No 74 84 65 Question 14b: What did your diet say about how much sugar you should use? Total Men Women Respondents who have been on (132=100%) (41=100%) (91=100%) reducing diet Comments: No sugar at all, cut it out eventually, use only saccharine 30% 24% 33% Limit amount, cut down usage, use as little as possible, just enough to sweeten beverages 24 24 24 Sugar not specifically mentioned by doctor, just cut down on sweets, fats, starches, eat less of every- thing, certain calorie count 21 32 17 Cut down to 1/2 to 1 teaspoon a day 11 7 12 Cut down to 2 or 3 teaspoons a day 2 - 3 Put self on diet, own diet, not Doctor's orders 10 13 8 Don't know - No answer 2 - 3 Source: https://www.industrydocuments.ucsf.edu/docs/lpdl0226 Question 15: Do you drink Coffee or Tea? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Drink: Coffee 22% 24% 20% Tea 6 4 9 Both 66 68 64 Neither 6 4 7 Question 16: Do you use sugar with the Coffee or Tea you drink? Total Men Women Respondents who drink coffee: (446-100%) (229-100%) (217-100%) Yes 54% 65% 41% No 46 34 59 No answer * 1 - Total Men Women Respondents who drink tea, (367-100%) (179-100%) (188-100%) Yes 57% 63% 52% No 42 36 47 No answer 1 1 1 * Less than 0.5% Question 17: How many teaspoons of sugar do you use with coffee? With tea? Respondents who use sugar in Total Men Women coffee: (239=100%) (149=1C0%) (90=100%) Use: Less than 1 teaspoon 26% 26% 25% 1 teaspoon 40 47 39 l 1/2 teaspoons 4 4 3 2 teaspoons 29 27 32 More than 2 teaspoons 1 2 - No answer * - 1 Total Men Women Respondents who use sugar in tea: (210=100%) (112=100%) (98=100%) Use : Less than 1 teaspoon 30% 29% 30% 1 teaspoon 37 36 37 1 1/2 teaspoons 2 3 2 2 teaspoons 28 27 29 Over 2 teaspoons 2 2 2 No answer 1 3 - * Less than 0.5% Source. https://www.industrydocuments.ucsf.edu/docs//pdl0226 Question 18a: Do you ever eat candy? b: Would you say you eat it frequently or just occasionally? c: If not frequently - Is it because you don't like it, or because you think it is fattening, or do you have another reason? Total Men Women Total Respondents (506-100%) (249-100%) (257-100%) Eat candy 85% 84% 86% Do not eat candy 15 16 14 Total Men Women Respondents who eat candy (430-100%) (208-100%) (22-100%) Eat it occasionally 76% 76% 76% Eat it frequently 24 24 24 Respondents who do not eat Total* Men* Women candy frequently (326-100%) (158-100%) (168-100%) Reasons: Don't like it 40% 47% 33% Think it is fattening 29 16 40 Don't creve sweets, don't care for it too much, can take it or leave it, no special desire, don't care for it too often 11 13 10 Don't buy often, just don't have it around to tempt, doesn't last long 8 11 5 Hard on teeth, bad for teeth 6 3 8 Not good for me, doesn't agree with me 3 2 5 Diet - diabetic 9 1 1 All other 4 6 2 *Adds to more than 100% because some respondents gave more than one answer. Source: htps.//www.industrydocuments.ucsf.edu/docs//pdl0226

How many people doesn't follow balance diet and eat too much meat ?

lpdl0226

lpdl0226_p16, lpdl0226_p17, lpdl0226_p18, lpdl0226_p19, lpdl0226_p20, lpdl0226_p21, lpdl0226_p22, lpdl0226_p23, lpdl0226_p24, lpdl0226_p25, lpdl0226_p26, lpdl0226_p27

(5), 5

Question 6a: Are there any foods you don't eat at all because you are afraid they are too fattening? Total Men Women Total Respondents (506=100%) (2119=100%) (25%==1UUY) Yes 15% 8% 21% No 85 92 79 Question 6b: If yes, which foods? Total Men Women Respondents who have (506=100%) (2114=100%) (257=100%) quit eating certain foods Fats - animal or vege- 6% 3% 8% table butter, cream, whipped cream, whole milk, fat meat, fried foods Desserts, pies, pastries, 5 2 7 cake, cookies, pudding, ice cream. Sugar 4 3 5 Potatoes 4 3 4 Bread, rolls 2 2 1 Candy 1 * 2 Starches, macaroni, spag- 1 * 2 hetti, noodles, etc. Sweets, sweet food 1 1 2 Liquor, soft drinks * - 1 Beans, corn * * * All other 2 2 2 Less than 0.5% Source. htps://www.industrydocuments.ucst.edu/docs/lpdl022 Question 7a: Do you think the general health of people is harmed more by : eating too much sugar; eating too much salt or by eating too much meat? Total* Men* Women* Total Respondents (506=100%) (249=100%) (257=100%) Eating too much sugar 53% 52% 54% Eating too much salt 34 29 40 Eating too much meat 6 5 7 Don't, know 9 12 7 None of these 11 10 11 *Adds to more than 100% because some respondents gave more than one answer. Question 7b: Why do you say that? Those who say eating too much sugar Total* Men* Women* is harmful, (268=100%) (130=100%) (138=100%) Reasons: Fattening, makes one fat, causes overweight 32% 32% 33% Causes diabetes 31 28 33 Bad for teeth 16 14 18 Bad for blood, gets in blood stream, thins blood, blood turns to water 7 8 7 Causes overweight which in turn causes ailments, affects organs 6 8 4 Bad for general health, causes ailments 4 2 7 Causes heart trouble, hard on heart 4 2 6 Not necessary, can get along without it, not much food value, no protein 3 4 1 Causes rash, skin blemishes 2 2 2 Causes high blood pressure 1 2 1 Causes acid condition 1 2 1 Too much isn't good, too much of anything isn't good 9 7 11 All other 2 2 1 Don't know 2 4 - *Adds to more than 100% because some respondents gave more than one answere Question 7b Continued Source: Question 7b (Cont'd) Why do you say that? Total* Men* Women* Those who say too much salt is harmful (174=100%) (71=100%) (103=100%) REASONS: Retains water in body, upsets water balance 21% 15% 25% Causes high blood pressure 21 20 21 Fattening, creates fat 16 8 21 Causes heart trouble, bad for the heart 16 18 15 Causes hardening of the arteries, bad for arteries 11 11 11 Bad for blood, acts on blood 6 4 8 Makes one drink too much water 5 3 7 Just bad for you 5 6 4 Bad for kidney 3 4 3 Causes bloating, swelling 2 1 3 Has no food value, no protein 2 4 - Too much isn't good, too much of anything isn't good 10 10 11 All other 9 10 8 Don't know, no answer 6 8 4 Adds to more than 100% because some respondents gave more than one answer. Question 7b Continued Source: https://www.industrydocuments.ucsf.edu/docs/lpdl0226 Question Tb why do you say that? Those who say eating too much meat Total* Men* Women* is harmful (31) (13) (18) Reasons: Doesn't balance diet, eat too much meat not other foods, too much protein (5) (3) (2) Fattening (5) (2) (3) Most people eat more than body requires, eat too much meat (4) (4) (-) Causes high blood pressure (4) (1) (3) Can harm blood (3) (1) (2) Harmful to body (2) (-) (2) Hurts stomach (1) (-) (1) Causes heart trouble (1) (-) (1) Too much just isn't good (7) (3) (4) Don't know (1) ( ) (1) Actual numbers are shown rather than percentages since totals are too small to express in percentage form. Question 8: Have you ever heard of "Saccharine"? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Yes 91% 90% 92% No 9 10 8 Question 9: Have you ever used "Saccharine"? Total Men Tomen Respondents who have ever (460=100%) (224=100%) (236=100%) heard "Saccharine" Yes 35% 33% 37% No 65 67 63 Question 10: Are you currently using "Saccharine"? Total Men Women Respondents who have used (161=100%) (74=100%) (87=100%) " Saccharine" Yes 24% 28% 20% No 76 72 80 Source: https://www.industrydocuments.ucsf.edu/docs//pdl0226 Question 11: Have you ever heard of "Sucaryl"? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Yes 54% 45% 62% No 43 49 37 No answer 3 5 1 Question 12: Have you ever used "Sucaryl"? Total Men Women Respondents who have ever used (274=100%) (115=100%) (159=100%) 11 Sucaryl" Yes 25% 21% 27% No 75 78 73 Don't know * 1 - Question 13: Are you currently using "Sycaryl"? Total Men Women Respondents who have used (67=100%) (24=100%) (43=100%) "Sycaryl" Yes 45% 42% 47% No 54 58 51 No answer 1 - 2 *Less than 0.5% Source: Question 14a: Have you ever been on a reducing diet? Total Men Women Total Respondents (506-100%) (249=100%) (257-100%) Yes 26% 16% 35% No 74 84 65 Question 14b: What did your diet say about how much sugar you should use? Total Men Women Respondents who have been on (132=100%) (41=100%) (91=100%) reducing diet Comments: No sugar at all, cut it out eventually, use only saccharine 30% 24% 33% Limit amount, cut down usage, use as little as possible, just enough to sweeten beverages 24 24 24 Sugar not specifically mentioned by doctor, just cut down on sweets, fats, starches, eat less of every- thing, certain calorie count 21 32 17 Cut down to 1/2 to 1 teaspoon a day 11 7 12 Cut down to 2 or 3 teaspoons a day 2 - 3 Put self on diet, own diet, not Doctor's orders 10 13 8 Don't know - No answer 2 - 3 Source: https://www.industrydocuments.ucsf.edu/docs/lpdl0226 Question 15: Do you drink Coffee or Tea? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Drink: Coffee 22% 24% 20% Tea 6 4 9 Both 66 68 64 Neither 6 4 7 Question 16: Do you use sugar with the Coffee or Tea you drink? Total Men Women Respondents who drink coffee: (446-100%) (229-100%) (217-100%) Yes 54% 65% 41% No 46 34 59 No answer * 1 - Total Men Women Respondents who drink tea, (367-100%) (179-100%) (188-100%) Yes 57% 63% 52% No 42 36 47 No answer 1 1 1 * Less than 0.5% Question 17: How many teaspoons of sugar do you use with coffee? With tea? Respondents who use sugar in Total Men Women coffee: (239=100%) (149=1C0%) (90=100%) Use: Less than 1 teaspoon 26% 26% 25% 1 teaspoon 40 47 39 l 1/2 teaspoons 4 4 3 2 teaspoons 29 27 32 More than 2 teaspoons 1 2 - No answer * - 1 Total Men Women Respondents who use sugar in tea: (210=100%) (112=100%) (98=100%) Use : Less than 1 teaspoon 30% 29% 30% 1 teaspoon 37 36 37 1 1/2 teaspoons 2 3 2 2 teaspoons 28 27 29 Over 2 teaspoons 2 2 2 No answer 1 3 - * Less than 0.5% Source. https://www.industrydocuments.ucsf.edu/docs//pdl0226 Question 18a: Do you ever eat candy? b: Would you say you eat it frequently or just occasionally? c: If not frequently - Is it because you don't like it, or because you think it is fattening, or do you have another reason? Total Men Women Total Respondents (506-100%) (249-100%) (257-100%) Eat candy 85% 84% 86% Do not eat candy 15 16 14 Total Men Women Respondents who eat candy (430-100%) (208-100%) (22-100%) Eat it occasionally 76% 76% 76% Eat it frequently 24 24 24 Respondents who do not eat Total* Men* Women candy frequently (326-100%) (158-100%) (168-100%) Reasons: Don't like it 40% 47% 33% Think it is fattening 29 16 40 Don't creve sweets, don't care for it too much, can take it or leave it, no special desire, don't care for it too often 11 13 10 Don't buy often, just don't have it around to tempt, doesn't last long 8 11 5 Hard on teeth, bad for teeth 6 3 8 Not good for me, doesn't agree with me 3 2 5 Diet - diabetic 9 1 1 All other 4 6 2 *Adds to more than 100% because some respondents gave more than one answer. Source: htps.//www.industrydocuments.ucsf.edu/docs//pdl0226

How many men doesn't follow balance diet and eat too much meat ?

lpdl0226

lpdl0226_p16, lpdl0226_p17, lpdl0226_p18, lpdl0226_p19, lpdl0226_p20, lpdl0226_p21, lpdl0226_p22, lpdl0226_p23, lpdl0226_p24, lpdl0226_p25, lpdl0226_p26, lpdl0226_p27

(3), 3

Question 6a: Are there any foods you don't eat at all because you are afraid they are too fattening? Total Men Women Total Respondents (506=100%) (2119=100%) (25%==1UUY) Yes 15% 8% 21% No 85 92 79 Question 6b: If yes, which foods? Total Men Women Respondents who have (506=100%) (2114=100%) (257=100%) quit eating certain foods Fats - animal or vege- 6% 3% 8% table butter, cream, whipped cream, whole milk, fat meat, fried foods Desserts, pies, pastries, 5 2 7 cake, cookies, pudding, ice cream. Sugar 4 3 5 Potatoes 4 3 4 Bread, rolls 2 2 1 Candy 1 * 2 Starches, macaroni, spag- 1 * 2 hetti, noodles, etc. Sweets, sweet food 1 1 2 Liquor, soft drinks * - 1 Beans, corn * * * All other 2 2 2 Less than 0.5% Source. htps://www.industrydocuments.ucst.edu/docs/lpdl022 Question 7a: Do you think the general health of people is harmed more by : eating too much sugar; eating too much salt or by eating too much meat? Total* Men* Women* Total Respondents (506=100%) (249=100%) (257=100%) Eating too much sugar 53% 52% 54% Eating too much salt 34 29 40 Eating too much meat 6 5 7 Don't, know 9 12 7 None of these 11 10 11 *Adds to more than 100% because some respondents gave more than one answer. Question 7b: Why do you say that? Those who say eating too much sugar Total* Men* Women* is harmful, (268=100%) (130=100%) (138=100%) Reasons: Fattening, makes one fat, causes overweight 32% 32% 33% Causes diabetes 31 28 33 Bad for teeth 16 14 18 Bad for blood, gets in blood stream, thins blood, blood turns to water 7 8 7 Causes overweight which in turn causes ailments, affects organs 6 8 4 Bad for general health, causes ailments 4 2 7 Causes heart trouble, hard on heart 4 2 6 Not necessary, can get along without it, not much food value, no protein 3 4 1 Causes rash, skin blemishes 2 2 2 Causes high blood pressure 1 2 1 Causes acid condition 1 2 1 Too much isn't good, too much of anything isn't good 9 7 11 All other 2 2 1 Don't know 2 4 - *Adds to more than 100% because some respondents gave more than one answere Question 7b Continued Source: Question 7b (Cont'd) Why do you say that? Total* Men* Women* Those who say too much salt is harmful (174=100%) (71=100%) (103=100%) REASONS: Retains water in body, upsets water balance 21% 15% 25% Causes high blood pressure 21 20 21 Fattening, creates fat 16 8 21 Causes heart trouble, bad for the heart 16 18 15 Causes hardening of the arteries, bad for arteries 11 11 11 Bad for blood, acts on blood 6 4 8 Makes one drink too much water 5 3 7 Just bad for you 5 6 4 Bad for kidney 3 4 3 Causes bloating, swelling 2 1 3 Has no food value, no protein 2 4 - Too much isn't good, too much of anything isn't good 10 10 11 All other 9 10 8 Don't know, no answer 6 8 4 Adds to more than 100% because some respondents gave more than one answer. Question 7b Continued Source: https://www.industrydocuments.ucsf.edu/docs/lpdl0226 Question Tb why do you say that? Those who say eating too much meat Total* Men* Women* is harmful (31) (13) (18) Reasons: Doesn't balance diet, eat too much meat not other foods, too much protein (5) (3) (2) Fattening (5) (2) (3) Most people eat more than body requires, eat too much meat (4) (4) (-) Causes high blood pressure (4) (1) (3) Can harm blood (3) (1) (2) Harmful to body (2) (-) (2) Hurts stomach (1) (-) (1) Causes heart trouble (1) (-) (1) Too much just isn't good (7) (3) (4) Don't know (1) ( ) (1) Actual numbers are shown rather than percentages since totals are too small to express in percentage form. Question 8: Have you ever heard of "Saccharine"? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Yes 91% 90% 92% No 9 10 8 Question 9: Have you ever used "Saccharine"? Total Men Tomen Respondents who have ever (460=100%) (224=100%) (236=100%) heard "Saccharine" Yes 35% 33% 37% No 65 67 63 Question 10: Are you currently using "Saccharine"? Total Men Women Respondents who have used (161=100%) (74=100%) (87=100%) " Saccharine" Yes 24% 28% 20% No 76 72 80 Source: https://www.industrydocuments.ucsf.edu/docs//pdl0226 Question 11: Have you ever heard of "Sucaryl"? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Yes 54% 45% 62% No 43 49 37 No answer 3 5 1 Question 12: Have you ever used "Sucaryl"? Total Men Women Respondents who have ever used (274=100%) (115=100%) (159=100%) 11 Sucaryl" Yes 25% 21% 27% No 75 78 73 Don't know * 1 - Question 13: Are you currently using "Sycaryl"? Total Men Women Respondents who have used (67=100%) (24=100%) (43=100%) "Sycaryl" Yes 45% 42% 47% No 54 58 51 No answer 1 - 2 *Less than 0.5% Source: Question 14a: Have you ever been on a reducing diet? Total Men Women Total Respondents (506-100%) (249=100%) (257-100%) Yes 26% 16% 35% No 74 84 65 Question 14b: What did your diet say about how much sugar you should use? Total Men Women Respondents who have been on (132=100%) (41=100%) (91=100%) reducing diet Comments: No sugar at all, cut it out eventually, use only saccharine 30% 24% 33% Limit amount, cut down usage, use as little as possible, just enough to sweeten beverages 24 24 24 Sugar not specifically mentioned by doctor, just cut down on sweets, fats, starches, eat less of every- thing, certain calorie count 21 32 17 Cut down to 1/2 to 1 teaspoon a day 11 7 12 Cut down to 2 or 3 teaspoons a day 2 - 3 Put self on diet, own diet, not Doctor's orders 10 13 8 Don't know - No answer 2 - 3 Source: https://www.industrydocuments.ucsf.edu/docs/lpdl0226 Question 15: Do you drink Coffee or Tea? Total Men Women Total Respondents (506=100%) (249=100%) (257=100%) Drink: Coffee 22% 24% 20% Tea 6 4 9 Both 66 68 64 Neither 6 4 7 Question 16: Do you use sugar with the Coffee or Tea you drink? Total Men Women Respondents who drink coffee: (446-100%) (229-100%) (217-100%) Yes 54% 65% 41% No 46 34 59 No answer * 1 - Total Men Women Respondents who drink tea, (367-100%) (179-100%) (188-100%) Yes 57% 63% 52% No 42 36 47 No answer 1 1 1 * Less than 0.5% Question 17: How many teaspoons of sugar do you use with coffee? With tea? Respondents who use sugar in Total Men Women coffee: (239=100%) (149=1C0%) (90=100%) Use: Less than 1 teaspoon 26% 26% 25% 1 teaspoon 40 47 39 l 1/2 teaspoons 4 4 3 2 teaspoons 29 27 32 More than 2 teaspoons 1 2 - No answer * - 1 Total Men Women Respondents who use sugar in tea: (210=100%) (112=100%) (98=100%) Use : Less than 1 teaspoon 30% 29% 30% 1 teaspoon 37 36 37 1 1/2 teaspoons 2 3 2 2 teaspoons 28 27 29 Over 2 teaspoons 2 2 2 No answer 1 3 - * Less than 0.5% Source. https://www.industrydocuments.ucsf.edu/docs//pdl0226 Question 18a: Do you ever eat candy? b: Would you say you eat it frequently or just occasionally? c: If not frequently - Is it because you don't like it, or because you think it is fattening, or do you have another reason? Total Men Women Total Respondents (506-100%) (249-100%) (257-100%) Eat candy 85% 84% 86% Do not eat candy 15 16 14 Total Men Women Respondents who eat candy (430-100%) (208-100%) (22-100%) Eat it occasionally 76% 76% 76% Eat it frequently 24 24 24 Respondents who do not eat Total* Men* Women candy frequently (326-100%) (158-100%) (168-100%) Reasons: Don't like it 40% 47% 33% Think it is fattening 29 16 40 Don't creve sweets, don't care for it too much, can take it or leave it, no special desire, don't care for it too often 11 13 10 Don't buy often, just don't have it around to tempt, doesn't last long 8 11 5 Hard on teeth, bad for teeth 6 3 8 Not good for me, doesn't agree with me 3 2 5 Diet - diabetic 9 1 1 All other 4 6 2 *Adds to more than 100% because some respondents gave more than one answer. Source: htps.//www.industrydocuments.ucsf.edu/docs//pdl0226

Who is the Chairman of United States Cane Sugar Refiners' Association ?

rxfl0226

rxfl0226_p0, rxfl0226_p1, rxfl0226_p2, rxfl0226_p3, rxfl0226_p4, rxfl0226_p5, rxfl0226_p6, rxfl0226_p7, rxfl0226_p8, rxfl0226_p9, rxfl0226_p10

MR. ELLSWORTH BUNKER

POSITION OF THE UNITED STATES CANE SUGAR REFINING INDUSTRY ON THE EXTENSION OF THE SUGAR QUOTA ACT The Sugar Bill H. R. 9654 would extend the Sugar Act of 1937 with its quotas on raw and refined sugar until December 31, 1941. x Statement of Mr. ELLSWORTH BUNKER, Chairman United States Cane Sugar Refiners' Association at HEARINGS before the SENATE FINANCE COMMITTEE WASHINGTON, D. C. OCTOBER 2, 1940 Source: https:/lwww.industrydocuments.ucsf.edu/docs/rxfl0226 HEARINGS BEFORE THE SENATE FINANCE COMMITTEE ON SUGAR BILL H. R. 9654 Statement Made by the United States Cane Sugar Refiners' Association, MR. ELLSWORTH BUNKER, Chairman October 2, 1940 Industry and Representation The refining of raw cane sugar has been carried on in this country for over 200 years, and today this national industry is located in Massachusetts, New York, New Jersey, Pennsylvania, Maryland, Georgia, Louisiana, Texas and California, and also in Illinois, Wisconsin and Indiana. The 12 refining states represent over 50% of the population of the United States. The United States Cane Sugar Refiners' Association has a membership of 9 refining companies which operate about 14 plants. These refineries account for about 70% of the present total conti- nental output of about 4,200,000 short tons of refined cane sugar. Position on Bill In 1934 we testified before Congress that our industry would cooperate in every way with the Government in setting up a quota program which would stabilize the sugar industry in all of its branches. This was our position in 1937 and it remains our position in 1940. Specifically, we do not oppose the enactment of the Sugar Bill, H. R. 9654, in the form in which it was passed by the House of Representatives on June 20. But we must urge you to oppose any amendment to the Sugar Bill which directly or indirectly would decrease our present refining quota, or which would increase the quota for any other refining group without allowing us to share proportionately in such increase. You will recall that the Sugar Act of 1937, which H. R. 9654 would extend for one year, divides the total refined sugar market 3 Source: https://www.industrydocuments.ucsf.edu/docs/rxfl0226 among the three refining groups in approximately the following amounts: Tons refined sugar Continental refiners of raw cane sugar 4,200,000 United States beet sugar factories 1,500,000 Tropical plantation refineries (Cuba, Hawaii, Puerto Rico and the Philippines) 600,000 6,300,000 The Quota System Has Not Improved the Position of Refining Labor The U. S. cane sugar refining industry gives work to about 18,000 men and women who have a gross wage income of about $29,000,000 a year. These employees receive the highest wage scale of any branch of the American sugar system. With the excep- tion of the refineries in two southern states, the industry is 100% unionized, collective bargaining being in force with units of the American Federation of Labor and the Congress for Industrial Organization. Since 1934, the amount of work available to the men and women in the cane sugar refining industry each year has been on the average about 1,000,000 tons less than the work available in 1925 and 1926. On the other hand, labor in beet sugar refining and labor employed in the tropical refineries has had, under the Sugar Act, 1,000,000 tons more work each year than it had in 1925 and 1926. Thus, as compared with the year 1926, the volume of work in our industry has shrunk by about 20%, whereas the com- bined work in the other two refining groups has increased by 100%. But our industry has not laid off 20% of its employees, nor has there been a 20% decrease in the hours of work made available for the men. The men have been protected, as far as possible, by a general policy of spreading work, and the net result is that there are more man-hours of employment than would normally be neces- sary to refine the reduced output of sugar. Of course this brings an increase in operating expenses, an increase which is reflected in reduced earnings for the investor. But even under a spread-work policy and with high minimum wages of between 65c and 700 an hour, it is difficult for the worker to earn a total yearly wage 4 Source: https://www.industrydocuments.ucsf.edu/docs/rxfl0226 sufficient to furnish his family with the necessaries of life on a decent American scale. Labor and management in the domestic cane sugar refining industry are making a sincere attempt to make available as much work as possible. Under these circumstances, it can be understood why we must vigorously oppose any further inroads upon our volume of output through any modification of the existing quotas. The Quota System Has Not Improved the Position of the Refining Investor The 70,000 investors in the domestic cane sugar refining in- dustry have been hard hit since 1934. The record clearly shows that these investors, like the refinery employees, have not shared in the benefits which other sugar groups have enjoyed. There is only one cane sugar refining company in the United States which reports having paid dividends on its common stock continuously since I934. And whereas the market value of our industry was $232,000,000 when the first Sugar Act went into effect in July, 1934, the value today, as measured by the price of shares of stock currently quoted on the open market, is around $112,000,000, a decline of 50%. In the 6 years under the Sugar Act, our industry has earned on an average only 3,500,000 a year, or about 1.8% on its investment. Some of the refining companies have had losses in this period. Investors in the other important branches of the American sugar industry have fared much better; for example their enter- prises have earned a net income, as a percent of capital, of from about 10% in the case of Puerto Rico to about 6% in the case of Hawaii. Reasons for the Decline of the Position of the Industry The employees and investors in our industry have not benefited under the Sugar Act for at least three reasons: In the first place, our industry does not receive, directly or indirectly, any of the income protection which is afforded other American sugar groups. Our refining industry neither receives a price protection through tariffs or quotas, nor does it receive cash subsidies from the Federal Treasury. On the other hand, we must compete with the domestic beet sugar refiners and the American tropical cane sugar refiners who do receive such benefits. 5 Source: https://www.industrydocuments.ucsf.edu/docs/rxfl0226 Secondly, beet sugar refiners and the refiners in the American tropics have received marketing quotas for their refined sugar which have permitted them to operate at a full volume of output. You will recall that the Sugar Acts of 1934 and 1937 assigned the refiners in Hawaii and Puerto Rico a yearly marketing quota equal to their previous maximum deliveries, and the beet sugar factories received a refined sugar quota somewhat higher than their marketings in any previous year. On the other hand, the continental cane sugar re- fining industry received a quota of about 1,000,000 tons a year less than its previous maximum yearly sales, and the industry now oper- ates at something less than 60% of capacity. Thirdly, the refining industry has had serious losses from the sharp fluctuations in sugar prices which have arisen under the quota system. The refining industry purchases about $250,000,000 of raw sugar a year, and, to maintain an adequate supply for consum- ers, it must always carry a substantial part of that sugar as inventory, either in a raw or refined form. Sudden and unpredictable changes in prices, resulting largely, although not entirely, from shifts in the quota policy of the Department of Agriculture, have made it diffi- cult for the refiners to purchase their raw sugar in an orderly man- ner and to avoid severe inventory losses. The Present Bill Will Merely Continue the Status as of September, 1937 The Sugar Bill, H. R. 9654, will not improve the position of the employees and investors in the continental cane sugar refining industry. The bill merely continues the 1937 Sugar Act in the form in which it was written by the Congress. Of course, we are extremely gratified that the House of Representatives, by a vote of 134 to 20, restored the quotas on refined sugar from Hawaii and Puerto Rico. Without that provision, we and our employees could not possibly go along with this bill. But even with this provision, there is noth- ing in the bill which would provide relief for the disadvantages presently suffered by our industry under the quota system. We continue to have no tariff protection as against our most important tropical competitor, the Cuban refiners, and of course, we do not receive, nor da we ask for, cash subsidies from the Fed- eral Treasury. There is nothing in the bill which would assure the refining industry of more stable prices and less risk of inventory 6 Source: https://www.industrydocuments.ucsf.edu/docs/rxfl0226 loss. And finally, the bill would not increase the quota assigned to our industry in previous quota legislation, which forces us to operate at a depressed level of output. On the other hand, about 600,000 tons of refined sugar produced by tropical labor will con- tinue to come into this country every year, and the beet sugar fac- tories will continue to have a marketing quota which will permit them to produce and sell a normal full volume of sugar. No Increase in the Quota for Tropical Refined Sugar This spring, when the House of Representatives held public hearings upon the sugar bills, there was little objection on the part of the sugar industry generally to the continuation of the general quota plan for one year, but two important deviations from it were proposed. The first proposal was made by the sugar industries of Hawaii and Puerto Rico for an unlimited quota in their sales of refined sugar to continental United States. Our industry vigorously opposed this proposal to eliminate the refined sugar quotas which Congress provided in the Sugar Acts of 1934, 1936, and 1937. In our testimony, we stressed the following points: First, any increase in tropical refining for this market auto- matically brings a decrease in refining in continental United States. The reason for this is that the continental refiners are prohibited from buying their raw material, raw sugar, except from those areas and in those amounts prescribed by the Sugar Act. Hawaii and Puerto Rico are given a monopoly on supplying the refiners with about 1,600,000 tons of their raw sugar requirements. If those islands were permitted to retain this raw sugar for refining, the continental refiners would not be allowed under the quota law to purchase their raw material from any other source to fill the gap, and consequently, the output of our industry would decline by ap- proximately 33%. To our knowledge, no other American industry operates under a comparable prohibition. For example, a roaster of coffee or a tire manufacturer is free to import any amount of coffee or rubber from any source at any price. Secondly, the refiners in the American tropics are sugarcane growers and, as such, they have received their share of the $522,- 000,000 direct and indirect subsidy which has been paid to Hawaii and Puerto Rico by the American Treasury and consumers since 1934- We believe it would be both unfair and contrary to the 7 Source: https:/lwww.industrydocuments.ucsf.edu/docs/rxfl022 theory of the quota system to permit the heavily subsidized refiners in the American tropics to expand their operations at the expense of the non-subsidized continental industry. Thirdly, labor conditions in the tropics are fundamentally dif- ferent from those in the United States. The substantial difference in wage scales is well-known. The Wagner Act does not apply to Puerto Rico, and collective bargaining, according to the Depart- ment of Agriculture, is not a part of the plantation system in Hawaii. And although the Wages and Hours Act applies to Hawaii, the Act has not full application to Puerto Rico, inasmuch as an amendment to the Act last spring opened the way for an exemption, through Administrative action, from the payment of the minimum wages required to be paid in continental United States. (Sec. 3 (c) Pub. Res. 88.) An Increase in Refined Beet Sugar Would Reduce Refined Cane Sugar Under a quota system, an increase in the quota for beet sugar would bring a decrease in the quota assigned to the raw sugar pro- ducers in the tropics. This would mean, other things remaining equal, that our industry could obtain less raw cane sugar and obvi- ously, with less raw material available, there would be less refining. It could hardly be expected that any American industry would look with favor upon any legislation which would arbitrarily reduce its volume of business, especially while increasing that of its competitors. The quota system enacted in 1934 provided for a sharing of the American market among the various producing and refining groups in accordance with a formula deemed to be fair by Congress. The underlying philosophy of the quota system was that continental beet sugar producers were to receive price protection and cash sub- sidies which would give them a fair or parity income upon their allotted production. To qualify for these subsidies, farmers were not asked to reduce their production, but merely to forego the "right" to further expand their output. We believe that it is self- contradictory to establish a quota system and then permit an expan- sion of the quota of any one group at the expense of any other group. An alternative to the present quota system is to return to a tariff system, such as that existing before 1934. The tariff system 8 Source: https://www.industrydocuments.ucsf.edu/docs/rxfl0226 is a freer system in the sense that there is no quota limitation upon tariff be the growth system cash subsidies of would any give group, paid everyone domestic anyone. the Under right foreign. to the expand, present But although there system or the would no to the truth is that cash subsidies are in effect paid to an expanding produc- tion, or at least they operate to promote expansion. For several years our refining industry has suffered the disadvantage of having no tariff protection, while our chief competitors enjoy high protection. We do not believe that a continuation of the status quo for quotas will be harmful to the beet sugar industry. The official record shows that since 1934 American beet farmers, with cash sub- sidies, have received approximately full fair exchange for their product and, unlike other farmers, they have not had to reduce their output. No evidence is before us to show that a continuation of the present beet quota would work a positive hardship upon any beet sugar factory. But there is plenty of evidence to show that an ex- pansion of that quota would work a definite hardship upon the men and women in our industry, who are now only partially employed, and upon the investors in our industry, who have suffered substan- tial losses in recent years. Expansion of Beet Quota Cannot Be Defended on Grounds of National Defense Some persons who advocate an expansion of the beet sugar quota maintain that such expansion is necessary in order to assure this country of an adequate wartime supply of sugar. As we view it, an expansion in the beet sugar industry in 1940 cannot be sup- ported on the grounds of national defense. It is true that there was a slight reduction in the consumption of sugar in the last war, but this came about only because the United States had to send some 2,000,000 tons of sugar to its Allies- England, France and Italy. There was a substantial increase in the total supply of refined sugar available in this country in 1917 and 1918. Some rationing took place in sugar-as in meat, flour, and other food products-only because this country had assumed the enormous burden of feeding millions of persons in war-stricken Europe. The United States Food Administration, controlling the entire sugar industry, sought larger sugar supplies for Europe and made every attempt to expand domestic production. But the record 9 Source: https://www.industrydocuments.ucsf.edu/docs/rxfl0226 shows that during the last World War no expansion of production took place in the beet sugar industry or in the cane sugar industries in Louisiana, Hawaii or Puerto Rico. Cuba, alone, had the ability to increase her production of raw sugar and this sugar was imported and refined by our industry under the direction of the Food Ad- ministration. A serious sugar shortage in this country was thereby avoided. And when sugar prices skyrocketed with other foods in the general speculative mania of 1920, due in the case of sugar to pre- mature removal of Government control, the continental refiners again played a leading part in maintaining adequate supplies. There was actually more refined sugar available for consumption in this country in 1920 than there was in any previous year. But again this increase in supply did not come from continental producers, but from the substantial expansion which took place in the importations by the continental refiners of overseas raw sugar. Unless prohibited by legal obstacles, unduly high domestic sugar prices will always bring foreign sugars into this country in times of stress. Unlike 1917, Present and Prospective Sugar Supplies Are Ample Today the stocks and prospective supplies of sugar in the Uni- ted States are at record-breaking levels; supplies of sugar in the Western Hemisphere and throughout the world are ample. These generous supplies of sugar are reflected in the fact that the price of raw sugar, outside the American quota protective wall, is now less than a cent a pound, whereas in 1915, one year after the out- break of the first World War, the price was over 3c a pound. It is the general concensus of opinion in this country, we be- lieve, that if this nation becomes involved in the second World War, it will be to defend our legitimate interests in the Western Hemi- sphere. If war comes to us, we will not be called upon to send sugar to the Latin American countries because these countries now produce more sugar than they consume. In fact, the Western Hemi- sphere has an exportable surplus of sugar of some 1,000,000 tons a year. Along with wheat, meat, cotton, tobacco, and coffee, there is an abundance of sugar in the Western Hemisphere. Even if the supply of Hawaiian and Philippine sugars were entirely cut off, there would be no shortage of sugar in this country. Cuba expanded her production by over 1,000,000 tons in the last 10 Source: https://www.industrydocuments.ucsf.edu/docs/rxfl0226 World War, and today she has the capacity to expand her output by 2,000,000 to 3,000,000 tons. Some expansion would no doubt occur in other islands in the Western Hemisphere, probably Puerto Rico and Santo Domingo. And the continental refining industry has, at the present time, the capacity to refine enough tropical raw sugar to supply all the needs of this country. These are probably the reasons why the expert of the War Department, in testimony in February, 1939, before the House Committee on Military Affairs and War Materials, did not recommend the accumulation of sugar supplies or the enlargement of present production capacity in con- tinental United States. The Quota System Gives Subsidies to Refiners in the American Tropics My final point relates to the claim made by the Hawaiian and Puerto Rican sugar refiners that, as growers, they do not really re- ceive cash subsidies from the Federal Treasury. In testimony before the House Committee on Agriculture, spokesmen for Hawaii and Puerto Rico maintained that the $78,000,000 received in cash sub- sidies since 1934 were not subsidies at all, but merely a rebate to them of taxes taken out of the proceeds of the sale of their sugar. As we see it, the facts clearly indicate otherwise. The cost of pro- tecting sugar producers, including those in Hawaii and Puerto Rico, that is to say, the cost of maintaining for them a domestic price level which is very substantially above the free world market level, always has been and always will be paid for by American consumers and taxpayers. It is not paid by the producers themselves. A so- called self-liquidating subsidy system for sugar is a clear contradic- tion of terms. The continental cane sugar refining industry pays about $45,000,000 a year as a manufacturer's sale tax upon refined sugar. This tax is a cost of doing business, and, as in the case of other costs, the refiners must look to the consumer to recoup this outlay. This $45,000,000 goes into the Federal Treasury and, in turn, is paid out as subsidies to American sugar producers, including those in Hawaii and Puerto Rico. This cash is a part of the total contri- bution of from $300,000,000 to $350,000,000 which, according to the Secretary of Agriculture, is made by consumers each year to assist the sugar producing industry. The quota-subsidy plan works as follows: 11 Source: https://www.industrydocuments.ucsf.edu/docs/rxfl0226 The sugar quotas raise and maintain the price! of sugar in the United States well above the world price, becausé quotas artificially limit the quantities of sugar which can come to the market. This gives the sugar producer a substantial price protection. In addition, the grower receives a direct cash bounty from the Treasury. Since the Sugar Act went into effect in 1934, the total protection which has been realized by sugar producers has been on the average 2.51C per pound, or an ad valorem equivalent of 214%. This total pro- tection per pound is 20% higher than the tariff on raw sugar under the Tariff Act of 1930, and is the highest in the history of the American sugar producing industry. We do not oppose equitable treatment for American sugar producers, whether in continental United States or in Hawaii or Puerto Rico, but we do maintain that the receipt of cash subsidies by the refiners in Hawaii and Puerto Rico gives them a competitive advantage over our own industry which is non-subsidized and also without tariff protection. We believe these facts should be recog- nized by Congress in its determination of our national sugar policy. Conclusion In conclusion, we urge that if the quota-subsidy system is to be continued, then there should be no increase in the quotas for the tropical refining industry or the beet sugar industry and that H. R. 9654 should be passed in its present form. 317 12 Source: https://www.industrydocuments.ucsf.edu/docs/rxfl0226

Which act is extended by "The sugar Bill H.R .9654"?

rxfl0226

rxfl0226_p0, rxfl0226_p1, rxfl0226_p2, rxfl0226_p3, rxfl0226_p4, rxfl0226_p5, rxfl0226_p6, rxfl0226_p7, rxfl0226_p8, rxfl0226_p9, rxfl0226_p10

Sugar Act of 1937, SUGAR ACT OF 1937

POSITION OF THE UNITED STATES CANE SUGAR REFINING INDUSTRY ON THE EXTENSION OF THE SUGAR QUOTA ACT The Sugar Bill H. R. 9654 would extend the Sugar Act of 1937 with its quotas on raw and refined sugar until December 31, 1941. x Statement of Mr. ELLSWORTH BUNKER, Chairman United States Cane Sugar Refiners' Association at HEARINGS before the SENATE FINANCE COMMITTEE WASHINGTON, D. C. OCTOBER 2, 1940 Source: https:/lwww.industrydocuments.ucsf.edu/docs/rxfl0226 HEARINGS BEFORE THE SENATE FINANCE COMMITTEE ON SUGAR BILL H. R. 9654 Statement Made by the United States Cane Sugar Refiners' Association, MR. ELLSWORTH BUNKER, Chairman October 2, 1940 Industry and Representation The refining of raw cane sugar has been carried on in this country for over 200 years, and today this national industry is located in Massachusetts, New York, New Jersey, Pennsylvania, Maryland, Georgia, Louisiana, Texas and California, and also in Illinois, Wisconsin and Indiana. The 12 refining states represent over 50% of the population of the United States. The United States Cane Sugar Refiners' Association has a membership of 9 refining companies which operate about 14 plants. These refineries account for about 70% of the present total conti- nental output of about 4,200,000 short tons of refined cane sugar. Position on Bill In 1934 we testified before Congress that our industry would cooperate in every way with the Government in setting up a quota program which would stabilize the sugar industry in all of its branches. This was our position in 1937 and it remains our position in 1940. Specifically, we do not oppose the enactment of the Sugar Bill, H. R. 9654, in the form in which it was passed by the House of Representatives on June 20. But we must urge you to oppose any amendment to the Sugar Bill which directly or indirectly would decrease our present refining quota, or which would increase the quota for any other refining group without allowing us to share proportionately in such increase. You will recall that the Sugar Act of 1937, which H. R. 9654 would extend for one year, divides the total refined sugar market 3 Source: https://www.industrydocuments.ucsf.edu/docs/rxfl0226 among the three refining groups in approximately the following amounts: Tons refined sugar Continental refiners of raw cane sugar 4,200,000 United States beet sugar factories 1,500,000 Tropical plantation refineries (Cuba, Hawaii, Puerto Rico and the Philippines) 600,000 6,300,000 The Quota System Has Not Improved the Position of Refining Labor The U. S. cane sugar refining industry gives work to about 18,000 men and women who have a gross wage income of about $29,000,000 a year. These employees receive the highest wage scale of any branch of the American sugar system. With the excep- tion of the refineries in two southern states, the industry is 100% unionized, collective bargaining being in force with units of the American Federation of Labor and the Congress for Industrial Organization. Since 1934, the amount of work available to the men and women in the cane sugar refining industry each year has been on the average about 1,000,000 tons less than the work available in 1925 and 1926. On the other hand, labor in beet sugar refining and labor employed in the tropical refineries has had, under the Sugar Act, 1,000,000 tons more work each year than it had in 1925 and 1926. Thus, as compared with the year 1926, the volume of work in our industry has shrunk by about 20%, whereas the com- bined work in the other two refining groups has increased by 100%. But our industry has not laid off 20% of its employees, nor has there been a 20% decrease in the hours of work made available for the men. The men have been protected, as far as possible, by a general policy of spreading work, and the net result is that there are more man-hours of employment than would normally be neces- sary to refine the reduced output of sugar. Of course this brings an increase in operating expenses, an increase which is reflected in reduced earnings for the investor. But even under a spread-work policy and with high minimum wages of between 65c and 700 an hour, it is difficult for the worker to earn a total yearly wage 4 Source: https://www.industrydocuments.ucsf.edu/docs/rxfl0226 sufficient to furnish his family with the necessaries of life on a decent American scale. Labor and management in the domestic cane sugar refining industry are making a sincere attempt to make available as much work as possible. Under these circumstances, it can be understood why we must vigorously oppose any further inroads upon our volume of output through any modification of the existing quotas. The Quota System Has Not Improved the Position of the Refining Investor The 70,000 investors in the domestic cane sugar refining in- dustry have been hard hit since 1934. The record clearly shows that these investors, like the refinery employees, have not shared in the benefits which other sugar groups have enjoyed. There is only one cane sugar refining company in the United States which reports having paid dividends on its common stock continuously since I934. And whereas the market value of our industry was $232,000,000 when the first Sugar Act went into effect in July, 1934, the value today, as measured by the price of shares of stock currently quoted on the open market, is around $112,000,000, a decline of 50%. In the 6 years under the Sugar Act, our industry has earned on an average only 3,500,000 a year, or about 1.8% on its investment. Some of the refining companies have had losses in this period. Investors in the other important branches of the American sugar industry have fared much better; for example their enter- prises have earned a net income, as a percent of capital, of from about 10% in the case of Puerto Rico to about 6% in the case of Hawaii. Reasons for the Decline of the Position of the Industry The employees and investors in our industry have not benefited under the Sugar Act for at least three reasons: In the first place, our industry does not receive, directly or indirectly, any of the income protection which is afforded other American sugar groups. Our refining industry neither receives a price protection through tariffs or quotas, nor does it receive cash subsidies from the Federal Treasury. On the other hand, we must compete with the domestic beet sugar refiners and the American tropical cane sugar refiners who do receive such benefits. 5 Source: https://www.industrydocuments.ucsf.edu/docs/rxfl0226 Secondly, beet sugar refiners and the refiners in the American tropics have received marketing quotas for their refined sugar which have permitted them to operate at a full volume of output. You will recall that the Sugar Acts of 1934 and 1937 assigned the refiners in Hawaii and Puerto Rico a yearly marketing quota equal to their previous maximum deliveries, and the beet sugar factories received a refined sugar quota somewhat higher than their marketings in any previous year. On the other hand, the continental cane sugar re- fining industry received a quota of about 1,000,000 tons a year less than its previous maximum yearly sales, and the industry now oper- ates at something less than 60% of capacity. Thirdly, the refining industry has had serious losses from the sharp fluctuations in sugar prices which have arisen under the quota system. The refining industry purchases about $250,000,000 of raw sugar a year, and, to maintain an adequate supply for consum- ers, it must always carry a substantial part of that sugar as inventory, either in a raw or refined form. Sudden and unpredictable changes in prices, resulting largely, although not entirely, from shifts in the quota policy of the Department of Agriculture, have made it diffi- cult for the refiners to purchase their raw sugar in an orderly man- ner and to avoid severe inventory losses. The Present Bill Will Merely Continue the Status as of September, 1937 The Sugar Bill, H. R. 9654, will not improve the position of the employees and investors in the continental cane sugar refining industry. The bill merely continues the 1937 Sugar Act in the form in which it was written by the Congress. Of course, we are extremely gratified that the House of Representatives, by a vote of 134 to 20, restored the quotas on refined sugar from Hawaii and Puerto Rico. Without that provision, we and our employees could not possibly go along with this bill. But even with this provision, there is noth- ing in the bill which would provide relief for the disadvantages presently suffered by our industry under the quota system. We continue to have no tariff protection as against our most important tropical competitor, the Cuban refiners, and of course, we do not receive, nor da we ask for, cash subsidies from the Fed- eral Treasury. There is nothing in the bill which would assure the refining industry of more stable prices and less risk of inventory 6 Source: https://www.industrydocuments.ucsf.edu/docs/rxfl0226 loss. And finally, the bill would not increase the quota assigned to our industry in previous quota legislation, which forces us to operate at a depressed level of output. On the other hand, about 600,000 tons of refined sugar produced by tropical labor will con- tinue to come into this country every year, and the beet sugar fac- tories will continue to have a marketing quota which will permit them to produce and sell a normal full volume of sugar. No Increase in the Quota for Tropical Refined Sugar This spring, when the House of Representatives held public hearings upon the sugar bills, there was little objection on the part of the sugar industry generally to the continuation of the general quota plan for one year, but two important deviations from it were proposed. The first proposal was made by the sugar industries of Hawaii and Puerto Rico for an unlimited quota in their sales of refined sugar to continental United States. Our industry vigorously opposed this proposal to eliminate the refined sugar quotas which Congress provided in the Sugar Acts of 1934, 1936, and 1937. In our testimony, we stressed the following points: First, any increase in tropical refining for this market auto- matically brings a decrease in refining in continental United States. The reason for this is that the continental refiners are prohibited from buying their raw material, raw sugar, except from those areas and in those amounts prescribed by the Sugar Act. Hawaii and Puerto Rico are given a monopoly on supplying the refiners with about 1,600,000 tons of their raw sugar requirements. If those islands were permitted to retain this raw sugar for refining, the continental refiners would not be allowed under the quota law to purchase their raw material from any other source to fill the gap, and consequently, the output of our industry would decline by ap- proximately 33%. To our knowledge, no other American industry operates under a comparable prohibition. For example, a roaster of coffee or a tire manufacturer is free to import any amount of coffee or rubber from any source at any price. Secondly, the refiners in the American tropics are sugarcane growers and, as such, they have received their share of the $522,- 000,000 direct and indirect subsidy which has been paid to Hawaii and Puerto Rico by the American Treasury and consumers since 1934- We believe it would be both unfair and contrary to the 7 Source: https:/lwww.industrydocuments.ucsf.edu/docs/rxfl022 theory of the quota system to permit the heavily subsidized refiners in the American tropics to expand their operations at the expense of the non-subsidized continental industry. Thirdly, labor conditions in the tropics are fundamentally dif- ferent from those in the United States. The substantial difference in wage scales is well-known. The Wagner Act does not apply to Puerto Rico, and collective bargaining, according to the Depart- ment of Agriculture, is not a part of the plantation system in Hawaii. And although the Wages and Hours Act applies to Hawaii, the Act has not full application to Puerto Rico, inasmuch as an amendment to the Act last spring opened the way for an exemption, through Administrative action, from the payment of the minimum wages required to be paid in continental United States. (Sec. 3 (c) Pub. Res. 88.) An Increase in Refined Beet Sugar Would Reduce Refined Cane Sugar Under a quota system, an increase in the quota for beet sugar would bring a decrease in the quota assigned to the raw sugar pro- ducers in the tropics. This would mean, other things remaining equal, that our industry could obtain less raw cane sugar and obvi- ously, with less raw material available, there would be less refining. It could hardly be expected that any American industry would look with favor upon any legislation which would arbitrarily reduce its volume of business, especially while increasing that of its competitors. The quota system enacted in 1934 provided for a sharing of the American market among the various producing and refining groups in accordance with a formula deemed to be fair by Congress. The underlying philosophy of the quota system was that continental beet sugar producers were to receive price protection and cash sub- sidies which would give them a fair or parity income upon their allotted production. To qualify for these subsidies, farmers were not asked to reduce their production, but merely to forego the "right" to further expand their output. We believe that it is self- contradictory to establish a quota system and then permit an expan- sion of the quota of any one group at the expense of any other group. An alternative to the present quota system is to return to a tariff system, such as that existing before 1934. The tariff system 8 Source: https://www.industrydocuments.ucsf.edu/docs/rxfl0226 is a freer system in the sense that there is no quota limitation upon tariff be the growth system cash subsidies of would any give group, paid everyone domestic anyone. the Under right foreign. to the expand, present But although there system or the would no to the truth is that cash subsidies are in effect paid to an expanding produc- tion, or at least they operate to promote expansion. For several years our refining industry has suffered the disadvantage of having no tariff protection, while our chief competitors enjoy high protection. We do not believe that a continuation of the status quo for quotas will be harmful to the beet sugar industry. The official record shows that since 1934 American beet farmers, with cash sub- sidies, have received approximately full fair exchange for their product and, unlike other farmers, they have not had to reduce their output. No evidence is before us to show that a continuation of the present beet quota would work a positive hardship upon any beet sugar factory. But there is plenty of evidence to show that an ex- pansion of that quota would work a definite hardship upon the men and women in our industry, who are now only partially employed, and upon the investors in our industry, who have suffered substan- tial losses in recent years. Expansion of Beet Quota Cannot Be Defended on Grounds of National Defense Some persons who advocate an expansion of the beet sugar quota maintain that such expansion is necessary in order to assure this country of an adequate wartime supply of sugar. As we view it, an expansion in the beet sugar industry in 1940 cannot be sup- ported on the grounds of national defense. It is true that there was a slight reduction in the consumption of sugar in the last war, but this came about only because the United States had to send some 2,000,000 tons of sugar to its Allies- England, France and Italy. There was a substantial increase in the total supply of refined sugar available in this country in 1917 and 1918. Some rationing took place in sugar-as in meat, flour, and other food products-only because this country had assumed the enormous burden of feeding millions of persons in war-stricken Europe. The United States Food Administration, controlling the entire sugar industry, sought larger sugar supplies for Europe and made every attempt to expand domestic production. But the record 9 Source: https://www.industrydocuments.ucsf.edu/docs/rxfl0226 shows that during the last World War no expansion of production took place in the beet sugar industry or in the cane sugar industries in Louisiana, Hawaii or Puerto Rico. Cuba, alone, had the ability to increase her production of raw sugar and this sugar was imported and refined by our industry under the direction of the Food Ad- ministration. A serious sugar shortage in this country was thereby avoided. And when sugar prices skyrocketed with other foods in the general speculative mania of 1920, due in the case of sugar to pre- mature removal of Government control, the continental refiners again played a leading part in maintaining adequate supplies. There was actually more refined sugar available for consumption in this country in 1920 than there was in any previous year. But again this increase in supply did not come from continental producers, but from the substantial expansion which took place in the importations by the continental refiners of overseas raw sugar. Unless prohibited by legal obstacles, unduly high domestic sugar prices will always bring foreign sugars into this country in times of stress. Unlike 1917, Present and Prospective Sugar Supplies Are Ample Today the stocks and prospective supplies of sugar in the Uni- ted States are at record-breaking levels; supplies of sugar in the Western Hemisphere and throughout the world are ample. These generous supplies of sugar are reflected in the fact that the price of raw sugar, outside the American quota protective wall, is now less than a cent a pound, whereas in 1915, one year after the out- break of the first World War, the price was over 3c a pound. It is the general concensus of opinion in this country, we be- lieve, that if this nation becomes involved in the second World War, it will be to defend our legitimate interests in the Western Hemi- sphere. If war comes to us, we will not be called upon to send sugar to the Latin American countries because these countries now produce more sugar than they consume. In fact, the Western Hemi- sphere has an exportable surplus of sugar of some 1,000,000 tons a year. Along with wheat, meat, cotton, tobacco, and coffee, there is an abundance of sugar in the Western Hemisphere. Even if the supply of Hawaiian and Philippine sugars were entirely cut off, there would be no shortage of sugar in this country. Cuba expanded her production by over 1,000,000 tons in the last 10 Source: https://www.industrydocuments.ucsf.edu/docs/rxfl0226 World War, and today she has the capacity to expand her output by 2,000,000 to 3,000,000 tons. Some expansion would no doubt occur in other islands in the Western Hemisphere, probably Puerto Rico and Santo Domingo. And the continental refining industry has, at the present time, the capacity to refine enough tropical raw sugar to supply all the needs of this country. These are probably the reasons why the expert of the War Department, in testimony in February, 1939, before the House Committee on Military Affairs and War Materials, did not recommend the accumulation of sugar supplies or the enlargement of present production capacity in con- tinental United States. The Quota System Gives Subsidies to Refiners in the American Tropics My final point relates to the claim made by the Hawaiian and Puerto Rican sugar refiners that, as growers, they do not really re- ceive cash subsidies from the Federal Treasury. In testimony before the House Committee on Agriculture, spokesmen for Hawaii and Puerto Rico maintained that the $78,000,000 received in cash sub- sidies since 1934 were not subsidies at all, but merely a rebate to them of taxes taken out of the proceeds of the sale of their sugar. As we see it, the facts clearly indicate otherwise. The cost of pro- tecting sugar producers, including those in Hawaii and Puerto Rico, that is to say, the cost of maintaining for them a domestic price level which is very substantially above the free world market level, always has been and always will be paid for by American consumers and taxpayers. It is not paid by the producers themselves. A so- called self-liquidating subsidy system for sugar is a clear contradic- tion of terms. The continental cane sugar refining industry pays about $45,000,000 a year as a manufacturer's sale tax upon refined sugar. This tax is a cost of doing business, and, as in the case of other costs, the refiners must look to the consumer to recoup this outlay. This $45,000,000 goes into the Federal Treasury and, in turn, is paid out as subsidies to American sugar producers, including those in Hawaii and Puerto Rico. This cash is a part of the total contri- bution of from $300,000,000 to $350,000,000 which, according to the Secretary of Agriculture, is made by consumers each year to assist the sugar producing industry. The quota-subsidy plan works as follows: 11 Source: https://www.industrydocuments.ucsf.edu/docs/rxfl0226 The sugar quotas raise and maintain the price! of sugar in the United States well above the world price, becausé quotas artificially limit the quantities of sugar which can come to the market. This gives the sugar producer a substantial price protection. In addition, the grower receives a direct cash bounty from the Treasury. Since the Sugar Act went into effect in 1934, the total protection which has been realized by sugar producers has been on the average 2.51C per pound, or an ad valorem equivalent of 214%. This total pro- tection per pound is 20% higher than the tariff on raw sugar under the Tariff Act of 1930, and is the highest in the history of the American sugar producing industry. We do not oppose equitable treatment for American sugar producers, whether in continental United States or in Hawaii or Puerto Rico, but we do maintain that the receipt of cash subsidies by the refiners in Hawaii and Puerto Rico gives them a competitive advantage over our own industry which is non-subsidized and also without tariff protection. We believe these facts should be recog- nized by Congress in its determination of our national sugar policy. Conclusion In conclusion, we urge that if the quota-subsidy system is to be continued, then there should be no increase in the quotas for the tropical refining industry or the beet sugar industry and that H. R. 9654 should be passed in its present form. 317 12 Source: https://www.industrydocuments.ucsf.edu/docs/rxfl0226

When the sender filed the letter ?

pqgl0226

pqgl0226_p0, pqgl0226_p1, pqgl0226_p2, pqgl0226_p3, pqgl0226_p4, pqgl0226_p5

10/4/43

NO ANSWER L V P W M M to (6) N October 25, 1948C M 8 L Dear Duck, This morning I have received your letter dated the 23rd. I have not telephoned to you as requested because, though the envelope is postmarked 5:30 PM on the 23rd, it must have teen written before I talked with you over the telephone at about 11:45 AM of that same day. I know that Mr. Rionda returned your phone call to him on Friday morning, the 22nd, but received the report that your phone did not answere I was out of the office on Friday morning but I returned your call in the afternoon. I too was unable to reach you. Later, after 5:00 PM, apparently a call came in from you but I had already lert to keep an carly dinner appointment in the country. Finally I put in a call for you on Saturday morn- ing but the circuits were busy until I reached you at about 11:45 AM. yours sincerely, Mr. M. W. Lewis, Jr. Lewis & Company 102 W. Mein Street Louisville, Ky. Louis V. Place, Jr. MTS Source: https://www.industrydocuments.ucsf.edu/docs/pqgl0226 NEW YORK. N. Y. LEWIS & COMPANY M. w. LEWIS, JR. LOUISVILLE, KY. H. w. CARNIGHAN INCORPONATED CINCINNATI, OHIO BROKERS R. w. ENGELHARD P. o. SIMMONS BOSTON, MASS. 102 w. MAIN STREET e. H. MOORE LOUISVILLE. KY. B. F. SANDS October 23, 194,3. Mr. Louis Place, McCahan Sugar Ref. de Molasses Co., 101 Front Street, Philadelphia, Pennsylvania. Dear Louis: I was sorry that I could not reach you this morning by phone as I was very anxious to talk with you on the Cincinnati situation. I have been holding up on the Cincinnati affair waiting for your decision so wondered if you would be kind enough to call me Monday morning upon receipt of this letter. Yours truly, LEWIS ycompany, INC. Duek MI Lewis, Jr. MWL*EL Source: https://www.industrydocuments.ucsf.edu/docs/pqgl0226 501 #540 1000 STRAIGHT CORRESPONDENCE COPY COPY OF TELEGRAM SENT BY THE W. J. McCAHAN SUGAR REFINING & MOLASSES Co. VIA WESTERN UNION FROM PHILADELPHIA, PA., OCT. 5, 1943 No. S 74 Lost the TIME STAMP TO M. W. LEWIS JR. LEWIS & CO. CINCINNATI, OH10 -5.1943 TELEGRAM RECEIVED UPON ARRIVAL AT OFFICE NOON TODAY AFTER ABSENCE FROM TOWN. REGRET UNABLE GIVE YOU ANY DECISION AS HAVE BEEN UNABLE CLEAR SUBJECT WITH MR. RIONDA WHO IS ABSOLUTELY TIED UP WITH SUBJECTS WHICH REQUIRE IMMEDIATE ATTENTION. BEING ONE OF EXECUTORS OF HIS UNCLES ESTATE HAS THROWN MANY UNUNSUAL BURDENS UPON HIM IN CONNECTION WITH PERSONAL AFFAIRS AS WELL AS AFFAIRS OF COMPANIES IN WHICH HE HAS SUCCEEDED HIS UNCLE, UNDER THE CIRCUMSTANCES YOU WILL UNDERSTAND THAT I DO NOT WISH TO ADD TO HIS IMMEDIATE BURDENS AT THIS TIME WITH A SUBJECT WHICH AFTER ALL HAS BEEN VERY DELAYED THROUGH NO FAULT OF His. ON THE OTHER HAND HIS GREAT PERSONAL INTEREST IN THIS SUBJECT PREVENTS MY TAKING ANY ACTION WITHOUT HIM. GIVE OUR BEST REGARDS TO MESSRS. REOCK AND SIGEL. LOUIS Source: ittps://wwvw.industrydocuments.ucsf.edu/docs/pqgl0226 so 0543 1000 STRAIGHT CONFIRMATION COPY CONFIRMATION OF TELEGRAM SENT BY THE W. J. McGAHAN SUGAR REFINING & MOLASSES Co. VIA WESTERN UNION FROM PHILADELPHIA, PA., OCT. 5, 1943 of TIME STAMP No. S 74 TO M. W. LEWIS JR. LEWIS de CO. CINCINNATI, 0H10 OCT-51018 TELEGRAM RECEIVED UPON ARRIVAL AT OFFICE NOON TODAY AFTER ABSENCE FROM TOWN. REGRET UNABLE GIVE YOU ANY DECISION AS HAVE BEEN UNABLE CLEAR SUBJECT WITH MRe RIONDA WHO IS ABSOLUTELY TIED UP WITH SUBJECTS WHICH REQUIRE IMMEDIATE ATTENTION. BEING ONE OF EXECUTORS OF HIS UNCLES ESTATE HAS THROWN MANY UNUNSUAL BURDENS UPON HIM IN CONNECTION WITH PERSONAL AFFAIRS A3 WELL AS AFFAIRS OF COMPANIES IN WHICH HE HAS SUCCEEDED HIS UNCLE, UNDER THE CIRCUMSTANCES YOU WILL UNDERSTAND THAT ! DO NOT WISH TO ADO TO HIS IMMEDIATE BURDENS AT THIS TIME WITH A SUBJECT WHICH AFTER ALL HAS BEEN VERY DELAYED THROUGH NO FAULT OF His+ ON THE OTHER HAND H13 GREAT PERSONAL INTEREST IN THIS SUBJECT PREVENTS MY TAKING ANY ACTION WITHOUT HIM. GIVE OUR BEST REGARDS TO MESSRS. REOCK AND SIGEL. LOUIS Source: https://www.industrydocuments.ucsf.edu/docs/pqgl0226 8549 1000 NL CORRESPONDENCE COPY COPY OF TELEGRAM RECEIVED BY THE W. J. McCAHAN SUGAR REFINING & MOLASSES Co. VIAWESTERN UNION FILED BY SENDER 10/4/43 728PM PHILADELPHIA, PA. 10/5/43 900A M No. R 84 LOUIS PLACE FROM M. W. LEWIS JR. LOUISVILLE, KY. LEAVING EARLY IN MORNING TO SEE SIGEL AND LUNCH REOCK. TRIED ALL DAY TO REACH YOU BY PHONE. ADVISE ME CINCINNATI OFFICE LF YOU HAVE MADE ANY DECISION AS MUST TELL REOCK SOME- THING AFTER LENGTHY TALK LAST WEEK REGAROS. Time one noophila than MAF Source: Ittps://www.industrydocuments.ucsf.edu/docs/pqgl0226 8543 1000 NL CONFIRMATION COPY GONFIRMATION OF TELEGRAM RECEIVED BY The W. J. McCAHAN SUGAR REFINING & MOLASSES Co. VIA WESTERN UNION FILED BY SENDER 10/4/43 728PM PHILADELPHIA. PA., 10/5/43 900A M No. R 84 LOUIS PLACE FROM M. W. LEWIS JR. LOUISVILLE, KY. LEAVING EARLY IN MORNING TO SEE SIGEL ANO LUNCH REOCK. TRIED ALL DAY TO REACH YOU BY PHONE. ADVISE ME CINCINNATI OFFICE IF YOU HAVE MADE ANY DECISION AS MUST TELL REOCK SOME- THING AFTER LENGTHY TALK LAST WEEK REGAROS. MAF Source: ttps://www.industrydocuments.ucsf.edu/docs/pqgl0226

Paper WMC(1) belongs to which classification?

zxbw0217

zxbw0217_p0, zxbw0217_p1, zxbw0217_p2

Preclinical

PROGRESS REPORT 11 Totelle 1mg CLIENT WYETH CONTACTS Wyeth: Richie Lu luy@wyeth.com) MJ Roach (RoachM2@labs.wyeth.com) Daniele Speilmann (SpielmD@war.wyeth.com) Dave Downey (downey@labs.wyeth.com) Current Projects Rick Winneker WinnekR@labs.wyeth.com) Jasmine Baleva (balevaj@wai.wyeth.com/ Jim Gurr gurrj@war.wyeth.com Phil Vinall fvinollp@war.wyeth.com) David Dubinski (chubtwsd@labs.wyeth.com) DATE 18 October, 2002 PAPERS PROJECT CLASSIFICATION TARGET STATUS/ACTION SUBMISSION DATE/JOURNAL Paper PC(1) Efficacy February 2003 First draft submitted for initial review August 7 A study of the efficacy of continuous Comments received from Daniele October 4 combined regimens of lmg estradiol and trimegestone compared with regimens containing estradiol and norethisterone acetate in postmenopausal women for up to 2 years Paper PC(2) Endometrium/safety March 2003 First draft submitted for initial review August 19 A comparison of the effects of continuous combined regimens of 1 mg estradiol and trimegestone with regimens containing estradiol and norethisterone acetate upon the profiles of endometrial bleeding and safety in postmenopausal women for up to 2 years Paper PC(3) Hemostasis/metabolic impact April 2003 First draft submitted for initial review April 4 Metabolic and hemostatic profile of Comments received from Gary May 13th postmenopausal women receiving a continuous combined regimen of either 1mg estradiol with trimegestone or estradiol and norethisterone acetate over a 1-year period Paper PS(1) Climacteric symptoms March 2003 First draft submitted for initial review August 8 A study of the control of climacteric symptoms in postmenopausal women following sequential regimens of lmg estradiol and trimegestone compared with a regimen containing estradiol and norethisterone over a period of 2 years Paper PS(2) Endometrium/safety March 2003 First draft submitted for initial review August 9 A comparative 2-year study of the effects of sequential regimens of 1 mg estradiol and trimegestone with a regimen containing estradiol and norethisterone upon the patterns of endometrial bleeding and safety in postmenopausal women 1 Confidential Pursuant to Confidentiality OLIVS019-012556 Order Source: https://www.industrydocuments.ucsf.edu/docs/zxbw0217 PROGRESS REPORT 11 Totelle 1mg Client: Wyeth October 18, 2002 PROJECT CLASSIFICATION TARGET STATUS/ACTION SUBMISSION DATE/JOURNAL Paper PS(3) Hemostasis/metabolic impact April 2003 First draft submitted for initial review April 19th Metabolic and hemostatic profile of postmenopausal women receiving a Comments received from Gary May 13th combined sequential regimen of either lmg estradiol and trimegestone or estradiol and norethisterone over a 1-year period PAPERS FOR WMC SYMPOSIUM PROCEEDINGS Paper WMC(1) Preclinical December, 2002 First draft submitted for initial review July 29 The preclinical biology of trimegestone: a new potent and Climacteric Suppl. selective progestin R. Winneker Paper WMC(2) Safety December, 2002 First draft submitted for initial review August 1 An overview of the comparative Bleeding profile Comments received from Gary October 9 efficacy, safety, bleeding profile and Metabolism Climacteric Suppl. effect on lipids of a sequential HRT preparation containing 2 mg estradiol and trimegestone H.P.G. Schneider Paper WMC(3) Bone December, 2002 First draft submitted for initial review July 30 A comparative clinical evaluation of Comments received from Gary October 14 the effect of a new sequential HRT Climacteric Suppl. preparation containing 2 mg estradiol and the progestin trimegestone on postmenopausal bone loss M. Gambacciani Paper WMC(4) Climacteric symptoms December, 2002 First draft submitted for initial review August 9 A comparative clinical evaluation of Efficacy Comments received from Daniele October 9 a continuous HRT preparation Climacteric Suppl. containing 1 mg estradiol and the novel progestin trimegestone P. Bouchard PAPERS FOR PROGESTIN SYMPOSIUM Clinical experience with 2nd International Paper prepared and in review trimegestone as a new progestin in Progestin HRT Symposium Sienna G. Grubb SUPPORTING ACTIVITIES 2 Confidential Pursuant to Confidentiality OLIVS019-012557 Order Source: https://www.industrydocuments.ucsf.edu/docs/zxbw0217 PROGRESS REPORT 11 Totelle 1mg Client: Wyeth October 18, 2002 PROJECT TARGET STATUS/ACTION PUBLICATION DATE Totelle Monograph 1 and 2mg December 2002 Draft manuscript submitted for review February 1st Comments received from Dave Downey. Revised draft submitted to Dave on April 23rd. Formatted and designed document and highlighted refs. submitted for review to Jasmine Totelle 1 mg Slide Set on CD-ROM February 2003 Text written, to be formatted 3 Confidential Pursuant to Confidentiality OLIVS019-012558 Order Source: https://www.industrydocuments.ucsf.edu/docs/zxbw0217

Paper WMC(3) belongs to which classification?

zxbw0217

zxbw0217_p0, zxbw0217_p1, zxbw0217_p2

Bone

PROGRESS REPORT 11 Totelle 1mg CLIENT WYETH CONTACTS Wyeth: Richie Lu luy@wyeth.com) MJ Roach (RoachM2@labs.wyeth.com) Daniele Speilmann (SpielmD@war.wyeth.com) Dave Downey (downey@labs.wyeth.com) Current Projects Rick Winneker WinnekR@labs.wyeth.com) Jasmine Baleva (balevaj@wai.wyeth.com/ Jim Gurr gurrj@war.wyeth.com Phil Vinall fvinollp@war.wyeth.com) David Dubinski (chubtwsd@labs.wyeth.com) DATE 18 October, 2002 PAPERS PROJECT CLASSIFICATION TARGET STATUS/ACTION SUBMISSION DATE/JOURNAL Paper PC(1) Efficacy February 2003 First draft submitted for initial review August 7 A study of the efficacy of continuous Comments received from Daniele October 4 combined regimens of lmg estradiol and trimegestone compared with regimens containing estradiol and norethisterone acetate in postmenopausal women for up to 2 years Paper PC(2) Endometrium/safety March 2003 First draft submitted for initial review August 19 A comparison of the effects of continuous combined regimens of 1 mg estradiol and trimegestone with regimens containing estradiol and norethisterone acetate upon the profiles of endometrial bleeding and safety in postmenopausal women for up to 2 years Paper PC(3) Hemostasis/metabolic impact April 2003 First draft submitted for initial review April 4 Metabolic and hemostatic profile of Comments received from Gary May 13th postmenopausal women receiving a continuous combined regimen of either 1mg estradiol with trimegestone or estradiol and norethisterone acetate over a 1-year period Paper PS(1) Climacteric symptoms March 2003 First draft submitted for initial review August 8 A study of the control of climacteric symptoms in postmenopausal women following sequential regimens of lmg estradiol and trimegestone compared with a regimen containing estradiol and norethisterone over a period of 2 years Paper PS(2) Endometrium/safety March 2003 First draft submitted for initial review August 9 A comparative 2-year study of the effects of sequential regimens of 1 mg estradiol and trimegestone with a regimen containing estradiol and norethisterone upon the patterns of endometrial bleeding and safety in postmenopausal women 1 Confidential Pursuant to Confidentiality OLIVS019-012556 Order Source: https://www.industrydocuments.ucsf.edu/docs/zxbw0217 PROGRESS REPORT 11 Totelle 1mg Client: Wyeth October 18, 2002 PROJECT CLASSIFICATION TARGET STATUS/ACTION SUBMISSION DATE/JOURNAL Paper PS(3) Hemostasis/metabolic impact April 2003 First draft submitted for initial review April 19th Metabolic and hemostatic profile of postmenopausal women receiving a Comments received from Gary May 13th combined sequential regimen of either lmg estradiol and trimegestone or estradiol and norethisterone over a 1-year period PAPERS FOR WMC SYMPOSIUM PROCEEDINGS Paper WMC(1) Preclinical December, 2002 First draft submitted for initial review July 29 The preclinical biology of trimegestone: a new potent and Climacteric Suppl. selective progestin R. Winneker Paper WMC(2) Safety December, 2002 First draft submitted for initial review August 1 An overview of the comparative Bleeding profile Comments received from Gary October 9 efficacy, safety, bleeding profile and Metabolism Climacteric Suppl. effect on lipids of a sequential HRT preparation containing 2 mg estradiol and trimegestone H.P.G. Schneider Paper WMC(3) Bone December, 2002 First draft submitted for initial review July 30 A comparative clinical evaluation of Comments received from Gary October 14 the effect of a new sequential HRT Climacteric Suppl. preparation containing 2 mg estradiol and the progestin trimegestone on postmenopausal bone loss M. Gambacciani Paper WMC(4) Climacteric symptoms December, 2002 First draft submitted for initial review August 9 A comparative clinical evaluation of Efficacy Comments received from Daniele October 9 a continuous HRT preparation Climacteric Suppl. containing 1 mg estradiol and the novel progestin trimegestone P. Bouchard PAPERS FOR PROGESTIN SYMPOSIUM Clinical experience with 2nd International Paper prepared and in review trimegestone as a new progestin in Progestin HRT Symposium Sienna G. Grubb SUPPORTING ACTIVITIES 2 Confidential Pursuant to Confidentiality OLIVS019-012557 Order Source: https://www.industrydocuments.ucsf.edu/docs/zxbw0217 PROGRESS REPORT 11 Totelle 1mg Client: Wyeth October 18, 2002 PROJECT TARGET STATUS/ACTION PUBLICATION DATE Totelle Monograph 1 and 2mg December 2002 Draft manuscript submitted for review February 1st Comments received from Dave Downey. Revised draft submitted to Dave on April 23rd. Formatted and designed document and highlighted refs. submitted for review to Jasmine Totelle 1 mg Slide Set on CD-ROM February 2003 Text written, to be formatted 3 Confidential Pursuant to Confidentiality OLIVS019-012558 Order Source: https://www.industrydocuments.ucsf.edu/docs/zxbw0217

What is the date of submission of the project "Paper PS(3)"?

zxbw0217

zxbw0217_p0, zxbw0217_p1, zxbw0217_p2

April 2003

PROGRESS REPORT 11 Totelle 1mg CLIENT WYETH CONTACTS Wyeth: Richie Lu luy@wyeth.com) MJ Roach (RoachM2@labs.wyeth.com) Daniele Speilmann (SpielmD@war.wyeth.com) Dave Downey (downey@labs.wyeth.com) Current Projects Rick Winneker WinnekR@labs.wyeth.com) Jasmine Baleva (balevaj@wai.wyeth.com/ Jim Gurr gurrj@war.wyeth.com Phil Vinall fvinollp@war.wyeth.com) David Dubinski (chubtwsd@labs.wyeth.com) DATE 18 October, 2002 PAPERS PROJECT CLASSIFICATION TARGET STATUS/ACTION SUBMISSION DATE/JOURNAL Paper PC(1) Efficacy February 2003 First draft submitted for initial review August 7 A study of the efficacy of continuous Comments received from Daniele October 4 combined regimens of lmg estradiol and trimegestone compared with regimens containing estradiol and norethisterone acetate in postmenopausal women for up to 2 years Paper PC(2) Endometrium/safety March 2003 First draft submitted for initial review August 19 A comparison of the effects of continuous combined regimens of 1 mg estradiol and trimegestone with regimens containing estradiol and norethisterone acetate upon the profiles of endometrial bleeding and safety in postmenopausal women for up to 2 years Paper PC(3) Hemostasis/metabolic impact April 2003 First draft submitted for initial review April 4 Metabolic and hemostatic profile of Comments received from Gary May 13th postmenopausal women receiving a continuous combined regimen of either 1mg estradiol with trimegestone or estradiol and norethisterone acetate over a 1-year period Paper PS(1) Climacteric symptoms March 2003 First draft submitted for initial review August 8 A study of the control of climacteric symptoms in postmenopausal women following sequential regimens of lmg estradiol and trimegestone compared with a regimen containing estradiol and norethisterone over a period of 2 years Paper PS(2) Endometrium/safety March 2003 First draft submitted for initial review August 9 A comparative 2-year study of the effects of sequential regimens of 1 mg estradiol and trimegestone with a regimen containing estradiol and norethisterone upon the patterns of endometrial bleeding and safety in postmenopausal women 1 Confidential Pursuant to Confidentiality OLIVS019-012556 Order Source: https://www.industrydocuments.ucsf.edu/docs/zxbw0217 PROGRESS REPORT 11 Totelle 1mg Client: Wyeth October 18, 2002 PROJECT CLASSIFICATION TARGET STATUS/ACTION SUBMISSION DATE/JOURNAL Paper PS(3) Hemostasis/metabolic impact April 2003 First draft submitted for initial review April 19th Metabolic and hemostatic profile of postmenopausal women receiving a Comments received from Gary May 13th combined sequential regimen of either lmg estradiol and trimegestone or estradiol and norethisterone over a 1-year period PAPERS FOR WMC SYMPOSIUM PROCEEDINGS Paper WMC(1) Preclinical December, 2002 First draft submitted for initial review July 29 The preclinical biology of trimegestone: a new potent and Climacteric Suppl. selective progestin R. Winneker Paper WMC(2) Safety December, 2002 First draft submitted for initial review August 1 An overview of the comparative Bleeding profile Comments received from Gary October 9 efficacy, safety, bleeding profile and Metabolism Climacteric Suppl. effect on lipids of a sequential HRT preparation containing 2 mg estradiol and trimegestone H.P.G. Schneider Paper WMC(3) Bone December, 2002 First draft submitted for initial review July 30 A comparative clinical evaluation of Comments received from Gary October 14 the effect of a new sequential HRT Climacteric Suppl. preparation containing 2 mg estradiol and the progestin trimegestone on postmenopausal bone loss M. Gambacciani Paper WMC(4) Climacteric symptoms December, 2002 First draft submitted for initial review August 9 A comparative clinical evaluation of Efficacy Comments received from Daniele October 9 a continuous HRT preparation Climacteric Suppl. containing 1 mg estradiol and the novel progestin trimegestone P. Bouchard PAPERS FOR PROGESTIN SYMPOSIUM Clinical experience with 2nd International Paper prepared and in review trimegestone as a new progestin in Progestin HRT Symposium Sienna G. Grubb SUPPORTING ACTIVITIES 2 Confidential Pursuant to Confidentiality OLIVS019-012557 Order Source: https://www.industrydocuments.ucsf.edu/docs/zxbw0217 PROGRESS REPORT 11 Totelle 1mg Client: Wyeth October 18, 2002 PROJECT TARGET STATUS/ACTION PUBLICATION DATE Totelle Monograph 1 and 2mg December 2002 Draft manuscript submitted for review February 1st Comments received from Dave Downey. Revised draft submitted to Dave on April 23rd. Formatted and designed document and highlighted refs. submitted for review to Jasmine Totelle 1 mg Slide Set on CD-ROM February 2003 Text written, to be formatted 3 Confidential Pursuant to Confidentiality OLIVS019-012558 Order Source: https://www.industrydocuments.ucsf.edu/docs/zxbw0217

What is the page number?

rrnc0227

rrnc0227_p44, rrnc0227_p45, rrnc0227_p46, rrnc0227_p47, rrnc0227_p48, rrnc0227_p49, rrnc0227_p50, rrnc0227_p51

42, - 42 -

PAKISTAN NUTRIENT VALUES USED IN CALCULATIONS (Continued) (Values per 100 grams "As Purchased" basis) 1/ Calo- - Pro- Fat Ca Fe Vit. A Thia- - Ribo- Niacin Vit. C Ref. Item ries tein mine flavin Food Gms Gms. Mg Mg I.U. Mg Mg Mg Mg Carrots 37 1.1 0.3 34 0.7 10,560 0.05 0.05 0.5 5 A 120 Peas, fresh 45 3.0 0.2 10 0.9 310 0.15 0.07 1.2 12 A 160 Cabbage 17 1.0 0.1 34 0.4 60 0.04 0.04 0.2 36 A 118 Spinach 16 1.9 0.2 66 2.5 7,720 0.09 0.16 0.5 48 A 176 Coriander, Fresh 32 2.2 0.4 152 5.3 5,350 0.09 0.11 0.9 75 A 131 Karela (Momordica charantia) - - (?) - - - 140 D Eggplant 23 1.1 0.2 14 0.4 30 0.04 0.05 0.6 5 A 136 Potato 70 1.7 0.1 9 0.6 - 0.09 0.03 1 14 A 163 Onion, dry 42 1.3 0.2 30 0.5 50 0.03 0.04 0.2 8 A 154 Onion, green 24 1.1 0.2 27 0.6 20 0.06 0.03 0.3 9 A 145D 16 Turnip 28 1.0 0.2 35 0.4 - 0.04 0.06 0.4 24 A 187 I Cauliflower 14 1.4 0.1 13 0.6 50 0.06 0.06 0.3 39 A 122 Veg. Marrow 20 0.7 - - 0.7 - - - - 18 D Tomato, fresh 18 0.9 0.3 10 0.5 970 0.05 0.04 0.04 20 A 184 Tomato, can 98 2 0.4 12 0.8 1,880 0.09 0.07 2.2 11 A 361 Orange, malta 32 0.6 0.1 24 0.3 140 0.06 0.02 0.1 35 A 71 Guava 58 0.8 0.5 13 0.7 160 0.05 0.03 0.8 246 A 53 Papaya 27 0.4 0.1 14 0.2 1,190 0.02 0.03 0.2 38 A 77 Banana 59 0.8 0.1 5 0.4 290 0.03 .03 0.5 7 A 41 Tamarind 115 1.3 0.3 36 0.3 ; 10 0.16 0.07 0.6 1 A 96 Raisins 268 2.3 0.5 78 3.3 50 0.15 0.08 0.5 - C 553 Garlic 84 4.0 0.2 37 0.9 - 0.19 0.07 0.4 13 A 139 Chillies, dry245 14.8 7 15 1.5 575 - - - 50 D. , E Spices, mix 325 11.8 11.4 53 21 822 - - - - D 1/ References: A. Composition of foods used in Far Eastern countries. USDA Handbook #34, 1952 B. Food Composition Tables - minerals and vitamins for international use. FAO United Nations, 1954. C. Composition of Foods - raw, processed, prepared. USDA Handbook #8, 1950. D. Major M. Iqbal, GHQ Science Laboratories, Chuklala, Pakistan. E. Analyses of Medical Nutrition Laboratory, Denver, Colorado. Source: https:llwww.industrydocuments.ucsf.edu/docs/rrnc0227 - 37 - APPENDIX 2 Conservative Vitamin Losses on Cooking (Pakistan) Food Class Thiamine Riboflavin Niacin Vitamin C % % % % Meats 35 20 25 - Cereals 10 - 10 - Legumes 20 - - - Leaf Green Veg. 35 20 25 60 Vegetables, Other 35 20 25 60 Tomatoes - - - 15 Potatoes 40 20 25 60 1/ References: U.S. Department of the Army TM 8-501, Nutri- tion, p. 19, September, 1949, and Pakistan Army data from Major M. Iqbal, P.A.S.C. GHQ Science Laboratory, Chuklala. Pakistan losses, especially of vitamins A and C, would be expected to exceed these in cases of prolonged cooking and the use of copper vessels. Source: https://www.industrydocuments.ucsf.edu/docs/rrnc0227 APPENDIX 3 PAKISTAN: Analysis of Dried Raw Foods 1/ Ca Thiamine Riboflavin NAME Protein Fat Moisture Ash Carbohydrate mg/100 gm mg/100 gm mg/100 gm Italian Millet 10.97 2.63 5.63 2.28 78.49 30 0.35 0.31 Dhal Mong 22.27 0.37 5.85 3.86 67.65 109 0.78 0.25 Dhal Masur Split 26.19 0.34 5.26 2.22 65.99 61 0.35 0.53 Gram Split 15.73 1.17 5.69 3.19 74.22 80 0.51 0.29 White Gram 22.95 2.30 6.98 3.68 64.09 - - - Ginger 10.20 1.93 7.12 13.65 67.10 - - - Green Gram 24.14 0.53 6.30 3.71 65.32 176 - - Dried Chillies (Peppers) 2/ 14.50 2.29 7.83 - - - - Mothh (Moth Bean) 22.68 0.58 3.24 4.98 68.52 311 0.44 - Bullrush Millet 11.39 3.59 2.58 7.62 74.82 214 0.56 0.26 Dhal Urd Split 21.80 0.04 3.53 3.86 70.77 153 0.62 0.21 3 8 Gram Whole 25.91 4.04 5.09 4.55 60.41 - - - Cardamon (condiment) 22.24 5.21 - 72.55 I - - - - Arum (Taro) 31.90 0.16 64.85 2.82 0.27 99 0.09 0.32 Imlok 40.42 1.00 0.37 2.59 55.62 253 - - Tamarind 11.27 0.43 2.31 10.62 75.37 - - - Atta 11.58 0.93 0.36 2.32 84.81 45 0.70 0.17 Black Gram 2/ 0.37 6.24 3.70 - - - - Betel Nut 2/ - 0.42 1.66 - 108 0.04 - French Bean 2/ 3.50 - - - - - - 1/ Analyses by the Army Medical Nutrition Laboratory, Denver. 2/ Not enough sample for analysis. Source: https://www.industrydocuments.ucst.edu/docs/rrnc0227 - 39 - APPENDIX 4 PAKISTAN: Caloric, Protein and Fat Content of the Packaged Ration (French Source) 1/ Gms Gms of Carbo- Food Item Food Item Protein Fat hydrate Calories Breakfast Sweet Biscuits 98.8 8.59 20.71 65.60 483.2 Apricot Flav. Conc. Food 100.6 10.38 10.87 74.09 435.7 Lunch Sweet Biscuits 103.1 6.84 19.06 71.88 486.4 Plain Biscuits 72.5 7.22 6.55 54.59 306.2 Chocolate Flav. Conc. Food 98.2 11.75 10.56 71.12 426.5 Supper Chocolate Flav. Conc. Food 50.3 5.53 5.89 36.60 221.5 Apricot Flav. Conc. Food 50.2 5.64 5.93 36.11 220.4 Plain Biscuits 68.7 6.72 5.22 54.08 290.2 Sweet Biscuits 105.5 9.17 22.11 70.03 515.8 Misc. Items Jam 57.8 0.80 0.14 56.60 228.7 Tea 6.7 -- 6.02 24.2 Lemon Candies 27.1 0.11 0.11 26.08 105.8 Powdered Milk 7.9 2.82 0.12 4.14 28.9 Orange Crystals 50.5 0.20 0.38 44.62 182.7 Vitamin Chocolate Pill 5.4 -- -- -- Salt -- -- Sugar 22.3 -- - - 22.29 89.2 Totals/ration -- 75.0 107.7 693.3 4045.0 1/ Analyses by the Army Medical Nutrition Laboratory, Denver. Source: https:/lwww.industrydocuments.ucsf.edu/docs/rrnc0227 - 40 - APPENDIX 5 Pakistan: Nutritional Evaluation of Spices 1/ 1. The various spices used in dishes varied from unit to unit in number as well as quantity of each spice. The following, however, gives a fair average. % of Total Spice Used Cumin 20% Coriander Seed 40% Turmeric 40% 2. Spices as given in the inventory form were a mixture as above and the nutritional value of the mixed spices has been based on their individual values in the above proportion. The actual figures used in the calculations are given below. Per 100 Gms Carbo- Spices Calories Protein hydrate Fat Calcium Iron Vit. A gm. gm. gm. mg. mg. I.U. Cumin 356 18.7 36.6 15.0 108 31.0 870 Coriander Seed 288 14.1 21.6 16.1 63 17.9 1570 Turmeric 349 6.3 69.4 5.1 15 18.6 50 Composition in Usual Proportion of All Three Gm. Cumin 20 71 3.6 7.2 3.0 21.6 6.2 174 Coriander Seed 40 115 5.6 8.6 6.4 25.2 7.2 628 Turmeric 40 139 2.6 27.7 2.0 6.0 7.2 20 Total 100 325 11.8 43.5 11.4 11.4 52.8 822 1/ Pakistan Army Data from Major M. Iqbal, P.A.S.C., GHQ Science - Laboratory, Chuklala Source: https://www.industrydocuments.ucsf.edu/docs/rmnc0227 - -41 - APPENDIX 6 A. Guide Used In Interpretation of Urinary Vitamin Excretion Data - Adult Males. Deficient Low Acceptable High N° Methylnicotinamide mg./6 hrs. 0.2 0.2-0.59 0.6 >1.6 mg./gm. creatinine 0.5 0.5-1.59 1.6 >4.3 Riboflavin g./6 hrs. 1/ VI 10 10-29 30 100 g./gm. creatinine 27 27-79 80 270 Thiamine g./6 hrs. <10 10-24 25 > 50 g./gm. creatinine 527 27-65 66 >130 The urinary values indicated above are based on an average creatinine coefficient of 23 and a 65 kg. man who would be expected to excrete 1.5 gm. of creatinine daily. B. Guide Used In Interpretation of Blood Data - Young Adult Men Deficient Low Acceptable High Hemoglobin gms./100 ml. 12.0 12-13.9 14.0 > 15.0 Hematocrit (PVC) % <36 36-41 42 745 Total Serum Protein (TSP) gms./100 ml. V 6.0 6.0-6.4 6.5 > 7.0 Serum Ascorbic Acid mg./100 ml. <0.1 0.1-0.19 0.2 > 0.4 Serum Vitamin A g./100 ml. T 10 10-19 20 > 50 Serum Carotene g./100 ml. <20 20-39 40 100 1/ ug. means mcg. Source: https://www.industrydocuments.ucsf.edu/docs/rrnc0227 - 42 - APPENDIX 7 Guide Used In Interpretation of Nutrient Intake Data- Young Adult Males (1) Deficient Low Acceptable High Niacin mg./day < 5 5-10 10-15 > 15 Riboflavin mg. / day < 0.7 0.7-1.2 1.2-1.5 >1.5 Thiamine mg/1000 cal. <0.2 0.2-0.3 0.3-0.5 0.5 Ascorbic Acid mg./day < 10 10-29 30-50 > 50 Vitamin A I.U./day 2000 2000-3500 3500-5000 >5000 Calcium gm./day 0.3 0.3-0.4 0.4-0.8 70.8 Iron mg./day <6.0 6-9 9-12 712 Protein gm./kg $0.5 0.5-1.0 1.0-1.5 > 1.5 (1) Prepared by the Interdepartmental Committee on Nutrition for National Defense. These guides are intended to apply to 25 yr. old physically active males of 67 in. (170 cm.) in height and 143 (65 kg. ) lb. in weight living in a temperate climate and consuming a varied diet. The quantities specified should never be considered as inflexible "requirements". In interpreting nutrition surveys of population groups average values falling in one or another of the above cate- gories conceal the fact that some individuals will receive more and others less than average. In addition it is known that there is much variability from one to another individual in their re- quirement for various nutrients. Variations in body size, activity, climate, types of food available, and other factors modify require- ments and, consequently, interpretation of survey data. The nu- trient content of food may be altered materially during food pre- paration, a fact which must always be considered in evaluating dietary intake data. Source: https://www.industrydocuments.ucsf.edu/docs/rmnc0227 "IS Ao003 o W

What is the appendix number?

rrnc0227

rrnc0227_p44, rrnc0227_p45, rrnc0227_p46, rrnc0227_p47, rrnc0227_p48, rrnc0227_p49, rrnc0227_p50, rrnc0227_p51

Appendix 7, 7

PAKISTAN NUTRIENT VALUES USED IN CALCULATIONS (Continued) (Values per 100 grams "As Purchased" basis) 1/ Calo- - Pro- Fat Ca Fe Vit. A Thia- - Ribo- Niacin Vit. C Ref. Item ries tein mine flavin Food Gms Gms. Mg Mg I.U. Mg Mg Mg Mg Carrots 37 1.1 0.3 34 0.7 10,560 0.05 0.05 0.5 5 A 120 Peas, fresh 45 3.0 0.2 10 0.9 310 0.15 0.07 1.2 12 A 160 Cabbage 17 1.0 0.1 34 0.4 60 0.04 0.04 0.2 36 A 118 Spinach 16 1.9 0.2 66 2.5 7,720 0.09 0.16 0.5 48 A 176 Coriander, Fresh 32 2.2 0.4 152 5.3 5,350 0.09 0.11 0.9 75 A 131 Karela (Momordica charantia) - - (?) - - - 140 D Eggplant 23 1.1 0.2 14 0.4 30 0.04 0.05 0.6 5 A 136 Potato 70 1.7 0.1 9 0.6 - 0.09 0.03 1 14 A 163 Onion, dry 42 1.3 0.2 30 0.5 50 0.03 0.04 0.2 8 A 154 Onion, green 24 1.1 0.2 27 0.6 20 0.06 0.03 0.3 9 A 145D 16 Turnip 28 1.0 0.2 35 0.4 - 0.04 0.06 0.4 24 A 187 I Cauliflower 14 1.4 0.1 13 0.6 50 0.06 0.06 0.3 39 A 122 Veg. Marrow 20 0.7 - - 0.7 - - - - 18 D Tomato, fresh 18 0.9 0.3 10 0.5 970 0.05 0.04 0.04 20 A 184 Tomato, can 98 2 0.4 12 0.8 1,880 0.09 0.07 2.2 11 A 361 Orange, malta 32 0.6 0.1 24 0.3 140 0.06 0.02 0.1 35 A 71 Guava 58 0.8 0.5 13 0.7 160 0.05 0.03 0.8 246 A 53 Papaya 27 0.4 0.1 14 0.2 1,190 0.02 0.03 0.2 38 A 77 Banana 59 0.8 0.1 5 0.4 290 0.03 .03 0.5 7 A 41 Tamarind 115 1.3 0.3 36 0.3 ; 10 0.16 0.07 0.6 1 A 96 Raisins 268 2.3 0.5 78 3.3 50 0.15 0.08 0.5 - C 553 Garlic 84 4.0 0.2 37 0.9 - 0.19 0.07 0.4 13 A 139 Chillies, dry245 14.8 7 15 1.5 575 - - - 50 D. , E Spices, mix 325 11.8 11.4 53 21 822 - - - - D 1/ References: A. Composition of foods used in Far Eastern countries. USDA Handbook #34, 1952 B. Food Composition Tables - minerals and vitamins for international use. FAO United Nations, 1954. C. Composition of Foods - raw, processed, prepared. USDA Handbook #8, 1950. D. Major M. Iqbal, GHQ Science Laboratories, Chuklala, Pakistan. E. Analyses of Medical Nutrition Laboratory, Denver, Colorado. Source: https:llwww.industrydocuments.ucsf.edu/docs/rrnc0227 - 37 - APPENDIX 2 Conservative Vitamin Losses on Cooking (Pakistan) Food Class Thiamine Riboflavin Niacin Vitamin C % % % % Meats 35 20 25 - Cereals 10 - 10 - Legumes 20 - - - Leaf Green Veg. 35 20 25 60 Vegetables, Other 35 20 25 60 Tomatoes - - - 15 Potatoes 40 20 25 60 1/ References: U.S. Department of the Army TM 8-501, Nutri- tion, p. 19, September, 1949, and Pakistan Army data from Major M. Iqbal, P.A.S.C. GHQ Science Laboratory, Chuklala. Pakistan losses, especially of vitamins A and C, would be expected to exceed these in cases of prolonged cooking and the use of copper vessels. Source: https://www.industrydocuments.ucsf.edu/docs/rrnc0227 APPENDIX 3 PAKISTAN: Analysis of Dried Raw Foods 1/ Ca Thiamine Riboflavin NAME Protein Fat Moisture Ash Carbohydrate mg/100 gm mg/100 gm mg/100 gm Italian Millet 10.97 2.63 5.63 2.28 78.49 30 0.35 0.31 Dhal Mong 22.27 0.37 5.85 3.86 67.65 109 0.78 0.25 Dhal Masur Split 26.19 0.34 5.26 2.22 65.99 61 0.35 0.53 Gram Split 15.73 1.17 5.69 3.19 74.22 80 0.51 0.29 White Gram 22.95 2.30 6.98 3.68 64.09 - - - Ginger 10.20 1.93 7.12 13.65 67.10 - - - Green Gram 24.14 0.53 6.30 3.71 65.32 176 - - Dried Chillies (Peppers) 2/ 14.50 2.29 7.83 - - - - Mothh (Moth Bean) 22.68 0.58 3.24 4.98 68.52 311 0.44 - Bullrush Millet 11.39 3.59 2.58 7.62 74.82 214 0.56 0.26 Dhal Urd Split 21.80 0.04 3.53 3.86 70.77 153 0.62 0.21 3 8 Gram Whole 25.91 4.04 5.09 4.55 60.41 - - - Cardamon (condiment) 22.24 5.21 - 72.55 I - - - - Arum (Taro) 31.90 0.16 64.85 2.82 0.27 99 0.09 0.32 Imlok 40.42 1.00 0.37 2.59 55.62 253 - - Tamarind 11.27 0.43 2.31 10.62 75.37 - - - Atta 11.58 0.93 0.36 2.32 84.81 45 0.70 0.17 Black Gram 2/ 0.37 6.24 3.70 - - - - Betel Nut 2/ - 0.42 1.66 - 108 0.04 - French Bean 2/ 3.50 - - - - - - 1/ Analyses by the Army Medical Nutrition Laboratory, Denver. 2/ Not enough sample for analysis. Source: https://www.industrydocuments.ucst.edu/docs/rrnc0227 - 39 - APPENDIX 4 PAKISTAN: Caloric, Protein and Fat Content of the Packaged Ration (French Source) 1/ Gms Gms of Carbo- Food Item Food Item Protein Fat hydrate Calories Breakfast Sweet Biscuits 98.8 8.59 20.71 65.60 483.2 Apricot Flav. Conc. Food 100.6 10.38 10.87 74.09 435.7 Lunch Sweet Biscuits 103.1 6.84 19.06 71.88 486.4 Plain Biscuits 72.5 7.22 6.55 54.59 306.2 Chocolate Flav. Conc. Food 98.2 11.75 10.56 71.12 426.5 Supper Chocolate Flav. Conc. Food 50.3 5.53 5.89 36.60 221.5 Apricot Flav. Conc. Food 50.2 5.64 5.93 36.11 220.4 Plain Biscuits 68.7 6.72 5.22 54.08 290.2 Sweet Biscuits 105.5 9.17 22.11 70.03 515.8 Misc. Items Jam 57.8 0.80 0.14 56.60 228.7 Tea 6.7 -- 6.02 24.2 Lemon Candies 27.1 0.11 0.11 26.08 105.8 Powdered Milk 7.9 2.82 0.12 4.14 28.9 Orange Crystals 50.5 0.20 0.38 44.62 182.7 Vitamin Chocolate Pill 5.4 -- -- -- Salt -- -- Sugar 22.3 -- - - 22.29 89.2 Totals/ration -- 75.0 107.7 693.3 4045.0 1/ Analyses by the Army Medical Nutrition Laboratory, Denver. Source: https:/lwww.industrydocuments.ucsf.edu/docs/rrnc0227 - 40 - APPENDIX 5 Pakistan: Nutritional Evaluation of Spices 1/ 1. The various spices used in dishes varied from unit to unit in number as well as quantity of each spice. The following, however, gives a fair average. % of Total Spice Used Cumin 20% Coriander Seed 40% Turmeric 40% 2. Spices as given in the inventory form were a mixture as above and the nutritional value of the mixed spices has been based on their individual values in the above proportion. The actual figures used in the calculations are given below. Per 100 Gms Carbo- Spices Calories Protein hydrate Fat Calcium Iron Vit. A gm. gm. gm. mg. mg. I.U. Cumin 356 18.7 36.6 15.0 108 31.0 870 Coriander Seed 288 14.1 21.6 16.1 63 17.9 1570 Turmeric 349 6.3 69.4 5.1 15 18.6 50 Composition in Usual Proportion of All Three Gm. Cumin 20 71 3.6 7.2 3.0 21.6 6.2 174 Coriander Seed 40 115 5.6 8.6 6.4 25.2 7.2 628 Turmeric 40 139 2.6 27.7 2.0 6.0 7.2 20 Total 100 325 11.8 43.5 11.4 11.4 52.8 822 1/ Pakistan Army Data from Major M. Iqbal, P.A.S.C., GHQ Science - Laboratory, Chuklala Source: https://www.industrydocuments.ucsf.edu/docs/rmnc0227 - -41 - APPENDIX 6 A. Guide Used In Interpretation of Urinary Vitamin Excretion Data - Adult Males. Deficient Low Acceptable High N° Methylnicotinamide mg./6 hrs. 0.2 0.2-0.59 0.6 >1.6 mg./gm. creatinine 0.5 0.5-1.59 1.6 >4.3 Riboflavin g./6 hrs. 1/ VI 10 10-29 30 100 g./gm. creatinine 27 27-79 80 270 Thiamine g./6 hrs. <10 10-24 25 > 50 g./gm. creatinine 527 27-65 66 >130 The urinary values indicated above are based on an average creatinine coefficient of 23 and a 65 kg. man who would be expected to excrete 1.5 gm. of creatinine daily. B. Guide Used In Interpretation of Blood Data - Young Adult Men Deficient Low Acceptable High Hemoglobin gms./100 ml. 12.0 12-13.9 14.0 > 15.0 Hematocrit (PVC) % <36 36-41 42 745 Total Serum Protein (TSP) gms./100 ml. V 6.0 6.0-6.4 6.5 > 7.0 Serum Ascorbic Acid mg./100 ml. <0.1 0.1-0.19 0.2 > 0.4 Serum Vitamin A g./100 ml. T 10 10-19 20 > 50 Serum Carotene g./100 ml. <20 20-39 40 100 1/ ug. means mcg. Source: https://www.industrydocuments.ucsf.edu/docs/rrnc0227 - 42 - APPENDIX 7 Guide Used In Interpretation of Nutrient Intake Data- Young Adult Males (1) Deficient Low Acceptable High Niacin mg./day < 5 5-10 10-15 > 15 Riboflavin mg. / day < 0.7 0.7-1.2 1.2-1.5 >1.5 Thiamine mg/1000 cal. <0.2 0.2-0.3 0.3-0.5 0.5 Ascorbic Acid mg./day < 10 10-29 30-50 > 50 Vitamin A I.U./day 2000 2000-3500 3500-5000 >5000 Calcium gm./day 0.3 0.3-0.4 0.4-0.8 70.8 Iron mg./day <6.0 6-9 9-12 712 Protein gm./kg $0.5 0.5-1.0 1.0-1.5 > 1.5 (1) Prepared by the Interdepartmental Committee on Nutrition for National Defense. These guides are intended to apply to 25 yr. old physically active males of 67 in. (170 cm.) in height and 143 (65 kg. ) lb. in weight living in a temperate climate and consuming a varied diet. The quantities specified should never be considered as inflexible "requirements". In interpreting nutrition surveys of population groups average values falling in one or another of the above cate- gories conceal the fact that some individuals will receive more and others less than average. In addition it is known that there is much variability from one to another individual in their re- quirement for various nutrients. Variations in body size, activity, climate, types of food available, and other factors modify require- ments and, consequently, interpretation of survey data. The nu- trient content of food may be altered materially during food pre- paration, a fact which must always be considered in evaluating dietary intake data. Source: https://www.industrydocuments.ucsf.edu/docs/rmnc0227 "IS Ao003 o W

What is the acceptable range of iron in the body of a male?

rrnc0227

rrnc0227_p44, rrnc0227_p45, rrnc0227_p46, rrnc0227_p47, rrnc0227_p48, rrnc0227_p49, rrnc0227_p50, rrnc0227_p51

9-12

PAKISTAN NUTRIENT VALUES USED IN CALCULATIONS (Continued) (Values per 100 grams "As Purchased" basis) 1/ Calo- - Pro- Fat Ca Fe Vit. A Thia- - Ribo- Niacin Vit. C Ref. Item ries tein mine flavin Food Gms Gms. Mg Mg I.U. Mg Mg Mg Mg Carrots 37 1.1 0.3 34 0.7 10,560 0.05 0.05 0.5 5 A 120 Peas, fresh 45 3.0 0.2 10 0.9 310 0.15 0.07 1.2 12 A 160 Cabbage 17 1.0 0.1 34 0.4 60 0.04 0.04 0.2 36 A 118 Spinach 16 1.9 0.2 66 2.5 7,720 0.09 0.16 0.5 48 A 176 Coriander, Fresh 32 2.2 0.4 152 5.3 5,350 0.09 0.11 0.9 75 A 131 Karela (Momordica charantia) - - (?) - - - 140 D Eggplant 23 1.1 0.2 14 0.4 30 0.04 0.05 0.6 5 A 136 Potato 70 1.7 0.1 9 0.6 - 0.09 0.03 1 14 A 163 Onion, dry 42 1.3 0.2 30 0.5 50 0.03 0.04 0.2 8 A 154 Onion, green 24 1.1 0.2 27 0.6 20 0.06 0.03 0.3 9 A 145D 16 Turnip 28 1.0 0.2 35 0.4 - 0.04 0.06 0.4 24 A 187 I Cauliflower 14 1.4 0.1 13 0.6 50 0.06 0.06 0.3 39 A 122 Veg. Marrow 20 0.7 - - 0.7 - - - - 18 D Tomato, fresh 18 0.9 0.3 10 0.5 970 0.05 0.04 0.04 20 A 184 Tomato, can 98 2 0.4 12 0.8 1,880 0.09 0.07 2.2 11 A 361 Orange, malta 32 0.6 0.1 24 0.3 140 0.06 0.02 0.1 35 A 71 Guava 58 0.8 0.5 13 0.7 160 0.05 0.03 0.8 246 A 53 Papaya 27 0.4 0.1 14 0.2 1,190 0.02 0.03 0.2 38 A 77 Banana 59 0.8 0.1 5 0.4 290 0.03 .03 0.5 7 A 41 Tamarind 115 1.3 0.3 36 0.3 ; 10 0.16 0.07 0.6 1 A 96 Raisins 268 2.3 0.5 78 3.3 50 0.15 0.08 0.5 - C 553 Garlic 84 4.0 0.2 37 0.9 - 0.19 0.07 0.4 13 A 139 Chillies, dry245 14.8 7 15 1.5 575 - - - 50 D. , E Spices, mix 325 11.8 11.4 53 21 822 - - - - D 1/ References: A. Composition of foods used in Far Eastern countries. USDA Handbook #34, 1952 B. Food Composition Tables - minerals and vitamins for international use. FAO United Nations, 1954. C. Composition of Foods - raw, processed, prepared. USDA Handbook #8, 1950. D. Major M. Iqbal, GHQ Science Laboratories, Chuklala, Pakistan. E. Analyses of Medical Nutrition Laboratory, Denver, Colorado. Source: https:llwww.industrydocuments.ucsf.edu/docs/rrnc0227 - 37 - APPENDIX 2 Conservative Vitamin Losses on Cooking (Pakistan) Food Class Thiamine Riboflavin Niacin Vitamin C % % % % Meats 35 20 25 - Cereals 10 - 10 - Legumes 20 - - - Leaf Green Veg. 35 20 25 60 Vegetables, Other 35 20 25 60 Tomatoes - - - 15 Potatoes 40 20 25 60 1/ References: U.S. Department of the Army TM 8-501, Nutri- tion, p. 19, September, 1949, and Pakistan Army data from Major M. Iqbal, P.A.S.C. GHQ Science Laboratory, Chuklala. Pakistan losses, especially of vitamins A and C, would be expected to exceed these in cases of prolonged cooking and the use of copper vessels. Source: https://www.industrydocuments.ucsf.edu/docs/rrnc0227 APPENDIX 3 PAKISTAN: Analysis of Dried Raw Foods 1/ Ca Thiamine Riboflavin NAME Protein Fat Moisture Ash Carbohydrate mg/100 gm mg/100 gm mg/100 gm Italian Millet 10.97 2.63 5.63 2.28 78.49 30 0.35 0.31 Dhal Mong 22.27 0.37 5.85 3.86 67.65 109 0.78 0.25 Dhal Masur Split 26.19 0.34 5.26 2.22 65.99 61 0.35 0.53 Gram Split 15.73 1.17 5.69 3.19 74.22 80 0.51 0.29 White Gram 22.95 2.30 6.98 3.68 64.09 - - - Ginger 10.20 1.93 7.12 13.65 67.10 - - - Green Gram 24.14 0.53 6.30 3.71 65.32 176 - - Dried Chillies (Peppers) 2/ 14.50 2.29 7.83 - - - - Mothh (Moth Bean) 22.68 0.58 3.24 4.98 68.52 311 0.44 - Bullrush Millet 11.39 3.59 2.58 7.62 74.82 214 0.56 0.26 Dhal Urd Split 21.80 0.04 3.53 3.86 70.77 153 0.62 0.21 3 8 Gram Whole 25.91 4.04 5.09 4.55 60.41 - - - Cardamon (condiment) 22.24 5.21 - 72.55 I - - - - Arum (Taro) 31.90 0.16 64.85 2.82 0.27 99 0.09 0.32 Imlok 40.42 1.00 0.37 2.59 55.62 253 - - Tamarind 11.27 0.43 2.31 10.62 75.37 - - - Atta 11.58 0.93 0.36 2.32 84.81 45 0.70 0.17 Black Gram 2/ 0.37 6.24 3.70 - - - - Betel Nut 2/ - 0.42 1.66 - 108 0.04 - French Bean 2/ 3.50 - - - - - - 1/ Analyses by the Army Medical Nutrition Laboratory, Denver. 2/ Not enough sample for analysis. Source: https://www.industrydocuments.ucst.edu/docs/rrnc0227 - 39 - APPENDIX 4 PAKISTAN: Caloric, Protein and Fat Content of the Packaged Ration (French Source) 1/ Gms Gms of Carbo- Food Item Food Item Protein Fat hydrate Calories Breakfast Sweet Biscuits 98.8 8.59 20.71 65.60 483.2 Apricot Flav. Conc. Food 100.6 10.38 10.87 74.09 435.7 Lunch Sweet Biscuits 103.1 6.84 19.06 71.88 486.4 Plain Biscuits 72.5 7.22 6.55 54.59 306.2 Chocolate Flav. Conc. Food 98.2 11.75 10.56 71.12 426.5 Supper Chocolate Flav. Conc. Food 50.3 5.53 5.89 36.60 221.5 Apricot Flav. Conc. Food 50.2 5.64 5.93 36.11 220.4 Plain Biscuits 68.7 6.72 5.22 54.08 290.2 Sweet Biscuits 105.5 9.17 22.11 70.03 515.8 Misc. Items Jam 57.8 0.80 0.14 56.60 228.7 Tea 6.7 -- 6.02 24.2 Lemon Candies 27.1 0.11 0.11 26.08 105.8 Powdered Milk 7.9 2.82 0.12 4.14 28.9 Orange Crystals 50.5 0.20 0.38 44.62 182.7 Vitamin Chocolate Pill 5.4 -- -- -- Salt -- -- Sugar 22.3 -- - - 22.29 89.2 Totals/ration -- 75.0 107.7 693.3 4045.0 1/ Analyses by the Army Medical Nutrition Laboratory, Denver. Source: https:/lwww.industrydocuments.ucsf.edu/docs/rrnc0227 - 40 - APPENDIX 5 Pakistan: Nutritional Evaluation of Spices 1/ 1. The various spices used in dishes varied from unit to unit in number as well as quantity of each spice. The following, however, gives a fair average. % of Total Spice Used Cumin 20% Coriander Seed 40% Turmeric 40% 2. Spices as given in the inventory form were a mixture as above and the nutritional value of the mixed spices has been based on their individual values in the above proportion. The actual figures used in the calculations are given below. Per 100 Gms Carbo- Spices Calories Protein hydrate Fat Calcium Iron Vit. A gm. gm. gm. mg. mg. I.U. Cumin 356 18.7 36.6 15.0 108 31.0 870 Coriander Seed 288 14.1 21.6 16.1 63 17.9 1570 Turmeric 349 6.3 69.4 5.1 15 18.6 50 Composition in Usual Proportion of All Three Gm. Cumin 20 71 3.6 7.2 3.0 21.6 6.2 174 Coriander Seed 40 115 5.6 8.6 6.4 25.2 7.2 628 Turmeric 40 139 2.6 27.7 2.0 6.0 7.2 20 Total 100 325 11.8 43.5 11.4 11.4 52.8 822 1/ Pakistan Army Data from Major M. Iqbal, P.A.S.C., GHQ Science - Laboratory, Chuklala Source: https://www.industrydocuments.ucsf.edu/docs/rmnc0227 - -41 - APPENDIX 6 A. Guide Used In Interpretation of Urinary Vitamin Excretion Data - Adult Males. Deficient Low Acceptable High N° Methylnicotinamide mg./6 hrs. 0.2 0.2-0.59 0.6 >1.6 mg./gm. creatinine 0.5 0.5-1.59 1.6 >4.3 Riboflavin g./6 hrs. 1/ VI 10 10-29 30 100 g./gm. creatinine 27 27-79 80 270 Thiamine g./6 hrs. <10 10-24 25 > 50 g./gm. creatinine 527 27-65 66 >130 The urinary values indicated above are based on an average creatinine coefficient of 23 and a 65 kg. man who would be expected to excrete 1.5 gm. of creatinine daily. B. Guide Used In Interpretation of Blood Data - Young Adult Men Deficient Low Acceptable High Hemoglobin gms./100 ml. 12.0 12-13.9 14.0 > 15.0 Hematocrit (PVC) % <36 36-41 42 745 Total Serum Protein (TSP) gms./100 ml. V 6.0 6.0-6.4 6.5 > 7.0 Serum Ascorbic Acid mg./100 ml. <0.1 0.1-0.19 0.2 > 0.4 Serum Vitamin A g./100 ml. T 10 10-19 20 > 50 Serum Carotene g./100 ml. <20 20-39 40 100 1/ ug. means mcg. Source: https://www.industrydocuments.ucsf.edu/docs/rrnc0227 - 42 - APPENDIX 7 Guide Used In Interpretation of Nutrient Intake Data- Young Adult Males (1) Deficient Low Acceptable High Niacin mg./day < 5 5-10 10-15 > 15 Riboflavin mg. / day < 0.7 0.7-1.2 1.2-1.5 >1.5 Thiamine mg/1000 cal. <0.2 0.2-0.3 0.3-0.5 0.5 Ascorbic Acid mg./day < 10 10-29 30-50 > 50 Vitamin A I.U./day 2000 2000-3500 3500-5000 >5000 Calcium gm./day 0.3 0.3-0.4 0.4-0.8 70.8 Iron mg./day <6.0 6-9 9-12 712 Protein gm./kg $0.5 0.5-1.0 1.0-1.5 > 1.5 (1) Prepared by the Interdepartmental Committee on Nutrition for National Defense. These guides are intended to apply to 25 yr. old physically active males of 67 in. (170 cm.) in height and 143 (65 kg. ) lb. in weight living in a temperate climate and consuming a varied diet. The quantities specified should never be considered as inflexible "requirements". In interpreting nutrition surveys of population groups average values falling in one or another of the above cate- gories conceal the fact that some individuals will receive more and others less than average. In addition it is known that there is much variability from one to another individual in their re- quirement for various nutrients. Variations in body size, activity, climate, types of food available, and other factors modify require- ments and, consequently, interpretation of survey data. The nu- trient content of food may be altered materially during food pre- paration, a fact which must always be considered in evaluating dietary intake data. Source: https://www.industrydocuments.ucsf.edu/docs/rmnc0227 "IS Ao003 o W

What is the acceptable range of protein in the body of a male?

rrnc0227

rrnc0227_p44, rrnc0227_p45, rrnc0227_p46, rrnc0227_p47, rrnc0227_p48, rrnc0227_p49, rrnc0227_p50, rrnc0227_p51

1.0-1.5

PAKISTAN NUTRIENT VALUES USED IN CALCULATIONS (Continued) (Values per 100 grams "As Purchased" basis) 1/ Calo- - Pro- Fat Ca Fe Vit. A Thia- - Ribo- Niacin Vit. C Ref. Item ries tein mine flavin Food Gms Gms. Mg Mg I.U. Mg Mg Mg Mg Carrots 37 1.1 0.3 34 0.7 10,560 0.05 0.05 0.5 5 A 120 Peas, fresh 45 3.0 0.2 10 0.9 310 0.15 0.07 1.2 12 A 160 Cabbage 17 1.0 0.1 34 0.4 60 0.04 0.04 0.2 36 A 118 Spinach 16 1.9 0.2 66 2.5 7,720 0.09 0.16 0.5 48 A 176 Coriander, Fresh 32 2.2 0.4 152 5.3 5,350 0.09 0.11 0.9 75 A 131 Karela (Momordica charantia) - - (?) - - - 140 D Eggplant 23 1.1 0.2 14 0.4 30 0.04 0.05 0.6 5 A 136 Potato 70 1.7 0.1 9 0.6 - 0.09 0.03 1 14 A 163 Onion, dry 42 1.3 0.2 30 0.5 50 0.03 0.04 0.2 8 A 154 Onion, green 24 1.1 0.2 27 0.6 20 0.06 0.03 0.3 9 A 145D 16 Turnip 28 1.0 0.2 35 0.4 - 0.04 0.06 0.4 24 A 187 I Cauliflower 14 1.4 0.1 13 0.6 50 0.06 0.06 0.3 39 A 122 Veg. Marrow 20 0.7 - - 0.7 - - - - 18 D Tomato, fresh 18 0.9 0.3 10 0.5 970 0.05 0.04 0.04 20 A 184 Tomato, can 98 2 0.4 12 0.8 1,880 0.09 0.07 2.2 11 A 361 Orange, malta 32 0.6 0.1 24 0.3 140 0.06 0.02 0.1 35 A 71 Guava 58 0.8 0.5 13 0.7 160 0.05 0.03 0.8 246 A 53 Papaya 27 0.4 0.1 14 0.2 1,190 0.02 0.03 0.2 38 A 77 Banana 59 0.8 0.1 5 0.4 290 0.03 .03 0.5 7 A 41 Tamarind 115 1.3 0.3 36 0.3 ; 10 0.16 0.07 0.6 1 A 96 Raisins 268 2.3 0.5 78 3.3 50 0.15 0.08 0.5 - C 553 Garlic 84 4.0 0.2 37 0.9 - 0.19 0.07 0.4 13 A 139 Chillies, dry245 14.8 7 15 1.5 575 - - - 50 D. , E Spices, mix 325 11.8 11.4 53 21 822 - - - - D 1/ References: A. Composition of foods used in Far Eastern countries. USDA Handbook #34, 1952 B. Food Composition Tables - minerals and vitamins for international use. FAO United Nations, 1954. C. Composition of Foods - raw, processed, prepared. USDA Handbook #8, 1950. D. Major M. Iqbal, GHQ Science Laboratories, Chuklala, Pakistan. E. Analyses of Medical Nutrition Laboratory, Denver, Colorado. Source: https:llwww.industrydocuments.ucsf.edu/docs/rrnc0227 - 37 - APPENDIX 2 Conservative Vitamin Losses on Cooking (Pakistan) Food Class Thiamine Riboflavin Niacin Vitamin C % % % % Meats 35 20 25 - Cereals 10 - 10 - Legumes 20 - - - Leaf Green Veg. 35 20 25 60 Vegetables, Other 35 20 25 60 Tomatoes - - - 15 Potatoes 40 20 25 60 1/ References: U.S. Department of the Army TM 8-501, Nutri- tion, p. 19, September, 1949, and Pakistan Army data from Major M. Iqbal, P.A.S.C. GHQ Science Laboratory, Chuklala. Pakistan losses, especially of vitamins A and C, would be expected to exceed these in cases of prolonged cooking and the use of copper vessels. Source: https://www.industrydocuments.ucsf.edu/docs/rrnc0227 APPENDIX 3 PAKISTAN: Analysis of Dried Raw Foods 1/ Ca Thiamine Riboflavin NAME Protein Fat Moisture Ash Carbohydrate mg/100 gm mg/100 gm mg/100 gm Italian Millet 10.97 2.63 5.63 2.28 78.49 30 0.35 0.31 Dhal Mong 22.27 0.37 5.85 3.86 67.65 109 0.78 0.25 Dhal Masur Split 26.19 0.34 5.26 2.22 65.99 61 0.35 0.53 Gram Split 15.73 1.17 5.69 3.19 74.22 80 0.51 0.29 White Gram 22.95 2.30 6.98 3.68 64.09 - - - Ginger 10.20 1.93 7.12 13.65 67.10 - - - Green Gram 24.14 0.53 6.30 3.71 65.32 176 - - Dried Chillies (Peppers) 2/ 14.50 2.29 7.83 - - - - Mothh (Moth Bean) 22.68 0.58 3.24 4.98 68.52 311 0.44 - Bullrush Millet 11.39 3.59 2.58 7.62 74.82 214 0.56 0.26 Dhal Urd Split 21.80 0.04 3.53 3.86 70.77 153 0.62 0.21 3 8 Gram Whole 25.91 4.04 5.09 4.55 60.41 - - - Cardamon (condiment) 22.24 5.21 - 72.55 I - - - - Arum (Taro) 31.90 0.16 64.85 2.82 0.27 99 0.09 0.32 Imlok 40.42 1.00 0.37 2.59 55.62 253 - - Tamarind 11.27 0.43 2.31 10.62 75.37 - - - Atta 11.58 0.93 0.36 2.32 84.81 45 0.70 0.17 Black Gram 2/ 0.37 6.24 3.70 - - - - Betel Nut 2/ - 0.42 1.66 - 108 0.04 - French Bean 2/ 3.50 - - - - - - 1/ Analyses by the Army Medical Nutrition Laboratory, Denver. 2/ Not enough sample for analysis. Source: https://www.industrydocuments.ucst.edu/docs/rrnc0227 - 39 - APPENDIX 4 PAKISTAN: Caloric, Protein and Fat Content of the Packaged Ration (French Source) 1/ Gms Gms of Carbo- Food Item Food Item Protein Fat hydrate Calories Breakfast Sweet Biscuits 98.8 8.59 20.71 65.60 483.2 Apricot Flav. Conc. Food 100.6 10.38 10.87 74.09 435.7 Lunch Sweet Biscuits 103.1 6.84 19.06 71.88 486.4 Plain Biscuits 72.5 7.22 6.55 54.59 306.2 Chocolate Flav. Conc. Food 98.2 11.75 10.56 71.12 426.5 Supper Chocolate Flav. Conc. Food 50.3 5.53 5.89 36.60 221.5 Apricot Flav. Conc. Food 50.2 5.64 5.93 36.11 220.4 Plain Biscuits 68.7 6.72 5.22 54.08 290.2 Sweet Biscuits 105.5 9.17 22.11 70.03 515.8 Misc. Items Jam 57.8 0.80 0.14 56.60 228.7 Tea 6.7 -- 6.02 24.2 Lemon Candies 27.1 0.11 0.11 26.08 105.8 Powdered Milk 7.9 2.82 0.12 4.14 28.9 Orange Crystals 50.5 0.20 0.38 44.62 182.7 Vitamin Chocolate Pill 5.4 -- -- -- Salt -- -- Sugar 22.3 -- - - 22.29 89.2 Totals/ration -- 75.0 107.7 693.3 4045.0 1/ Analyses by the Army Medical Nutrition Laboratory, Denver. Source: https:/lwww.industrydocuments.ucsf.edu/docs/rrnc0227 - 40 - APPENDIX 5 Pakistan: Nutritional Evaluation of Spices 1/ 1. The various spices used in dishes varied from unit to unit in number as well as quantity of each spice. The following, however, gives a fair average. % of Total Spice Used Cumin 20% Coriander Seed 40% Turmeric 40% 2. Spices as given in the inventory form were a mixture as above and the nutritional value of the mixed spices has been based on their individual values in the above proportion. The actual figures used in the calculations are given below. Per 100 Gms Carbo- Spices Calories Protein hydrate Fat Calcium Iron Vit. A gm. gm. gm. mg. mg. I.U. Cumin 356 18.7 36.6 15.0 108 31.0 870 Coriander Seed 288 14.1 21.6 16.1 63 17.9 1570 Turmeric 349 6.3 69.4 5.1 15 18.6 50 Composition in Usual Proportion of All Three Gm. Cumin 20 71 3.6 7.2 3.0 21.6 6.2 174 Coriander Seed 40 115 5.6 8.6 6.4 25.2 7.2 628 Turmeric 40 139 2.6 27.7 2.0 6.0 7.2 20 Total 100 325 11.8 43.5 11.4 11.4 52.8 822 1/ Pakistan Army Data from Major M. Iqbal, P.A.S.C., GHQ Science - Laboratory, Chuklala Source: https://www.industrydocuments.ucsf.edu/docs/rmnc0227 - -41 - APPENDIX 6 A. Guide Used In Interpretation of Urinary Vitamin Excretion Data - Adult Males. Deficient Low Acceptable High N° Methylnicotinamide mg./6 hrs. 0.2 0.2-0.59 0.6 >1.6 mg./gm. creatinine 0.5 0.5-1.59 1.6 >4.3 Riboflavin g./6 hrs. 1/ VI 10 10-29 30 100 g./gm. creatinine 27 27-79 80 270 Thiamine g./6 hrs. <10 10-24 25 > 50 g./gm. creatinine 527 27-65 66 >130 The urinary values indicated above are based on an average creatinine coefficient of 23 and a 65 kg. man who would be expected to excrete 1.5 gm. of creatinine daily. B. Guide Used In Interpretation of Blood Data - Young Adult Men Deficient Low Acceptable High Hemoglobin gms./100 ml. 12.0 12-13.9 14.0 > 15.0 Hematocrit (PVC) % <36 36-41 42 745 Total Serum Protein (TSP) gms./100 ml. V 6.0 6.0-6.4 6.5 > 7.0 Serum Ascorbic Acid mg./100 ml. <0.1 0.1-0.19 0.2 > 0.4 Serum Vitamin A g./100 ml. T 10 10-19 20 > 50 Serum Carotene g./100 ml. <20 20-39 40 100 1/ ug. means mcg. Source: https://www.industrydocuments.ucsf.edu/docs/rrnc0227 - 42 - APPENDIX 7 Guide Used In Interpretation of Nutrient Intake Data- Young Adult Males (1) Deficient Low Acceptable High Niacin mg./day < 5 5-10 10-15 > 15 Riboflavin mg. / day < 0.7 0.7-1.2 1.2-1.5 >1.5 Thiamine mg/1000 cal. <0.2 0.2-0.3 0.3-0.5 0.5 Ascorbic Acid mg./day < 10 10-29 30-50 > 50 Vitamin A I.U./day 2000 2000-3500 3500-5000 >5000 Calcium gm./day 0.3 0.3-0.4 0.4-0.8 70.8 Iron mg./day <6.0 6-9 9-12 712 Protein gm./kg $0.5 0.5-1.0 1.0-1.5 > 1.5 (1) Prepared by the Interdepartmental Committee on Nutrition for National Defense. These guides are intended to apply to 25 yr. old physically active males of 67 in. (170 cm.) in height and 143 (65 kg. ) lb. in weight living in a temperate climate and consuming a varied diet. The quantities specified should never be considered as inflexible "requirements". In interpreting nutrition surveys of population groups average values falling in one or another of the above cate- gories conceal the fact that some individuals will receive more and others less than average. In addition it is known that there is much variability from one to another individual in their re- quirement for various nutrients. Variations in body size, activity, climate, types of food available, and other factors modify require- ments and, consequently, interpretation of survey data. The nu- trient content of food may be altered materially during food pre- paration, a fact which must always be considered in evaluating dietary intake data. Source: https://www.industrydocuments.ucsf.edu/docs/rmnc0227 "IS Ao003 o W

What is the acceptable range of niacin in the body of a male?

rrnc0227

rrnc0227_p44, rrnc0227_p45, rrnc0227_p46, rrnc0227_p47, rrnc0227_p48, rrnc0227_p49, rrnc0227_p50, rrnc0227_p51

10-15

PAKISTAN NUTRIENT VALUES USED IN CALCULATIONS (Continued) (Values per 100 grams "As Purchased" basis) 1/ Calo- - Pro- Fat Ca Fe Vit. A Thia- - Ribo- Niacin Vit. C Ref. Item ries tein mine flavin Food Gms Gms. Mg Mg I.U. Mg Mg Mg Mg Carrots 37 1.1 0.3 34 0.7 10,560 0.05 0.05 0.5 5 A 120 Peas, fresh 45 3.0 0.2 10 0.9 310 0.15 0.07 1.2 12 A 160 Cabbage 17 1.0 0.1 34 0.4 60 0.04 0.04 0.2 36 A 118 Spinach 16 1.9 0.2 66 2.5 7,720 0.09 0.16 0.5 48 A 176 Coriander, Fresh 32 2.2 0.4 152 5.3 5,350 0.09 0.11 0.9 75 A 131 Karela (Momordica charantia) - - (?) - - - 140 D Eggplant 23 1.1 0.2 14 0.4 30 0.04 0.05 0.6 5 A 136 Potato 70 1.7 0.1 9 0.6 - 0.09 0.03 1 14 A 163 Onion, dry 42 1.3 0.2 30 0.5 50 0.03 0.04 0.2 8 A 154 Onion, green 24 1.1 0.2 27 0.6 20 0.06 0.03 0.3 9 A 145D 16 Turnip 28 1.0 0.2 35 0.4 - 0.04 0.06 0.4 24 A 187 I Cauliflower 14 1.4 0.1 13 0.6 50 0.06 0.06 0.3 39 A 122 Veg. Marrow 20 0.7 - - 0.7 - - - - 18 D Tomato, fresh 18 0.9 0.3 10 0.5 970 0.05 0.04 0.04 20 A 184 Tomato, can 98 2 0.4 12 0.8 1,880 0.09 0.07 2.2 11 A 361 Orange, malta 32 0.6 0.1 24 0.3 140 0.06 0.02 0.1 35 A 71 Guava 58 0.8 0.5 13 0.7 160 0.05 0.03 0.8 246 A 53 Papaya 27 0.4 0.1 14 0.2 1,190 0.02 0.03 0.2 38 A 77 Banana 59 0.8 0.1 5 0.4 290 0.03 .03 0.5 7 A 41 Tamarind 115 1.3 0.3 36 0.3 ; 10 0.16 0.07 0.6 1 A 96 Raisins 268 2.3 0.5 78 3.3 50 0.15 0.08 0.5 - C 553 Garlic 84 4.0 0.2 37 0.9 - 0.19 0.07 0.4 13 A 139 Chillies, dry245 14.8 7 15 1.5 575 - - - 50 D. , E Spices, mix 325 11.8 11.4 53 21 822 - - - - D 1/ References: A. Composition of foods used in Far Eastern countries. USDA Handbook #34, 1952 B. Food Composition Tables - minerals and vitamins for international use. FAO United Nations, 1954. C. Composition of Foods - raw, processed, prepared. USDA Handbook #8, 1950. D. Major M. Iqbal, GHQ Science Laboratories, Chuklala, Pakistan. E. Analyses of Medical Nutrition Laboratory, Denver, Colorado. Source: https:llwww.industrydocuments.ucsf.edu/docs/rrnc0227 - 37 - APPENDIX 2 Conservative Vitamin Losses on Cooking (Pakistan) Food Class Thiamine Riboflavin Niacin Vitamin C % % % % Meats 35 20 25 - Cereals 10 - 10 - Legumes 20 - - - Leaf Green Veg. 35 20 25 60 Vegetables, Other 35 20 25 60 Tomatoes - - - 15 Potatoes 40 20 25 60 1/ References: U.S. Department of the Army TM 8-501, Nutri- tion, p. 19, September, 1949, and Pakistan Army data from Major M. Iqbal, P.A.S.C. GHQ Science Laboratory, Chuklala. Pakistan losses, especially of vitamins A and C, would be expected to exceed these in cases of prolonged cooking and the use of copper vessels. Source: https://www.industrydocuments.ucsf.edu/docs/rrnc0227 APPENDIX 3 PAKISTAN: Analysis of Dried Raw Foods 1/ Ca Thiamine Riboflavin NAME Protein Fat Moisture Ash Carbohydrate mg/100 gm mg/100 gm mg/100 gm Italian Millet 10.97 2.63 5.63 2.28 78.49 30 0.35 0.31 Dhal Mong 22.27 0.37 5.85 3.86 67.65 109 0.78 0.25 Dhal Masur Split 26.19 0.34 5.26 2.22 65.99 61 0.35 0.53 Gram Split 15.73 1.17 5.69 3.19 74.22 80 0.51 0.29 White Gram 22.95 2.30 6.98 3.68 64.09 - - - Ginger 10.20 1.93 7.12 13.65 67.10 - - - Green Gram 24.14 0.53 6.30 3.71 65.32 176 - - Dried Chillies (Peppers) 2/ 14.50 2.29 7.83 - - - - Mothh (Moth Bean) 22.68 0.58 3.24 4.98 68.52 311 0.44 - Bullrush Millet 11.39 3.59 2.58 7.62 74.82 214 0.56 0.26 Dhal Urd Split 21.80 0.04 3.53 3.86 70.77 153 0.62 0.21 3 8 Gram Whole 25.91 4.04 5.09 4.55 60.41 - - - Cardamon (condiment) 22.24 5.21 - 72.55 I - - - - Arum (Taro) 31.90 0.16 64.85 2.82 0.27 99 0.09 0.32 Imlok 40.42 1.00 0.37 2.59 55.62 253 - - Tamarind 11.27 0.43 2.31 10.62 75.37 - - - Atta 11.58 0.93 0.36 2.32 84.81 45 0.70 0.17 Black Gram 2/ 0.37 6.24 3.70 - - - - Betel Nut 2/ - 0.42 1.66 - 108 0.04 - French Bean 2/ 3.50 - - - - - - 1/ Analyses by the Army Medical Nutrition Laboratory, Denver. 2/ Not enough sample for analysis. Source: https://www.industrydocuments.ucst.edu/docs/rrnc0227 - 39 - APPENDIX 4 PAKISTAN: Caloric, Protein and Fat Content of the Packaged Ration (French Source) 1/ Gms Gms of Carbo- Food Item Food Item Protein Fat hydrate Calories Breakfast Sweet Biscuits 98.8 8.59 20.71 65.60 483.2 Apricot Flav. Conc. Food 100.6 10.38 10.87 74.09 435.7 Lunch Sweet Biscuits 103.1 6.84 19.06 71.88 486.4 Plain Biscuits 72.5 7.22 6.55 54.59 306.2 Chocolate Flav. Conc. Food 98.2 11.75 10.56 71.12 426.5 Supper Chocolate Flav. Conc. Food 50.3 5.53 5.89 36.60 221.5 Apricot Flav. Conc. Food 50.2 5.64 5.93 36.11 220.4 Plain Biscuits 68.7 6.72 5.22 54.08 290.2 Sweet Biscuits 105.5 9.17 22.11 70.03 515.8 Misc. Items Jam 57.8 0.80 0.14 56.60 228.7 Tea 6.7 -- 6.02 24.2 Lemon Candies 27.1 0.11 0.11 26.08 105.8 Powdered Milk 7.9 2.82 0.12 4.14 28.9 Orange Crystals 50.5 0.20 0.38 44.62 182.7 Vitamin Chocolate Pill 5.4 -- -- -- Salt -- -- Sugar 22.3 -- - - 22.29 89.2 Totals/ration -- 75.0 107.7 693.3 4045.0 1/ Analyses by the Army Medical Nutrition Laboratory, Denver. Source: https:/lwww.industrydocuments.ucsf.edu/docs/rrnc0227 - 40 - APPENDIX 5 Pakistan: Nutritional Evaluation of Spices 1/ 1. The various spices used in dishes varied from unit to unit in number as well as quantity of each spice. The following, however, gives a fair average. % of Total Spice Used Cumin 20% Coriander Seed 40% Turmeric 40% 2. Spices as given in the inventory form were a mixture as above and the nutritional value of the mixed spices has been based on their individual values in the above proportion. The actual figures used in the calculations are given below. Per 100 Gms Carbo- Spices Calories Protein hydrate Fat Calcium Iron Vit. A gm. gm. gm. mg. mg. I.U. Cumin 356 18.7 36.6 15.0 108 31.0 870 Coriander Seed 288 14.1 21.6 16.1 63 17.9 1570 Turmeric 349 6.3 69.4 5.1 15 18.6 50 Composition in Usual Proportion of All Three Gm. Cumin 20 71 3.6 7.2 3.0 21.6 6.2 174 Coriander Seed 40 115 5.6 8.6 6.4 25.2 7.2 628 Turmeric 40 139 2.6 27.7 2.0 6.0 7.2 20 Total 100 325 11.8 43.5 11.4 11.4 52.8 822 1/ Pakistan Army Data from Major M. Iqbal, P.A.S.C., GHQ Science - Laboratory, Chuklala Source: https://www.industrydocuments.ucsf.edu/docs/rmnc0227 - -41 - APPENDIX 6 A. Guide Used In Interpretation of Urinary Vitamin Excretion Data - Adult Males. Deficient Low Acceptable High N° Methylnicotinamide mg./6 hrs. 0.2 0.2-0.59 0.6 >1.6 mg./gm. creatinine 0.5 0.5-1.59 1.6 >4.3 Riboflavin g./6 hrs. 1/ VI 10 10-29 30 100 g./gm. creatinine 27 27-79 80 270 Thiamine g./6 hrs. <10 10-24 25 > 50 g./gm. creatinine 527 27-65 66 >130 The urinary values indicated above are based on an average creatinine coefficient of 23 and a 65 kg. man who would be expected to excrete 1.5 gm. of creatinine daily. B. Guide Used In Interpretation of Blood Data - Young Adult Men Deficient Low Acceptable High Hemoglobin gms./100 ml. 12.0 12-13.9 14.0 > 15.0 Hematocrit (PVC) % <36 36-41 42 745 Total Serum Protein (TSP) gms./100 ml. V 6.0 6.0-6.4 6.5 > 7.0 Serum Ascorbic Acid mg./100 ml. <0.1 0.1-0.19 0.2 > 0.4 Serum Vitamin A g./100 ml. T 10 10-19 20 > 50 Serum Carotene g./100 ml. <20 20-39 40 100 1/ ug. means mcg. Source: https://www.industrydocuments.ucsf.edu/docs/rrnc0227 - 42 - APPENDIX 7 Guide Used In Interpretation of Nutrient Intake Data- Young Adult Males (1) Deficient Low Acceptable High Niacin mg./day < 5 5-10 10-15 > 15 Riboflavin mg. / day < 0.7 0.7-1.2 1.2-1.5 >1.5 Thiamine mg/1000 cal. <0.2 0.2-0.3 0.3-0.5 0.5 Ascorbic Acid mg./day < 10 10-29 30-50 > 50 Vitamin A I.U./day 2000 2000-3500 3500-5000 >5000 Calcium gm./day 0.3 0.3-0.4 0.4-0.8 70.8 Iron mg./day <6.0 6-9 9-12 712 Protein gm./kg $0.5 0.5-1.0 1.0-1.5 > 1.5 (1) Prepared by the Interdepartmental Committee on Nutrition for National Defense. These guides are intended to apply to 25 yr. old physically active males of 67 in. (170 cm.) in height and 143 (65 kg. ) lb. in weight living in a temperate climate and consuming a varied diet. The quantities specified should never be considered as inflexible "requirements". In interpreting nutrition surveys of population groups average values falling in one or another of the above cate- gories conceal the fact that some individuals will receive more and others less than average. In addition it is known that there is much variability from one to another individual in their re- quirement for various nutrients. Variations in body size, activity, climate, types of food available, and other factors modify require- ments and, consequently, interpretation of survey data. The nu- trient content of food may be altered materially during food pre- paration, a fact which must always be considered in evaluating dietary intake data. Source: https://www.industrydocuments.ucsf.edu/docs/rmnc0227 "IS Ao003 o W

What is the number of overtime patients in 1974?

xjcf0227

xjcf0227_p0, xjcf0227_p1, xjcf0227_p2, xjcf0227_p3, xjcf0227_p4, xjcf0227_p5, xjcf0227_p6, xjcf0227_p7, xjcf0227_p8, xjcf0227_p9, xjcf0227_p10, xjcf0227_p11, xjcf0227_p12, xjcf0227_p13, xjcf0227_p14, xjcf0227_p15, xjcf0227_p16, xjcf0227_p17, xjcf0227_p18, xjcf0227_p19

1,405

BARNES EMERGENCY ROOM 74 COMPARISON OF CENSUS DATA - 19%5 - 1977 1977 1974 1975 1976 1977 VER DAY Patients Seen in E.R. 46,530 50,708 55,218 56,970 156 Direct Admissions 2,296 3,174 1,808 1,393 3.8 Screened Not Registered 2,296 2,560 4,538 4,785 13.1 Evening Ambulatory Service 5,315 5,158 5,233 5,013 13.7 Patients Registered 36,625 39,816 43,639 45,764 12514 Admitted After Exam 4,894 4,776 5,653 5,749 15.7 Number of Overtime Patients 1,405 1,387 1,157 735 2.0 (more than 4 hours) Observation Unit Patients 96 776 872 762 2,1 2.13 2.39 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 19.0 Resident Medicine 9,648 11,124 12,126 13,337 36.5 Private Surgery 6,053 6,176 6,681 6,474 17.7 Resident Surgery 11,531 12,952 14,628 15,599 42.7 Private ENT 389 419 483 310 0 8 Resident ENT 1,194 1,130 889 604 1. 6 Private Eye 820 856 983 854 2.3 Resident Eye 1,640 1,774 1,653 1,651 4. 5 Source: https://www.industrydocuments.ucsf.edu/docsixicf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762. Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https://lwww.industrydocuments.ucsf.edu/docsixjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https:/lwww.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https://www.industrydocuments.ucst.edu/docsixjct0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https:/lwww.industrydocuments.ucsf.edu/docsixjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E. R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764- Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docs/x)cf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https:llwww.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number : 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., . about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docs/xjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 .1,651 Source: https://www.industrydocuments.ucsf.edu/docsix)cf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered Source: https:llwww.industrydocuments.ucsf.edu/docsixjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E. R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https:llwww.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docsixjc0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.I R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source:https://www.industrydocuments.ucsf.edu/docsix)cf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docsix)cf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227

What is the number of direct admissions 1975?

xjcf0227

xjcf0227_p0, xjcf0227_p1, xjcf0227_p2, xjcf0227_p3, xjcf0227_p4, xjcf0227_p5, xjcf0227_p6, xjcf0227_p7, xjcf0227_p8, xjcf0227_p9, xjcf0227_p10, xjcf0227_p11, xjcf0227_p12, xjcf0227_p13, xjcf0227_p14, xjcf0227_p15, xjcf0227_p16, xjcf0227_p17, xjcf0227_p18, xjcf0227_p19

3,174

BARNES EMERGENCY ROOM 74 COMPARISON OF CENSUS DATA - 19%5 - 1977 1977 1974 1975 1976 1977 VER DAY Patients Seen in E.R. 46,530 50,708 55,218 56,970 156 Direct Admissions 2,296 3,174 1,808 1,393 3.8 Screened Not Registered 2,296 2,560 4,538 4,785 13.1 Evening Ambulatory Service 5,315 5,158 5,233 5,013 13.7 Patients Registered 36,625 39,816 43,639 45,764 12514 Admitted After Exam 4,894 4,776 5,653 5,749 15.7 Number of Overtime Patients 1,405 1,387 1,157 735 2.0 (more than 4 hours) Observation Unit Patients 96 776 872 762 2,1 2.13 2.39 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 19.0 Resident Medicine 9,648 11,124 12,126 13,337 36.5 Private Surgery 6,053 6,176 6,681 6,474 17.7 Resident Surgery 11,531 12,952 14,628 15,599 42.7 Private ENT 389 419 483 310 0 8 Resident ENT 1,194 1,130 889 604 1. 6 Private Eye 820 856 983 854 2.3 Resident Eye 1,640 1,774 1,653 1,651 4. 5 Source: https://www.industrydocuments.ucsf.edu/docsixicf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762. Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https://lwww.industrydocuments.ucsf.edu/docsixjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https:/lwww.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https://www.industrydocuments.ucst.edu/docsixjct0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https:/lwww.industrydocuments.ucsf.edu/docsixjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E. R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764- Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docs/x)cf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https:llwww.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number : 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., . about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docs/xjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 .1,651 Source: https://www.industrydocuments.ucsf.edu/docsix)cf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered Source: https:llwww.industrydocuments.ucsf.edu/docsixjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E. R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https:llwww.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docsixjc0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.I R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source:https://www.industrydocuments.ucsf.edu/docsix)cf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docsix)cf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227

The number of patients registered is higher in which year?

xjcf0227

xjcf0227_p0, xjcf0227_p1, xjcf0227_p2, xjcf0227_p3, xjcf0227_p4, xjcf0227_p5, xjcf0227_p6, xjcf0227_p7, xjcf0227_p8, xjcf0227_p9, xjcf0227_p10, xjcf0227_p11, xjcf0227_p12, xjcf0227_p13, xjcf0227_p14, xjcf0227_p15, xjcf0227_p16, xjcf0227_p17, xjcf0227_p18, xjcf0227_p19

1977

BARNES EMERGENCY ROOM 74 COMPARISON OF CENSUS DATA - 19%5 - 1977 1977 1974 1975 1976 1977 VER DAY Patients Seen in E.R. 46,530 50,708 55,218 56,970 156 Direct Admissions 2,296 3,174 1,808 1,393 3.8 Screened Not Registered 2,296 2,560 4,538 4,785 13.1 Evening Ambulatory Service 5,315 5,158 5,233 5,013 13.7 Patients Registered 36,625 39,816 43,639 45,764 12514 Admitted After Exam 4,894 4,776 5,653 5,749 15.7 Number of Overtime Patients 1,405 1,387 1,157 735 2.0 (more than 4 hours) Observation Unit Patients 96 776 872 762 2,1 2.13 2.39 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 19.0 Resident Medicine 9,648 11,124 12,126 13,337 36.5 Private Surgery 6,053 6,176 6,681 6,474 17.7 Resident Surgery 11,531 12,952 14,628 15,599 42.7 Private ENT 389 419 483 310 0 8 Resident ENT 1,194 1,130 889 604 1. 6 Private Eye 820 856 983 854 2.3 Resident Eye 1,640 1,774 1,653 1,651 4. 5 Source: https://www.industrydocuments.ucsf.edu/docsixicf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762. Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https://lwww.industrydocuments.ucsf.edu/docsixjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https:/lwww.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https://www.industrydocuments.ucst.edu/docsixjct0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https:/lwww.industrydocuments.ucsf.edu/docsixjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E. R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764- Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docs/x)cf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https:llwww.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number : 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., . about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docs/xjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 .1,651 Source: https://www.industrydocuments.ucsf.edu/docsix)cf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered Source: https:llwww.industrydocuments.ucsf.edu/docsixjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E. R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https:llwww.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docsixjc0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.I R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source:https://www.industrydocuments.ucsf.edu/docsix)cf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docsix)cf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227

The number of direct admissions is lower in which year?

xjcf0227

xjcf0227_p0, xjcf0227_p1, xjcf0227_p2, xjcf0227_p3, xjcf0227_p4, xjcf0227_p5, xjcf0227_p6, xjcf0227_p7, xjcf0227_p8, xjcf0227_p9, xjcf0227_p10, xjcf0227_p11, xjcf0227_p12, xjcf0227_p13, xjcf0227_p14, xjcf0227_p15, xjcf0227_p16, xjcf0227_p17, xjcf0227_p18, xjcf0227_p19

1977

BARNES EMERGENCY ROOM 74 COMPARISON OF CENSUS DATA - 19%5 - 1977 1977 1974 1975 1976 1977 VER DAY Patients Seen in E.R. 46,530 50,708 55,218 56,970 156 Direct Admissions 2,296 3,174 1,808 1,393 3.8 Screened Not Registered 2,296 2,560 4,538 4,785 13.1 Evening Ambulatory Service 5,315 5,158 5,233 5,013 13.7 Patients Registered 36,625 39,816 43,639 45,764 12514 Admitted After Exam 4,894 4,776 5,653 5,749 15.7 Number of Overtime Patients 1,405 1,387 1,157 735 2.0 (more than 4 hours) Observation Unit Patients 96 776 872 762 2,1 2.13 2.39 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 19.0 Resident Medicine 9,648 11,124 12,126 13,337 36.5 Private Surgery 6,053 6,176 6,681 6,474 17.7 Resident Surgery 11,531 12,952 14,628 15,599 42.7 Private ENT 389 419 483 310 0 8 Resident ENT 1,194 1,130 889 604 1. 6 Private Eye 820 856 983 854 2.3 Resident Eye 1,640 1,774 1,653 1,651 4. 5 Source: https://www.industrydocuments.ucsf.edu/docsixicf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762. Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https://lwww.industrydocuments.ucsf.edu/docsixjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https:/lwww.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https://www.industrydocuments.ucst.edu/docsixjct0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https:/lwww.industrydocuments.ucsf.edu/docsixjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E. R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764- Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docs/x)cf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https:llwww.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number : 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., . about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docs/xjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 .1,651 Source: https://www.industrydocuments.ucsf.edu/docsix)cf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered Source: https:llwww.industrydocuments.ucsf.edu/docsixjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E. R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https:llwww.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docsixjc0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.I R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source:https://www.industrydocuments.ucsf.edu/docsix)cf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docsix)cf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227

The number of observation unit patients is higher in which year?

xjcf0227

xjcf0227_p0, xjcf0227_p1, xjcf0227_p2, xjcf0227_p3, xjcf0227_p4, xjcf0227_p5, xjcf0227_p6, xjcf0227_p7, xjcf0227_p8, xjcf0227_p9, xjcf0227_p10, xjcf0227_p11, xjcf0227_p12, xjcf0227_p13, xjcf0227_p14, xjcf0227_p15, xjcf0227_p16, xjcf0227_p17, xjcf0227_p18, xjcf0227_p19

1976

BARNES EMERGENCY ROOM 74 COMPARISON OF CENSUS DATA - 19%5 - 1977 1977 1974 1975 1976 1977 VER DAY Patients Seen in E.R. 46,530 50,708 55,218 56,970 156 Direct Admissions 2,296 3,174 1,808 1,393 3.8 Screened Not Registered 2,296 2,560 4,538 4,785 13.1 Evening Ambulatory Service 5,315 5,158 5,233 5,013 13.7 Patients Registered 36,625 39,816 43,639 45,764 12514 Admitted After Exam 4,894 4,776 5,653 5,749 15.7 Number of Overtime Patients 1,405 1,387 1,157 735 2.0 (more than 4 hours) Observation Unit Patients 96 776 872 762 2,1 2.13 2.39 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 19.0 Resident Medicine 9,648 11,124 12,126 13,337 36.5 Private Surgery 6,053 6,176 6,681 6,474 17.7 Resident Surgery 11,531 12,952 14,628 15,599 42.7 Private ENT 389 419 483 310 0 8 Resident ENT 1,194 1,130 889 604 1. 6 Private Eye 820 856 983 854 2.3 Resident Eye 1,640 1,774 1,653 1,651 4. 5 Source: https://www.industrydocuments.ucsf.edu/docsixicf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762. Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https://lwww.industrydocuments.ucsf.edu/docsixjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https:/lwww.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https://www.industrydocuments.ucst.edu/docsixjct0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https:/lwww.industrydocuments.ucsf.edu/docsixjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E. R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764- Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docs/x)cf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https:llwww.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number : 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., . about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docs/xjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 .1,651 Source: https://www.industrydocuments.ucsf.edu/docsix)cf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered Source: https:llwww.industrydocuments.ucsf.edu/docsixjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E. R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https:llwww.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docsixjc0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.I R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source:https://www.industrydocuments.ucsf.edu/docsix)cf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docsix)cf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227

What is the number of child patients in the year 1976?

xjcf0227

xjcf0227_p0, xjcf0227_p1, xjcf0227_p2, xjcf0227_p3, xjcf0227_p4, xjcf0227_p5, xjcf0227_p6, xjcf0227_p7, xjcf0227_p8, xjcf0227_p9, xjcf0227_p10, xjcf0227_p11, xjcf0227_p12, xjcf0227_p13, xjcf0227_p14, xjcf0227_p15, xjcf0227_p16, xjcf0227_p17, xjcf0227_p18, xjcf0227_p19

1,584

BARNES EMERGENCY ROOM 74 COMPARISON OF CENSUS DATA - 19%5 - 1977 1977 1974 1975 1976 1977 VER DAY Patients Seen in E.R. 46,530 50,708 55,218 56,970 156 Direct Admissions 2,296 3,174 1,808 1,393 3.8 Screened Not Registered 2,296 2,560 4,538 4,785 13.1 Evening Ambulatory Service 5,315 5,158 5,233 5,013 13.7 Patients Registered 36,625 39,816 43,639 45,764 12514 Admitted After Exam 4,894 4,776 5,653 5,749 15.7 Number of Overtime Patients 1,405 1,387 1,157 735 2.0 (more than 4 hours) Observation Unit Patients 96 776 872 762 2,1 2.13 2.39 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 19.0 Resident Medicine 9,648 11,124 12,126 13,337 36.5 Private Surgery 6,053 6,176 6,681 6,474 17.7 Resident Surgery 11,531 12,952 14,628 15,599 42.7 Private ENT 389 419 483 310 0 8 Resident ENT 1,194 1,130 889 604 1. 6 Private Eye 820 856 983 854 2.3 Resident Eye 1,640 1,774 1,653 1,651 4. 5 Source: https://www.industrydocuments.ucsf.edu/docsixicf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762. Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https://lwww.industrydocuments.ucsf.edu/docsixjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https:/lwww.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https://www.industrydocuments.ucst.edu/docsixjct0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https:/lwww.industrydocuments.ucsf.edu/docsixjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E. R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764- Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docs/x)cf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https:llwww.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number : 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., . about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docs/xjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 .1,651 Source: https://www.industrydocuments.ucsf.edu/docsix)cf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered Source: https:llwww.industrydocuments.ucsf.edu/docsixjcf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E. R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https:llwww.industrydocuments.ucsf.edu/docsixjcf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i.e., about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docsixjc0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.I R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source:https://www.industrydocuments.ucsf.edu/docsix)cf0227 A FEW OBSERVATIONS DERIVING FROM THE BARNES EMERGENCY ROOM CENSUS DATA (1974-1977) In 1977 on the daily basis an average of: 1) 156 patients were seen in the E.R. 2) 27 patients were screened out or seen in the Evening Ambulatory Service 3) 125 patients were registered as E.R. patients. Of this number: 16 patients were admitted to the Hospital and 2 patients were placed in the observation unit for an average period of 13 hours 4) 56 patients were assigned to the Medical Service in the E.R. 5) 60 patients were assigned to the Surgical Service in the E.R. In the period from 1974 through 1977: 1) the number of patients seen annually has increased by 22% 2) the number of direct admissions has decreased by 40% 3) the number of patients screened but not registered has doubled 4) the Evening Ambulatory Service has provided services for a relatively constant number of patients, i.e. 5,013 to 5,315 annually 5) there has been a 25% increase in the number of patients registered as E.R. patients 6) the number of patients admitted to the Hospital after registration as E.R. patients has increased 17% 7) the proportion of E.R. patients admitted to the Hospital has not changed, i. e., about 13% of patients registered Source: https://www.industrydocuments.ucsf.edu/docsix)cf0227 BARNES EMERGENCY ROOM COMPARISON OF CENSUS DATA - 1974 - 1977 1974 1975 1976 1977 Patients Seen in E.R. 46,530 50,708 55,218 56,970 Direct Admissions 2,296 3,174 1,808 1,393 Screened Not Registered 2,296 2,560 4,538 4,785 Evening Ambulatory Service 5,315 5,158 5,233 5,013 Patients Registered 36,625 39,816 43,639 45,764 Admitted After Exam 4,894 4,776 5,653 5,749 Number of Overtime Patients 1,405 1,387 1,157 735 (more than 4 hours) Observation Unit Patients 96 776 872 762 Average/Day 2.53 3.29 Average Length of Stay in O.U. 13 hours Child Patients 1,584 Private Medicine 5,348 5,385 6,197 6,935 Resident Medicine 9,648 11,124 12,126 13,337 Private Surgery 6,053 6,176 6,681 6,474 Resident Surgery 11,531 12,952 14,628 15,599 Private ENT 389 419 483 310 Resident ENT 1,194 1,130 889 604 Private Eye 820 856 983 854 Resident Eye 1,640 1,774 1,653 1,651 Source: https://www.industrydocuments.ucsf.edu/docsixjcf0227

What is the table number?

xtkg0227

xtkg0227_p0, xtkg0227_p1, xtkg0227_p2, xtkg0227_p3, xtkg0227_p4, xtkg0227_p5, xtkg0227_p6, xtkg0227_p7, xtkg0227_p8, xtkg0227_p9

Table 2, 2

Department of the Army Office of the Surgeon General Contract No. DA-49-007-MD 544 ON THE NUTRITIVE VALUE OF THE MAJOR NUTRIENTS OF IRRADIATED FOODS and APPRAISAL OF THE TOXICITY OF IRRADIATED FOODS V. Chalam Metta M. S. Mameesh P. B. Rama Rao Connor Johnson Division of Animal Nutrition University of Illinois Urbana, Illinois Progress Report No. 18 for period March 16, 1960-Sept. 1, 1960 This is not a final report. Conclusions stated are subject to change on the basis of additional evidence. Information contained herein is not to be reprinted or published without written permission from Research and Development Division, Office of the Surgeon General, Department of the Army, Washington 25, D. C. J-1 Source: https://www.industrydocuments.ucsf.edu/docsixtkg0227 -2- Table of Contents Page Summary 3 Effect of feeding vitamin K-deficient diets to female rats. 4 Reproduction in the irradiated beef-fed female rats 4 Synthetic diets and vitamin K nutrition of the female rats. 4 Reproduction by the female rat on synthetic vitamin K-low diet. 4 Relationship of the female sex hormone and vitamin K in the rat 5 Vitamin K deficiency in the male and female chick 5 Vitamin K content of casein chick assay 6 Effect of different diets on the plasma prothrombin time of rats. 6 Studies on solvent-extracted beef (irradiated and non-irradiated) 6 Studies in progress 7 Papers published and personnel. 7 Tables. 8 J-2 Source: https://www.industrydocuments.ucsf.edu/docsixtkg0227 -3- Summary 1. Feeding of irradiated beef or vitamin K-low synthetic diets results in hypoprothrombinemia and hemorrhagic deaths of growing male rats. The female rat is markedly resistant to K deficiency. The possibility of estrogen involvement in the role of K in some unknown manner is worthy of further study. 2. Normal reproduction was obtained in female rats maintained on synthetic K-low diets or irradiated beef diets and mated with normal males. The survival of the pups was, however, poor. None of them died of hemorrhage, and good survival has been obtained on rats fed irradiated beef diets with supplements of K only when they are maintained in an isolated room free from respiratory disease. 3. Although it was found that the female rat is markedly resistant to vitamin K deficiency, our work with chicks suggests that both male and female chicks are equally succeptible to vitamin K deficiency. 4. Bioassay of the chick for vitamin K indicated that there is a difference in content of vitamin K between Labco casein (approximately 30 Y K/100 gm) and Nutritional Biochemicals Corporation casein (less than 15 / 1/100 gm). Rats main- tained on Labco casein showed normal prothrombin times, whereas those on NBC showed elevated prothrombin times. 5. When beef (irradiated and non-irradiated), after extraction by alcohol and ether, is fed to male rats, hypoprothrombinemia results. The primary cause of hemorrhagic syndrome in the male rat fed irradiated beef is the destruction of K in beef by irradiation. J-3 Source: https://www.industrydocuments.ucsf.edu/docs/xtkg0227 -4- Effect of feeding vitamin K-deficient diets to female rats. The resistance of the female rat, as compared to the male rat, to vitamin K deficiency on irradiated beef and synthetic K-free diets has been repeatedly demonstrated in our laboratory. Several hypotheses have been suggested to explain this difference. One is that the female rat may practice coprophagy to a greater extent and thus obtain more K from the feces. It may also be that the male rat, because of his greater food intake and growth, may develop the deficiency more rapidly than the female. The third possibility is that there is an actual sex difference under hormonal control. In report 17, data have been presented (table 2 of same report) to show that the greater food intake, and hence greater rate of body weight gain of the male rat, does not result in this specific difference with respect to K deficiency of the female rat. This was demonstrated by suitable paired-feeding of the irradiated beef. Also, prevention of coprophagy did not result in hypoprothrombinemia of the female rats over a 36-day period. Reproduction in the irradiated-beef-fed female Three female rats which had been housed in tubular cages to prevent coprophagy were continued on the irradiated beef diet (ad libitum) for 80 days. Then they were transferred to regular screen-bottom cages and mated with normal male rats. They conceived and gave birth to 11, 10 and 8 pups, respectively. Although 15 of these pups died within 15 days, there was no evidence of hemorrhage in them. The fact that essentially normal reproduction occurred in female rats fed a diet on which all males had died of vitamin K deficiency further emphasizes the marked resistance of the female to this vitamin deficiency. Synthetic diets and vitamin K nutrition of the female rat An experiment was conducted to study the vitamin K requirement of the growing female rat. The basal synthetic diet containing 25% NBC casein (report 17) was used with and without supplementation of 1% sulphathalidine, Data presented in the earlier report (table 2, report 17) show that 2 out of 7 female rats prevented from practicing coprophagy, and consuming ad libitum this K-low synthetic diet, died of hemorrhage after 60 days. When coprophagy was not prevented they main- tained normal prothrombin levels. Addition of sulphathalidine at a 1% level in the diet resulted in elevated plasma prothrombin time (mean value for 7 female rats, 33.5 seconds) even when coprophagy was allowed, presumably due to the effect of sulphathalidine on the availability of intestinally synthesized vitamin K. Thus the marked resistance of the female rat to K deficiency, in comparison to the susceptibility of the male rat, is not affected by the prevention of coprophagy, nor due to food intake or slower rate of growth, but is apparently due to a sex difference presumably under hormonal control. Reproduction by the female rat on synthetic K-low diet. In continuation of the above experiment, 5 female rats maintained on the K-low diet in tubular cages for 94 days to prevent coprophagy were transferred to regular cages and mated with control male rats which had been raised on Purina chow to study again the effect of dietary K deficiency on reproduction. All females conceived and gave birth to live pups. Most of them died within 5 days, although none showed any hemorrhagic symptoms. This poor survival of the pups was also obtained when female rats had been maintained in tubular cages on irradiated beef diets. J-4 Source: https://www.industrydocuments.ucsf.edu/docs/xtkg0227 -5- In our earlier studies on longevity and reproduction performance of female rats maintained on irradiated beef diets (Metta et al., $59) supplemented with 0.1 Y K3 (menadione) per gram dry diet, there was practically no survival of pups following the first mating and about 35% survival following the second mating with stock male rats. However, when the rats were maintained in an isolation room free from respiratory disease, 66-74% survival of the pups was obtained. Relationship of the female sex hormone and vitamin K in the rat The very low vitamin K needs of the female rat for growth and reproduction suggested that estrogens may be involved in some unknown manner in vitamin K function and metabolism in the body. Since a well-known function of K is in the production of prothrombin from the polygonal cells of the liver, a pre- liminary study was made to determine if estrogen was involved in the production of prothrombin. Six male weanling rats of the Sprague-Dawley strain were housed in tubular cages and fed ad libitum a K-free diet of the following percentage composition: sucrose, 66.5; Drackett soya protein, 20; DL methionine, 0.5; vitaminized cerelose (without K), 5; glycerol, 2; methyl linoleate (60% potency) 2; œ-tocopheryl succinate, 0.012; vitamin A, 1000 I.U.: vitamin Da, 100 units; and minerals 446, 4. On the 16th day of feeding one rat showed symptoms of subcutaneous bleeding. On the 18th day the rats were taken off the experiment. One rat was injected intramuscularly with 20 Y° of K3 in corn oil; 3 rats were injected with 1 mg each of estrodiol in 1/2 ml corn oil; and 2 other rats served as controls. After 24 hours, plasma prothrombin times were determined according to Quick (1938)¹ Results as follows: Intramuscular No. of rats Plasma prothrombin injection time, seconds 20 Y K3 injected 1 17 1 mg estrodiol 3 15,14,60+ None 2 17, 27 This preliminary trial indicates only the necessity of repeating this experiment with at least 8-10 rats in each group, since the deficiency is not uniformly produced in all rats. Vitamin K deficiency in the male and female chick We have routinely used female chicks for the bioassay of vitamin K. Since a marked resistance to K deficiency is shown by the female rat, a similar possibility needed to be investigated in the chick. Fifty male and 50 female one-day-old chicks were fed a vitamin K-free diet for 15 days. At 5, 10 and 15 days, respectively, 15 chicks of each group were sacrificed and the plasma prothrombin times determined. The clotting time increased progressively, but no significant differences were obtained with respect to the prothrombin times between the male and the female chicks at any of the specified intervals. 1 Quick, A. J. 1938 The nature of the bleeding in jaundice. J. Am. Med. Assoc. 110: 1658. U-5 Source: https://www.industrydocuments.ucsf.edu/docs/xtkg0227 -6- Vitamin K content of casein as determined by chick assay. Dietary need for vitamin K by the rat was not considered essential for a long time. Reports by Barnes and Fiala (1959)2 and by Mameesh and Johnson (1959) have demonstrated the need for dietary K on certain purified diets. We have routinely used the Drackett soya protein diet for producing K deficiency in the rat as well as in the chick. Also, casein (Nutritional Biochemicals Corporation) has been successfully used in place of the soya protein. When the SO=called "vitamin-free" casein (Labco) was incorporated into the rat diet, it did not result in K deficiency. The purpose of this experiment was to determine the vitamin K activity in these two different brands of casein by the chick assay. Fifty one-day-old female chicks were maintained on the K-free soya protein diet (report 17) for 19 days. They were then divided into five groups. One of these groups was fed a diet containing 35% NBC casein; a second, 35% Labco casein; and the remaining three groups, a basal soya protein diet with graded supplements of vitamin K (table 1). The plasma prothrombin times were then determined. Data in table 1 show that a supplementation of 0.1 r/gm diet to the basal soya protein diet is necessary to maintain normal prothrombin time (25 seconds) in the chick. The mean prothrombin time of chicks on the Labco casein is 33 seconds, and the difference is significant at about 3% level. Calculation shows that 100 gms of Labco casein has about 30 Y of K. The mean prothrombin time of chicks on the NBC casein diet is 46 seconds and significantly higher than that on the basal soya diet supplemented with .1 Y° K/gm diet (25 seconds P < . 01). NBC casein provides less than half as much vitamin K as Labco casein. Effect of different diets on the plasma prothrombin time of rats For a period of 4 weeks, 50 male rats were fed beef, Drackett soya protein and Labco casein diets ad libitum, as detailed in table 2. At the end of the experiment the plasma prothrombin times were determined. Results in table 2 show that an oral supplement of 2 Y K3/rat/day is needed to maintain normal pro- thrombin times in rats fed the soya protein diet. The prothrombin times of rats fed Labco casein and non-irradiated beef diets were in the normal range (13=35). Hypothrombinemie was noted in rats on the irradiated beef (prothrombin time 49-72 seconds) and oral supplementation of 2 Y K3/rat/day maintained the prothrombin time in the range 19-38 seconds. These findings corroborate the results obtained on the K content of casein by the chick assay. Studies on solvent-extracted beef (irradiated and non-irradiated) Bioassay of irradiated and non-irradiated beef using the chick has shown that irradiation destroys, or renders unavailable, vitamin K in the beef (report 17). The purpose of this experiment was to determine the effect of feeding rats irradiated and non-irradiated beef (after exhaustive extraction with alcohol and ether to remove the lipid material) on the plasma prothrombin levels. The basal composition of the diet used is given in table 3. In table 4 data are given on the prothrombin time of rats fed these diets with and without K supplementation. It is clearly seen that even non-irradiated beef (Bos lipid-free) is a poor source of vitamin K 2 Barnes, Richard Ho, and Grace Fiala 1959 Effects of the prevention of coprophagy in the rat. VI. Vitamin K. J. Nutrition, 68, 603. J-6 Source: https://wwww.industrydocuments.ucsf.edu/docs/xtkg0227 -1- High prothrombin times within the range 76-120 are obtained. Oral supplementation of 2 Y K1/rat/day maintains the prothrombin times in the range 15-30 on both irradiated and non-irradiated beef diets. This confirms our earlier observation that the principal cause of the hemorrhagic syndrome obtained on irradiated beef diets is the destruction of vitamin K in beef by irradiation and indicates the absence of any vitamin K antagonist produced in beef by irradiation. Studies in progress Further studies are in progress on: 1) the very marked sex difference with respect to vitamin K deficiency, 2) development of a sensitive chemical assay for vitamin K1 and analogues; and 3) absorption of dietary and intestinally synthesized vitamin K. Papers published Johnson, B. Connor, M. S. Mameesh, V. C. Metta, and P. B. Rama Rao. Vitamin K nutrition and irradiation sterilization. Fed. Proceedings (in press). Mameesh, M. S., and B. Connor Johnson. The absence of hemorrhagic compounds in irradiated beef. J. Nutrition, 71, 122, 1960. Metta, V. C., and B. Connor Johnson. Effect of feeding vitamin K-deficient diets to female rats. J. Nutrition (in press). Rama Rao, P. B., V. C. Metta, and B. Connor Johnson. The amino acid composition and nutritive value of proteins. II. Amino acid mixtures as a dietary source of nitrogen for growth. Jo Nutrition, 71, 327, 1960. Rama Rao, P. V. C. Metta, H. W. Norton, and B. Connor Johnson. The amino acid composition and nutritive value of proteins. III. The total protein and the non- essential amino nitrogen requirement. J. Nutrition, 71, 361, 1960. Mameesh, M. S., and V. C. Metta. Irradiation sterilization in vitamin K nutrition. Fifth International Congress on Nutrition, Sept. g 1960. Paper No. 260, p. 57. Rama Rao, P. Bo, H. W. Norton, and B. Connor Johnson. The amino acid composition and nutritive value of proteins. IV. Methionine, cystine, phenylalanine and tyrosine requirements. J. Nutrition (in press). Personnel Chief Investigator: Dr. B. Connor Johnson Personnel working on the project during the period of this report: Dr. V. Chalam Metta, Research Assistant Professor Dr. M. S. Mameesh, Research Associate Dr. P. B. Rama Rao, Research Associate Mr. James Bergan, (Half-time) Junior Laboratory Attendant Mr. Louis Nash, Junior Laboratory Attendant Plus student help. TCM:MSM:PBR:BCJ:rmd J-7 Source: https://www.industrydocuments.ucsf.edu/docs/xtkg0227 Table 1 Effect of menadione and casein diets on the prothrombin time of K-deficient chicks1 Diet Supplement Prothrombin time2 sec. Soya protein - 200 + Soya protein 0.01 K33 T/gm diet 146 + 3.35 Soya protein 0.1 K3 r/gm diet 25 1.7 Casein (Labco) 4 - 33 2.9 Casein (NBC) - 46 + 4.0 1 Chicks were maintained on the soya protein (K-deficient) diet for 19 days. They were then grouped and fed the diets indicated for 4 days and the plasma prothrombin time of chicks determined. 2 Average of 6 chicks/group. 3 2-methyl-1,4-naphthoquinone. The protein level in all the diets was 35% (N X 6.25). Mean standard deviation of the mean. J-8 Source: https://www.industrydocuments.ucsf.edu/docs/xtkg0227 Table 2 Hemorrhagic deaths and plasma prothrombin times of rats fed irradiated beef, Drackett soya protein and vitamin-free casein diets 1 Oral Plasma pro- No. of Diet supplement thrombin hemorrhagic time, seconds deaths Drackett soya protein - 120 + 4 " " " 1 Y K3²/rat/day 75 (33-120) 1 11 " " 2 Y K3/rat/day 21 (17-30) - Labco (vit.-free casein) - 21 (14-35) - Beef O - 15 (13-19) - Beef 6 - 54 (49-72) 1 Beef 6 1 Y K3/rat/day 38 (21-65) 1 Beef 6 2 Y K3/rat/day 28 (19-38) - 1 6 male rats per group. 2 2-methyl-1,4-naphthoquinone. Rats fed these diets for 4 weeks. J-9 Source: https://www.industrydocuments.ucsf.edu/docs/xtkg0227 Table 3 Ingredient gm Beef¹ 15 Vitaminized glucose² 15 Sucrose 10 Triolein 5 Cod-liver oil 1.5 Wheat-germ oil 0.5 Mineral mix 446 4.0 Starch 49.0 1 Beef (irradiated 5.58 megarad, or non- irradiated) was freeze-dried and extracted for 24 hours with alcohol and for 24 hours with ether. 2 Without K. d-10 Source: https://www.industrydocuments.ucsf.edu/docsixtkg0227

What is the title of the first column of the table?

xtkg0227

xtkg0227_p0, xtkg0227_p1, xtkg0227_p2, xtkg0227_p3, xtkg0227_p4, xtkg0227_p5, xtkg0227_p6, xtkg0227_p7, xtkg0227_p8, xtkg0227_p9

Diet, diet

Department of the Army Office of the Surgeon General Contract No. DA-49-007-MD 544 ON THE NUTRITIVE VALUE OF THE MAJOR NUTRIENTS OF IRRADIATED FOODS and APPRAISAL OF THE TOXICITY OF IRRADIATED FOODS V. Chalam Metta M. S. Mameesh P. B. Rama Rao Connor Johnson Division of Animal Nutrition University of Illinois Urbana, Illinois Progress Report No. 18 for period March 16, 1960-Sept. 1, 1960 This is not a final report. Conclusions stated are subject to change on the basis of additional evidence. Information contained herein is not to be reprinted or published without written permission from Research and Development Division, Office of the Surgeon General, Department of the Army, Washington 25, D. C. J-1 Source: https://www.industrydocuments.ucsf.edu/docsixtkg0227 -2- Table of Contents Page Summary 3 Effect of feeding vitamin K-deficient diets to female rats. 4 Reproduction in the irradiated beef-fed female rats 4 Synthetic diets and vitamin K nutrition of the female rats. 4 Reproduction by the female rat on synthetic vitamin K-low diet. 4 Relationship of the female sex hormone and vitamin K in the rat 5 Vitamin K deficiency in the male and female chick 5 Vitamin K content of casein chick assay 6 Effect of different diets on the plasma prothrombin time of rats. 6 Studies on solvent-extracted beef (irradiated and non-irradiated) 6 Studies in progress 7 Papers published and personnel. 7 Tables. 8 J-2 Source: https://www.industrydocuments.ucsf.edu/docsixtkg0227 -3- Summary 1. Feeding of irradiated beef or vitamin K-low synthetic diets results in hypoprothrombinemia and hemorrhagic deaths of growing male rats. The female rat is markedly resistant to K deficiency. The possibility of estrogen involvement in the role of K in some unknown manner is worthy of further study. 2. Normal reproduction was obtained in female rats maintained on synthetic K-low diets or irradiated beef diets and mated with normal males. The survival of the pups was, however, poor. None of them died of hemorrhage, and good survival has been obtained on rats fed irradiated beef diets with supplements of K only when they are maintained in an isolated room free from respiratory disease. 3. Although it was found that the female rat is markedly resistant to vitamin K deficiency, our work with chicks suggests that both male and female chicks are equally succeptible to vitamin K deficiency. 4. Bioassay of the chick for vitamin K indicated that there is a difference in content of vitamin K between Labco casein (approximately 30 Y K/100 gm) and Nutritional Biochemicals Corporation casein (less than 15 / 1/100 gm). Rats main- tained on Labco casein showed normal prothrombin times, whereas those on NBC showed elevated prothrombin times. 5. When beef (irradiated and non-irradiated), after extraction by alcohol and ether, is fed to male rats, hypoprothrombinemia results. The primary cause of hemorrhagic syndrome in the male rat fed irradiated beef is the destruction of K in beef by irradiation. J-3 Source: https://www.industrydocuments.ucsf.edu/docs/xtkg0227 -4- Effect of feeding vitamin K-deficient diets to female rats. The resistance of the female rat, as compared to the male rat, to vitamin K deficiency on irradiated beef and synthetic K-free diets has been repeatedly demonstrated in our laboratory. Several hypotheses have been suggested to explain this difference. One is that the female rat may practice coprophagy to a greater extent and thus obtain more K from the feces. It may also be that the male rat, because of his greater food intake and growth, may develop the deficiency more rapidly than the female. The third possibility is that there is an actual sex difference under hormonal control. In report 17, data have been presented (table 2 of same report) to show that the greater food intake, and hence greater rate of body weight gain of the male rat, does not result in this specific difference with respect to K deficiency of the female rat. This was demonstrated by suitable paired-feeding of the irradiated beef. Also, prevention of coprophagy did not result in hypoprothrombinemia of the female rats over a 36-day period. Reproduction in the irradiated-beef-fed female Three female rats which had been housed in tubular cages to prevent coprophagy were continued on the irradiated beef diet (ad libitum) for 80 days. Then they were transferred to regular screen-bottom cages and mated with normal male rats. They conceived and gave birth to 11, 10 and 8 pups, respectively. Although 15 of these pups died within 15 days, there was no evidence of hemorrhage in them. The fact that essentially normal reproduction occurred in female rats fed a diet on which all males had died of vitamin K deficiency further emphasizes the marked resistance of the female to this vitamin deficiency. Synthetic diets and vitamin K nutrition of the female rat An experiment was conducted to study the vitamin K requirement of the growing female rat. The basal synthetic diet containing 25% NBC casein (report 17) was used with and without supplementation of 1% sulphathalidine, Data presented in the earlier report (table 2, report 17) show that 2 out of 7 female rats prevented from practicing coprophagy, and consuming ad libitum this K-low synthetic diet, died of hemorrhage after 60 days. When coprophagy was not prevented they main- tained normal prothrombin levels. Addition of sulphathalidine at a 1% level in the diet resulted in elevated plasma prothrombin time (mean value for 7 female rats, 33.5 seconds) even when coprophagy was allowed, presumably due to the effect of sulphathalidine on the availability of intestinally synthesized vitamin K. Thus the marked resistance of the female rat to K deficiency, in comparison to the susceptibility of the male rat, is not affected by the prevention of coprophagy, nor due to food intake or slower rate of growth, but is apparently due to a sex difference presumably under hormonal control. Reproduction by the female rat on synthetic K-low diet. In continuation of the above experiment, 5 female rats maintained on the K-low diet in tubular cages for 94 days to prevent coprophagy were transferred to regular cages and mated with control male rats which had been raised on Purina chow to study again the effect of dietary K deficiency on reproduction. All females conceived and gave birth to live pups. Most of them died within 5 days, although none showed any hemorrhagic symptoms. This poor survival of the pups was also obtained when female rats had been maintained in tubular cages on irradiated beef diets. J-4 Source: https://www.industrydocuments.ucsf.edu/docs/xtkg0227 -5- In our earlier studies on longevity and reproduction performance of female rats maintained on irradiated beef diets (Metta et al., $59) supplemented with 0.1 Y K3 (menadione) per gram dry diet, there was practically no survival of pups following the first mating and about 35% survival following the second mating with stock male rats. However, when the rats were maintained in an isolation room free from respiratory disease, 66-74% survival of the pups was obtained. Relationship of the female sex hormone and vitamin K in the rat The very low vitamin K needs of the female rat for growth and reproduction suggested that estrogens may be involved in some unknown manner in vitamin K function and metabolism in the body. Since a well-known function of K is in the production of prothrombin from the polygonal cells of the liver, a pre- liminary study was made to determine if estrogen was involved in the production of prothrombin. Six male weanling rats of the Sprague-Dawley strain were housed in tubular cages and fed ad libitum a K-free diet of the following percentage composition: sucrose, 66.5; Drackett soya protein, 20; DL methionine, 0.5; vitaminized cerelose (without K), 5; glycerol, 2; methyl linoleate (60% potency) 2; œ-tocopheryl succinate, 0.012; vitamin A, 1000 I.U.: vitamin Da, 100 units; and minerals 446, 4. On the 16th day of feeding one rat showed symptoms of subcutaneous bleeding. On the 18th day the rats were taken off the experiment. One rat was injected intramuscularly with 20 Y° of K3 in corn oil; 3 rats were injected with 1 mg each of estrodiol in 1/2 ml corn oil; and 2 other rats served as controls. After 24 hours, plasma prothrombin times were determined according to Quick (1938)¹ Results as follows: Intramuscular No. of rats Plasma prothrombin injection time, seconds 20 Y K3 injected 1 17 1 mg estrodiol 3 15,14,60+ None 2 17, 27 This preliminary trial indicates only the necessity of repeating this experiment with at least 8-10 rats in each group, since the deficiency is not uniformly produced in all rats. Vitamin K deficiency in the male and female chick We have routinely used female chicks for the bioassay of vitamin K. Since a marked resistance to K deficiency is shown by the female rat, a similar possibility needed to be investigated in the chick. Fifty male and 50 female one-day-old chicks were fed a vitamin K-free diet for 15 days. At 5, 10 and 15 days, respectively, 15 chicks of each group were sacrificed and the plasma prothrombin times determined. The clotting time increased progressively, but no significant differences were obtained with respect to the prothrombin times between the male and the female chicks at any of the specified intervals. 1 Quick, A. J. 1938 The nature of the bleeding in jaundice. J. Am. Med. Assoc. 110: 1658. U-5 Source: https://www.industrydocuments.ucsf.edu/docs/xtkg0227 -6- Vitamin K content of casein as determined by chick assay. Dietary need for vitamin K by the rat was not considered essential for a long time. Reports by Barnes and Fiala (1959)2 and by Mameesh and Johnson (1959) have demonstrated the need for dietary K on certain purified diets. We have routinely used the Drackett soya protein diet for producing K deficiency in the rat as well as in the chick. Also, casein (Nutritional Biochemicals Corporation) has been successfully used in place of the soya protein. When the SO=called "vitamin-free" casein (Labco) was incorporated into the rat diet, it did not result in K deficiency. The purpose of this experiment was to determine the vitamin K activity in these two different brands of casein by the chick assay. Fifty one-day-old female chicks were maintained on the K-free soya protein diet (report 17) for 19 days. They were then divided into five groups. One of these groups was fed a diet containing 35% NBC casein; a second, 35% Labco casein; and the remaining three groups, a basal soya protein diet with graded supplements of vitamin K (table 1). The plasma prothrombin times were then determined. Data in table 1 show that a supplementation of 0.1 r/gm diet to the basal soya protein diet is necessary to maintain normal prothrombin time (25 seconds) in the chick. The mean prothrombin time of chicks on the Labco casein is 33 seconds, and the difference is significant at about 3% level. Calculation shows that 100 gms of Labco casein has about 30 Y of K. The mean prothrombin time of chicks on the NBC casein diet is 46 seconds and significantly higher than that on the basal soya diet supplemented with .1 Y° K/gm diet (25 seconds P < . 01). NBC casein provides less than half as much vitamin K as Labco casein. Effect of different diets on the plasma prothrombin time of rats For a period of 4 weeks, 50 male rats were fed beef, Drackett soya protein and Labco casein diets ad libitum, as detailed in table 2. At the end of the experiment the plasma prothrombin times were determined. Results in table 2 show that an oral supplement of 2 Y K3/rat/day is needed to maintain normal pro- thrombin times in rats fed the soya protein diet. The prothrombin times of rats fed Labco casein and non-irradiated beef diets were in the normal range (13=35). Hypothrombinemie was noted in rats on the irradiated beef (prothrombin time 49-72 seconds) and oral supplementation of 2 Y K3/rat/day maintained the prothrombin time in the range 19-38 seconds. These findings corroborate the results obtained on the K content of casein by the chick assay. Studies on solvent-extracted beef (irradiated and non-irradiated) Bioassay of irradiated and non-irradiated beef using the chick has shown that irradiation destroys, or renders unavailable, vitamin K in the beef (report 17). The purpose of this experiment was to determine the effect of feeding rats irradiated and non-irradiated beef (after exhaustive extraction with alcohol and ether to remove the lipid material) on the plasma prothrombin levels. The basal composition of the diet used is given in table 3. In table 4 data are given on the prothrombin time of rats fed these diets with and without K supplementation. It is clearly seen that even non-irradiated beef (Bos lipid-free) is a poor source of vitamin K 2 Barnes, Richard Ho, and Grace Fiala 1959 Effects of the prevention of coprophagy in the rat. VI. Vitamin K. J. Nutrition, 68, 603. J-6 Source: https://wwww.industrydocuments.ucsf.edu/docs/xtkg0227 -1- High prothrombin times within the range 76-120 are obtained. Oral supplementation of 2 Y K1/rat/day maintains the prothrombin times in the range 15-30 on both irradiated and non-irradiated beef diets. This confirms our earlier observation that the principal cause of the hemorrhagic syndrome obtained on irradiated beef diets is the destruction of vitamin K in beef by irradiation and indicates the absence of any vitamin K antagonist produced in beef by irradiation. Studies in progress Further studies are in progress on: 1) the very marked sex difference with respect to vitamin K deficiency, 2) development of a sensitive chemical assay for vitamin K1 and analogues; and 3) absorption of dietary and intestinally synthesized vitamin K. Papers published Johnson, B. Connor, M. S. Mameesh, V. C. Metta, and P. B. Rama Rao. Vitamin K nutrition and irradiation sterilization. Fed. Proceedings (in press). Mameesh, M. S., and B. Connor Johnson. The absence of hemorrhagic compounds in irradiated beef. J. Nutrition, 71, 122, 1960. Metta, V. C., and B. Connor Johnson. Effect of feeding vitamin K-deficient diets to female rats. J. Nutrition (in press). Rama Rao, P. B., V. C. Metta, and B. Connor Johnson. The amino acid composition and nutritive value of proteins. II. Amino acid mixtures as a dietary source of nitrogen for growth. Jo Nutrition, 71, 327, 1960. Rama Rao, P. V. C. Metta, H. W. Norton, and B. Connor Johnson. The amino acid composition and nutritive value of proteins. III. The total protein and the non- essential amino nitrogen requirement. J. Nutrition, 71, 361, 1960. Mameesh, M. S., and V. C. Metta. Irradiation sterilization in vitamin K nutrition. Fifth International Congress on Nutrition, Sept. g 1960. Paper No. 260, p. 57. Rama Rao, P. Bo, H. W. Norton, and B. Connor Johnson. The amino acid composition and nutritive value of proteins. IV. Methionine, cystine, phenylalanine and tyrosine requirements. J. Nutrition (in press). Personnel Chief Investigator: Dr. B. Connor Johnson Personnel working on the project during the period of this report: Dr. V. Chalam Metta, Research Assistant Professor Dr. M. S. Mameesh, Research Associate Dr. P. B. Rama Rao, Research Associate Mr. James Bergan, (Half-time) Junior Laboratory Attendant Mr. Louis Nash, Junior Laboratory Attendant Plus student help. TCM:MSM:PBR:BCJ:rmd J-7 Source: https://www.industrydocuments.ucsf.edu/docs/xtkg0227 Table 1 Effect of menadione and casein diets on the prothrombin time of K-deficient chicks1 Diet Supplement Prothrombin time2 sec. Soya protein - 200 + Soya protein 0.01 K33 T/gm diet 146 + 3.35 Soya protein 0.1 K3 r/gm diet 25 1.7 Casein (Labco) 4 - 33 2.9 Casein (NBC) - 46 + 4.0 1 Chicks were maintained on the soya protein (K-deficient) diet for 19 days. They were then grouped and fed the diets indicated for 4 days and the plasma prothrombin time of chicks determined. 2 Average of 6 chicks/group. 3 2-methyl-1,4-naphthoquinone. The protein level in all the diets was 35% (N X 6.25). Mean standard deviation of the mean. J-8 Source: https://www.industrydocuments.ucsf.edu/docs/xtkg0227 Table 2 Hemorrhagic deaths and plasma prothrombin times of rats fed irradiated beef, Drackett soya protein and vitamin-free casein diets 1 Oral Plasma pro- No. of Diet supplement thrombin hemorrhagic time, seconds deaths Drackett soya protein - 120 + 4 " " " 1 Y K3²/rat/day 75 (33-120) 1 11 " " 2 Y K3/rat/day 21 (17-30) - Labco (vit.-free casein) - 21 (14-35) - Beef O - 15 (13-19) - Beef 6 - 54 (49-72) 1 Beef 6 1 Y K3/rat/day 38 (21-65) 1 Beef 6 2 Y K3/rat/day 28 (19-38) - 1 6 male rats per group. 2 2-methyl-1,4-naphthoquinone. Rats fed these diets for 4 weeks. J-9 Source: https://www.industrydocuments.ucsf.edu/docs/xtkg0227 Table 3 Ingredient gm Beef¹ 15 Vitaminized glucose² 15 Sucrose 10 Triolein 5 Cod-liver oil 1.5 Wheat-germ oil 0.5 Mineral mix 446 4.0 Starch 49.0 1 Beef (irradiated 5.58 megarad, or non- irradiated) was freeze-dried and extracted for 24 hours with alcohol and for 24 hours with ether. 2 Without K. d-10 Source: https://www.industrydocuments.ucsf.edu/docsixtkg0227

What is the number of hemorrhagic deaths due to Drackett's soya protein?

xtkg0227

xtkg0227_p0, xtkg0227_p1, xtkg0227_p2, xtkg0227_p3, xtkg0227_p4, xtkg0227_p5, xtkg0227_p6, xtkg0227_p7, xtkg0227_p8, xtkg0227_p9

4

Department of the Army Office of the Surgeon General Contract No. DA-49-007-MD 544 ON THE NUTRITIVE VALUE OF THE MAJOR NUTRIENTS OF IRRADIATED FOODS and APPRAISAL OF THE TOXICITY OF IRRADIATED FOODS V. Chalam Metta M. S. Mameesh P. B. Rama Rao Connor Johnson Division of Animal Nutrition University of Illinois Urbana, Illinois Progress Report No. 18 for period March 16, 1960-Sept. 1, 1960 This is not a final report. Conclusions stated are subject to change on the basis of additional evidence. Information contained herein is not to be reprinted or published without written permission from Research and Development Division, Office of the Surgeon General, Department of the Army, Washington 25, D. C. J-1 Source: https://www.industrydocuments.ucsf.edu/docsixtkg0227 -2- Table of Contents Page Summary 3 Effect of feeding vitamin K-deficient diets to female rats. 4 Reproduction in the irradiated beef-fed female rats 4 Synthetic diets and vitamin K nutrition of the female rats. 4 Reproduction by the female rat on synthetic vitamin K-low diet. 4 Relationship of the female sex hormone and vitamin K in the rat 5 Vitamin K deficiency in the male and female chick 5 Vitamin K content of casein chick assay 6 Effect of different diets on the plasma prothrombin time of rats. 6 Studies on solvent-extracted beef (irradiated and non-irradiated) 6 Studies in progress 7 Papers published and personnel. 7 Tables. 8 J-2 Source: https://www.industrydocuments.ucsf.edu/docsixtkg0227 -3- Summary 1. Feeding of irradiated beef or vitamin K-low synthetic diets results in hypoprothrombinemia and hemorrhagic deaths of growing male rats. The female rat is markedly resistant to K deficiency. The possibility of estrogen involvement in the role of K in some unknown manner is worthy of further study. 2. Normal reproduction was obtained in female rats maintained on synthetic K-low diets or irradiated beef diets and mated with normal males. The survival of the pups was, however, poor. None of them died of hemorrhage, and good survival has been obtained on rats fed irradiated beef diets with supplements of K only when they are maintained in an isolated room free from respiratory disease. 3. Although it was found that the female rat is markedly resistant to vitamin K deficiency, our work with chicks suggests that both male and female chicks are equally succeptible to vitamin K deficiency. 4. Bioassay of the chick for vitamin K indicated that there is a difference in content of vitamin K between Labco casein (approximately 30 Y K/100 gm) and Nutritional Biochemicals Corporation casein (less than 15 / 1/100 gm). Rats main- tained on Labco casein showed normal prothrombin times, whereas those on NBC showed elevated prothrombin times. 5. When beef (irradiated and non-irradiated), after extraction by alcohol and ether, is fed to male rats, hypoprothrombinemia results. The primary cause of hemorrhagic syndrome in the male rat fed irradiated beef is the destruction of K in beef by irradiation. J-3 Source: https://www.industrydocuments.ucsf.edu/docs/xtkg0227 -4- Effect of feeding vitamin K-deficient diets to female rats. The resistance of the female rat, as compared to the male rat, to vitamin K deficiency on irradiated beef and synthetic K-free diets has been repeatedly demonstrated in our laboratory. Several hypotheses have been suggested to explain this difference. One is that the female rat may practice coprophagy to a greater extent and thus obtain more K from the feces. It may also be that the male rat, because of his greater food intake and growth, may develop the deficiency more rapidly than the female. The third possibility is that there is an actual sex difference under hormonal control. In report 17, data have been presented (table 2 of same report) to show that the greater food intake, and hence greater rate of body weight gain of the male rat, does not result in this specific difference with respect to K deficiency of the female rat. This was demonstrated by suitable paired-feeding of the irradiated beef. Also, prevention of coprophagy did not result in hypoprothrombinemia of the female rats over a 36-day period. Reproduction in the irradiated-beef-fed female Three female rats which had been housed in tubular cages to prevent coprophagy were continued on the irradiated beef diet (ad libitum) for 80 days. Then they were transferred to regular screen-bottom cages and mated with normal male rats. They conceived and gave birth to 11, 10 and 8 pups, respectively. Although 15 of these pups died within 15 days, there was no evidence of hemorrhage in them. The fact that essentially normal reproduction occurred in female rats fed a diet on which all males had died of vitamin K deficiency further emphasizes the marked resistance of the female to this vitamin deficiency. Synthetic diets and vitamin K nutrition of the female rat An experiment was conducted to study the vitamin K requirement of the growing female rat. The basal synthetic diet containing 25% NBC casein (report 17) was used with and without supplementation of 1% sulphathalidine, Data presented in the earlier report (table 2, report 17) show that 2 out of 7 female rats prevented from practicing coprophagy, and consuming ad libitum this K-low synthetic diet, died of hemorrhage after 60 days. When coprophagy was not prevented they main- tained normal prothrombin levels. Addition of sulphathalidine at a 1% level in the diet resulted in elevated plasma prothrombin time (mean value for 7 female rats, 33.5 seconds) even when coprophagy was allowed, presumably due to the effect of sulphathalidine on the availability of intestinally synthesized vitamin K. Thus the marked resistance of the female rat to K deficiency, in comparison to the susceptibility of the male rat, is not affected by the prevention of coprophagy, nor due to food intake or slower rate of growth, but is apparently due to a sex difference presumably under hormonal control. Reproduction by the female rat on synthetic K-low diet. In continuation of the above experiment, 5 female rats maintained on the K-low diet in tubular cages for 94 days to prevent coprophagy were transferred to regular cages and mated with control male rats which had been raised on Purina chow to study again the effect of dietary K deficiency on reproduction. All females conceived and gave birth to live pups. Most of them died within 5 days, although none showed any hemorrhagic symptoms. This poor survival of the pups was also obtained when female rats had been maintained in tubular cages on irradiated beef diets. J-4 Source: https://www.industrydocuments.ucsf.edu/docs/xtkg0227 -5- In our earlier studies on longevity and reproduction performance of female rats maintained on irradiated beef diets (Metta et al., $59) supplemented with 0.1 Y K3 (menadione) per gram dry diet, there was practically no survival of pups following the first mating and about 35% survival following the second mating with stock male rats. However, when the rats were maintained in an isolation room free from respiratory disease, 66-74% survival of the pups was obtained. Relationship of the female sex hormone and vitamin K in the rat The very low vitamin K needs of the female rat for growth and reproduction suggested that estrogens may be involved in some unknown manner in vitamin K function and metabolism in the body. Since a well-known function of K is in the production of prothrombin from the polygonal cells of the liver, a pre- liminary study was made to determine if estrogen was involved in the production of prothrombin. Six male weanling rats of the Sprague-Dawley strain were housed in tubular cages and fed ad libitum a K-free diet of the following percentage composition: sucrose, 66.5; Drackett soya protein, 20; DL methionine, 0.5; vitaminized cerelose (without K), 5; glycerol, 2; methyl linoleate (60% potency) 2; œ-tocopheryl succinate, 0.012; vitamin A, 1000 I.U.: vitamin Da, 100 units; and minerals 446, 4. On the 16th day of feeding one rat showed symptoms of subcutaneous bleeding. On the 18th day the rats were taken off the experiment. One rat was injected intramuscularly with 20 Y° of K3 in corn oil; 3 rats were injected with 1 mg each of estrodiol in 1/2 ml corn oil; and 2 other rats served as controls. After 24 hours, plasma prothrombin times were determined according to Quick (1938)¹ Results as follows: Intramuscular No. of rats Plasma prothrombin injection time, seconds 20 Y K3 injected 1 17 1 mg estrodiol 3 15,14,60+ None 2 17, 27 This preliminary trial indicates only the necessity of repeating this experiment with at least 8-10 rats in each group, since the deficiency is not uniformly produced in all rats. Vitamin K deficiency in the male and female chick We have routinely used female chicks for the bioassay of vitamin K. Since a marked resistance to K deficiency is shown by the female rat, a similar possibility needed to be investigated in the chick. Fifty male and 50 female one-day-old chicks were fed a vitamin K-free diet for 15 days. At 5, 10 and 15 days, respectively, 15 chicks of each group were sacrificed and the plasma prothrombin times determined. The clotting time increased progressively, but no significant differences were obtained with respect to the prothrombin times between the male and the female chicks at any of the specified intervals. 1 Quick, A. J. 1938 The nature of the bleeding in jaundice. J. Am. Med. Assoc. 110: 1658. U-5 Source: https://www.industrydocuments.ucsf.edu/docs/xtkg0227 -6- Vitamin K content of casein as determined by chick assay. Dietary need for vitamin K by the rat was not considered essential for a long time. Reports by Barnes and Fiala (1959)2 and by Mameesh and Johnson (1959) have demonstrated the need for dietary K on certain purified diets. We have routinely used the Drackett soya protein diet for producing K deficiency in the rat as well as in the chick. Also, casein (Nutritional Biochemicals Corporation) has been successfully used in place of the soya protein. When the SO=called "vitamin-free" casein (Labco) was incorporated into the rat diet, it did not result in K deficiency. The purpose of this experiment was to determine the vitamin K activity in these two different brands of casein by the chick assay. Fifty one-day-old female chicks were maintained on the K-free soya protein diet (report 17) for 19 days. They were then divided into five groups. One of these groups was fed a diet containing 35% NBC casein; a second, 35% Labco casein; and the remaining three groups, a basal soya protein diet with graded supplements of vitamin K (table 1). The plasma prothrombin times were then determined. Data in table 1 show that a supplementation of 0.1 r/gm diet to the basal soya protein diet is necessary to maintain normal prothrombin time (25 seconds) in the chick. The mean prothrombin time of chicks on the Labco casein is 33 seconds, and the difference is significant at about 3% level. Calculation shows that 100 gms of Labco casein has about 30 Y of K. The mean prothrombin time of chicks on the NBC casein diet is 46 seconds and significantly higher than that on the basal soya diet supplemented with .1 Y° K/gm diet (25 seconds P < . 01). NBC casein provides less than half as much vitamin K as Labco casein. Effect of different diets on the plasma prothrombin time of rats For a period of 4 weeks, 50 male rats were fed beef, Drackett soya protein and Labco casein diets ad libitum, as detailed in table 2. At the end of the experiment the plasma prothrombin times were determined. Results in table 2 show that an oral supplement of 2 Y K3/rat/day is needed to maintain normal pro- thrombin times in rats fed the soya protein diet. The prothrombin times of rats fed Labco casein and non-irradiated beef diets were in the normal range (13=35). Hypothrombinemie was noted in rats on the irradiated beef (prothrombin time 49-72 seconds) and oral supplementation of 2 Y K3/rat/day maintained the prothrombin time in the range 19-38 seconds. These findings corroborate the results obtained on the K content of casein by the chick assay. Studies on solvent-extracted beef (irradiated and non-irradiated) Bioassay of irradiated and non-irradiated beef using the chick has shown that irradiation destroys, or renders unavailable, vitamin K in the beef (report 17). The purpose of this experiment was to determine the effect of feeding rats irradiated and non-irradiated beef (after exhaustive extraction with alcohol and ether to remove the lipid material) on the plasma prothrombin levels. The basal composition of the diet used is given in table 3. In table 4 data are given on the prothrombin time of rats fed these diets with and without K supplementation. It is clearly seen that even non-irradiated beef (Bos lipid-free) is a poor source of vitamin K 2 Barnes, Richard Ho, and Grace Fiala 1959 Effects of the prevention of coprophagy in the rat. VI. Vitamin K. J. Nutrition, 68, 603. J-6 Source: https://wwww.industrydocuments.ucsf.edu/docs/xtkg0227 -1- High prothrombin times within the range 76-120 are obtained. Oral supplementation of 2 Y K1/rat/day maintains the prothrombin times in the range 15-30 on both irradiated and non-irradiated beef diets. This confirms our earlier observation that the principal cause of the hemorrhagic syndrome obtained on irradiated beef diets is the destruction of vitamin K in beef by irradiation and indicates the absence of any vitamin K antagonist produced in beef by irradiation. Studies in progress Further studies are in progress on: 1) the very marked sex difference with respect to vitamin K deficiency, 2) development of a sensitive chemical assay for vitamin K1 and analogues; and 3) absorption of dietary and intestinally synthesized vitamin K. Papers published Johnson, B. Connor, M. S. Mameesh, V. C. Metta, and P. B. Rama Rao. Vitamin K nutrition and irradiation sterilization. Fed. Proceedings (in press). Mameesh, M. S., and B. Connor Johnson. The absence of hemorrhagic compounds in irradiated beef. J. Nutrition, 71, 122, 1960. Metta, V. C., and B. Connor Johnson. Effect of feeding vitamin K-deficient diets to female rats. J. Nutrition (in press). Rama Rao, P. B., V. C. Metta, and B. Connor Johnson. The amino acid composition and nutritive value of proteins. II. Amino acid mixtures as a dietary source of nitrogen for growth. Jo Nutrition, 71, 327, 1960. Rama Rao, P. V. C. Metta, H. W. Norton, and B. Connor Johnson. The amino acid composition and nutritive value of proteins. III. The total protein and the non- essential amino nitrogen requirement. J. Nutrition, 71, 361, 1960. Mameesh, M. S., and V. C. Metta. Irradiation sterilization in vitamin K nutrition. Fifth International Congress on Nutrition, Sept. g 1960. Paper No. 260, p. 57. Rama Rao, P. Bo, H. W. Norton, and B. Connor Johnson. The amino acid composition and nutritive value of proteins. IV. Methionine, cystine, phenylalanine and tyrosine requirements. J. Nutrition (in press). Personnel Chief Investigator: Dr. B. Connor Johnson Personnel working on the project during the period of this report: Dr. V. Chalam Metta, Research Assistant Professor Dr. M. S. Mameesh, Research Associate Dr. P. B. Rama Rao, Research Associate Mr. James Bergan, (Half-time) Junior Laboratory Attendant Mr. Louis Nash, Junior Laboratory Attendant Plus student help. TCM:MSM:PBR:BCJ:rmd J-7 Source: https://www.industrydocuments.ucsf.edu/docs/xtkg0227 Table 1 Effect of menadione and casein diets on the prothrombin time of K-deficient chicks1 Diet Supplement Prothrombin time2 sec. Soya protein - 200 + Soya protein 0.01 K33 T/gm diet 146 + 3.35 Soya protein 0.1 K3 r/gm diet 25 1.7 Casein (Labco) 4 - 33 2.9 Casein (NBC) - 46 + 4.0 1 Chicks were maintained on the soya protein (K-deficient) diet for 19 days. They were then grouped and fed the diets indicated for 4 days and the plasma prothrombin time of chicks determined. 2 Average of 6 chicks/group. 3 2-methyl-1,4-naphthoquinone. The protein level in all the diets was 35% (N X 6.25). Mean standard deviation of the mean. J-8 Source: https://www.industrydocuments.ucsf.edu/docs/xtkg0227 Table 2 Hemorrhagic deaths and plasma prothrombin times of rats fed irradiated beef, Drackett soya protein and vitamin-free casein diets 1 Oral Plasma pro- No. of Diet supplement thrombin hemorrhagic time, seconds deaths Drackett soya protein - 120 + 4 " " " 1 Y K3²/rat/day 75 (33-120) 1 11 " " 2 Y K3/rat/day 21 (17-30) - Labco (vit.-free casein) - 21 (14-35) - Beef O - 15 (13-19) - Beef 6 - 54 (49-72) 1 Beef 6 1 Y K3/rat/day 38 (21-65) 1 Beef 6 2 Y K3/rat/day 28 (19-38) - 1 6 male rats per group. 2 2-methyl-1,4-naphthoquinone. Rats fed these diets for 4 weeks. J-9 Source: https://www.industrydocuments.ucsf.edu/docs/xtkg0227 Table 3 Ingredient gm Beef¹ 15 Vitaminized glucose² 15 Sucrose 10 Triolein 5 Cod-liver oil 1.5 Wheat-germ oil 0.5 Mineral mix 446 4.0 Starch 49.0 1 Beef (irradiated 5.58 megarad, or non- irradiated) was freeze-dried and extracted for 24 hours with alcohol and for 24 hours with ether. 2 Without K. d-10 Source: https://www.industrydocuments.ucsf.edu/docsixtkg0227

What is the title?

xnjg0227

xnjg0227_p3

Schedule of Expenses and Amounts Claimed, SCHEDULE OF EXPENSES AND AMOUNTS CLAIMED

SCHEDULE OF EXPENSES AND AMOUNTS CLAIMED WHEN TYPED USE SINGLE SPACE 1. Departed from official duty station (Date) (Hour) 2. Temporary duty station on last day of next preceding voucher period was ; date of arrival at such temporary duty station . (Fill in 1 and 2 above only when dates are prior to period covered by this voucher) NUMBER OF MILES AMOUNT CLAIMED DATE DESCRIPTION (Include all information required by current regulations; if speedometer readings are used to @ 19 compute distances, show beginning and ending readings in this column) MILEAGE SUBSISTENCE OTHER cents per mile Grand total to face of voucher (Subtotals, to be carried forward if necessary) TRANSPORTATION OBTAINED WITH GOVERNMENT TRANSPORTATION REQUESTS (Not to be claimed by traveler) AGENT'S MODE AND POINTS OF TRAVEL TRANSPORTATION VALUATION INITIALS OF CARRIER Class OF DATE REQUEST NUMBER OF TICKET ISSUING TICKET SERVICET ISSUED From- To- t'Pullman accommodations: MR, master room; DR, drawing room; CP, compartment ; BR, bedroom; DSR, duplex single room; RM, roomette; DRM, duplex roomette; sos, single occupancy section; LB, lower berth; UB, upper berth; LB-UB, lower and upper berth; S, seat." U. S. GOVERNMENT PRINTING OFFICE 1955-0-337019 Source: https://www.industrydocuments.ucsf.edu/docsixnjg227

what does sos stand for?

xnjg0227

xnjg0227_p3

single occupancy section

SCHEDULE OF EXPENSES AND AMOUNTS CLAIMED WHEN TYPED USE SINGLE SPACE 1. Departed from official duty station (Date) (Hour) 2. Temporary duty station on last day of next preceding voucher period was ; date of arrival at such temporary duty station . (Fill in 1 and 2 above only when dates are prior to period covered by this voucher) NUMBER OF MILES AMOUNT CLAIMED DATE DESCRIPTION (Include all information required by current regulations; if speedometer readings are used to @ 19 compute distances, show beginning and ending readings in this column) MILEAGE SUBSISTENCE OTHER cents per mile Grand total to face of voucher (Subtotals, to be carried forward if necessary) TRANSPORTATION OBTAINED WITH GOVERNMENT TRANSPORTATION REQUESTS (Not to be claimed by traveler) AGENT'S MODE AND POINTS OF TRAVEL TRANSPORTATION VALUATION INITIALS OF CARRIER Class OF DATE REQUEST NUMBER OF TICKET ISSUING TICKET SERVICET ISSUED From- To- t'Pullman accommodations: MR, master room; DR, drawing room; CP, compartment ; BR, bedroom; DSR, duplex single room; RM, roomette; DRM, duplex roomette; sos, single occupancy section; LB, lower berth; UB, upper berth; LB-UB, lower and upper berth; S, seat." U. S. GOVERNMENT PRINTING OFFICE 1955-0-337019 Source: https://www.industrydocuments.ucsf.edu/docsixnjg227

what is the heading of the second table?

xnjg0227

xnjg0227_p3

transportation obtained with government transportation requests, Transportation obtained with Government Transportation Requests

SCHEDULE OF EXPENSES AND AMOUNTS CLAIMED WHEN TYPED USE SINGLE SPACE 1. Departed from official duty station (Date) (Hour) 2. Temporary duty station on last day of next preceding voucher period was ; date of arrival at such temporary duty station . (Fill in 1 and 2 above only when dates are prior to period covered by this voucher) NUMBER OF MILES AMOUNT CLAIMED DATE DESCRIPTION (Include all information required by current regulations; if speedometer readings are used to @ 19 compute distances, show beginning and ending readings in this column) MILEAGE SUBSISTENCE OTHER cents per mile Grand total to face of voucher (Subtotals, to be carried forward if necessary) TRANSPORTATION OBTAINED WITH GOVERNMENT TRANSPORTATION REQUESTS (Not to be claimed by traveler) AGENT'S MODE AND POINTS OF TRAVEL TRANSPORTATION VALUATION INITIALS OF CARRIER Class OF DATE REQUEST NUMBER OF TICKET ISSUING TICKET SERVICET ISSUED From- To- t'Pullman accommodations: MR, master room; DR, drawing room; CP, compartment ; BR, bedroom; DSR, duplex single room; RM, roomette; DRM, duplex roomette; sos, single occupancy section; LB, lower berth; UB, upper berth; LB-UB, lower and upper berth; S, seat." U. S. GOVERNMENT PRINTING OFFICE 1955-0-337019 Source: https://www.industrydocuments.ucsf.edu/docsixnjg227

what is the heading of the first page?

tlnf0227

tlnf0227_p13, tlnf0227_p14, tlnf0227_p15, tlnf0227_p16, tlnf0227_p17, tlnf0227_p18, tlnf0227_p19, tlnf0227_p20, tlnf0227_p21, tlnf0227_p22, tlnf0227_p23, tlnf0227_p24, tlnf0227_p25, tlnf0227_p26, tlnf0227_p27, tlnf0227_p28, tlnf0227_p29, tlnf0227_p30, tlnf0227_p31, tlnf0227_p32

notes to combined financial statements, Notes to Combined Financial Statements

NOTES TO COMBINED FINANCIAL STATEMENTS American Heart Association, Inc. (National Center) (A) SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (B) TAX STATUS: Standards of Accounting and Reporting The Association is exempt from income taxes under Section STATEMENT OF SUPPORT, REVENUE AND EXPENSES AND CHANGES IN FUND BALANCES The Association follows the standards of accounting and 501(c)(3) of the U.S. Internal Revenue Code, has been determined to be an organization which is not a private YEAR ENDED JUNE 30, 1975 WITH COMPARATIVE TOTALS FOR 1974 financial reporting for voluntary health and welfare agencies prescribed by the National Health Council, the National foundation; and is qualified for the 50% charitable contributions Assembly of National Voluntary Health and Social Welfare deduction. Current Funds Building and Total All Funds Organization and United Way of America. These standards are inconformity with the recommendations of the American (C) NATIONAL CENTER CONSTRUCTION AND ELOCATION: Equipment Endowment Institute of Certified Public Accountants which became Inprior years, the Board of Directors authorized the construction Unrestricted Restricted Fund Fund 1975 1974 effective in fiscal 1975. In accordance with these standards, ofa National Center office building in Dallas, Texas, and expenditures for buildings and equipment and the fair value of designated funds for construction and relocation, PUBLIC SUPPORT AND REVENUE: donated equipment are capitalized Depreciation is recorded The National Center initiated the move to Dallas during the year Public support- over the estimated useful lives of the assets. Investments are ended June 30. 1975 and all estimated relocation costs have stated at cost. All contributions are considered available for the been accrued and charged to expense National Center share of campaign general programs of the Association, unless specifically The National Center obtained a $3,000,000 line of credit and a contributions and bequests (Notel) $14,215,881 $262,609 $ $ $14,478,490 $14,202,372 restricted by the donor. Interfund receivables and payables. commitment for an additional $1,000,000 line, with interest at the Contributions to building fund - - 22.948 - 22,948 35.731 arising from transactions which are to be completed after year- floating prime rate (7% at June 30. 1975). from a Dallas bank to end, have been eliminated finance construction and relocation costs. As of June 30. 1975. Contributed by affiliated organizations The amounts shown for 1974 in the accompanying financial the National Center was committed for approximately (net of their fund raising costs estimated statements are presented in accordance with the $1.600.000 of additional construction costs. at $40,046 in 1975 and $27,134 in 1974) - 294.458 - - 294,458 195.209 recommen dations of the American Institute of Certified Public Accountants. This financial information is included to provide a (D) LEGACIES IN PROCESS Total support from public 14,215,881 557.067 22.948 - 14,795,896 14.433.312 basis for comparison with 1975. and, other than for the balance The Association is the beneficiary under various wills and trust sheet. presents summarized totals only Accordingly. the 1974 agreements. the total realizable amount of which is not Fees and grants from governmental amounts are not intended to present all information necessary presently determinable Such amounts will be recorded when agencies - 222.927 - - 222.927 227.157 for a fair presentation in accordance with generally accepted clear title is established and the proceeds are measurable. accounting principles. Certain amounts for 1974 have been Other revenue reclassified to conform with the presentation used in the 1975 (E) ACCOUNTING CHANGES AND PRIOR YEAR financial statements. FINANCIAL STATEMENTS Membership dues council membership 91,060 - - - 91.060 72.615 Effective July 1974, the Association changed its accounting Program service fees 405,997 - - - 405.997 355.969 Awards and Grants policy to conform with the "Standards of Accounting and The Association's awards for research grants- in- aid, Financial Reporting for Voluntary Health and Welfare Investment income and miscellaneous investigators. fellowships and professional education generally Organizations as revised during fiscal 1975 (see Note. A) (Note 2) 1,575,186 7.224 26.978 - 1.609.388 1.575.147 cover a periodo of from one to five years. subject to annual Accordingly, in most instances the comparative financial Gains (losses) on investment transactions - (9.681) - renewal at the option of the Association The liability for awards information as of June 30. 1974has been retroactively restated (12,650) (22.331) 21.208 is recorded on an annual basis upon notification to the recipient to reflect these changes in accountir procedure. Where Total other revenue 2.072.243 (2,457) 26.978 (12,650) 2.084.114 2.024.939 at the time of approval or renewal (see Note E). restatement was not practicable or appropriate the cumulative Continuing awards and awards granted in the future will be effect of the change has been reflected in the current year's Total public support and revenue 16.288.124 777.537 49.926 (12,650) 17.102.937 16.685.408 made from the Current Unrestricted Fund Balance designated financial statements. for research of $13,199,697. from donor restricted funds of $4,778,050 and from contributions received in future years. (F) INVESTMENTS: All investments, other than endowment securities. are or a short- EXPENSES Available Funds- term basis. Income from nvestments carried in all funds is Program services The expenditures for each fiscal year are financed principally credited directly to Current Unrestricted Funds unless such Research 7.777.772 496,204 7.997 - 8.281.973 7,507,009 by funds received from the campaign of the previous year. income is restricted by the contributors. Accordingly, the campaign income shown in the Public health education 1.075.312 9,032 14,873 - 1,099,217 1,062,137 accompanying statement of support. revenue and expenses Professional education and training 2,481,862 203.967 27.983 - 2.713.812 2,483,811 and changes in fund balances will be available for research Community services 1,166,194 11.441 10.250 - 1,187,885 1.055.192 awards and for programs and operations budgeted for the ensuing fiscal year. Total program services 12,501,140 720,644 61.103 - 13.282.887 12.108.149 Designated for Program Supplementation Supporting services- and Contingencies- This portion of the Current Unrestricted Fund Balance. which Management and general 1,435,908 30,949 25,425 - 1.492.282 1,409,984 may be utilized by specific action of the various governing Fund raising 824,007 20,356 8.205 - 852.568 731.906 Boards is reserved for the continuity of the Association's general activities. its scientific research program and to meet Total supporting services 2,259,915 51,305 33.630 - 2,344,850 2.141.890 emergency demands. Total program and supporting services expenses 14,761,055 771,949 94,733 - 15.627.737 14.250.039 Excess (deficit) of public support and revenue over expenses, before relocation costs and cumulative effect of accounting change 1,527,069 5,588 (44.807) (12,650) 1.475.200 2,435,369 RELOCATION COSTS (Note 3) (1,277,070) - (15,010) - (1.292.080) - CUMULATIVE EFFECT OF ACCOUNTING CHANGE Research Expenses (Note 8) (549,278) - - - (549.278) - Excess (deficit) of public support and revenue over expenses (299.279) 5,588 (59.817) (12.650) (366.158) 2,435,369 OTHER CHANGES IN FUND BALANCES Property and equipment acquisitions from unrestricted funds (Notes and 8) (225,205) - 225.205 - - - FUND BALANCES. beginning of year 19.510.077 725,893 752,924 339.914 21.328.808 18.893.439 FUND BALANCES. end of year $18,985,593 $731,481 $918,312 $327,264 $20.962.650 $21,328,808 See accompanying notes to financial statements. 24 25 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 American Heart Association, Inc. (National Center) BALANCE SHEET - JUNE 30, 1975 AND 1974 ASSETS 1975 1974 LIABILITIES AND FUND BALANCES 1975 1974 CURRENT FUNDS-UNRESTRICTED CURRENT FUNDS-UNRESTRICTED CASH $ 930,505 $ 118,109 ACCOUNTS PAYABLE AND ACCRUED EXPENSES $ 772.814 $ 745.844 CERTIFICATES OF DEPOSIT AND U.S. TREASURY BILLS, at cost, ACCRUED RELOCATION COSTS (Note 3) 882.690 - which approximates market (Note 2) 13.502.628 13.591.866 UNEXPENDED BALANCE OF RESEARCH GRANTS IN AID, INVESTIGATORS, FELLOWSHIPS AND ACCRUED INVESTMENT INCOME 62,477 186.346 PROFESSIONAL EDUCATION AWARDS. payable within one year (Notes and 8) 8.073.496 6.840.212 DUE FROM AFFILIATES: NET UNEXPIRED SUBSCRIPTIONS TO PROFESSIONAL PUBLICATIONS 181,000 90,000 Campaign contributions (Notel) 12.145,466 11.569.365 9.910.000 7.676.056 Educational and campaign materials purchased 351.947 323.111 FUND BALANCE (Note 1): Notes receivable 206.435 89,500 Designated by the Board for - Programs and operations for the ensuing year (Note 6) 6.403.375 6,346,665 INVENTORY OF EDUCATIONAL AND CAMPAIGN MATERIALS, at first-in, first-out cost Research 9.302.317 8.562.338 or market, whichever is lower 1.131.422 945,053 Relocation (Note 3) - 1.000.000 National center (Note 3) 2.850.070 2.567.233 Program supplementation and contingencies 429.831 1.033.841 OTHER RECEIVABLES AND PREPAID EXPENSES 564,713 362.783 Total fund balance 18.985.593 19.510.077 $28,895,593 $27.186.133 $28,895,593 $27.186.133 CURRENT FUNDS-RESTRICTED CURRENT FUNDS RESTRICTED CASH $ 99,392 $ 67,573 FUND BALANCE: MARKETABLE SECURITIES, at cost, which approximates market (Note 2) 162,914 133.199 DUE FROM AFFILIATES: Designated by donors for - Campaign contributions 172.921 367,911 Research $ 462.291 $ 526.466 Cooperative research 233,001 116,735 Other 269,190 199,427 GRANTS RECEIVABLE 63.253 40,475 $ 731,481 $ 725,893 $ 731,481 $ 725.893 BUILDING AND EQUIPMENT FUND BUILDING AND EQUIPMENT FUND CASH $ - $ 18.304 CONSTRUCTIONNOTE PAYABLE (Note 3) $ 1,482,813 $ - CERTIFICATES OF DEPOSIT AND SHORT-TERM COMMERCIAL NOTES, at cost, which approximates market (Note 2) - 486,000 ACCRUED INVESTMENT INCOME - 8,280 FUND BALANCE: NATIONAL CENTER DEVELOPMENT COSTS (Notes 3 and 4) 2.300.875 110,773 Net investment in building and equipment 918,312 240.340 Unexpended-restricted - 512.584 EQUIPMENT at cost or appraised value, less accumulated depreciation of $418,157 in1975 and $323.424 in 1974 (Note 4) 100,250 129,567 Totalfund balance 918.312 752.924 $ 2,401,125 $ 752.924 $ 2,401,125 $ 752.924 ENDOWMENT FUND ENDOWMENT FUND ACCRUED INVESTMENT INCOME $ 4,785 $ 2,815 MARKETABLE SECURITIES, at cost. which approximates market (Note 2) 322,479 337,099 FUND BALANCE $ 327.264 $ 339.914 $ 327,264 $ 339,914 $ 327.264 $ 339.914 See accompanying notes to financial statements. 26 27 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 American Heart Association, Inc. (National Center) STATEMENT OF FUNCTIONAL EXPENSES YEAR ENDED JUNE 30, 1975 WITH COMPARATIVE TOTALS FOR 1974 Program Services Supporting Services Total Program and Supporting Services Public Professional Expenses Health Education Management Research Education and Training Community and Fund Services Total General Raising Total 1975 1974 Salaries $ 277.005 $ 515,137 $ 865.826 $ 424.613 $ 2.082.581 $ 698.175 $341.036 $1,039,211 $ 3.121.792 $ 2.915.012 Payroll taxes, etc. 16.999 31,020 47.283 23.186 118,488 35.984 19.699 55,683 174,171 168.782 Employee benefits (Note 5) 31.171 62.823 97.128 49.214 240.336 69,860 41.805 111.665 352.001 319.017 Occupancy 41,698 60,223 100.935 44.855 247.711 71.127 38.517 109.644 357.355 376.067 Telephone 14,644 31,040 41.362 24.303 111.349 35.962 20.608 56.570 167.919 156.686 Supplies 12,754 20.500 35.826 11,847 80.927 31,179 11.966 43,145 124.072 124.929 Rental and maintenance of equipment 15.595 21,426 39,439 13.335 89.795 30.951 12,531 43,482 133.277 101.195 Printing and publications (Notel) 20.977 120.726 283.838 65,473 491,014 41.352 124.600 165.952 656.966 490.356 Postage and shipping 10.773 19,167 29.963 12.254 72,157 19,195 11.641 30.836 102.993 121.637 Visual aids, films and media 1.202 90,573 25.233 178.886 295,894 7,210 64.706 71.916 367.810 314.125 Conferences, conventions and meetings: Travel 76.244 21.080 323,686 83.338 504.348 192,464 53.386 245.850 750.198 823.043 Other direct expenses - - 412.961 - 412.961 1,465 - 1,465 414.426 312.200 Other travel 12,177 29.356 55,008 49.810 146,351 80.269 37.344 117.613 263.964 266.990 Professional fees 892 33.224 18,071 22.385 74.572 65,139 45,602 110.741 185.313 135,422 Awards and grants (Note 8) 7,719,497 17.041 200,382 166.594 8.103.514 31,317 9.876 41.193 8.144.707 7.345.430 Other expenses 22,348 11,008 108.888 7.542 149.786 55.208 11.046 66.254 216.040 186.607 Total before depreciation and amortization 8.273.976 1.084.344 2.685.829 1.177.635 13.221.784 1,466,857 844.363 2.311.220 15.533.004 14.157.498 Depreciation and amortization (Notes 4 and 8) 7.997 14,873 27.983 10.250 61,103 25,425 8.205 33,630 94.733 92,541 Total functional expenses $8.281.973 $1,099,217 $2.713.812 $1,187,885 $13.282.887 $1,492,282 $852,568 $2,344,850 $15,627,737 $14,250.039 See accompanying notes to financial statements. 28 29 Source: :https://www.industrydocuments.ucsf.edu/docs/tInf0227 AUDITORS' REPORT AMERICAN HEART ASSOCIATION, INC. (NATIONAL CENTER) (2) INVESTMENTS All investments other than endowment securities. are on a short- To the Board of Directors of NOTES TO FINANCIAL STATEMENTS term basis. Income from investments carried in all funds is American Heart Association, Inc. credited directly to the Current Unrestricted Fund unless such (1) SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: income is restricted by the contributors We have examined the balance sheet of National Center- (3) NATIONAL CENTER: American Heart Association, Inc (National The accompanying financial statements reflect the accounts of In prior years the Board of Directors authorized the construction American Heart Association Inc. (National Center), and do not of a National Center in Dallas, Texas. and designated funds for Center a New York not-for-profi corporation) as include the accounts of affiliated associations which are construction and relocation of June 30, 1975. and the related statements of maintained individually by such associations Contribution are The Association initiated the move to Dallas during the year support, revenue and expenses and changes in received principally by the affiliated associations and are ended June 30. 1975. and all estimated relocation costs have shared with the National Center The National Center's share of fund balances and of functional expenses for the been accrued and charged to expense contributions and bequ jests reflected in these financial year then ended. We have also examined the statements for 1975 was $14,478 490 and $14.202 372 for 1974 The Association obtained a 3.000.000 line of credit and The related fund raising costs of affiliated associations were commitment for an additional $1,000.000 line with interest at the restated financial information for 1974 presented approximately $2.028.000 in 1975 and $1,869,000 in 1974. floating prime rate (7% at June 30 1975), from a Dallas bank to for comparative purposes. Our examinations finance construction and relocation costs. During 1975, an were made in accordance with generally Standards of Accounting and Reporting - average of $340.00 was outstanding under the line at an accepted auditing standards. and accordingly The Association follows the standards of accounting and average interest rate of 7.6%. The maximum balance outstanding was $1 1.482 813 Subsequent to year end additional included such tests of the accounting records financial reporting for voluntary health and welfare agencies prescribed by the National Health Council, the National draws were made on the line as construction on the building and such other auditing procedures as we Assembly of National Voluntary Health and Social Welfare progressed. The balance is due on July 1976 Alternative long considered necessary in the circumstances. Organizations and United Way of America. These standards are term financing methods are being considered As discussed in Notes and 8 to the financial in conformity with the recommendations of the American Asof June 30. 1975 the Association was committed for Institute of Certified Public Accountant which became approximately $1 600,000 of additional capital expenditures statements, the Association has changed its effective in fiscal 1975 (see Note 8) In accordance with these related to facilities of the National Center. methods of accounting for fringe benefits on standards expenditures for buildings and equipment and the research awards and for the costs of building and fair value of donated equipment are capitalized Depreciation (4) BUILDING AND EQUIPMENT: is recorded over the estimated useful lives of the assets. Depreciation of equipment is recorded on the straight line basis equipment additions and related depreciation. Investments are stated at cost All contributions are considered over the estimated useful lives of the assets. In our opinion, the accompanying financial available for the general programs of the Association unless No depreciation was recorded on the uncompleted National statements present fairly the financial position of specifically restricted by the donor. Interfund receivables and Center during 1975 will be depreciated on the straight line payables. arising from transactions which are to be completed basis over 40 years beginning December 1975 The building is American Heart Association, Inc (National after year end, have been eliminated situated or a donated leasehold The fair rental value of the Center) as of June 30, 1975, and its support, The amounts shown for 1974 in the accompanying financial leasehold will be recorded each year as a donation and revenue and expenses and changes in fund statements are presented in accordance with the corresponding expense when the building is put in service. balances for the year then ended, in conformity recommendation of the American Institute of Certified Public Accountants. This financial information is included to provide a (5) RETIREMENT PLAN: with generally accepted accounting principles. basis for comparison with 1975. and, other than for the balance The Association provides retirement benefits for substantially all In our opinion, except for the change (with which sheet. presents summarized totals only. Accordingly the 1974 employees and certain research awardees through individual amounts are not intended to present all information necessary annuities with Teachers Insurance and Annuity Association and we concur) in the method of accounting for fringe College Retirement iquities Fund Retirement benefits equal the benefits described in Note 8. the accounting for a fair presentation in accordance with generally accepted accounting principles In addition to the accounting changes amount accumulated to the imployees' individual credit at the principles were applied on a basis consistent with discussed in Note 8. certain amounts for 1974 have been date of retirement. All costs of the Plan are borne by the that of the preceding year, after giving reclassified to conform with the presentation used in the 1975 Association except that norder to increase benefits. a participant may at his election contribute a portion of his retroactive effect to the change (with which we financial statements. compensation The Plan costs to the Association for the years concur) in the method of accounting for building Awards and Grants- ended June 30. 1975 and 1974 were 4.000 and $266.000 for and equipment additions and related The Association's awards for research grants- in aid, employees and $325,000 and $316,000 for research awardees. depreciation discussed in Notes and 8. investigators. fellowships and professional education generally respectively cover a period of from one to five years, subject to annual The Pension Reform Act of 1974 requires the Association to Also, in our opinion, the financial information for renewal at oppion of the Association The liability for awards amend its Plan to conform with certain provisions of the Act. 1974, which has been restated for the change in is recorded on an annual basis upon notification to the recipient which will become effective in 1976. The Association estimates method of accounting for building and at the time of approval or renewal (see Note 8). that there will be no significant increase in the costs of the Plan equipment additions and related depreciation The aggregate contingent liability for payment of continuing as a result of the changes awards beyond the currently authorized year is estimated to be and is presented for comparative purposes (see S11 350 June 30. 1975. In addition, thirteen Career (6) OTHER COMMITMENTS: Notes and 8). presents fairly the information set Investigator Awards have been approved by the Board of The Association's lease agreements for office and warehouse forth therein. Directors providing salary and laboratory expenses for the space. which expire through 1979 provide for annual rental recipients, the aggregate contingent liability for such awards payments of $369 000 in 1976 (including $120,00 of unexpired Arthur Andersen & Co. (assuming payment to normal refirement date of each lease commitments on office space vacated in connection with Investigator) is estimated to be $6,000.000. Thus, the total the relocation. which has been expensed as discussed in Note Dallas, Texas, contingent liability for awards and grants at June 30. 1975 is 3). $14,500 in 1977 and $12,000 in 1978. December 5, 1975. estimated to be $17 .350.000. Continuing awards and awards granted in the future will be (7) TAX STATUS: The Association is exempt from income taxes under Section made from the Current Unrestricted Fund Balance designated for research of $9,302,317 from donor restricted funds 501(c)(3) of the U.S. Internal Revenue Code, has been determined to be an organization which not a private $462.29 and from contributions received in future years. foundation; and is qualified for the 50% charitable contributions Educational and Campaign Materials- deduction. Included in printing and publications expenses for 1975 and 1974 are net costs attributable to distribution of educational and (8) ACCOUNTING CHANGES AND PRIOR YEAR campaign materials and professiona pi oublications. The FINANCIAL STATEMENTS: Association absorbs costs for such items in excess of the Prior to July .1974. the costs of building and equipment amounts charged to affiliates and others. Amounts charged in additions were expensed in the Current Unrestricted Fund in the 1975 and 1974 were $2 919. 334, and $2,529,525; costs were year of acquisition. The cost and accumulated depreciation for $3.201.062 and $2 748 285. resulting in a net cost of $281,728 for major ecquisitions were recorded in the Building and 1975 and $218.760 for 1974, Equipment Fund. Straight line depreciation was reflected by charges to the Building and Equipment Fund balance. Designated for Program Supplementation Effective July 1974, the Association changed ifs accounting and Contingencies- policy to conform with the "Standards of Accounting and This portion of the Current Unrestricted Fund Balance. which may Financial Reporting for Voluntary Health and Welfare be utilized by specific action of the Board of Directors (see Note Organizations as revised during fiscal 1975 (see Note 1) 3). is reserved for the continuity of the Association' general Accordingly, the comparative financial information as of June activities, its scientific research program and to meet 30. 1974, has been retroactively restated to reflect this change in emergency demands. accounting procedure The effect of this change was to decrease expenditures and increase interfund transfers for the Available Funds- year ended June 30. 1974, by $23.508. The expenditures for each fiscal year are financed principally In years prior to fiscal 1975. fringe benefits related to research by funds received from the campaign of the previous year. awards were charged to expense as paid. Effective July 1974, Accordingly, the campaign income shown in the horder to reflect the total liability incurred as research awards accompanying statement of support, revenue and expenses are granted. the Association changed ifs policy to record and changes in fund balances will be available for research concurrently the estimated fringe benefits payable on research awards and for programs and operations budgeted for the awards with the basic award (see Note 1). The effect of this ensuing fiscal year. change was to increase expenses and unexpended awards payable for the year ended June 30. 1975. by $550,000. Had the Legacies in Process- Association consistently followed this policy in prior years. total The Association the beneficiary under various wills and trust program and supporting expenses for 1974 would have been agreements the total realizable amount of which not increased by approximately $64 000 and total fund balances presently determinable Such amounts will be recorded when would have been decreased by $549.278 31 clear title is established and the proceeds are measurable. 30 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 The American Heart Association The American Heart Association is comprised of 55 affiliates and ,996 local subdivisions of which 126 are chapters Each has its own volunteer leadership and operates within the policies of AHA. Eight Regional Heart Committees of the Board of Directors provide leadership and guidance through representative membership from the affiliates. GREAT PLAINS REGION Colorado Heart Association American Heart Association, Dakota Affiliate 4521 East Virginia Ave. Denver 1005 Twelfth Ave. S.E. Jamestown, N. Dakota Idaho Heart Association Iowa Heart Association 2309 Mountain View Drive, Suite TIO. Boise 3810 Ingersoll Ave. Des Moines Montana Heart Association Kansas Heart Association Professional Bldg. 510 1st Ave., North, Great Falls 5229 West 7th St. Topeka Oregon Heart Association Minnesota Heart Association 1500 S.W. 12th Ave Portland 4701 West 77th St. Minneapolis Utah Heart Association Missouri Heart Association 250 East 1st South, Salt Lake City 601 East Broadway, Columbia Washington State Heart Association Nebraska Heart Association 333 First Avenue West Seattle 3624 Farnam Omaha Wyoming Heart Association 217 West 18th St., Cheyenne MIDDLE ATLANTIC REGION Heart Association of Maryland SOUTHERN REGION 10 South St. Suite 100, Baltimore Alabama Heart Association North Carolina Heart Association 7061/2 South 29th St., Birmingham 1 Heart Circle, Chapel Hill Arkansas Heart Association South Carolina Heart Association 909 West 2nd St. Little Rock 2864 Devine St. Columbia Florida Heart Association Virginia Heart Association 2828 Central Ave. St Petersburg 316 East Clay St. Richmond Georgia Heart Association Washington (D.C.) Heart Association Broadview Plaza, Level C., 2581 Piedmont Rd. N.E., D. C. Medical Society Bldg. Atlanta 2007 Eye St. N.W. Washington, D.C. Louisiana Heart Association American Heart Association, West Virginia Affiliate 3303 Tulane Ave. New Orleans 211 35th St. S.E., Charleston Mississippi Heart Association 4830 East McWillie Circle, Jackson NEW ENGLAND REGION Oklahoma Heart Association Connecticut Heart Association 800 Northeast 15ths St., Oklahoma City 234 Murphy Road, Hartford Tennessee Heart Association Maine Heart Association Suite 308. 1720 West End Building. Nashville 20 Winter St., Augusta American Heart Association, SOUTHWEST REGION Massachusetts Affiliate American Heart Association, Arizona Affiliate 85 Devonshire St. Boston 1445 East Thomas. Phoenix New Hampshire Heart Association American Heart Association, California Affiliate 54 South State St., Concord 1370 Mission St. San Francisco Rhode Island Heart Association American Heart Association of Hawaii, Inc. 40 Broad St. Pawtucket 245 North Kukui St., Honolulu Vermont Heart Association American Heart Association, 56 Church St., Rutland Greater Los Angeles Affiliate 2405 West 8th St. Los Angeles NORTH CENTRAL REGION Nevada Heart Association Chicago Heart Association 455 West 5th St. Reno 22 West Madison St. Chicago New Mexico Heart Association Illinois Heart Association 142 Truman St., N.E. Suite D Albuquerque 1181 North Dirksen Parkway, Springfield American Heart Association, Texas Affiliate, Inc. American Heart Association, Indiana Affiliate, Inc. 860 North Highway 183. Austin 222 South Downey, Suite 222. Indianapolis Kentucky Heart Association UPPER ATLANTIC REGION 207 Speed Bldg. 333 Guthrie St., Louisville Delaware Heart Association Michigan Heart Association Independence Mall, Suite 46. 1601 Concord Pike. 16310 West Twelve Mile Rd. Southfield Wilmington American Heart Association, American Heart Association, New Jersey Affiliate Northeast Ohio Affiliate 1525 Morris Ave., Union 1689 East 115th St., Cleveland New York Heart Association American Heart Association, Ohio Affiliate 2 East 64th St. New York City 10 East Town St.: Room 506. Columbus American Heart Association, Wisconsin Heart Association New York State Affiliate 795 North Van Buren St., Milwaukee 3 West 29th St. New York City American Heart Association, Pennsylvania Affiliate NORTHWEST-ROCKY MOUNTAIN REGION 2743 North Front St. Harrisburg Alaska Heart Association Puerto Rico Heart Association 211 East 4th Ave., Anchorage Box 8215. Fernadez Juncos Station, Sanfurce 32 THE AMERICAN HEART ASSOCIATION 7320 Greenville Avenue Dallas, Texas 75231 This 1975 Annual Report was designed and written by the American Heart Association's Communications Division and, for the first time in Association history, was printed by the print production facility at the National Center. Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 American Heart Association Annual Report 1975 i This report to the public on the conduct of the American Heart Association program during 1975 is dedicated to the more than two million volunteers who are the lifeblood of the Association. They represent men and women from the grass roots of America who call on friends and neighbors in communities large and small to collect the dollars that finance the Association's work. And they include scientists, physicians, nurses and leaders of business, industry, law, the arts, and communications who sit on Boards, Councils, Committees and Task Forces to help set policies, develop programs and oversee their successful accomplishment. Without their freely-given time and skills we would not have been able to achieve the enormous strides of the past 25 years against cardiovascular disease. Indeed, without all of them, there would be no American Heart Association at all. Cover photo shows an echocardiogram of a patient's heart. Echocardiography is a relatively recent non-invasive technique, rapidly growing in use, which has made a major contribution to the diagnostic skills of the cardiologist. If aims ultra-high frequency sound waves through the chest wall to the target area of the heart. Returning echoes generate electrical impulses which are received and recorded by the echograph instrument. President's Message We know what the priorities and goals are: Research We still don't know the cause of coronary During the past year, the Association heart disease, even though heart attack death rates are declining; provided funds for the work of approximately We don't know the cause of 90 percent of 1,400 scientific investigators on all career all high blood pressure, though we have levels-to - assure that outstanding learned to control much of it; independent researchers may pursue We don't know the cause of primary original lines of thought to wherever they myocardial disease; and may lead, that the established investigator We still don't know why normal mothers has the means to complete his project and have babies with congenital heart disease. that younger scientists of promise have the Heart Association staff members and support they need to develop their skills. volunteers are rededicating themselves to unlocking more of these unknowns. We seek the support of all Americans so that the same sense of urgency that motivates us can have its expression in new and expanded programs. In the year covered by this report, the Our network of affiliates and chapters has American Heart Association allocated a steadily developed. Today it reaches into record amount of $18 million for heart thousands of communities involving citizen research, sending the total for such support volunteers, laymen, scientists, physicians, past the quarter billion dollar mark. During nurses and people from all walks of life in an the same period, there was confirmation that amalgam to cope with a complex of distinct the death rates from coronary disease had diseases generally referred to as turned downward. An analysis of these cardiovascular. closely watched statistics suggested that a Armies of distinguished scientists and combination of better prevention and more physicians, corps of non-medical personnel effective emergency treatment played an and more than two million volunteers form important role in this downtrend. the Heart Association. Much of the public There is reason to take satisfaction in funds donated to the Association support our contributions toward reaching these research scientists in their attempts to further milestones. But there is even more reason unlock the secrets of heart disease. Assisting to report that these achievements have in translating new medical knowledge from stimulated in us a new sense of urgency. We all sources into professional programs are have seen what dollars and dedication can about 10,000 scientists and physicians do. Yet, while heart and blood vessel forming 14 Scientific Councils, each diseases continue to impose an intolerable dedicated to a field of science or a medical health burden and economic cost on the specialty relating to heart disease. Through nation, we must do much more. their valuable guidance, the Association is in essence a micro-universify, developing and conducting hundreds of postgraduate medical courses across the country throughout the year to refine the skills of physicians and nurses and thus ensure better patient care. The Scientific Councils also are active in the development of programs for the general public, assuring that those programs are based on scientific fact and designed to educate Americans in the prevention of heart attack and stroke. In the pages that follow you will find highlights of our programs in the year covered by this report. Elliot Rapaport, M.D. President 2 If we are to make further inroads on the Professional Education enormous toll of death and disability caused by cardiovascular diseases, we must continue to help develop new scientific knowledge. This is at the foundation of all programs, professional and public, conducted by the Association. What increases our sense of urgency in this matter is that progress against cardiovascular disease, while rapid and progressive, must rely on one piece of new knowledge being gathered here atop another piece gathered elsewhere. We are forging a mosaic of hope and help. The results of research projects supported by AHA continue to find clinical expression in improvements in the diagnosis and treatment of heart disease. Two of the more significant advances reported during the past year are: The first significant decrease in mortality from coronary artery disease; There are hundreds of other bits and pieces A doubling of the number of patients with reported each year that may prove to be hypertension who have been recognized, put on therapy and had part of a new weapon in the war on heart their blood pressure controlled. disease. Biomedical investigators are facing Examples of research supported by the AHA up to the challenges. What we need are which promise to provide additional more of the means. Each of these new advances in overcoming heart disease approaches must be tried, tested and include: duplicated- in laboratories, on animals and Techniques for improved and earlier finally in humans- - before they can be recognition of heart attacks and the accepted as conclusive and beneficial and protection of injured heart muscle from added to the list of armaments. Knowledge gained through research is only progressive damage; as good as its application. With the Providing the means requires a new Recognition of the fundamental cellular acceleration in research in recent years has defect in a form of hereditary commitment from the public to support our come a steady increase in new information hypercholesterolemia, associated with a responsibility to do all in our power to help about cardiovascular diseases and new high incidence of heart attacks among gather and disseminate new knowledge. ways of treating and preventing such affected people in their 20's and 30's; The faster scientists can nail down disorders. This new knowledge often Development of sophisticated X-ray preliminary findings, the faster they can be techniques which will graphically becomes available at a pace swifter than applied to reducing suffering and death. demonstrate the intricate workings of the the busy cardiologist, coronary care nurse heart in the intact human; Simply put, the urgency is dollars to save or other health care specialists can be Proof that a prolonged regimen of diet lives. expected to seek it out and assimilate it. and exercise improve circulatory Aso result, a special sense of urgency derangements in the legs; stimulates us in development of our medical Application of new approaches to the recognition and treatment of education programs, to assure that they hypertension caused by decreased keep pace with advances in the field and blood flow to the kidneys; that they are geared to bringing new Improved diagnosis and therapy of research findings to the medical community thrombophlebitis in the legs, the source as quickly and as clearly as possible. of blood clots which cause 50,000 deaths each year in the U.S. Keystones for dissemination of valuable knowledge are the American Heart Association's 14 Scientific Councils, headed by many of the nation's foremost scientists and cardiovascular experts. Each of the Councils represents a special professional interest; together they reflect the broad scope of cardiovascular diseases and the concerns of the American Heart Association. They set the standards and conduct the professional activities of the Association. 4 5 The Councils conduct continuing education Public Education programs for their own members who total approximately 10,000. Reaching out to others A college professor in Baltimore, Maryland, in the medical community, the Councils are showed the AHA-produced film, active in the development of a wide range ``Hypertension: The Challenge of Diagnosis," of learning materials available to all to his biology class. One student was so 270 physicians and nurses. These include moved at learning hypertension or high pamphlets, newsletters, films, lecture series, blood pressure is a 'silent killer" that she 250 audio-visual aids and a group of scientific immediately urged her mother to undergo a journals which have a combined monthly long-delayed medical checkup. 230 circulation of more than 300,000. At the apex The examination revealed the woman of this activity is the annual Scientific indeed had high blood pressure, but thanks 210 Sessions, a meeting which attracts more than to a concerned daughter and a Heart 200 10,000 health professionals to exchange and Association message, her condition was 190 assess the year's new findings. brought to medical attention at an early 180 Affiliates and chapters of the Association time. 170 conduct hundreds of their own programs While that film was produced for 160 which bring together physicians and nurses professional education, it does show there on a community or state level, as contrasted are many ways of reaching the general 150 140 to Council-sponsored programs which are public with information vital to its welfare. conducted on a national basis. These 130 And the Association employs all means of 120 programs are not necessarily of interest just mass communication to alert Americans to / to the cardiologist, but are planned for the magnitude of the problem of heart 110 100 anyone concerned with better patient care disease; to what is known about factors that for prevention of heart disease and increase an individual's risk; and what one 90 80 management of patients. can do on his or her own and with a doctor's The Association constantly seeks to innovate help to change life styles moderately, 70 60 in its educational programs, as it has in control some easily identifiable health establishing research support programs conditions, and thus reduce that risk. 50 subsequently adopted elsewhere. Better The heart of this message includes these patient care is one of our goals and to get to major points: the crux of it, we conduct a unique Teaching If you have high blood pressure, follow Scholarship Program. This has a two-fold your doctor's orders and continue to take purpose: to raise standards of medication. undergraduate education for medical If you don't know whether you have high blood pressure, or suspect you might careers by creating a corps of unusually have it, visit your doctor. He can quickly, effective cardiology teachers, and thereby easily and painlessly find out. It usually on a day-to-day basis influence the has no set symptoms. So only a trained development of hundreds of students who person can tell. eventually will be in practice. This program If you smoke cigarettes, stop. has reached into medical schools across the If you eat foods rich in cholesterol and saturated fats, cut down on them. If you country and to date has supported 26 young don't know what they are, ask your Heart physicians, allowing them to devote virtually Association for booklets that tell you in all of their time to teaching and to plain, concise language. development of improved teaching If you that don't you exercise do become more regular active. basis, on a see If methods. you're middle-aged and/ have been leading a more than usual chair-borne existence, it would be wise to see your doctor before engaging in unaccustomed activity. 6 Community Programs Having just learned it in school, cardiopulmonary resuscitation was fresh in the mind of 13-year-old Lyn Kraft of Ventnor, N.J., the October night her father suffered a massive heart attack and lost consciousness. Lyn was able to maintain his breathing and heart beat for 10 minutes until medical help arrived. Usually, a victim of cardiac arrest who is denied oxygen for more than four to six minutes suffers brain damage. But today, Mr. Kraft is recovering, thanks to Lyn's prompt action, the CPR training she received from her school nurse, Marie Paludi, and to the South Jersey Shore Heart Chapter which certified Ms. Paludi in CPR which quickly proved its worth in that community. CPR is just one facet of a growing concept of area-wide comprehensive emergency pressure screening and control. This latter cardiac care systems being promoted by one has received particular emphasis the Association. But CPR's life-saving because there may be as many as 12 million potential has spurred us into teaching it to "hidden" cases of high blood pressure in this cadres of health professionals who, returning country; and among those known to be to their home areas or institutions, can afflicted, only one out of eight is receiving quickly train others-professionals and adequate medical care. public alike to provide basic emergency Other new efforts to improve and expand help wherever a life needs to be saved. community services include development of One example of this mushrooming effect: guidelines for medical management of last October, the Association conducted a teenagers with high levels of artery-clogging training course for 20 inspectors from the cholesterol in their blood; work on model Mining Enforcement and Safety programs applying principles of behavioral Minority Program Administration. Within two weeks, three of the science to risk reduction motivation; and a inspectors were conducting a course for 30 new film and stroke guide explaining the role Barrios, ghettos, isolated American Indian found heart disease, high blood pressure others- - other inspectors and of community hospitals in the optimum reservations. depressed rural villages. inner- and their devastating aftermaths, heart representatives from 24 industries covering a treatment of stroke victims, and then in city slums and other "out-of-the- attack and stroke, more so than in urban, seven-state area. They, in turn, are now returning them to as useful a life as modern mainstream" places- - all are synonymous higher income societies. prepared to train other groups. science makes possible. with minority groups, poverty and apathy. In recent years as more became known Where these elements exist, there also are In the past year, the Association distributed about the present concepts of programming more than 1.2 million copies of a booklet on for the total community and about the new standards in CPR, developed in concert relatively more serious impact of with the National Research Council-National cardiovascular diseases on isolated and Academy of Sciences. These went to health lower income groups, the Association professionals across the country and around began reaching out - to bring aid and the world. information to these groups and to encourage them to help design programs The same sense of urgency which underlies based on their urgent needs. our CPR activities, has prodded us into other community programming to motivate Starting in 1971, several national conferences Americans to reduce their risk of heart attack were sponsored by the Association to bring and stroke by making moderate changes in all interested organizations together. Today, life styles and controlling identifiable health Minority Involvement Working Group and a disorders. Poverty Planning and Development Fund These programs include smoking withdrawal Committee are working towards improving clinics, nutrition and diet instruction, the Association's program in the total community. rheumatic fever control, screening children for hidden heart disorders, stroke and heart Hand in hand with minority involvement in attack rehabilitation and high blood Association affairs has come a substantial 9 8 increase in programs of education and directors and in activities of state and local Major Awards Mrs. Alexander Ripley, Los Angeles. She prevention conducted jointly with those for Heart Associations. Thus, minority group Research Achievement Award, the "created an impressive record with the Heart whom the programs have been developed. leadership to further combat cardiovascular American Heart Association's highest award Cause in California and in the national The response has been impressive. Example: disease in these areas can be nurtured. for research accomplishment, to Arthur C. In South Dakota, at Standing Rock community," while encouraging other In 1975, AHA worked closely with the Guyton, M.D., in recognition of his brilliant, women's participation in that cause. Reservation alone, more than 5,000 Sioux Association of Black Cardiologists, the tireless research efforts spanning more than Moreover, she helped develop national are learning how to reduce their risk of heart National Medical Association composed of two decades, for his profound contributions attack and stroke. In Tulsa, Oklahoma, policies, and displayed organizational skills minority physicians, the National Congress of toward advancing knowledge of virtually Indians living in the urban area, are doing in planning annual meetings for the American Indians and the National every aspect of cardiovascular physiology, Association. likewise. Association of American Indian Physicians to and the influence his work had in stimulating Paul N. Yu, M.D., Professor of Medicine, Across the country, Heart Associations are encourage participation on regional, the efforts of other scientists. Dr. Guyton is University of Rochester (N.Y.) Medical Center. conducting high blood pressure screening affiliate and national boards and Professor and Chairman of the Department Dr. Yu, a former AHA president, "performed for blacks because this disease affects committees and on the Scientific Councils of of Physiology and Biophysics. University of brilliantly in the service of all elements of the blacks at double the rate of whites, and the Heart Association. Mississippi Medical Center. Association" for many years. Many of his usually with more devastating efforts have been directed toward consequences of heart attack and stroke. James B. Herrick Award, granted by the improving the quality of medical education When high blood pressure is detected, this Council on Clinical Cardiology to Lewis and the delivery of emergency cardiac program provides patients with follow-up Dexter, M.D., for outstanding achievement in care. resources for therapy and educational clinical cardiology. With almost 40 years programs. devoted to his field, he has "excelled in Howard W. Blakeslee Awards for Though critically important, educating advancing scientific knowledge, improving distinguished media communication minorities at the local level is only a part of the practice of cardiology. and in regarding cardiovascular diseases: the program's mission. Equally as important developing legions of medical students and JoAnn Ellison Rodgers of the "Baltimore News in reaching its objectives is achieving a scores of research fellows who today are American" for her four-part newspaper series higher degree of minority member making significant contributions of their own involvement in committees, boards of to cardiology.' Dr. Dexter is Professor of that comprehensively reported the rising incidence of heart disease in women. Medicine at Harvard University and Director of the Cardiovascular Laboratory at Peter Good Times, a CBS-TV weekly series Bent Brigham Hospital, Boston, featuring the episode "The Check Up.' This Massachusetts. particular telecast, aired May 8.1974, emphasized the importance of medical Gold Heart Awards honor those volunteers check ups for hypertension-prone black who have served with highest distinction in males. "Good Times" is produced by advancing the American Heart Association's Norman Lear and Tandem Productions. work. Recipients are: Andy Guthrie of WKYC-TVI News, Cleveland, Julius H. Comroe, Jr., M.D., Herzstein Professor Ohio, for his five-part report "The of Biology, University of California in San Ambulance Crisis: Who Will Come for You?" Francisco. As a scientist, he contributed If examined problems confronting importantly toward the enrichment of Cleveland's ambulance system, compared cardiovascular knowledge and improved it to those in other cities, and proposed clinical practice. Through his editorial solutions to these shortcomings. leadership, he brought "excellence" to AHA's scientific journal, "Circulation Research.' Elwood Ennis, Vice President, Griffenhagen- Kroeger, a management consultant firm in San Francisco. His knowledge of management procedures proved invaluable in establishing performance standards for AHA Affiliates and in developing personnel and training policies during his 20 years as a volunteer leader of the Association. 10 11 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 Joan Solomon, a science writer for Rose Pinneo, R.N., Associate Professor of Board Chairman's Message In 1975, we received 130 requests from young "Consumer Reports" magazine, for her Nursing, University of Rochester School of scientists for five-year Established article, "High Blood Pressure: What to Do Medicine and Dentistry, Rochester, New Investigatorships to support their heart When Your Numbers Are Up." Her story, York. research Monies were available to fund only according to competition judges, told the Richard H. C. Taylor, Richmond, Virginia. 32 of these qualified men and women. truth about the causes, diagnosis and Sam A. Threefoot, M.D., Assistant Dean and Moreover, we could support only 23 percent treatment of hypertension while dispelling Professor of Medicine, Medical College of of the over 400 Grants-in-Aid projects old myths about the disease. Georgia, Augusta. requested by investigators needing funding JoAnn Stichman and Jane Schoenberg for to perform vital heart research. Had the their book, "How to Survive Your Husband's Citation for Distinguished Service to dollars been available, more of these highly Heart Attack." The authors were cited for Research to: regarded people and projects would have "giving frank, full advice to women who David Bohr, M.D., Professor of Physiology, received funds from the Heart Association cope with a wide variety of new problems" University of Michigan, Ann Arbor. Inflation is also having undesirable effects on when facing heart attack crises. Jack Geer, M.D., Professor and Chairman, professional and public education Louis N. Katz Basic Science Research Department of Pathology, University of programs the Association conducts Alabama, Birmingham. nationwide. We are seeking both increased Prize for Young Investigators, to Kent Hermsmeyer, Ph.D., for demonstrating and Karlman Wasserman, M.D., Ph.D., Chief- fund-raising results and more cost-effective Respiratory Division, Harbor General programs to keep ahead of this specter of explaining an increased sensitivity of the Hospital, Torrance, California. shrinking dollars. blood vessels in high blood pressure to the hormone called norepinephrine. His Irwin Weiner, M.D., Professor and Chairman- Americans exhibited an increasing Additionally, we are working to cut research represents a significant advance Department of Pharmacology, State confidence in the American Heart operating costs and have done so. In this toward understanding how essential University, New York Upstate Medical Center, Association and its programs by contributing regard, the Executive Vice President's hypertension, a mysterious disease, gets Syracuse. record $59,951,245 in 1975. message on the following page explains some of the actions we have taken and started. Dr. Hermsmeyer is an Assistant However, the cost of "doing business" has Professor of Pharmacology at University of results already achieved. also reached all-time highs; the Association lowa College of Medicine in lowa City. has felt the impact of inflation as have other Through the years, past and present organizations. programs have proven their worth in Distinguished Achievement Award to contributing to reducing death and Irving S. Wright, M.D., Emeritus Clinical This new enemy in our war on heart disease is improving the quality of life. They have Professor of Medicine at Cornell University causing AHA dollars to shrink and is adding received increasing support from Medical College and Consulting Physician to our sense of urgency because it contributing individuals. to New York Hospital. Dr. Wright jeopardizes our ability to accelerate accomplished the "monumental task of progress through expanded programs. But they especially merit renewed consideration and more generous support bringing together, blending and presiding We feel inflation as a two-way stretch. Our from industry and business. over the work of the Inter-Society dollars don't buy as much research, education and community services. Yet Underlying this consideration should be the Commission for Heart Disease Resources. His fact that heart and blood vessel diseases leadership, knowledge, guidance and inflation makes increasing demands on us. Some of these demands grow out of cost the nation an estimated $22.7 billion understanding of human affairs resulted in the most effective collaboration among retrenchment in the federal government's annually. In addition to lost income and expenditures for medical care, 52,000,000 more than 200 experts representing the 29 research training program which affects the organizations and disciplines represented bright young scientist much more than it man-days of production are lost each year. Other 'hidden' costs such as losses in on the Commission." He is a foremost does the established researcher who has management skills, production know-how, authority on cardiovascular disease who other sources of support. These young personnel training and development, and pioneered in the study of thrombosis. scientists are turning to us for support in labor turn-over are difficult to determine, but greater numbers than before. are obviously significant. Awards of Merit for outstanding The Report on the Commission on Private contributions to development of the organization's national program to: Philanthropy and Public Needs has recommended that corporations set as a Donald S. Fredrickson, M.D., Director, minimum goal, to be reached no later than National Institutes of Health, Bethesda, 1980, the giving to charitable purposes of Maryland. two percent of pre-tax net income and that Robert J. Michtom, M.D., Rockville Centre, further studies of means to stimulate Long Island - -Associate Professor of corporate giving be pursued. Medicine, State University of New York, Stony Greater investment in our Heart program Brook. could turn out to be a long-term investment Robert H. Mitchell, M.D., Clinical Professor of in corporate health. Medicine, Texas Tech University School of Medicine, Lubbock, Texas. Richard D. Dotts Chairman 12 13 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 Executive Vice President's OFFICERS BOARD OF DIRECTORS Message Richard D. Dotts Walter H. Abelmann, M.D. Chairman of the Board Boston, Mass. As a meeting place and resource center for John T. Shepherd, M.D., D. Sc. William H. Ames, M.D. the dedicated workers of the American President St. Joseph, Mo. Heart Association, our new National Center now enables closer relationships and Harriet P. Dustan, M.D. John S. Andrews President-Elect Youngstown, Ohio communications with 55 Affiliates and 1,196 Philip P. Ardery Chapters and Units. It is also national Elliot Rapaport, M.D. Louisville, Ky. Immediate Past President headquarters of the Association. Adm. Philip F. Ashler Ross Reid Tallahassee, Fla. Planned and executed with long-term Immediate Past Chairman of the Board W. Gerald Austen, M.D. savings in mind, this relocation is but a part of the Association's strategy to refine VICE PRESIDENTS Boston. Mass. Philip P. Ardery Owen Beard, M.D. management practices and to implement Little Rock, Ark. economies and confront the challenge of Owen Beard, M.D. Rene Bine, Jr., M.D. fiscal restraint. John J. DeFeo, Ph.D. San Francisco, Calif. In this regard, am pleased to report that Mrs. Frank A. Dresslar, Jr. Miss Virginia Black, R.N. combined expenditures by the national Ham Jackson, M.D. Cheyenne, Wyo. office and all affiliates for fund raising and Kenneth W. Kihle, M.D. Reagan H. Bradford, Ph.D. Ira L. Lavin Oklahoma City, Okla. other overhead costs have been reduced John G. Martin Guy E. Bramon, Jr. dramatically from a high point of 30 percent Edward Meilman, M.D. Bloomfield, Conn. in the 1968 fiscal year to a low of 23 percent Nanette K. Wenger, M.D. Miss Grace Brown, R.N. in the fiscal year ending last June 30. Stanford Wessler, M.D. Riverdale, N.Y. To have curbed overhead while increasing James G. White, M.D. Jay D. Coffman, M.D. In 1975, the American Heart Association and expanding our program is a Boston, Mass. John S. Andrews William E. Conner, M.D. moved from New York to a newly- remarkable achievement, not only from a Treasurer Portland, Ore. constructed National Center in Dallas. management standpoint, but also for what it Mrs. M. Jeanne Pontious, R.N. B. Trent Cooper, M.D. Volunteer leaders of the Association contributed toward our public Secretary Roanoke, Ind. determined that a geographically central accountability. By practicing economies Robert J. Cruikshank location and modern facilities would bring and instituting other solid management Houston, Tx. about operating efficiency and economies. devices, the Heart Association has been Gordon Curren able to channel almost 80 cents of every Sisseton, S. Dak. This new building is the nerve center of our dollar spent into positive programs for the Vincent DeCristotaro voluntary mission to reduce premature death public's benefit. Providence, R.I. and disability from cardiovascular diseases. John J. DeFeo, Ph.D. If becomes the focal point of an By improving the processes of our planning Kingston, R.I. organization comprising 40,000 of America's and management systems, we are further Richard D. Dotts foremost scientists and physicians, 65,000 developing orderly mechanisms for doing Newport Beach, Calif. other key members and more than 2,000,000 an even better job and determining future Mrs. Frank A. Dresslar, Jr. citizen volunteers. priorities, objectives, and costs. Thus, we will Fresno, Calif. be increasingly able to approach the public Harriet P. Dustan, M.D. with targeted needs, rather than simply our Cleveland, Ohio overall program of research, education, and Robert R. Eddy community services. In this manner, am Concord, N.H. confident Americans will respond even more William H. Eells Columbus, Ohio positively. Blair D. Erb, M.D. Knoxville, Tenn. Allan L. Friedlich, M.D. William W. Moore Boston, Mass Emilio R. Giuliani, M.D. Executive Vice President Rochester, Minn. Samuel Goldfein, M.D. Tucson, Ariz. Judith Graham, M.D. Great Falls, Mont. Jared Grantham, M.D. Kansas City, Ks. 14 15 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 Robert Hay, M.D. C. Richard Newpher Gary Walkup, M.D. COUNCIL CHAIRMEN NATIONAL OFFICE STAFF Nampa, Idaho Cleveland, Ohio Fairbanks, Alaska Arteriosclerosis William W. Moore Robert N. Headley, M.D. Thomas R. Oglevie Nanette K. Wenger, M.D. William E. Conner, M.D. Executive Vice President Winston-Salem, N.C. Goodland, Ks. Atlanta, Ga. Portland, Ore. SPECIAL ASSISTANTS E. H. Heinrichs, M.D. Donald C. Overy, M.D. Stanford Wessler, M.D. Basic Science Dawn Bryan, Chief, Public Policy Watertown, S. Dak. Birmingham, Mich. New York, N.Y. Arnold Schwartz, Ph.D. and Government Affairs Jacob F. Hess, Jr. Raul Penagaricano James G. White, M.D. Carolina, P.R. Houston, Tex. James D. Lowe, Public Relations Canton, Ohio Minneapolis, Minn. Mrs. Haywood N. Hill J. Stephen Phalen, M.D. Robert W. Wissler, Ph.D., M.D. Cardiopulmonary Diseases Counsel Reno, Nev. Chicago, III. Gerard M. Turino, M.D. John T. Connolly Atlanta, Ga. Hon. Charles A. Pomeroy New York, N.Y. Deputy Vice President, Office of Operations Florencio A. Hipona, M.D. Richard A. Young, M.D. Portland, Me. Hagerstown, Md. Cardiovascular Disease in the Young Eugene J. Brennan Boston, Mass. Mrs. M. Jeanne Pontious, R.N. Paul N. Yu, M.D. Angelo V. Taranta, M.D. Director, Division of Fund Raising Edmund M. Hoffman Indianapolis, Ind. Rochester, N.Y. New York, N.Y. Leonard P. Cook Dallas, Tx. W. Gerald Rainer, M.D. Harry F. Zinsser, M.D. Cardiovascular Nursing Director, Division of Management Information Services Thomas B. Hogan Denver, Colo. Gladwyne. Pa Miss Grace E. Brown, R.N. Robert E. Killian New York, N.Y. Elliof Rapaport, M.D. Robert Levy, M.D. Riverdale, N.Y. Director, Division of Communications M. Harland Ison San Francisco, Calif. Bethesda, Md. Cardiovascular Radiology W. Timothy Mask Mobile, Ala. Ross Reid (Representing National Heart Florencio A. Hipona, M.D. Director, Division of Personnel and Training New York, N.Y. and Lung Institute) Ham Jackson, M.D. James Blozie Boston, Mass. Richard S. Ross, M.D. Richard E. Hurley, M.D. Ft. Morgan, Colo. Baltimore, Md. Hartford, Conn. Cardiovascular Surgery Deputy Vice President, Office of Medical Programs Harry I. Johnson, Jr., M.D. Mrs. Adria Rubin (Representing Society of Heart W. Gerald Austen, M.D. Joseph D. Goldstrich, M.D. Roanoke, Va. Association Professional Staff) Boston, Mass. Elmira, N.Y. Director, Division of Education and Community Programs James E. Kamas Circulation Clare J. Sanchez Curtis B. Nelson, Ph.D. Lincoln, Neb. Jay D. Coffman, M.D. Director, Division of Scientific Affairs William B. Kannel, M.D. Denver, Colo. Boston, Mass. Framingham, Mass. Donald E. Saunders, M.D. Norman M. Kaplan, M.D. Clinical Cardiology John W. Kendall Columbia, S.C. Deputy Vice President, Office of Research Programs Henry D. McIntosh, M.D. Portland, Ore. Samuel J. Castranova Elijah Saunders, M.D. Houston, Tex. Joseph H. Kern, Ph.D. Director, Division of Planning and Evaluation Baltimore, Md. Monroe, La. Epidemiology Arnold Schwartz, Ph.D. Howard Weisberg, Ph.D. Kenneth W. Kihle, M.D. William B. Kannel, M.D. Director, Division of Research Awards Bottineau, N. Dak. Houston, Tx. Framingham, Mass. Richard I. Schein Richard A. Koebler John T. Shepherd, M.D., D. Sc. High Blood Pressure Research Director, Division of Business Administration Springfield, III. Rochester, Minn. William H. Eells Ira L. Lavin Sam N. Sherman Columbus, Ohio Earl B. Beagle Phoenix, Ariz. Milwaukee, Wisc. President, Executive Board Southern Affiliate Services Coordinator Charles Levy, M.D. Sol Sherry, M.D. Louis Tobian, M.D. Jerry H. Bruner Wilmington, Del. Philadelphia, Pa. Minneapolis, Minn. Eastern Affiliate Services Coordinator W. Sexton Lewis, M.D. MartinD Shickman, M.D. Chairman, Executive Committee Warren L. Duntley Little Rock, Ark. Los Angeles, Calif. Medical Advisory Board Midwest Affiliate Services Coordinator W. Jefferson Lyon Robert G. Siekert, M.D. Kidney in Cardiovascular Disease Robert D. Moore Newark, N.J. Rochester, Minn. Jared Grantham, M.D. Western Affiliate Services Coordinator GermanE. Malaret, M.D. Ernest G. Spivey Kansas City, Ks. San Juan, P.R. Jackson, Miss. Stroke John G. Martin Robert A. Stewart Robert Siekert, M.D. Columbia, S.C. Seattle, Wash. Mrs. Ruby Massingale, R.N. Perry Sundust Rochester, Minn. Phoenix, Ariz. Thrombosis Seattle, Wash. Angelo V. Taranta, M.D. Stanford Wessler, M.D. John E. Mazuzan, Jr., M.D. Burlington, Vt. New York, N.Y. New York, N.Y. Paul N. McDaniel Thomas Tarnay, M.D. Honolulu, Hawaii Morgantown, W. Va. Henry D. McIntosh, M.D. B. W. (Jack) Taylor Houston, Tx. Mabank, Tx. William J. McManus Richard H. C. Taylor Washington, D.C. Richmond, Va. Edward Meilman, M.D. AlanF. Toronto, M.D. New Hyde Park, N.Y. Salt Lake City, Utah Franklin B. Moosnick, M.D. Gerard M. Turino, M.D. Lexington, Ky. New York, N.Y. Frank M. Mowry, M.D. Ray Uhlhorn Albuquerque, N.M. Council Bluffs, lowa 16 17 Source: https://www.industrydocuments.ucsf.edu/docs/tInf02 AMERICAN HEART ASSOCIATION, INC. and all affiliated Heart Associations Memorial Gifts Bequests and Planned Gifts COMBINED STATEMENT OF SUPPORT, REVENUE, AND EXPENSES AND CHANGES IN FUND BALANCES Many people find that the most fitting tribute Planned giving is an arrangement between YEAR ENDED JUNE 30, 1975 WITH COMPARATIVE TOTALS FOR 1974 to the memory of a victim of heart disease is a donor and the American Heart Association a memorial gift to the American Heart by which a gift of money or property is Land, Association. Memorials are an important irrevocably identified for use by the Building and Current Funds Equipment Endowment Total All Funds source of support in the fight against American Heart Association. Though the Unrestricted Restricted Fund Fund 1975 1974 premature heart deaths. All gifts are right to use the gift may be deferred, there PUBLIC SUPPORT AND REVENUE: promptly acknowledged both to the family can be immediate and future tax benefits to Public support- of the person honored and to the donor. To the donor. Received directly- make a memorial gift to the American Heart There are a variety of methods for planned Contributions $36,590,080 $1,112,214 $ 26,450 $ 52.605 $37,781,349 $37,793,548 Association, specify your name and address gifts including gifts of cash, appreciated Contributions to building fund - - 26,407 - 26.407 35.731 and the name and address of the family to Special events 2.852.307 82,443 6.175 - 2.940.925 2.285.195 property, such as securities or real estate, which acknowledgement should be sent. and of life insurance, outright or in trust. Your Legacies and bequests(Note D) 12.445.982 1.039.375 199.613 30.584 13.715.554 14.085.522 Send this information with your donation to attorney can advise you how to bring your Total received directly 51.888.369 2.234.032 258,645 83.189 54,464,235 54,199,996 your local American Heart Association estate plans up-to-date, and can assist you Received indirectly- affiliate or to the local chapter nearest you. to consider ways in which a planned gift to Allocated by federated fund the American Heart Association may not raising organizations 3.657.750 3.755 - - 3.661.505 2.996.352 only support its work, but may also help to Allocated by unassociated and improve your income, lessen taxes, and nonfederated fund-raising organizations (net of their fund-raising costs) 1.824.960 545 - - 1.825.505 1.724.621 reduce the costs of probate. Total received indirectly 5,482,710 4.300 - - 5,487,010 4.720.973 Legacies and bequests are among the most Total support from public 57.371.079 2.238.332 258,645 83.189 59.951.245 58.920.969 frequently used methods of perpetuating the work of the American Heart Association. The Fees and grants from governmental 2.720.683 1.968.633 following form can be used to name the agencies 782.950 1.936.133 1,600 - Association as beneficiary in your will: Other revenue- Membership dues individuals 314.194 - - - 314.194 285,483 "Igive to the American Heart Association, Inc. a corporation organized under the Not- Program service fees and net for-Profit Corporation Law of the State of New incidental revenue 935.930 81.704 - - 1.017.634 1,067,677 York and having its principal office at 7320 Investment income (Note F) 6.081.486 180.856 32,285 20.863 6.315.490 5.375.072 Greenville Avenue, Dallas, Texas 75231, the Gains (losses) on investment transactions (51.788) (32.585) (28.632) (12.650) (125.655) - sum of dollars, to be used for the general Miscellaneous revenue 101.359 206.168 (3.334) - 304.193 205.574 purpose of such corporation." Totalother revenue 7.381.181 436.143 319 8.213 7.825.856 6.933.806 Similar forms may be obtained from your Total public support and revenue 65,535,210 4.610.608 260.564 91,402 70.497.784 67.823.408 local Heart Association for your attorney's EXPENSES: convenience. Program services- For information regarding gifts or bequests Research 17,088,595 1,275,975 31.344 - 18.395.914 17.897.746 for specific program purposes contact the Public health education 8.999.125 369,020 156.127 - 9.524.272 8.377.183 American Heart Association or the Heart Professional education and training 8.334.006 554,203 165,401 1,000 9.054.610 8.361.679 Community services 10.143.520 1.519.202 217.264 1,000 11.880.986 10,079,542 Association in your community. Total program services 44.565.246 3.718.400 570.136 2.000 48.855.782 44.716.150 Supporting services- Management and general 7,040,155 26.946 137.137 - 7.204.238 6.907.590 Fund raising 8.790.353 34.992 122.674 - 8.948.019 8.303.264 Total supporting services 15,830,508 61.938 259.811 - 16.152.257 15.210.854 Total program and supporting services expenses 60.395.754 3.780.338 829.947 2,000 65.008.039 59.927.004 Excess (deficit) of public support and revenue over expenses, before relocation costs and cumulative effect of accounting changes 5,139,456 830.270 (569.383) 89.402 5,489,745 7.896.404 RELOCATION COSTS of National Center (Note C) (1.277.070) - (15,010) - (1.292.080) - CUMULATIVE EFFECT OF ACCOUNTING CHANGES (Note E) (1,210,740) 215.204 (116.471) (39.898) (1,151.905) 777,477 Excess (deficit) of public support and revenue over expenses 2.651.646 1.045.474 (700,864) 49.504 3.045.760 8.673.881 OTHER CHANGES IN FUND BALANCES Property and equipment acquisitions from unrestricted and other designated funds (1.425.839) (117.152) 1.566.351 (23.360) - - FUND BALANCES. beginning of year (Note E) 75.337.418 4.701.516 8.213.041 1.214.725 89.466.700 80.792.819 FUND BALANCES, end of year $76,563,225 $5,629,838 $9,078,528 $1,240,869 $92.512.460 $89,466.700 The accompanying notes to financial statements are an integral part of this statement. 18 19 Note: This statement has been prepared by the National Center from the individual certified audit report of each affiliated association and is not covered by the report of Arthur Andersen & Co. Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 American Heart Association, Inc. and all affiliated Heart Associations COMBINED BALANCE SHEET - JUNE 30, 1975 and 1974 ASSETS 1975 1974 LIABILITIES AND FUND BALANCES 1975 1974 CURRENT FUNDS-UNRESTRICTED CURRENT FUNDS UNRESTRICTED CASH: ACCOUNTS PAYABLE AND ACCRUED EXPENSES $ 1.706.284 $ 1.525.556 Checking accounts $ 6.381.182 $ 5.935.773 ACCRUED RELOCATION COSTS-NATIONAL CENTER (Note C) 882.690 - Savings accounts 17.682.249 18.692.730 UNEXPENDED BALANCE OF RESEARCH, PROFESSIONAL EDUCATION AND SHORT-TERM INVESTMENTS, at cost, which approximates market value (Note F) 60.778.388 55.235.818 COMMUNITY PROGRAM AWARDS (Note A) 9.748.704 7.553.522 SUPPORT AND REVENUE DESIGNATED FOR FUTURE PERIODS 1.555.263 938.084 ACCRUED INVESTMENT INCOME 490,477 552.221 13.892.941 10.017.162 ACCOUNTS RECEIVABLE: Federated and nonfederated fund-raising organizations 1.590.784 2.130.727 FUND BALANCES (Note A): Other 1.184.595 1.058.216 Designated by the governing Boards for - Budgetary expenditures for the year commencing Julyl 52.598.909 54.189.021 EDUCATIONAL AND CAMPAIGN MATERIALS HELD FOR USE, Research awards 13.199.697 11.929.597 at first-in, first-out cost or market, whichever is lower 1.652.612 1.327.873 National center construction and relocation 2.850.070 3.568.233 PREPAID EXPENSES 461,391 219.658 Undesignated, available for program supplementation and contingencies 7.914.549 5,650,567 OTHER ASSETS 234.488 201,564 Totalfund balances 76.563.225 75.337.418 $90,456,166 $85,354,580 $90,456,166 $85,354,580 CURRENT FUNDS RESTRICTED CURRENT FUNDS RESTRICTED ACCOUNTS PAYABLE AND ACCRUED EXPENSES $ 39.224 $ 105,502 CASH: UNEXPENDED BALANCE OF RESEARCH, PROFESSIONAL Checking accounts $ 318.394 $ 264,973 EDUCATION AND COMMUNITY PROGRAM AWARDS - 172.011 Savings accounts 2.013.132 2.539.891 SUPPORT AND REVENUE DESIGNATED FOR FUTURE PERIODS 145.118 293.320 184.342 570.833 SHORT-TERM INVESTMENTS, at cost, which approximates market value (Note F) 2.825.715 2.021.804 FUND BALANCES: ACCRUED INVESTMENT INCOME 6.818 3.250 Designated by donors for - Research 4.778.050 3.994.449 ACCOUNTS RECEIVABLE 483.216 210,620 Public health education 144.464 117.064 GRANTS RECEIVABLE 147,351 95,547 Professional education and training 107.746 88.968 Community services 599.578 501.035 OTHER ASSETS 19,554 136.264 Total fund balances 5.629.838 4.701.516 $ 5.814.180 $ 5.272.349 $ 5.814.180 $ 5.272.349 LAND, BUILDING AND EQUIPMENT FUND LAND, BUILDING AND EQUIPMENT FUND CASH $ 21.911 $ 18,304 ACCOUNTS PAYABLE $ 37.752 $ 68.856 CONSTRUCTIONLOAN PAYABLE (Note C) 1.482.813 - SHORT-TERM INVESTMENTS. at cost, which approximates market value (Note F) 20.812 488,500 MORTGAGES PAYABLE 1.540.184 1.096.228 ACCRUED INVESTMENT INCOME 1.579 8.280 3.060.749 1.165,084 FUND BALANCES: NATIONAL CENTER DEVELOPMENT COSTS (Note C) 2,300,875 110.773 Expended 9.034.226 7.697.957 LAND. BUILDINGS AND EQUIPMENT at cost or appraised value, Unexpended restricted 44.302 515.084 less accumulated depreciation 9,794,100 8.752.268 Total fund balances 9.078.528 8.213.041 $12.139.277 $ 9.378.125 $12.139.277 $ 9.378.125 ENDOWMENT FUND ENDOWMENT FUND CASH in savings accounts $ 385.505 $ 333.946 ACCOUNTS PAYABLE $ 44,661 $ - INVESTMENTS, at cost, which approximates market value (Note F) 900,025 880.779 FUND BALANCE 1.240.869 1.214.725 $ 1.285.530 $ 1.214.725 $ 1.285.530 $ 1.214.725 The accompanying notes to financial statements are an integral part of this balance sheet. Note: This statement has been prepared by the National Center from the individual certified audit report of each affiliated association and is not covered by the report of Arthur Andersen & Co. 20 21 Source: https:/lwww.industrydocuments.ucsf.edu/docs/tInf02 American Heart Association, Inc. and all affiliated Heart Associations COMBINED STATEMENT OF FUNCTIONAL EXPENSES YEAR ENDED JUNE 30, 1975 WITH COMPARATIVE TOTALS FOR 1974 Program Services Supporting Services Total Program and Supporting Services Public Professional Expenses Health Education Management Research Education and Training Community and Fund Services Total General Raising Total 1975 1974 Salaries $ 791,421 $4,833,323 $3,764,723 $ 5,725,938 $15,115,405 $3.765,345 $4,528,990 $ 8.294.335 $23,409,740 $20,917,005 Payroll taxes, etc. 53,500 334,117 254,143 384.260 1.026.020 253.746 310.182 563.928 1.589.948 1.432.357 Employee benefits 77.206 365.545 318.207 404.337 1,165,295 345,231 304.954 650.185 1.815.480 1.605.113 Occupancy 96.223 511.785 423.029 563.465 1,594,502 393.491 407.531 801.022 2.395.524 2.323.774 Telephone 40.996 304.919 214.760 323,898 884,573 221.510 345.597 567.107 1.451.680 1.286.031 Supplies 35.965 223.169 190.196 287,058 736.388 187.428 227.774 415.202 1.151.590 1.020.550 Rental and maintenance of equipment 23.967 106.289 109.257 183,007 422.520 99,581 95,136 194.717 617.237 871.647 Printing and publications 50,070 987.453 850.046 529.103 2.416.672 189,141 1.013.400 1.202.541 3.619.213 3.024.560 Postage and shipping 34.985 351.235 245.046 327.422 958.688 186.826 503.476 690.302 1.648.990 1.457.238 Visual aids, films and media 4,651 310,631 135,710 351,433 802.425 36.518 151,043 187,561 989.986 987.219 Conferences. conventions and meetings Travel 103.813 236.019 674,218 392.668 1.406.718 408.978 200.174 609,152 2.015.870 1.747.753 Other direct expenses 4,127 41.128 507,864 19,846 572.965 27.877 19.603 47,480 620,445 551.922 Other travel 42.417 373,461 331,209 491,350 1.238.437 284.371 342.287 626.658 1,865,095 1.744.814 Professional fees 10.346 140.320 83.182 503.975 737.823 453.700 208.965 662,665 1,400,488 1.073.466 Awards and grants to individuals and other organizations 16.947.136 94,491 580.932 946.035 18.568.594 3.902 4.628 8.530 18.577.124 17.733.614 Other expenses 47,747 154,260 206.687 229.927 638.621 209.456 161.605 371,061 1.009.682 1.282.876 Total before depreciation and amortization 18,364,570 9.368.145 8.889.209 11.663.722 48.285,646 7.067.101 8.825.345 15.892.446 64.178.092 59.059.939 Depreciation and amortization of buildings, equipment and improvements 31,344 156.127 165,401 217.264 570.136 137.137 122.674 259.811 829.947 867.065 Total functional expenses $18,395,914 $9,524,272 $9,054,610 $11,880,986 $48,855,782 $7.204.238 $8.948,019 $16,152,257 $65,008,039 $59,927,004 The accompanying notes to financial statements are an integral part of this statement Note: This statement has been prepared by the National Center from the individual certified audit report of each affiliated association and is not covered by the report of Arthur Andersen & Co. 22 23 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 NOTES TO COMBINED FINANCIAL STATEMENTS American Heart Association, Inc. (National Center) (A) SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (B) TAX STATUS: Standards of Accounting and Reporting The Association is exempt from income taxes under Section STATEMENT OF SUPPORT, REVENUE AND EXPENSES AND CHANGES IN FUND BALANCES The Association follows the standards of accounting and 501(c)(3) of the U.S. Internal Revenue Code: has been determined to be an organization which is not a private YEAR ENDED JUNE 30, 1975 WITH COMPARATIVE TOTALS FOR 1974 financial reporting for voluntary health and welfare agencies prescribed by the National Health Council. the National foundation; and is qualified for the 50% charitable contributions Assembly of National Voluntary Health and Social Welfare deduction. Current Funds Organizations and United Way of America. These standards are Building and Total All Funds inconformity with the recommendations of the American (C) NATIONAL CENTER CONSTRUCTION AND RELOCATION: Equipment Endowment Institute of Certified Public Accountants which became In prior years. the Board of Directors authorized the construction Unrestricted Restricted Fund Fund of a National Center office building in Dallas, Texas. and 1975 1974 effective in fiscal 1975. In accordance with these standards, expenditures for buildings and equipment and the fair value of designated funds for construction and relocation PUBLIC SUPPORT AND REVENUE: donated equipment are capitalized Depreciation is recorded The National Center initiated the move to Dallas during the year Public support- over the estimated useful lives of the assets. Investments are ended June 30. 1975. and all estimated relocation costs have stated at cost. All contribu utions are considered available for the been accrued and charged to expense National Center share of campaign general programs of the Association, unless specifically The National Center obtained a $3,000,000 line of credit and a contributions and bequests (Note 1) $14,215,881 $262,609 $ $ - $14,478,490 $14,202,372 restricted by the donor. Interfund receivables and payables. commitment for an additional $1,000,000 line, with interest at the arising from transactions which are to be completed after year- Contributions to building fund - - 22.948 - 22.948 35.731 floating prime rate (7% at June 30. 1975), from a Dallas bank to end. have been eliminated finance construction and relocation costs Asof June 30. 1975, Contributed by affiliated organizations The amounts shown for 1974 in the accompanying financial the National Center was committed for approximately (net of their fund raising costs estimated statements are presented in accordance withthe $1,600.000 of additional construction costs. recommendations of the American Institute of Certified Public at $40,046 in 1975 and $27,134 in 1974) - 294.458 - - 294.458 195.209 Accountants, This financial information included to provide a (D) LEGACIES IN PROCESS basis for comparison with 1975. and, other than for the balance The Association is the beneficiary under various wills and trust Total support from public 14.215.881 557.067 22.948 - 14.795.896 14.433.312 sheet presents summarized totals only, Accordingly, the 1974 agreements, the total realizable amount of which not Fees and grants from governmental amounts are not intended to present all information necessary presently determinable Such amounts will be recorded when for a fair presentation in accordance with generally accepted clear title is established and the proceeds are measurable. agencies - 222.927 - - 222.927 227.157 accounting principles. Certain amounts for 1974 have been reclassified to conform with the presentation used in the 1975 (E) ACCOUNTING CHANGES AND PRIOR YEAR Other revenue- financial statements FINANCIAL STATEMENTS Membership dues council membership 91,060 - - - 91,060 72,615 Effective July 1974 the Association changed its accounting Awards and Grants- Program service fees 405.997 - - - policy to conform with the "Standards of Accounting and 405.997 355.969 The Association's awards for research grants- in aid, Financial Reporting for Voluntary Health and Welfare Investment income and miscellaneous investigators. fellowships and professional education generally Organizations' as revised during fiscal 1975 (see Note A) (Note 2) 1,575,186 7.224 26.978 - cover a period of from one to five years, subject to annua 1.609.388 1.575.147 Accordingly, in most instances the comparative financial renewal at the option of the Association The liability for awards information as of June 30. 1974 has been retroactively restated Gains (losses) on investment transactions - (9.681) - (12,650) (22.331) 21.208 is recorded on an annual basis upon notification to the recipient to reflect these changes in accounting procedure Where at the time of approval or renewal (see Note E). restatement was not practicable or appropriate the cumulative Total other revenue 2.072.243 (2,457) 26.978 (12.650) 2.084.114 2.024.939 Continuing awards and awards granted in the future will be effect of the change has been reflected in the current year's financial statements, Total public support and revenue 16.288.124 777.537 49.926 (12.650) 17.102.937 16.685.408 made from the Current Unrestricted Fund Balance designated for research of $13,199,697. from donor restricted funds of $4,778,050 and from contributions received in future years. (F) INVESTMENTS All investments, other than endowment securities, are on a short- EXPENSES: Available Funds- term basis. Income from investments carried in all funds is Program services - The expenditures for each fiscal year are financed principally credited directly to Current Unrestricted Funds unless such income is restricted by the contributors. Research 7.777.772 496.204 7,997 - by funds received from the campaign of the previous year. 8.281.973 7.507.009 Accordingly, the campaign income shown in the Public health education 1.075.312 9,032 14.873 - 1.099.217 1.062.137 accompanying statementof support revenue and expenses Professional education and training 2.481.862 203.967 27.983 - and changes in fund balances will be available for research 2.713.812 2.483.811 awards and for programs and operations budgeted for the Community services 1.166.194 11,441 10.250 - 1.187.885 1.055.192 ensuing fiscal year. Total program services 12.501.140 720,644 61.103 - 13.282.887 12.108.149 Designated for Program Supplementation and Contingencies Supporting services- This portion of the Current Unrestricted Fund Balance. which Management and general 1,435,908 30.949 25,425 - 1.492.282 1.409.984 may be utilized by specific action of the various governing Fund raising 824,007 20.356 8.205 - Boards, is reserved for the continuity of the Association's general 852.568 731.906 activities. its scientific research program and to meet Total supporting services 2.259.915 51,305 33.630 - 2.344.850 2.141.890 emergency demands Total program and supporting services expenses 14.761.055 771.949 94.733 - 15.627.737 14.250.039 Excess (deficit) of public support and revenue over expenses, before relocation costs and cumulative effect of accounting change 1,527.069 5,588 (44,807) (12.650) 1.475.200 2,435,369 RELOCATION COSTS (Note 3) (1,277,070) - (15.010) - (1.292.080) - CUMULATIVE EFFECT OF ACCOUNTING CHANGE Research Expenses (Note 8) (549.278) - - - (549.278) - Excess (deficit) of public support and revenue over expenses (299.279) 5,588 (59.817) (12.650) (366.158) 2.435.369 OTHER CHANGES IN FUND BALANCES: Property and equipment acquisitions from unrestricted funds (Notes and 8) (225.205) - 225.205 - - - FUND BALANCES, beginning of year 19.510.077 725,893 752.924 339.914 21.328.808 18.893.439 FUND BALANCES, end of year $18,985,593 $731,481 $918.312 $327,264 $20.962.650 $21,328.808 See accompanying notes to financial statements. 24 25 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227

Mention the heading of first column under "Desirable weight"?

mgxh0227

mgxh0227_p0, mgxh0227_p1, mgxh0227_p2, mgxh0227_p3, mgxh0227_p4, mgxh0227_p5, mgxh0227_p6, mgxh0227_p7, mgxh0227_p8, mgxh0227_p9, mgxh0227_p10

KILOGRAM, Kilogram

SCIENTIFIC BASES FOR THE RECOMMENDED ALLOWANCE 47 L CALORIES dedail (over) Calorie allowances have been established in all previous editions of Recommended Dietary Allowances with the objective of provision of energy in amounts sufficient when consumed over an extended period to maintain body weight or rates of growth at levels most conducive to well being and health. This general principle is reaffirmed and allowances have been carefully reevaluated with consideration of the results of a large number of investigations of human energy requirements. Qalorie állowances were modified in the last revision of had been Recommended Dietary Allowances to conform with certain standards and conditions established by the Food and Agricultural Organization of the United Nations through its International 8 Committee on Calorie Requirements + A second FAO Report on Calorie Requirements has recently been published in which a number of modifications have been made in the specification 9. of calorie requirements I. These have been considered in the preparation of this revision of Recommended Dietary Allowances. Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 2 - In specifying requirements for calories for individuals, the FAO committee utilized the device of the "reference" man and woman, both aged 25 and living in a temperate climate with a mean annual external of 10 degrees Centigrade. The weight of the "reference man" was given as 65 kilograms and was 55 kólograms for the "reference woman". Recommended Dietary Allowances adapted the same basis of reference in its 1953 revision. These characteristics cannot be considered average 10 for the young adult population of the United States, however. Therefore, in the present statement certain adaptations have been made to permit establishment of reference conditions more nearly conforming with United States standards of body size and living conditions. The "reference" man is again taken as of age 25 but the weight is given as 70 kólograms which would seem to be more nearly descriptive of the average young male in this population. Similarly, the "reference" woman is described as being 25 years of age but weighing 58 kólograms. Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 3 - Another modification is to establish allowances assuming that individuals are living in an environment with a mean environ- o C mental temperature of 20 degrees centigrade rather than the lower temperature given by FAO. This would again seem to be a more realistic description of the mean environmental temperature of most of the population of the United States. Both man and woman are presumed to lead a vigorous, healthy life and to be moderately active physically, with occupations which could not be described either as sedentary or as hard physical labor. The man would be likely to be in light industry or employed as delivery man, painter or outdoor salesman. The woman might be homemaker, saleswoman or bench worker in a factory. The daily allowances/ as derived for the "reference man" is 3200 calories and for the "reference" woman is 2300 calories. It should be realized that adjustments must be made in calorie allowances when individuals or population averages differ from the "reference" in characteristics of age, body Source: https://www.industrydocuments.ucst.edu/docs/mgxh0227 - 4 - size, climate or activity. Procedures for these adjustments are described below. Adjustments of Calories for Age - - Energy requirements decline progressively after the years of early adulthood, because of a decrease in basal metabolic rate as well as lessened physical activity. It is proposed that calorie allowances be reduced by 3 per cent per decade between ages 30 and 50 and by 7.5 per cent per decade from age 50 to 70. A further decreasement of 10 per cent is recommended for the years from 70 to 80. These adjustments are in accord with 9 FAO recommendations X Accordingly, the calórie allowances at age 45 are 6 per cent less than at age 25 and at age 65 are 21 per cent less (See Tolile II ). Adjustment for Body Size - - Calorie allowances must be adjusted for the variations in energy requirements which result from differences in body size. Therefore, in utilizing the allowances giver in the table, larger allowances must be Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 5 - derived for individuals of body size greater than indicated for the reference man and woman and smaller allowances should be prescribed for those of smaller size. In adapting allowances for differences in size, weight may be used as a basis provided the subjects are not overweight or underweight. Maximum body length (height) is usually attained by age 20 or shortly there- after, but in the United States the average person tends to continue to gain in body weight until about 60 years of age. Life insurance and other data indicate that these weight gains are undesirable and that the most favorable health expectation is associated with conditions under which weight as normally achieved by age 25 or 30 is maintained throughout later bife. Therefore, in these recommendations the calorie allowances for adults pertain not to actual body weight of individuals or groups but to desirable body weight (the average weight separd of individuals of given height at age 25). Table I may be used as a guide for this use and adaptation. Heights and weights Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 TABLE II Individuals Marious Calorie / allowances for men of Marred Body Weights and age 15 (as meanenvermental temperature 32 of 20 Centegrade and assuming moderate physics activity I MEN Calorie allowances Deserable Weight Kelogram Pounds 25 years 45 years 65 years 50 110 2500 2350 1950 55 121 2700 2550 2150 60 132 2850 2700 2250 65 143 3000 2800 2350 70 154 3200 3000 2550 75 165 3400 3200 2700 80 176 3550 3350 2800 85 187 3700 3500 2900 Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227 (tableth Calorie Allowanes for Women of Various Body Weight and age WOMEN 63 Deserable Weight Cultrie allowares 22 45 58 Pounds 70 Kelograms 25 years 45 15 years 65 years 40 88 1750 1650 1400 45 99 1900 1800 1500 50 110 2050 1950 1600 5T5 121 2200 2050 1750 58 128 2:300 2200 1800 60 132 2350 2200 1850 65 143 2500 2350 2000 70 154 2600 2450 2050 75 165 2750 2600 2150 Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 6 - usually as recorded include usual clothing worn indoors and shoes with one-inch - heels. ( Quest Table altop of page 5 To adapt calorie allowances for individuals whose weight and height are different from those of the reference man and a woman, the following formulae have been utilized 1, Calorie allowance for men - - - 815 + 36.6 W* Calorie allowance for women - - 580 + 31.1 W* * W = desirable body weight in kilograms By such adaptation the allowances for 25 year old men weighing 50, 60 and 80 kilograms would be 2500, 2850, and 3550 calories respectively. Women of the same age weighing 40, 50, 60 and 70 kilograms would receive 1750, 2050, 2350, and 2600 calories respectively. Adjustment by weight in pounds to other body sizes may be facilitated by reference to Table II . (Insert Table II) Adjustment of Calories for Climate - Standard conditions for estimating calorie allowances include mean environmental C temperature of 20° centigrade rather than 10° centigrade as Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227 - 7 - established by the FAO committee which was utilized in the 1953 revision of Recommended Dietary Allowances. It seems probable that most persons in the United States live in an environment with a mean temperature of approximately 20° centigrade. Most are protected against the effects of cold by warm clothes, central heating and heated means of transportation. Many also live and work in ir-conditioned atmospheres so that the effects of high temperatures are partially but not so completely ameliorated. If the external temperature varies widely from the standard, 2 corrections in calorie allowances may be made. For lower tempera- tures there is need for an increase in allowance. To accomplish increased this the allowance should be /reduced/by 5% for the first ten C degree centigrade decrease from the standard of 20° centigrade and by 3% for each additional ten degree decrease. Similarly, allowances should be reduced for high environmental temperatures and the reduction should be 5% for each increase of ten degrees Source: https://wwww.industrydocuments.ucsf.edu/docs/mgxh0227 - 8 - centigrade above the standard temperature, (20%). These adjustments are devised specifically for application to differences in mean annual temperature, but they may well serve for adjustment to seasonal differences as well. In various parts of the United States the difference in mean winter and summer temperatures may range from 10 degrees C to centegrade 30 degrees C. This would indicate corrections of from 5 to 15 per cent in the calorie allowances according to conditions. It should be observed that all adjustments for climate pre- suppose an ordinary amount of actual exposure to the climate. For persons spending most of their time out of doors, these adjustments may be insufficient, particularly during winter in the Northern and Central States. It is obvious that people who spend almost all their time in well heated buildings during the winter will not need the extra food calories required by individuals less effectively sheltered. When applying these adjustments of allowances for individuals or groups, duration Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 9 - of exposure to outside weather should be ascertained and taken into account. Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227

What is the table number?

zznc0227

zznc0227_p0, zznc0227_p1, zznc0227_p2, zznc0227_p3, zznc0227_p4, zznc0227_p5, zznc0227_p6, zznc0227_p7, zznc0227_p8, zznc0227_p9, zznc0227_p10, zznc0227_p11, zznc0227_p12, zznc0227_p13, zznc0227_p14, zznc0227_p15, zznc0227_p16, zznc0227_p17, zznc0227_p18, zznc0227_p19, zznc0227_p20, zznc0227_p21, zznc0227_p22, zznc0227_p23, zznc0227_p24, zznc0227_p25, zznc0227_p26, zznc0227_p27, zznc0227_p28, zznc0227_p29, zznc0227_p30, zznc0227_p31, zznc0227_p32, zznc0227_p33, zznc0227_p34, zznc0227_p35

4, Table 4

Alaska An Appraisal of the Health and Nutritional Status of the Eskimo A REPORT BY THE INTERDEPARTMENTAL COMMITTEE ON NUTRITION FOR NATIONAL DEFENSE AUGUST 1959 OF ASSISTANT SECRETARY OF DEFENSE WASHINGTON 25, D.C. HEALTH AND MEDICAL, August 31, 1959 On behalf of the Interdepartmental Committee on Nutrition for National Defense (ICNND), it is my pleasure to transmit this report, An Appraisal of the Health and Nutritional Status of the Eskimo in Alaska. The clinical and biochemical phases of the survey, conducted in March-April 1958, included the Eskimo National Guardsmen and a random sampling of eight Eskimo and two Indian villages. This was a cooperative undertaking of the ICNND with the Arctic Health Research Center, the Division of Indian Health of the U. S. Department of Health, Education, and Welfare, the Alaska Command of the U. S. Armed Forces, and the Alaska National Guard. A detailed report of the dietary studies conducted in the ten Alaskan villages will be published at a future date by the Arctic Health Research Center. Dr. Christine Heller of the Arctic Health Research Center is continuing these investigations. The evaluation of the dietary intake, customs, and habits of these few remaining native villages will enable a much more meaningful evaluation of the clinical data. The Alaskan aboriginal people have and will continue to have a remarkably successful adaptation to their environ- ment and unique food supply. The purpose of this study was to establish a baseline of nutritional appraisal in order to evaluate in future years the effects of cultural transition in relation to health. Continued assistance to provide medical and dental care, housing, and economic development is most essential. I wish to call your attention to the general conclusions of this report on page 118. Frankisterry Frank B. Berry, M. D. Source: https://www.industrydocuments.ucst.edu/docsizznc022 V INTERDEPARTMENTAL COMMITTEE ON NUTRITION FOR NATIONAL DEFENSE Department of Defense: Dr. Frank B. Berry, Assistant Secretary of Defense (Health and Medical), Chairman Dr. E. H. Cushing, Deputy Assistant Secretary of Defense (Health and Medical) Brig. Gen. Sheldon S. Brownton, USAF (MC) Army: Dr. John B. Youmans Lt. Col. William J. Wilson, MC Navy: Dr. Howard T. Karsner Rear Admiral Calvin B. Galloway, MC Air Force: Major George W. Powell, MC Department of State: Mr. Walter M. Rudolph Department of Agriculture: Mr. Clarence M. Purves Dr. Hazel K. Stiebeling Department of Health, Education, and Welfare: Dr. Floyd S. Daft Dr. H. van Zile Hyde International Cooperation Administration: Dr. Eugene P. Campbell Dr. Katharine Holtzclaw Atomic Energy Commission: Dr. James L. Liverman Secretariat Dr. Arnold E. Schaefer, Executive Director Dr. Ernest M. Parrott, Deputy Executive Director Dr. Arthur G. Peterson, Agricultural Economist Consultants Dr. William F. Ashe Dr. William J. Darby Dr. William McGanity Dr. S. Bayne-Jones Dr. Cyrus E. French Dr. William N. Pearson Dr. M. K. Bennett Dr. Wendell H. Griffith Dr. Herbert Pollack Dr. George H. Berryman Dr. David B. Hand Dr. W. H. Sebrell, Jr. Mr. Edwin B. Bridgforth Dr. D. Mark Hegsted Dr. Fredrick J. Stare Dr. Joseph S. Butts Dr. Norman Jolliffe Dr. Philip L. White Dr. Gerald F. Combs Dr. z. I. Kertesz Dr. Robert R. Williams Dr. L. A. Maynard Source: https:llwww.industrydocuments.ucsi.edu/docsizznc022 VII VI LIST OF FIGURES TABLE OF CONTENTS Page Page Title Number Part I Preface XI Frontispiece Guzema Wassilie, Medicine Man at Napaskiak 1. Administrative History XI 2. Acknowledgments XI Figure I Northern Cultural Areas and Tundra Region Facing 1 3. Objectives XIII 4. Explanatory Addendum XIII Figure II Tuberculosis Mortality for Alaska by Race, 11 1952-1957 Part II Introduction 1 1. The Cultural Background 1 Figure III Principal Ethnographic Divisions of Alaska, 14 2. Demographic Factors 4 and the Villages Studied 3. Health Facilities 7 4. General Plan of Study 13 Figure IV Plan of the Study with Numbers Examined 16 5. Clinical Calibration Studies 15 Figure V Enlargement of the Submaxillary Glands 30 Part III Native Men in the National Guard 20 1. The Population Studied 20 Figure VI Pigmentary Changes in a Young Eskimo Man 31 2. Clinical Findings 21 3. The Dental Study 34 Figure VII Dental Attrition in a 32-Year-Old Eskimo 46 Woman Part IV The Village Studies 42 1. Bethel Area - The Situation in Akiak, Kasigluk, Figure VIII Height by Age and Sex, Eskimo Villages, 1958, 42 Compared to Canadian Population 61 Napaskiak, Newktok and Hooper Bay 2. Kotzebue Area - The Situation in Noatak, Point Hope, Shishmaref, Allakaket and Hislia 49 Figure IX Weight by Age and Sex, Eskimo Villages, 1958, 62 3. Clinical Findings in the Villages 52 Compared to Canadian Population 4. Discussion of Clinical Findings 67 Eskimo and Indian Villages in Alaska, 1958, Figure X Part V Dietary Measurements 72 Blood Pressures and Pulse Rates, by Age 65 1. National Guardsmen - Camp Denali (Ft. Richardson) 72 2. Villages (Preliminary) 74 Figure XI Eskimo and Indian Villages in Alaska, 1958, 3. Discussion 91 Arm and Scapula Skinfold Thickness, by 70 Age and Sex Part VI Biochemical Findings 99 1. Methods 100 2. Results 100 3. Discussion 111 4. Summary 118 Part VII General Conclusions 120 Part VIII Specific Recommendations 121 Part IX Appendices 122 A - Criteria for Oral Examinations 122 B - Food Consumption, Males - Alaska, 1956-1958 124 C - Food Patterns by Village 134 D - National Research Council, Recommended Dietary Allowances 160 Bibliography 161 Source: ttps://www.industrydocuments.ucst.edu/docs zznc022 VIII IX LIST OF TABLES LIST OF TABLES (continued) Table Title Page Table Title Page Introduction Table 1 The Village Studies Eskimos, Indians and Aleuts in Alaska in 1950 1 Table 17 Eskimo and Indian Villages in Alaska, 1958; Percent 2 Alaska: Characterization of the Villages in the Study, Prevalence of Clinical Findings 54-55 and the Size of the Samples Examined, 1958 6 18 Eskimo and Indian Villages in Alaska, 1958; Percent 3 Eskimo Men, Alaska National Guard, 1958; Clinical Prevalence, Selected Clinical Findings by Age Calibration Studies 17 and Sex 57 4 Eskimo Men, Alaska National Guard, 1958; Summary of 19a Eskimos and Athabascan Indians in Alaska, 1958; Calibration Studies for the Clinical Examinations 19 Percentage of "Standard Weight" by Age and Sex 58 19b Eskimos and Athabascan Indians in Alaska, 1958; Native Men in the National Guard Table 5 "Obesity" in Adults by Age and Sex 59 Eskimo Men, Alaska National Guard, 1958, by Battalion; 20 Average Height and Weight of Eskimos and Athabascan Origin, Age, Height, Weight, Weight Status, Skinfolds, Indians in Alaska, 1958, Compared to Canadian Blood Pressure and Pulse 22 1953 Survey 60 6 Eskimo Men, Alaska National Guard, 1958, by Battalion 21 Eskimo and Indian Villages in Alaska, 1958; Pulse and Age; Height, Weight, Weight Status, Skinfolds, (Mean + S.E.) by Age, for Villages by Ethnographic Blood Pressure and Pulse 23 Groups 64 7 Eskimo Men, Alaska National Guard, 1958, by Battalion, 22 Eskimo Men, Alaska National Guard, 1958, by Battalion; Blood Pressure (Mean + Standard Error) by Height 23 Blood Pressure and Pulse Measurements, by Examiner 66 8 Eskimo Men, Alaska National Guard, 1958, by Battalion; 23 Eskimo and Indian Villages in Alaska, 1958; Blood Percent Prevalence of Clinical Findings, by Examiner 26-27 9 Pressure (Mean + S.E.) by Age, for Villages by Eskimo Men, Alaska National Guard, 1958, by Battalion Ethnographic Groups 68 and Age; Percent Prevalence of Selected Clinical 24 Eskimo and Indian Villages in Alaska, 1958; Arm and Findings 28 10 Scapula Skinfold Thickness by Age and Sex, for Eskimo Men, Alaska National Guard, 1958, by Region of Villages by Ethnographic Groups 69 Origin; Age, Height, Weight, Weight Status, Blood Pressure and Selected Clinical Findings 29 11 Dietary Measurements Relation of Clinical Signs and Biochemical Findings, Table 25 Eskimo Men, Alaska National Guard, Ft. Richardson, 1958; Serum Vitamin A, Alaska, 1958 33 12 Food Consumption from the Mess Hall Alone, Average Relation of Clinical Signs and Biochemical Findings, Per Man Per Day 72 Serum Vitamin C, Alaska, 1958 34 26 13 Eskimo Men, Alaska National Guard, Ft. Richardson, 1958; Eskimo Men, Alaska National Guard, 1958; Comparison of Plate Waste, Average Per Man Per Day 73 Dental Caries and Periodontal Status of 713 Eskimo 27 Eskimo Men, Alaska National Guard, Ft Richardson, 1958; Guardsmen with 1,400 White Male Residents of Birmingham Food Consumption from all Sources, Average Per Man and Baltimore 35 14 Per Day 73 Eskimo Men, Alaska National Guard, 1958; Mean Numbers of 28 Nutrient Composition of Recipes for Eskimo Dishes, as Decayed, Missing, or Filled Permanent Teeth in Four Calculated 75-81 Groups from the First and Second Battalions 36 15 29 Chemical Composition of Alaskan Foods, 1958 83-87 Eskimo Men, Alaska National Guard, 1958; Oral Status of 30 Food Consumption of Men in Villages, Alaska, 1956-1958 89 Members of First and Second Battalions 37-39 16 31 Food Consumption of Alaskan and Indian Men by Villages, Eskimo Men, Alaska National Guard, 1958; Gingival 1956-1958 90 Recession Scores, Men 35 Years of Age or Older, First 32 and Second Battalions Fat Content of Commonly Eaten Meats 93 41 33 Guide to Interpretation of Nutrient Intake Data 94 Source: https://www.industrydocuments.ucst.edu/docsizznc0227 X XI LIST OF TABLES (continued) I PREFACE Table Title Page 1. Administrative History Biochemical Findings A program of research on the nutritional status of Alaskan natives Table 34a Alaska, Nutrition Survey, March 1958; Biochemical has been under way in the Arctic Health Research Center, Anchorage, Findings, for National Guard and Villages, by Alaska, for several years. The present study arose from the interests Sex and Age Groups; Total Serum Protein and of the Department of Defense. Hematology 101 34b Alaska, Nutrition Survey, March 1958; Biochemical At a meeting of the Interdepartmental Committee on Nutrition for Findings, for National Guard and Villages, by National Defense (ICNND) 28 May 1956, Dr. Frank B. Berry reported that Sex and Age Groups; Serum Vitamin c, A and Carotene 102 the Secretary of Defense had inquired if the ICNND would be interested 34c Alaska, Nutrition Survey, March 1958; Biochemical in conducting a nutrition survey of the Alaskan natives. This proposal Findings, for National Guard and Villages, by was considered favorably by the Committee, and the Secretariat was Sex and Age Groups; Total Fatty Acids, Phospholipids authorized to explore the possibilities further. Discussions were held and Cholesterol 103 with Dr. Jack Haldeman, Chief, General Health Service, Public Health 34d Alaska, Nutrition Survey, March 1958; Biochemical Service, Department of Health, Education, and Welfare (HEW) and Dr. Findings, for National Guard and Villages, by John C. Cutler, Program Officer, Bureau of State Services, HEW. Toward Sex and Age Groups; Urinary Excretions 104 the end of 1956, the Committee received a formal request from the 35 Alaska, Nutrition Survey, March 1958; Comparison of Arctic Health Research Center for assistance in financing and con- Methods for Determination of N'Methylnicotinamide 106 ducting a nutrition survey of the Alaska National Guardsmen while they 36a Alaska, Nutrition Survey, March 1958; Total Serum were in their annual encampment in Anchorage and also in completing a Protein and Hematology by Village, for Men, Women survey of the inhabitants of ten native villages. The Commi ttee and Children 107 appointed an ad hoc group, with representatives from the General Health 36b Alaska, Nutrition Survey, March 1958; Serum Vitamin c, Service, Bureau of State Services and the Division of Indian Health of A and Carotene, by Village 108 the Public Health Service; and including Dr. E. M. Scott of the Arctic 36c Alaska, Nutrition Survey, March 1958; Mean Blood Fat Health Research Center, Anchorage, and Dr. John B. Youmans, Consultant Levels, by Village and Age 109 to the ICNND, to meet in April 1957 to draft a proposal for Committee 36d Alaska, Nutrition Survey, March 1958; Urinary Excretions action. by Villages, for Men, Women and Children 110 37 Alaska, Nutrition Survey, March 1958; Mean Blood Fat At a meeting in May 1957 the Committee agreed to serve as a co- Levels, by Survey Area and by Age 114 ordinating and sponsoring agency for a nutrition survey of the two 38 Alaska, Nutrition Survey, March 1958; Urinary Excretions National Guard Battalions during their 1958 encampment and a clinical of B-Vitamins, Village Areas, by Age and Sex 116 and biochemical survey of the inhabitants of the ten native villages 39 Alaska, Nutrition Survey, March 1958; Biochemical in which the Arctic Health Research Center, with the aid of the Findings, by Reproductive Status, Eskimo Villagers Division of Indian Health, had been conducting a survey of food intake in the Bethel Area 117 and dietary habits. 40 Suggested Guide to Interpretation of Biochemical Data 119 2. Acknowledgments Many people have contributed to the work of this study. The names are arranged here according to their respective organizations. Arctic Health Research Center, Anchorage, Alaska Dr. A. B. Colyar - Director, Arctic Health Research Center Alaska National Guard Brig. General Thomas P. Carroll, Adjutant General, Alaska National Guard Major William H. Crawford, Commander, First Scout Battalion Major Harry E. Voelker, Commander, Second Scout Battalion Source: ittps://www.industrydocuments.ucst.edu/docsizznc022 XII XIII Alaska Native Health Service Team Members (continued) Dr. Joseph A. Gallagher - Area Officer in Charge, Anchorage Mrs. Isabelle V. Griffith - Chemist, Arctic Health Research Center Dr. Robert I. Frazier - Medical Officer, Kotzebue Miss Anna J. Pitney - Chemist, Arctic Health Research Center Dr. Elmer E. Gaede - Medical Officer, Tanana Mr. Lyndon Sikes - Chemist, Arctic Health Research Center Dr. William A. Brownlee - Medical Officer, Bethel Dr. Milton Silverman - Biochemist, n/ National Institutes of Health Dr. Albert L. Russell - Dentist, National Institutes of Health Village Teachers Mr. Carl L. White - Statistician, National Institute of Health M/Sgt. Dale o. Starr - NCO in Charge, Dispensary, Fort Richardson Mr. and Mrs. Roman W. Kinney, Akiak M/Sgt. Harold G. Coffman - X-ray Technician, Dispensary, Fort Richardson Mr. and Mrs. Emil Kowalczyk, Kasigluk SP-5 Ronald J. Murphy - Technician, Dispensary, Fort Richardson Mrs. Mary McDougall, Napaskiak Mr. and Mrs. John F. Gordon, Hooper Bay 3. Objectives Mrs. Ida A. Hunter, Newktok Mr. and Mrs. Fred G. Fisher, Point Hope The extent of success of the adaptation of the Eskimo to a uniquely Mr. and Mrs. Russell McLaughlin, Shishmaref limited and precarious food supply in a harsh environment has been a Mr. and Mrs. Walter A. Ortman, Allakaket challenging question to physiologists for over a century. Arctic ex- Mr. and Mrs. Ley M. Kahl, Huslia plorers have often discussed this problem and some have taken highly Mr. and Mrs. S. William Benton, Noatak controversial positions based on their estimates either of the merits of the Eskimo dietary regimen or the status of the natives' health. U.S. Military Organizations - Alaskan Command The present study was undertaken to investigate this question in co- operation with the Arctic Health Research Center (AHRC) of the Lt. General Frank A. Armstrong, USAF - Commander in Chief, Alaskan Command Department of Health, Education, and Welfare, the Alaska Command of Maj. General G. C. Mudgett - Commander, U.S. Army, Alaska the U.S. Armed Forces, and the Alaska National Guard. Brig. General John R. Copenhaver - USAF Surgeon, Alaskan Command Colonel Sterrett E. Dietrich - U.S. Army, Surgeon Members of the AHRC with the support of the Indian Health Service Lt. Colonel Wade F. Heritage - U.S. Army, Deputy Surgeon have been conducting systematic studies of the dietary habits of the Lt. Colonel George D. Pleasants - Post Surgeon, Ft. Richardson Eskimo and, in particular, their hematological disorders. The present work was intended to complement those studies. The work described here Finally, the subjects themselves should be complimented for their was designed to evaluate the nutritional status of the Eskimo of all pleasant welcomes, patient forbearance and altogether cheerful and ages and both sexes by carrying out physical appraisals and biochemical intelligent willingness to help with the tasks at hand. measurements of specific nutrients in blood and urine. These data were then to be evaluated along with the dietary evaluations and food Team Members analyses made available by continuing studies of the Arctic Health Research Center. Additional measurements of consumption of food in Dr. John B. Youmans - Field Director, Army Medical Research and Develop- the mess halls were made among the native members of the Armed Forces ment Command Lt. Colonel Laurence M. Hursh - Director, 1 Army Medical Research and 4. Explanatory Addendum Nutrition Laboratory Dr. Edward M. Scott - Deputy Director, Arctic Health Research Center Since the present study was done and much of the report was written Dr. George V. Mann - Clinician, National Institutes of Health before or during the emergence of Alaska as the 49th state, there may Mr. C. Frank Consolazio - Biochemist, Army Medical Research and be descriptions herein or references to agencies or procedures which Nutritio; Laboratory have been superseded by new organizational arrangements. SP-3 Edward J. Sheehan - Technician, Army Medical Research and Nutrition Laboratory Pfc. Jay M. Jamison - Technician, 1 Army Medical Research and Nutrition Laboratory Dr. Donald B. Kettlecamp - Clinician, Alaska Native Health Service Dr. Ruth Coffin - Clinician, 2 Alaska Native Health Service 2 Field Team Member, Bethel party. Dr. Christine A. Heller - Nutritionist, 1 Arctic Health Research Center 1/ Field Team Member, Kotzebue party. Field Team Member, Bethel party. Source: htps.//www.industrydocuments.ucsi.edu/docsizznc022 1 30 60 40 50 50 of II - INTRODUCTION in 50 Alex 1. The Cultural Background The Eskimos, Indians and Aleuts of Alaska vary widely in their U 2 cultural traditions and present day mode of living. At the time or or the white man's arrival, the Eskimos occupied all the northern and western coasts of Alaska, and lived on the southern coast as far east a as Prince William Sound and on Kodiak Island. The Eskimos were divided culturally into a Northern group, the Thule culture, and a Southern group, the Old Bering culture, with the dividing line situated on 8 80 Norton Sound in the vicinity of Unalakleet. Northern Eskimos still a speak the same language as the Siberian, Canadian and Greenland Eskimos, E while the Southern Eskimo language is quite different. The Aleuts originally occupied the western half of the Alaska Peninsula and the Aleutian Islands. Thlingit Indians lived in southeast Alaska, while AND 06 Athabascan Indians occupied the interior regions of the territory. The map in Figure I shows these regions while Table 1 gives the population of these cultural groups in 1950. I 000 TABLE 1 ESKIMOS, INDIANS AND ALEUTS IN ALASKA IN 1950 Population Median Age 10 Eskimos 15,882 17.7 Athabascan Indians 6,783 -- Aleuts 3,892 17.9 20 Source: U.S. Census of Population, 1950, Vol. II, Parts 51- COAST 53. (1) The Eskimo culture in North America has been traced back through the Christian era. The "Thule" culture based on whaling seems to have of spread eastward from Alaska to Greenland during the period 500 to 1000 .D. In the saga of Eric the Red, reference is made to "skraelings" NEWARK (Eskimos) in Labrador in 1003. Possibly because of the disappearance 3MR of whales from the Central Arctic, a deviant culture based on fishing AIO and sealing spread back to Alaska. These migrations appear to account a for the presence of a single, primitive, Stone Age people with a com- : mon language and tools who occupied the 6,000 miles from Alaska to Greenland when Rink explored the latter area in about 1850. The oldest Eskimo culture is the "old Bering" culture which flourished on both 50 sides of the Bering Strait. This culture was based on the hunting of 60 21 0 00 00 00 fish and sea mammals. In Eurasia the Arctic culture was based on reindeer breeding, as in Lapland, except for a limited area of Eskimo culture on the Chukchi peninsula (2), The Eskimos, like the American Indians, are of Mongoloid ethnic origin. Eskimo skulls are narrow and oblong with a definite sagittal ridge. The lower jaws and maxillary bones are highly developed and Source: https://www.industrydocuments.ucsf.edu/docsizznc0227 2 3 prominent. The skin, hair, epicanthal folds and lumbar pigment testify to their Mongoloid origin. In contrast to the Negro the It is important to recognize that Alaskan Eskimos are not nomadic Eskimos have narrow noses. As in the American Indian, blood group people: They live in one or a few permanent homesites or campsites type o predominates among the Eskimos. Most of the sod houses have now been replaced by small frame or log structures. In one village in 1953 there were 36 houses with 47 rooms. The present study was concerned primarily with the two groups The floor space per fami ly was 227 square feet or an average of 51 square feet per person (3) Often these frame houses are poorly insu- of Eskimos, defined by geographic areas, and to a lesser extent with Athabascan Indians and Aleuts. In order to understand the situation lated and are therefore more difficult to heat adequately in winter of these people today it is important to review the primitive con- than were the primitive sod houses. ditions under which they once lived, since all of them are now in transition between the primitive and a modern way of life. This Each village had its own seasonal schedule for hunting and fishing, transition began in the 18th century for the Aleuts with their intro- but as in all hunting-fishing economies, there was a large element of duction to the Russian explorers and traders who followed Vitus Bering chance in this activity. The welfare of the people who depended on into their territory. For the Indians and Eskimos the transition hunting and fishing for food, clothing and fuel fluctuated accordingly. began later and at different times for different groups. The coastal Through the summer most Eskimo and Indian families found it necessary Eskimos who lived on marine mammals were exposed to the whit whalers to move from place to place in search of their supply of food. This and explorers of the 18th and 19th centuries, while some of the was particularly necessary for the tundral people who often traveled inland Eskimo and Indian villages have had important contact with considerable distances from the village in order to obtain sufficient white culture only during the past 60 years. The extent of accultu- food. These campsites, usually family affairs, were visited year after ration is thus variable. year as long as they yielded food. Almost all edible foods were eaten, and since food resources varied in different regions, there were wide Eskimos have managed by a number of ingenious methods to maintain geographic differences in diets. their numbers and to carry on a marginal existence under exceptionally adverse conditions. In order to survive in the Arctic, they have had There were three general types of Eskimo diets under the conditions to utilize every available resource. The primary consideration for of the primitive culture (2). On the northern and northwestern coasts the location of an Eskimo or Indian village in Alaska was the available of Alaska, Eskimos were primarily dependent on sea mammals -- seal, food, fuel and water supply. The population balance in such an walrus and whale -- for food. Farther south, chief dependence was on economy was important since overpopulation meant hunger and sometimes fish, while smaller numbers of interior Eskimos lived on land mammals, starvation. When the population became too large for the available primarily on caribou. In none of these areas was there total depen- food supply or if the food supply became scarce because of persistently dence on any one type of food. Use of fish was universal, while unfavorable weather conditions or some other accident of nature, shellfish, birds, birds' eggs, small mammals (including hares, porcupine, family groups would break away and try to find a more favorable place rabbits, muskrats, mink and beaver), berries, roots and green plants to establish themselves. were eaten when available. In retrospect these diets would seem to have had certain things in common. All of them were probably very high Winter homes were half buried in the ground and made of logs or in protein, moderate to high in fat content, and they contained very whale ribs covered with sod. The walls and ceiling of the main living little carbohydrate. They were beasonally low in ascorbic acid, and room were often lined with split driftwood, vegetable matting or skins. must have been on occasion deficient in calories. Such diets, however, Existing examples of these homes, when well constructed, are surpris- had no known nutritional disadvantages and no known advantages except ingly comfortable and can be heated with a minimum of fuel. They are, that they are generally believed responsible for the fact that Eskimo however, dark and small. Such houses were usually buili at permanent teeth were very nearly free of caries. The Eskimo did not usually have living sites and were then occupied only in the winter when they could a choice of foods from which to make a selection. Instead, his problem be kept reasonably free from condensation and seepage. In the spring, was the fundamental one of assuring a continuity of food and to this with the coming of the thaw, many of them became untenable. Because problem he devoted his energy, intelligence and ingenuity. of dampness of the house and because of the necessity to search for food, the people moved out of the sod huts into tents at camp sites, often at considerable distances from the village. In the early days, 1 tents were made of animal skins secured tightly over a willow frame. The tundra is the vast, treeless area of western and northern Alaska. For many years now the great majority of Eskimos have used canvas It is generally flat, dotted with ponds and sloughs and underlaid tents. Even today, though a family may not wish to move away from wi th permafrost. The vegetation in the summer consists of low shrubs the village for sealing or other activities, they will often move out and grasses and in the winter the surface may be buried to a depth of their winter residence into a tent pitched nearby. of several feet with snow. The winds pack and drift this snow almost continually. An approximate outline of the tundra is shown in Figure I. Source: tps:/lwww.industrydocuments.ucsi.edu/docs zznc0227 4 5 2. Demographic Factors creation of schools, stores, churches and postoffices in some villages Eskimos today live on a combination of foods obtained from the has tended to attract native families and to enlarge the villages, traditional sources and foods bought from stores. The latter are for whereas many small villages listed in 1950 are no longer in existence. the most part cereals and sugars. Some of the factors which presently affect the food habits of Eskimos are as follows: Eskimos seemed to accept Christianity readily and today every village has at least one church which is an important part of the social Eskimos now live at a low economic level. In a study made in life. Denomination of the churches is shown in Table 2 for the villages 1955(4), the estimated annual per capita cash income in 23 Eskimo vil- included in the present study. lages ranged from $69 to $475. Unless the Eskimo lives in one of the larger towns and has some education, he has little or no opportunit ty Schools have been in existence in Alaska for many years, but there for a job with a steady income. The income for a village comes from was never enough money to provide one for each of the smaller villages, a variety of sources. Fishing for profit provides income for many and until the past ten years there was little opportunity for a high families in the Bristol Bay area and at the mouth of the Yukon. While school education except in towns with a permanent white population. such fishing may require considerable capital for a boat, the profits Village schools (formerly called "Territorial Schools") are operated are large if the fishing is good. However, the trend in recent years by the State or by the Bureau of Indian Affairs (BIA). In recent years has been toward smaller catches of salmon. Some men from villages in the latter agency has started a special type of school -- The Instruc- the Kuskokwim area obtain employment in the canneries on Bristol Bay. tional Aid School in certain villages. In these schools the village The pay is high, averaging $600 for the month or six weeks when the furnishes the building, and a teacher is provided by the Bureau of cannery operates. Trapping provides part of the income of most vil- Indian Affairs. Such teachers are often not fully qualified. lages. Fur prices are now low, however, and only mink, muskrat and beaver are profitable enough to encourage the effort involved in Stores or trading posts were established in Alaska by the Russians, trapping. Twenty mink, 700 muskrat, or 20 beaver would represent a and traders have since been an important part of village life. Starting good year's trapping for one man in some areas. Generally, however, in the late 1930's, the Bureau of Indian Affairs helped to establish fewer than this are obtained. During the 1957-58 season, average cooperative stores in many of the large villages. There are several market prices for mink were $30, muskrat $0.25 and beaver $25. communities, however, which still have no store, and people must go varying distances for supplies. The typical village store has a very Service in the National Guard produces an appreciable proportion limited stock of supplies and limited storage facilities. In the of the total income in the villages. In addition, a few Eskimos work usual case, there is no place for storage where freezing can be on river barges in the summer or as storekeepers or janitors. Crafts, avoided in the winter or where food can be kept frozen in the summer. such as ivory carving, basket weaving and making of souvenirs, provide some income for Eskimos. A major source of income in all villages is The water supply of the Eskimo and Indian is traditionally the welfare. A large number of Eskimos are eligible for various forms of nearest river, lake, or pond. A hole is cut in the ice in winter to public assistance including Old Age Assistance and Aid-to-Dependent- dip water, or cakes of ice are cut, hauled on sleds to the home and Children. Welfare payments amount to between one fifth and one third then melted for use. Melting of ice is difficult in most areas because of the cash income in most communities. In four of the villages of the fuel shortage. The usual method of obtaining water in the included in the present survey, mean per capita income in 1955 (4) was winter is with a tank or barrel of ice in a corner of the house near estimated as follows: the stove. The room temperature slowly melts this ice and the water is drawn off from the bottom. The difficulty of obtaining uncontami- Village Mean Income Percent of Income nated ice plus this melting process may contribute to the prevalence per Capita from Welfare of enteric diseases. The true prevalence of these diseases has been difficult to measure since they occur sporadically and require long- Napaskiak $173 28 term surveillance for measurement. In Napaskiak, one of the villages in the present study, an investigation was made which indicated a Akiak 475 32 Kasigluk 138 35 seasonal variation in the prevalence of diarrhea(5). The high level Hooper Bay 137 30 occurred in the summer and affected especially the children under 10 years of age (6). The infection rates for Endamoeba histolytica The population in Alaska is sparse and the communities are small. and Diphylobothrium sp. were found to be 8.6 and 34.5 percent, respectively. In 1950 about 80 percent of the 287 places named in the census had fewer than 199 persons (1). This smallness was probably originally related to the availability of food in the surrounding area. The Most of the coastal people have to depend on driftwood for their fuel. Some portions of the coast have a good supply but in others this wood is almost nonexistent In some villages, where seal are Source: https://www.industrydocuments.ucsi.edu/docsizznc022 TABLE 2 ALASKA: CHARACTERIZATION OF THE VILLAGES IN THE STUDY, AND THE SIZE OF THE SAMPLES EXAMINED, 1958 Name Type Popu- No. of Persons Churches School Store or Distance Distance lation Examined to Nearest Store to Hospital Allakaket Indian 120 75 Episcopalian State Co-op. 150 miles Akiak Southern 187 76 Moravian Bureau of 1 Trader + 20 miles Eskimo Indian Affairs Co-op. Hooper Bay Southern 435 96 Roman Catholic Bureau of 2 Traders + 155 miles Eskimo Swedish Covenant Indian Affairs Co-op. Huslia Indian 145 90 Episcopalian State Trader 135 miles Kasigluk Southern 180 94 Russian Orthodox Bureau of (None) 35 miles Eskimo Moravian Indian Affairs (4 miles) Napaskiak Southern 137 81 Russian Orthodox Bureau of (None) 6 miles 6 Eskimo Indian Affairs (1 mile) Newktok Southern 118 59 Roman Catholic Bureau of 3 Traders 115 miles Eskimo Indian Affairs Instructional Aid Noatak Northern 400 69 Friends Bureau of Co-op. 50 miles Eskimo Indian Affairs Point Hope Northern 315 88 Episcopalian Bureau of Co-op. 150 mi les Eskimo Indian Affairs Shi shmaref Northern 200 77 Lutheran Bureau of Co-op. 110 mi les Eskimo Indian Affairs Totals 2,237 805 8 9 Village Complaint included experts in anthropology, nursing care, medical social services, tuberculosis control, hospital and medical care, sanitation, laboratory Hooper Bay 1. A woman, eight months pregnant, with pain, services and mental health. fever and dysuria suggesting pyelitis. Members of the party traveled through the major areas of Alaska. 2. A young man rith fever and malaise con- The observations were generally more concerned with the health organiza- sidered to be "flu. " tions and demographic and environmental conditions than with clinical problems. The study was done at a critical time, because in July 1955 3. A young boy with penile swelling and the responsibility for the health problems of the natives of Alaska was urinary obstruction, considered to be transferred by Public Law 568 from the Bureau of Indian Affairs of the balanitis. Department of the Interior to the Department of .Health, Education, and Welfare. The Pittsburgh report thus reflects the conditions of an older 4. A woman with pleurisy. system. Tanunak 1. An 18 month old child with a swollen and When Secretary Seward purchased Alaska in 1867, the contract wit] inflamed throat. the Czar stipulated, "The uncivilized tribes will be subject to such laws and regulations as the United States may from time to time adopt Pilot Station 1. A man with obstipation. in regard to aboriginal tribes of that country." Health services and regulations were almost nonexistent until 1914 when a medical program 2. A child with extensive eczema. was established in the Bureau of Education which was then the only governmental agency directly concerned with the natives. In 1916 this o 3. A fever of 105` F. in a 4 month old baby - Bureau established a migratory medical boat on the Yukon, but during no localizing signs of infection. the first summer the physician, Dr. J. W. Houston, fell overboard and was drowned. Small health surveys indicated that tuberculosis, syphilis Goodnews Bay 1. A woman with "flu." and "trachoma" were common. There is now reason to doubt that trachoma did, in fact, exist. 2. The supply of drugs very low. The first hospital for natives was built in Juneau in 1916. In Kipnuk 1. Query from the doctor concerning the con- 1931 when the Office of Indian Affairs assumed responsibility there dition of a patient with tuberculosis were five Alaska Native Health Service (ANHS) hospitals for the Alaskan recently returned to the village on Indians and Eskimos with six doctors and 15 nurses for the entire isoniazid therapy. population. There are now five general hospitals under the U.S. Public Health Service and these are located at Point Barrow, Bethel, 2. Query about the three villagers who were Kanakanak, Kotzebue and Tanana. There are, in addition, two medical sent to Bethel last month for medical care. centers, one at Anchorage and another at Mt. Edgecumbe in southeastern What are their conditions? Alaska near Sitka. Some specialized care, as for tuberculosis and mental disease, is obtained by contract in hospitals both in and outside Mountain Village 1. Query for news about a man recently sent Alaska. The 1958 budget of the Division of Indian Health, Public Health to the Anchorage Hospital. Service, for Alaska was: Scammon Bay 1. A 14 year old girl with pain in the right Activity lower abdomen, vomiting and with fever. Hospital Operations $ 8,702,000 A general description of the ecological and social factors which Contract Patient Care 694,000 bear upon the health problems in western Alaska has been outlined in the Field Health 784,000 report of a survey carried out in 1953-54 by the Graduate School of Management Services 122,000 Public Health of the University of Pittsburgh (7). The Department of the Interior, which was then responsible for the health problems and pro- Total $10,302,000 grams in the nátive population of Alaska, invited the faculty of the School of Public Health of the University of Pittsburgh to survey the situation and make suggestions for improvement. In the summers of 1953 and 1954 such a survey was carried out by medical specialists. These Source: https://www.industrydocuments.ucst.edu/docsizznc022 FIGURE II TUBERCULOSIS MORTALITY FOR ALASKA BY RACE 1952-- 1957 I50 140 130 WHITE 120 ESKIMO 110 INDIAN ALEUT 100 90 80 70 60 50 40 30 20 10 O NITION NITTION Sis 000000 or 13 The birth rates of racial groups in Alaska in 1956 are shown here (9) : Whites 32 per 1,000 population Eskimos, Indians, Aleuts 52 per 1,000 population The burden of disease in Alaska in 1950 and today bears a remark- able resemblance to that recorded for the United States in 1900. The opportunity for the application of modern medical skills and knowledge is obvious. "Native Alaska" could and should be made an almost ideal laboratory workshop for teaching, research and service. 4. General Plan of Study A large proportion of the able-bodied Eskimo men are members of two battalions of a National Guard Reserve Unit which is brought to Camp Denali (at Fort Richardson near Anchorage) each year for a two-week training period. In good weather when the widely scattered villages are accessible the men are often away on sealing expedition or tending traplines, so the period of National Guard duty offered a unique op- portunity to study these Eskimo men. This was also an economical way of assembling data on people from many widely separated villages. It was fortuitous that the Guard training period occurred in late winter when native food supplies might be expected to be diminished and limited, thus placing the nutritional status of the people at a low ebb. The clinical and biochemical methods used were those described in the "Manual for Nutrition Surveys" of the ICNND(10) Clinical observa- tions were recorded on data cards for the "detailed clinical examination. No abbreviated clinical examinations were done. The neurological, cardiovascular and abdominal examinations and the skinfold measurements were made by two members of the Alaska Native Health Service medical staff. Battalion 2 of the Eskimo Guardsmen arrived at Anchorage on March 1 and 2, 1958. The noncommissioned officers had arrived two weeks earlier. This unit comprises men from southwestern Alaska including the Aleutian chain and the Bering Sea islands except St. Lawrence and King Islands. Bethel and the Kuskokwim valley may be considered as its center. The men come from as far south as Dillingham, from west to Unalaska and the Pribilofs, and from north to Hooper Bay and the lower Yukon. They include two distinct ethnic groups, the Eskimos -- both inland and coastal -- and the Aleuts, who are few in number (Figure III). These men were examined during three days at Camp Denali. The group of examiners was then divided into two sections. One team proceeded to Bethel on March 7. In the following ten days they studied five villages in that area. A second team went to Kotzebue on March 7 where they undertook studies in five villages of that region. Upon completion of these field studies the two parties returned to Camp Denali and on March 24-27 examined Battalion 1 of the Eskimo Guardsmen. These men were assembled from the northern villages of Alaska extending from Barter Island near the Canadian border to Nome Source: https:llwww.industrydocuments.ucsi.edu/docsizznc0227 FIGURE III PRINCIPAL ETHNOGRAPHIC DIVISIONS OF ALASKA, AND THE VILLAGES STUDIED Pt. Barrow Point Hopee 52 Woatak 3 so I. Aleuts East Cape Shishmaref Allakaket 2. Southern Eskimos 3. Northern Eskimos 3 Huslia 4. Athabascan Indians River Nome (ukon Foirbanks 5. Thlingit, Tsimshian, St Lowrence and Haida Indians 14 Island Hooper Bay Newktok Kosigluk (Anchorage Nunivak Bethel Napaskiak Island 2 Juneau e Pribilof Bristol 8 Isls. Bay Kodiak Island 5 goo chain 08.. & joint 50 150 250 I I Miles pure 15 230 16 17 FIGURE IV TABLE 3 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 PLAN OF THE STUDY WITH NUMBERS CLINICAL CALIBRATION STUDIES 1/ EXAMINED (1) (2) (3) (4) Replicates Trials Bn 2 Bn 1 Total Duplicates N 16 N 20 A N 16 N 32 N 68 Examiner No. 1 - + + - + + - + + - + + Classification No. 2 - + + - - + + - - + + - + + Attribute BATTALION 2 General appearance 21 13 3 - - 16 4 - - 26 6 - - 55 13 - - Thyroid enlarged 16 - - - 19 - 1 - 26 1 4 1 61 1 5 1 B =20 Submaxillary enlarged 16 - - - 18 1 1 - 29 - - N = 323 3 63 1 4 - Nasolabial seborrhea 16 - - - 17 - 2 1 32 - - - 65 - 2 1 BETHEL KOTZEBUE Other seborrhea 16 - - - 20 - 28 - 4 - 64 - 4 - Erythema head 14 1 - 1 13 4 3 28 2 2 55 7 - 6 AREA AREA Pigmentation - head 14 2 - - 20 - - 28 3 1 62 5 - 1 Thickened conjunctivae 15 1 - 16 4 - 21 6 1 4 52 11 1 4 AKIAK NOATAK Pingueculae - 2 4 10 - 2 18 9 4 4 15 9 8 8 43 76 69 (6) Bitot's spots 15 - 1 - 19 - 1 - 32 - - - 66 - 2 - (I) Conjunctival injection 16 - - - 19 1 - - 26 4 2 - 61 5 2 - Angular scars 14 1 1 - 17 - 3 - 32 - - - 63 1 4 - Cheilosis 16 - - 19 - 1 - 32 - - - 67 - 1 - Filiform strophy, KASIGLUK PT. HOPE slight 16 - - 16 - 4 - 30 - 2 - 62 - 6 e 94 88 Glossal furrows 16 - - 15 4 1 23 5 2 2 54 9 2 3 (2) (7) Red gums 16 - - - 11 - 7 2 30 - 1 1 57 - 8 3 Swollen gums 16 - - 13 6 1 29 - 3 - 58 - 9 1 Gum recession 6 2 1 7 3 1 12 4 19 1 8 4 28 42 1 15 Unfilled caries 7 3 6 14 2 4 12 3 6 11 33 8 6 21 Worn teeth 1 8 1 6 2 3 1 14 16 5 2 9 19 16 4 29 NAPASKIAK SHISH MAREF Follicular 8I 77 hyperkeratosis 15 1 - - - (8) 15 5 28 - 4 58 10 - (3) Xerosis 16 - - 19 1 - - 28 3 1 - 63 4 1 - Acne 15 1 - - 18 1 - 1 25 2 2 3 58 4 2 4 The 43 items recorded for the detailed examination which were used exclusively NEWKTOK ALLA KAKET in the Alaska Survey have been abridged here to include only the 23 items which (4) 59 75 showed sufficient prevalence of a sign to allow comparison of observers. (9) 2/ Positive means less than "good general appearance.' HOOPER BAY HUSLIA 96 90 (5) (10) BATTALION I C N=32 N = 390 Source: https://www.industrydocuments.ucsi.edu/docsizznc022 18 19 follicular hyperkeratosis is an important area of dyscalibration. It will be shown later that this particular examiner difference is partially accounted for by an assignment of lesions by examiner 2 to follicular TABLE 4 hyperkeratosis whereas examiner 1 assigned similar conditions to xerosis. ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 A similar estimate of examiner difference was carried out with the Battalion 1 men after the survey parties returned from the village SUMMARY OF CALIBRATION STUDIES FOR THE CLINICAL EXAMINATIONS-/ surveys (column 3 in Table 3). The extent of the differences between examiners is both large and important. If the average difference between examiners in percent of subjects in which they disagree for all items is obtained for Battalion 2 and Battalion 1, the averages are respectively Number Examiner's Reaction of 16.6 N=25 and 14.0 N=25. There is no clear indication of a trend of Disagree examiner difference. For the total duplicate examinations (68 in all, Trial Observations Agree Positive No. 1 + No. 2 + Agree Negative column 4, Table 3), the examiners exceed 15 percent divergence for N % N % N % N % thickened conjunctivae and pingueculae, glossal furrows, gum atrophy and recession, unfilled caries, worn teeth and dental malposition. The Trial 1 368 30 8.2 24 6.5 92.4 289 78.6 divergence on follicular hyperkeratosis is just at 15 percent, but one 460 examiner identified all of these (N=10) whereas the other examiner Battalion 2 49 10.7 28 6.1 44 9.6 319 69.5 diagnosed 4 subjects with xerosis, not indicated by the first. These data are further condensed in Table 4. The secular consistency of the Battalion 1 736 53 7.2 45 6.1 49 6.7 557 75.6 examiners is notable. These clinical calibration studies were done on 5 percent of the Totals 1564 132 8.4 97 6.2 102 6.5 1165 74.5 subjects studied at Camp Denali. This approach will always be limited by the scarcity of clinical material showing a range of manifestations for many of the important clinical signs. The problem then is one of measuring the ability of individuals to fix their criteria for recogni - tion of threshold levels of clinical signs. It appears that a more Conclusion - In 1564 observations recorded in duplicate after independent rigorous set of definitions should be used. It is also necessary that evaluation by examiner 1 and examiner 2: more extensive estimates of observer differences be made. The present data suggest that perhaps 10 percent of all the clinical appraisals Both agree positive findings in 8% should have been replicates, and this process should have been arranged Both agree negative findings 75% to measure self-duplication as well as inter-examiner duplication. Disagree 13% With examiner 1 positive 6.2% The present studies appear to disqualify observation of thickened With examiner 2 positive 6.5% conjunctivae, pingueculae and follicular hyperkeratosis because of observational imprecision. The dental information will need to come from the independent dental examination. 1 Using the 23 items shown in Table 3. Source: https:/lwww.industrydocuments.ucsf.edu/docs/zznc0227 20 21 III - NATIVE MEN IN THE NATIONAL GUARD 2. Clinical Findings 1. The Population Studied The general impression of physical appearance obtained from casual observation of the two battalions was that these men were active, rugged, The Eskimo Guardsmen represent the majority of all the able-bodied deeply tanned and well-conditioned. They were short in stature, with Eskimo men in Alaska. They appear to find membership in the Alaska "Oriental" faces, short limbs and long trunks, and they generally had a National Guard (ANG) attractive because the service furnishes a cash mesomorphic body type. The men in Battalion 1 who came from northwestern income and also it supplies a pleasant social diversion for them. Alaska seemed somewhat taller, obesity was more frequent among them, and they more commonly had lighter eyes, hair and skin than the men in It appears that no medical screening is done in the villages when Battalion 2. The men in Battalion 1 were also more at ease, better ac- the groups are assembled for the annual duty at Anchorage. It is likely quainted with English, and their behavior was more like that of American that known tuberculosis and obvious crippling or chronic disease are troops. The height-weight measurements bear out some of these observa- causes for rejection, but the men are generally sworn in and assembled tions. A summary of the height, weight, skinfold, blood pressure and in Anchorage before application of the usual medical standards for mil- pulse measurements is shown in Table 5. itary acceptance (11). The frequency and severity of grossly visible defects strongly suggested that these battalions were composed of "able- The relationship of weight to age is shown in Table 6. The small bodied volunteers" who had not been subjected to effective medical gains of weight with age are in contrast to the usual findings in white screening. In Battalion 2, four cases of active pulmonary tuberculosis males in the United States. As noted above the men from northwestern were diagnosed by symptoms and x-ray among the 350 men present. Alaska (Battalion 1) were a little taller than those in Battalion 2, but no important trends were demonstrated. In particular, there is no The Division of Tuberculosis Control of the Alaska Department of evidence that Eskimo men are taller as their race becomes acculturated. Health, as part of its tuberculosis case finding mechanism, has three These data also indicate there is very little obesity. (It should be itinerant x-ray technicians who travel to villages of known high incidence remembered in using the U.S. Medico-Actuarial Tables of Standard Weight (13) to take chest x-rays of all available inhabitants. Active and probably that an appreciable increase of weight with age is incorporated in the active cases diagnosed in this manner, as well as by laboratory or "standard weight. The fall of percent "standard weight" with age clinical means, are placed under medical supervision, and their known shown in Table 18a is thus largely an artifact due to the use of these contacts are also examined. In 1958 this program identified 44 new J.S. reference tables(13). The percent distribution of men exceeding the active cases throughout Alaska among the Eskimos and Indians(la calculated "standard weight" is shown in Table 5. The physical appearance of these men suggests that the percent "standard weight" in excess of 100 The noneffective rates at Camp Denali among the Eskimo National is often an artifact due to excessive bone and muscle mass; that is, the Guardsmen were not made available. Since the survey examination consequence of high activity rather than of fat deposits. Body composi- facility was also the battalion dispensary, it was observed that from tion data on these people are not available, but body composition may 8 to 30 men appeared for sick call each morning from a battalion have some relevance to the physiological problem of adaptation to a cold strength of about 400. During the work with each battalion small epi- environment. This interpretation of the small elevation of percent demics of what seemed to be a contagious respiratory disease occurred "standard weight" is also supported by the relation of weight to age a few days after the men arrived in camp. This was variously called shown for the village groups in Figure IX where the weights are es- "flu,' "pneumonia" and "measles" by the orderlies. The medical facil- sentially constant after age 25 to 29. ities available to these men were the same as those for all U.S. military personnel in Alaska. These facilities and the local mess and The pulse rates have little clinical interest, although there was sanitary facilities would not be expected to have any lasting effect, evidence for important observer differences. however, since the men are in camp for only 14 days. As is usually true of blood pressure data, the observers showed a There is no question that duty with the Alaska National Guard has predilection for the end digits o, 5, and even numbers. For example, an important impact on these men, especially those from the Bethel area 76 percent of the diastolic blood pressures were recorded with a zero where acculturization has been slower. The Eskimos acceptance of end digit and 82 percent of the systolic pressures recorded ended with military food, clothing, customs and equipment is immediate and total. zero. This recording artifact requires a careful selection of groups They are sometimes said to dislike beans and they often find cheese in the analysis and also influences the positioning of an arbitrary revolting, but mess sergeants find they eat anything offered them and criterion of normalcy because it will affect the distribution of they eat this completely. It has been said that the word "Eskimo, subgroups. which means "one who eats raw meat" in the Athabascan language, would be more appropriately called "one who eats everything. " The mean systolic blood pressures are remarkably constant with age (Table 6). Furthermore, the number of men with systolic pressure of 160 or over comprises a very small percentage (8 men, 1.1 percent) Source: https://www.industrydocuments.ucsf.edu/docs/zznc0227 S 22 TABLE 6 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION AND AGE HEIGHT, WEIGHT, WEIGHT STATUS, SKINFOLDS, BLOOD PRESSURE & PULSE Battalion 2 Battalion 1 Age (years) Age (years) 17-19 20-39 40-54 Total 17-19 20-39 40-54 Total Number examined 21 255 47 323 42 318 30 390 I/ Height (inches) 65.5+0.4 64.5+0.1 63.8+0.3 64.5+0.1 65.8+0.3 66.2+0.1 65.840.4 66.2+0.1 Weight (pounds) 1/ 140 + 3 141 + 1 144 + 2 142 + 1 140 + 2 150 + 3 150 + 3 149 + 1 % of "Standard Weight" 108 + 2 104 +1 1 102 + 1 104+1 107 + 1 106 + 1 100 + 1 106 + 1 Median Arm 6.3 5.9 5.4 5.9 8.9 6.7 7.1 6.9 Skinfold Thickness Scapula 8.3 7.7 7.6 7.8 10.7 9.5 8.8 9.7 (mm) 23 Systolic Blood Pressure (mm Hg) 17 125 + 4 126 + 1 122 + 2 125 + 1 119 + 2 121 + 1 120 + 3 121 + 1 Diastolic Blood Pressure (mm Hg) I/ 73 + 2 73 + 1 72 + 2 67 + 1 67 + 2 70 + 1 74 + 1 70 + 1 % with B.P. > 140/90 0.0 6. 6.4 5.9 0.0 1.9 0.0 1.5 Pulse (beats/minute) 78 2 78 + 1 74 + 1 78 1 79 + 2 77 + 1 76 + 1 77 + 1 1/ Mean + Standard Error. TABLE 7 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION BLOOD PRESSURE (Mean I Standard Error), BY HEIGHT Height (inches) 59-63 64-67 68-73 Systolic Bn 2 122.3 + 1.4 127.1 + 1.1 127.8 + 3.0 Blood Pressure (mm Hg) Bn 1 117.6 + 2.1 119.7 + 0.9 125.1 I 1.5 Diastolic Bn 2 70.7 + 1.0 73.0 + 1.0 75.2 + 1.9 Blood Pressure (mm Hg) Bn 1 67.4 + 1.6 69.9 + 0.6 70.5 + 1.1 24 of the entire group examined. In neither group was there a significant number of men with diastolic pressures over 90 mm Hg and there were only five men with pressures over 100 mm. Since these were casual blood pressure measurements taken under moderately stressful conditions they may be presumed to be high estimates. They suggest that hypertensive heart disease is not an important problem among these men. Rodahl has also made this observation This fact is of particular interest because of the high protein diet which these men seem to have. It is of some interest that when systolic blood pressure is considered for each battalion by inch of height a definite trend is observed for higher mean pressure with increasing height. Grouping and comparing heights reveals mean differences as shown in Table 7. Diastolic pressures re- veal a similar trend. It may be concluded that the observed blood pressure readings reveal little or no signs of high blood pressure as an indicator of cardiovascular disease and that the minor fluctuations of blood pressure observed are reasonably related to small differences of a.m thickness. The absence of hypertension among the Eskimos may be of some importance in relation to the problem of causation of hyper- tensive heart disease among white cultures. The summary of other clinical findings for the Eskimo Guardsmen is shown in Tables 8, 9 and 10. The data are shown for the battalions separately (Table 8) because they seem to represent two distinct popu- lations. The examiners are also distinguished because of the procedural divergencies demonstrated above. Certain selected clinical signs are presented by battalion and age in Table 9 and by ethnographic origin in Table 10. The significant findings are as follows: No important prevalence of goiter was observed in the men of Battalion 2 but an average prevalence of 10 percent was seen in Bat- talion 1. These were, without exception, small goiters which were judged to be enlarged either with nodules or symmetrically. A 9.9 percent incidence of goiter was found among northern Eskimos, and 14.3 percent of the Athabascan Indians had enlarged thyroid glands. No instance of thyrotoxicosis was seen. The prevalence of enlarged sali- vary glands was low; the glands were not grossly enlarged and the sign did not seem important (Figure v). Erythema of the exposed parts was common, but this could be adequately explained by the known degree of exposure to sun, cold and wind. It was noted particularly among the Eskimos (Table 10). The late cutaneous results of cold injury which the men describe collectively as "ice" re- semble x-ray injury, with cicatrization, depilation and dilatation of venules. Excessive pigmentation of exposed parts was also common in the older men and was sometimes dramatic about the face. Over the trunk and especially the back it assumed a mottled effect with an irregular depo- sition of pigment (Figure VI). This change strongly resembled the erythema ab igne more often seen about the shins in some U.S. rural populations. In these people this sign, restricted to males, is probably related to the "kashim" or sweat bath procedure. Source: ttps://www.industrydocuments.ucsf.edu/docs/zznc0227 TABLE 8 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION PERCENT PREVALENCE OF CLINICAL FINDINGS , BY EXAMINER II Battalion 2 Battalion 1 Total Examiner Examiner Examiner # 1 # 2 Total # 1 # 2 Total # 1 # 2 Total Number examined 155 168 323 211 179 390 366 347 713 Suspected Disease Tuberculosis 3.9 1.8 2.8 1.9 3.9 2.8 2.7 2.9 2.8 Good 85.8 100.0 93.2 83.4 98.9 90.5 84.4 99.4 91.7 General Appearance Fair 12.9 0.0 6.2 16.1 1.1 9.2 14.8 0.6 7.9 Poor 1.3 0.0 0.6 0.5 0.0 0.3 0.8 0.0 0.4 Hair Staring hair 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Thyroid 0.7 1.2 0.9 11.4 8.9 10.3 6.8 5.2 6.0 Glands Enlarged Submaxillary 2.6 2.4 2.5 2.4 5.0 3.6 2.5 3.7 3.1 Nasolabial seborrhea 0.0 5.4 2.8 0.5 2.2 1.3 0.3 3.7 2.0 Other seborrhea 0.0 1.8 0.9 2.4 7.3 4.6 1.4 4.6 2.9 Skin - Face & Neck Erythema, face/neck 21.9 6.0 13.6 13.7 7.8 11.0 17.2 6.9 12,2 26 Pigmentation, face/neck 5.8 0.6 3.1 3.8 7.8 5.6 4.6 4.3 4.5 Thickened conjunctivae 11.0 1.2 5.9 31.8 19.0 25.9 23.0 10.4 16.8 Pingueculae 84.5 57.7 70.6 61.1 54.7 58.2 71.0 56.2 63.8 Bitot' spots 1.3 0.6 0.9 0.0 0.0 0.0 0.5 0.3 0.4 Eyes Circumcorneal injection 0.0 0.6 0.3 0.0 0.6 0.3 0.0 0.6 0.3 Conjunctival injection 4.5 0.0 2.2 9.0 3.4 6.4 7.1 1.7 4.5 Blepharitis 0.0 0.0 0.0 0.5 0.0 0.3 0.3 0.0 0.1 Corneal scarring 6.5 9.5 8.0 4.3 2.2 3.3 5.2 5.8 5.5 Angular lesions 0.7 0.0 0.3 0.5 1.7 1.0 0.5 0.9 0.7 Lips Angular scars 3.2 5.4 4.3 0.0 0.0 0.0 1.4 2.6 2.0 Cheilosis 0.0 1.2 0.6 0.0 0.0 0.0 0.0 0.6 0.3 Filiform atrophy, s1. 0.7 13.1 7.1 9.5 10.6 10.0 5.7 11.8 8.7 Filiform atrophy, mod. 1.3 1.8 1.5 2.8 2.8 2.8 2.2 2.3 2.2 Fungiform atrophy 2.6 0.0 1.2 0.0 0.0 0.0 1.1 0.0 0.6 Tongue Papillary hypertrophy 1.3 1.2 1.2 0.0 1.1 0.5 0.5 1.2 0.8 Furrows 7.1 1.2 4.0 12.8 6.7 10.0 10.4 4.0 7.3 Fissures, erosions, ulcers 2.6 0.0 1.2 1.4 0.0 0.8 1.9 0.0 1.0 Serrations or swellings 5.8 8.9 7.4 1.9 9.5 5.4 3.6 9.2 6.3 Red, tip or lat. margins 3.2 0.0 1.5 7.6 1.1 4.6 5.7 0.6 3.2 Geographic tongue 1.3 0.0 0.6 2.4 1.1 1.8 1.9 0.6 1.3 TABLE 8 (Cont inued) Red or swollen gums 9.7 25.6 18.0 5.2 14.0 9.2 7.1 19.6 13.2 Gums Atrophy or recession, pap. 40.0 66.7 53.9 23.7 43.6 32.8 30.6 54.8 42.4 Bleeding gums 0.0 2.4 1.2 0.0 0.0 0.0 0.0 1.2 0.6 Unfilled caries 27.0 20.9 23.8 42.2 44.1 43.1 36.8 34.4 35.6 Filled caries 10.4 12.4 11.5 30.8 45.3 37.4 23.6 31.5 27.4 Carious teeth, 0 62.6 65.1 63.9 32.7 20.1 26.9 43.3 39.0 41.2 " " 1-2 13.0 14.0 Teeth , 13.5 16.1 31.8 23.3 15.0 24.4 19.6 " " , 3-4 15.7 9.3 12.3 20.4 21.8 21.0 18.7 16.6 17.7 " " , 5+ 7.0 7.0 7.0 26.1 24.0 25.1 19.3 16.9 18.1 Edentulous 1.7 4.7 3.3 4.7 2.2 3.6 3.7 3.2 3.5 Worn 60.0 45.7 52.5 34.1 30.2 32.3 43.3 36.7 40.1 Fluorosis 0.0 0.0 0.0 1.4 2.2 1.8 0.9 1.3 1.1 Malposition 7.8 4.7 6.1 19,9 5.0 13.1 15.6 4.9 10.4 Follicular hyperkeratosis 3.9 11.3 7.7 0.0 10.6 4.9 1.6 11.0 6.2 22 Xerosis 1.3 0.0 0.6 14.2 0.6 7.9 8.7 0.3 4.6 Acneform eruption 5.2 1.8 3.4 9.0 5.0 7.2 7.4 3.5 5.5 Skin General Scrotal dermatitis 0.0 0.0 0.0 0.5 1.1 0.8 0.3 0.6 0.4 Thickened pressure points 1.3 0.0 0.6 1.4 5.6 3.3 1.4 2.9 2.1 Purpura or petechiae 0.6 0.0 0.3 0.0 0.0 0.0 0.3 0.0 0.1 Hyperpigmentation 0.0 2.4 1.2 1.9 0.6 1.3 1.1 1.4 1.3 Abdomen Hepatomegalia 0.0 2.4 1.2 0.5 0.0 0.3 0.3 1.2 0.7 Vibration sensation absent 1.3 0.0 0.6 0.0 0.0 0.0 0.5 0.0 0.3 Lower Extremities Loss of ankle jerk 0.6 0.6 0.6 0.5 0.0 0.3 0.5 0.3 0.4 1/ No findings of enlarged parotids, xerophthalmia, magenta tongue, "scorbutic-type"gums, crackled skin, pellagrous lesions, splenomegalia, ascites, or calf tenderness. Findings of 1 case each of glossitis, perifolliculosis and depigmentation of hair also omitted. Source: https://www.industrydocuments.ucsf.edu/docs/zznc022) TABLE 9 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION AND AGE PERCENT PREVALENCE OF SELECTED CLINICAL FINDINGS Battalion 2 Battalion 1 Age (years) Age (years) 17-19 20-39 40-54 Total 17-19 20-39 40-54 Total Number examined 21 255 47 323 42 318 30 390 Suspected Disease Tuberculosis 4.8 2.4 4.3 2.8 4.8 2.8 0.0 2.8 Good 90.5 92.9 95.8 93.2 83.3 91.5 90.0 90.5 General Appearance Fair 9.5 6.7 2.1 6.2 14.3 8.5 10.0 9.2 Poor 0.0 0.4 2.1 0.6 2.4 0.0 0.0 0.3 Thyroid 0.0 0.8 2.1 0.9 9.5 9.7 16.7 10.3 Glands Enlarged Submaxillary 0.0 2.7 2.1 2.5 0.0 3.5 10.0 3.6 Nasolabial seborrhea 4.8 3.1 0.0 2.8 4.8 0.9 0.0 1.3 Skin - Face & Neck Erythema, face/neck 9.5 13.7 14.9 13.6 2.4 12.3 10.0 11.0 Pigmentation, face/neck 4.8 2.7 4.3 3.1 2.4 6.3 3.3 5.6 2 8 Thickened conjunctivae 0.0 6.3 6.4 5.9 11.9 26.4 40.0 25.9 Pingueculae 38.1 69.4 91.5 70.6 23.8 61.0 76.7 58.2 Eyes Conjunctival injection 0.0 2.4 2.1 2.2 11.9 5.7 6.7 6.4 Corneal scarring 0.0 8.6 8.5 8.0 7.1 2.5 6.7 3.3 Filiform atrophy, s1. 0.0 7.8 6.4 7.1 14.3 9.7 6.7 10.0 " " mod. 0.0 1.6 2.1 1.5 0.0 2.8 6.7 2.8 , Tongue Furrows 0.0 3.5 8.5 4.0 9.5 10.4 6.7 10.0 Serrations and swellings 0.0 7.5 10.6 7.4 0.0 6.3 3.3 5.4 Red, tip, or lat. margins 0.0 1.6 2.1 1.5 4.8 5.0 0.0 4.6 Geographic tongue 4.8 0.4 0.0 0.6 2.4 1.9 0.0 1.8 Red or swollen gums 0.0 17.3 29.8 18.0 7.1 10.4 0.0 9.2 Gums Atrophy or recession 54.9 66.0 53.9 14.3 33.6 50.0 32.8 No carious teeth 36.8 64.6 75.0 63.9 14.3 26.7 46.7 26.9 Caries, filled 1-2 15.8 13.8 11.1 13.5 19.0 23.3 30.0 23.3 Teeth or unfilled 3+ 47.4 19.0 5.6 19.3 66.7 45.9 20.0 46.2 Edentulous 0.0 2.6 8.3 3.3 0.0 4.1 3.3 3.6 Worn 15.8 48.7 91.7 52.5 2.4 31.8 80.0 32.3 Follicular hyperkeratosis 9.5 8.6 2.1 7.7 7.1 4.7 3.3 4.9 Skin General Xerosis 0.0 0.8 0.0 0.6 7.1 8.2 6.7 7.9 Acneform eruption 9.5 3.5 0.0 3.4 11.9 6.6 6.7 7.2 29 PUEW ONNOVI VNWN w 006 oanoww wava NW the WNY PPOOP- compa FUN NWF oaitor JNWF via 3.6 over NFL OF JNN boing 00 0 FOUOND FOOUOD TE 000wooowwe coovoo ING HUYAN FN WNWWN- NVIN ONIXS ONnOX V NI SHONVHO GHL HO IA A 32 33 Thickening of the conjunctivae, especially in the palpebral fissures, because of the tendency of Eskimos to show a normocytic anemia of unknown occurred commonly in the men and was difficult to judge. In general, it cause(3). No true glossitis was seen. The other glossal changes are was diagnosed as present if lateral orbital pressure, through the lid, considered unimportant; the glossal serrations may possibly reflect a would cause definite folds to appear. Similarly, pingueculae of one thick muscular tongue, developed by vigorous eating habits. or both palpebral fissures were both common and extensive. These sometimes The dental data gathered by the clinicians are of interest in protruded between the closed lids medially and were dry and lichenified on the surface. Although over half the men showed these ocular lesions, demonstrating the need for a specialized appraisal of oral manifesta- it seemed they could be reasonably attributed to environmental irritation tions. The clinicians did suspect both age and geographic gradients rather than to nutritional causes. An age analysis (Table 9) conforms for dental caries (Tables 9 and 10). The extent of dental attrition with this interpretation, the prevalence increasing regularly with age. was remarkable and strongly age-related. Fluorosis, even though rarely The incidence was greatest among Eskimos from southern Alaska. diagnosed, seems to have been mistaken for hereditary hypoplasia of enamel. Results of the dental study are presented on pages 33-40. The Bitot's spots seen were rare, in the early examinations, and are in retrospect only suggestive of vitamin A deficiency. However, other Both follicular hyperkeratosis and xerosis were seen and probably corroborative evidence will be discussed in the section on the villages. often confused by two examiners (see discussion above). In Table 11 is shown a. summary of these clinical findings along with the rare Conjunctival injection was noted in 11.9 percent of men 17 to 19 diagnosis of Bitot's spots. The latter cannot be taken as conclusive years of age in Battalion 1 (Table 9), and in 26.7 percent of northern evidence of past or present vitamin A deficiency, but they do require Eskimos, and 19 percent of Athabascan Indians. This is attributed to biochemical evaluation. The lack of correlation between presence of environmental trauma rather than nutritional deficiency. Bitot's spots and serum vitamin A levels shown in Table 11 illustrates the imprecision of this clinical attribute as an indicator of vitamin A nutriture. Corneal scarring represents an important cause of morbidity among the Eskimos. No signs of trachoma were seen in the present studies. Neither were there evidences of "snow blindness, although there were several young people in the villages who had active phlyctenular kerato- TABLE 11 conjunctivitis (PKC) with typical photophobia. The exact nature of snow blindness seems not to be established. Whether there is a distinct entity, precipitated by excessive light and without corneal ulceration, RELATION OF CLINICAL SIGNS AND BIOCHEMICAL FINDINGS, is not clear. Certainly the Eskimos have been making and using narrow SERUM VITAMIN A, ALASKA, 1958 aperture "glasses" for many centuries, since these tools have been (Serum Vitamin A in micrograms per 100 ml. Mean + standard error) excavated by archeologists. Nevertheless, the occurrence of PKC has been very common in these people as judged by the presence of residual scars, Villages and it is a continuing, although lessening, medical problem. The causa- tion is not established, but it appears at least as probable that dietary National Guard Bethel Area Kotzebue Area factors are important as that the doctrinal assignment of cause to No. Serum A No. Serum A No. Serum A tuberculosis is true (15,16). The evidence indicates that while tubercu- losis is often associated with PKC this is not invariably the case. In Total Survey 574 37 + 1 196 31 + 1 220 29 + 1 the present study the frequency of corneal scars was somewhat greater among Battalion 2 men from the less acculturated area of southwestern Persons with follicular Alaska than in Battalion 1 (Tables 8 and 10). However, both groups had hyperkeratosis 34 37 + 2 7 28 + 7 69 30 + 1 significant numbers of men with such scars. Casual observation suggested an age gradient, the lesions being more common in older men than in young Persons with xerosis 30 38 + 2 26 35 + 3 o men. An analysis of the prevalence of this stigma by age and battalion is shown in Table 9. These questions will be considered again with the Persons with Bitot's village data. spots 3 40 + 13 2 12 + 10 o Angular scars were rarely seen in Battalion 2 and none were observed 1/ Two of five subjects recorded as having Bitot's spots had serum vitamin in Battalion 1. Slight filiform atrophy of the tongue was occasionally A levels below 20 mcg/100 ml; this is not a significant difference reported. Moderate atrophy, being more consistent, is better considered. (P= . 16). About two percent of the men showed this lesion to the latter degree. A moderate degree of filiform atrophy was found in 5.3 percent of the Aleuts and 3.2 percent of northern Eskimos. The finding is of interest Source: Ittps://www.industrydocuments.ucsf.edu/docs/zznc227 34 35 A similar comment may be made in regard to the lack of evidence of in field studies of fluoride-caries relations. The race and exact age of a relationship of serum ascorbic acid levels to the presence of red or the examinee and the village from which he came were unknown to the ob- swollen and bleeding gums (see Table 12). server at the time of examination. b. Results TABLE 12 The criteria used to appraise the conditions reported here are RELATION OF CLINICAL SIGNS AND BIOCHEMICAL FINDINGS, described in Appendix A. For the entire group of Alaskan males the life- SERUM VITAMIN C, ALASKA, 1958 time caries experience was generally lower, and diseases of the periodontal tissues generally were more prevalent and severe, than in approximately (Serum Vitamin C in milligrams per 100 ml. Mean + standard error) 1,400 white males examined in Baltimore (17) and in Birmingham(18) in the United States. The caries experience in these two latter groups is con- Villages sidered to be moderate, and periodontal conditions possibly typical, for National Guard Bethel Area Kotzebue Area U.S. white males in general. These specific data were selected as a basis for comparison because the same criteria and methods were used as No. Serum C No. Serum C No. Serum C in Alaska, and because the Alaska examiner participated in all three Total Survey 648 .52 + .01 222 .40 + .02 208 .47 + .02 studies. Comparative findings are shown in Table 13. Persons with red or swollen gums 86 .56+.03 18 .42 + .06 37 .49 + .03 TABLE 13 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 Persons with bleeding gums 4 .65 + .04 o 3 .44 + .06 COMPARISON OF DENTAL CARIES AND PERIODONTAL STATUS OF 713 ESKIMO GUARDSMEN WITH 1, 400 WHITE MALE RESIDENTS OF BIRMINGHAM AND BALTIMORE Mean Numbers of Decayed, In summary, the important clinical findings consisted of occasional Missing and Filled Per- thyroid enlargement in Battalion 1 and among northern Eskimos and Numbers manent Teeth per Man Mean Periodontal Scores 1/ Athabascan Indians, rare Bitot's spots, xerosis, phlyctenular corneal Age Examined Baltimore- Baltimore- scarring, markedly extensive and variable caries, attrition of the teeth (years) Alaska Birmingham Alaska Birmingham Alaska and periodontal disease, and cutaneous hyperpigmentation. The important negative findings were the lack of signs of inanition, anemia, or cardio- 15-19 63 11.3 10.2 .43 .40 vascular disease, or of specific signs of deficiency of B-vitamins or 20-29 359 12.9 9.5 .66 .69 protein. The most serious medical problems observed were the high 30-39 214 13.3 7.7 .82 1.39 prevalence of infectious diseases, especially tuberculosis, the frequency 40-49 68 15.8 6.3 1.25 1.44 of corneal scars and the generally poor teeth. Many of the observed 50-59 9 19.5 9.8 1.73 1.06 defects suggested strong age and geographic patterns which promise to enlighten the search for causation. Nonetheless, these men appeared fit 1/ The periodontal score for each individual is the average for the and rugged and in better physical condition than one might expect to teeth present in the mouth. The criteria for scoring are given in find in a group of U.S. Caucasian recruits. Appendix A. 3. The Dental Study This comparison is useful, however, only for general orientation of the a. Methods findings. There were four independent and geographically distinct pat- terns of dental caries experience, as measured by mean numbers of decayed, All of the dental examinations were carried out by a single missing and filled permanent teeth per man. These patterns are sum- observer. The men were seated in a portable dental chair under a standard, marized in Table 14. color-corrected examination light. Dental mouth mirrors and explorers were employed. Observations were dictated in code to an experienced recorder, who entered the data for each man upon an individual examination card separate from that used for the rest of the clinical observations and originally designed in the National Institute of Dental Research for use Source: https://www.industrydocuments.ucsf.edu/docs/zznc0227 25-34 15-24 OF se TABLE 15 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 ORAL STATUS OF MEMBERS OF FIRST AND SECOND BATTALIONS : Mean DMF Teeth : Mean Periodontal Score : Mean Recession Score Number Mean Age Age : Age Village Examined Age : Adjusted Observed1 : Adjusted Observed: : Adjusted Observed 1/ Group I: principal centers of population Bethel 14 26.6 11.0 7.9 + 1.89 0.63 0.65 + 0.20 8 7 + 3.0 Barrow 69 26.0 13.1 13.6 + 0.90 1.11 0.89 + 0.15 18 14 + 2.5 Kotzebue 19 26.2 14.2 14.2 + 1.63 1.96 1.12 + 0.51 30 18 + 7.5 Dillingham 7 22.1 15.7 12.1 + 2.97 0.21 0.37 + 0.27 0 0 Unalaska 12 25.8 16.7 15.5 + 1.76 1.40 0.80 + 0.38 12 8 + 3.5 Nome 17 22.1 17.1 14.5 + 1.82 1.02 065 + 0.16 6 8 + 6.6 St. Paul 26 31.8 20.2 20.6 + 1.27 1.34 1.34 + 0.39 16 16 + 4.7 All Group I 164 26.5 14.9 14.5 + 0.60 1.22 0.90 + .11 17 12 + 1.7 White U. S. Males 26.5 13.0 .69 13 37 Group II: villages near the principal centers of population Noatak 22 29.0 11.3 11.8 + 1.85 0.68 0.69 + 0.20 10 11 + 3.1 Deering 3 29.5 12.7 13.0 + 4.93 0.84 1.47 + 1.27 15 15 +11.8 Tuluksak 8 33.1 12.8 11.1 + 2.36 1.59 1.59 + 0.46 18 18 + 7.6 Wainwright 17 28.8 13.3 13.2 + 2.01 1.49 1.57 + 0.50 27 28 + 7.9 Napaskiak 14 26.8 13.9 14.2 + 1.98 1.29 1.24 + 0.31 18 13 + 5.3 Akiak 6 30.7 14.5 15.0 + 4.24 1.36 1.26 + 0.62 17 15 +14.1 White Mountain 5 30.7 15.3 14.8 + 2.22 0.71 0.90 + 0.16 7 10 + 5.7 Shishmaref 8 31.6 15.4 13.8 + 3.41 0.44 0.59 + 0.41 12 12 + 4.0 Unalakleet 13 28.5 15.6 16.2 + 2.43 0.86 0.90 + 0.47 25 23 +11.7 Elim 2 29.5 17.0 17.0 + 1.00 0.75 0.75 + 0.65 8 8 + 3.0 Shaktoolik 2 33.5 21.5 21.5 + 1.50 0.41 1.15 + 1.15 21 29 +29.0 All Group II 100 29.4 13.6 13.7 + 0.81 1.04 1.08 + 0.14 17 17 + 2.5 White U. S. Males 29.4 13.1 0.74 15 TABLE 15 (Continued) ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 ORAL STATUS OF MEMBERS OF FIRST AND SECOND BATTALIONS Group III: relatively remote villages, except those in the Yukon-Kuskokwim - delta area Shungnak 16 29.1 2.1 1.8 + 0.59 0.37 0.34 + 0.12 3 4 + 2.1 Little Diomede 7 29.2 3.3 4.4 + 0.90 1.32 1.01 + 0.67 19 16 + 10.0 Kasigluk 7 26.9 5.4 5.4 + 1.15 0.56 0.77 + 0.22 5 4 + 1.9 Akiachak 16 30.7 5.5 5.1 + 0.83 1.38 1.60 + 0.21 14 16 + 6.1 Barter Island 5 31.7 5.6 5.6 + 2.34 0.45 0.46 + 0.29 9 9 + 5.3 Alakanuk 16 32.1 5.9 5.3 + 1.21 1.59 1.88 + 0.47 10 13 + 4.0 Teller 9 27.9 5.9 5.6 + 1.51 0.58 0.54 + 0.22 12 11 + 3.9 Koyuk 4 23.8 6.1 6.5 + 3.23 2.04 2.05 + 0.53 11 12 + 12.0 Kwethluk 17 31.3 6.2 5.1 + 1.40 1.37 1.57 + 0.37 12 14 + 4.3 Stebbins 12 33.4 6.2 6.7 + 1.81 1.35 1.68 + 0.36 26 34 + 8.7 Selawik 14 29.5 6.3 6.6 + 1.48 0.49 0.50 + 0.12 10 10 + 4.6 Meade River 4 25.5 6.6 6.8 + 3.04 0.52 0.55 + 0.42 5 5 + 4.8 Eek 14 28.7 6.8 6.9 + 1.78 0.92 0.89 + 0.20 8 7 + 2.6 Mountain Village 14 36.7 6.8 7.5 + 1.61 0.78 0.94 + 0.28 15 20 + 4.6 Wales 5 43.9 6.8 6.8 + 1.32 1.22 1.22 + 0.49 30 30 + 11.8 Kivalina 11 26.8 7.9 7.7 + 1.91 1.81 1.31 + 0.56 28 19 + 9.9 Gambell 22 27.6 8.4 9.2 + 1.46 1.30 0.96 + 0.30 19 16 + 4.2 Kiana 8 22.8 8.8 7.4 + 2.71 0.34 0.36 + 0.15 4 3 + 1.5 Noorvik 11 26.3 8.9 9.0 + 2.64 0.78 0.55 + 0.25 2 1 + 0.8 Fort Yukon 21 28.3 9.2 9.0 + 1.46 0.36 0.32 + 0.17 9 4 + 2.3 Savoonga 27 25.7 9.3 8.4 + 1.08 0.88 0.70 + 0.20 17 13 + 2.6 King Island 5 33.5 9.6 9.4 + 2.79 1.37 1.40 + 0.32 13 15 + 6.7 St. Michael 12 29.2 9.6 9.6 + 1.63 1.64 1.72 + 0.45 27 28 + 9.3 Point Hope 20 32.0 10.4 10.1 + 1.57 1.18 1.20 + 0.32 14 15 + 4.7 All Group III 297 29.6 7.1 7.1 +1 .35 1.00 1.00 + .07 13 13 + 1.1 White U. S. Males 29.6 13.1 .74 15 1/ Standard error of the mean is included in the observed values. TABLE 15 (Continued) ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 ORAL STATUS OF MEMBERS OF FIRST AND SECOND BATTALIONS : Mean DMF Teeth : Mean Periodontal Score : Mean Recession Score Number Mean : Age : Age : Age Village Examined Age : Adjusted Observed 1/ : Adjusted Observed 1/ : Adjusted Observed Group IV: villages in the Yukon-Kuskokwim delta area Newktok 5 28.5 0 0 0.93 0.82 +0.52 12 11 + 9.2 Chevak 6 29.3 0.4 0.2 + 0.16 0.96 1.02 +0.25 16 18 + 6.2 Tanunak 11 37.8 0.4 0.6 + 0.36 0.23 0.31 +0.16 9 13 + 3.2 Mekoryuk 15 37.4 0.6 0.9 + 0.38 0.03 0.02 +0.01 4 5 + 2.0 Chefornak 5 22.3 1.1 0.4 + 0.40 0.90 0.38 +0.31 16 6 + 6.0 Kwillingnak 20 30.9 1.8 1.5 + 0.42 1.06 1.06 +0.19 10 11 + 2.4 Kipnuk 13 30.8 2,1 2.0 + 0.60 0.65 0.71 +0.17 15 15 + 4.7 Hooper Bay 25 30.8 3.3 3.3 + 0.88 0.73 0.88 + 0.28 10 13 + 3,1 Tuntutulial: 11 30.1 3.4 3.2 + 0.98 1.39 1.32 +0.29 12 13 + 4.6 Quinhagak 22 33.0 3.7 3.4 + 0.76 0.97 0.95 +0.17 6 7 + 2.1 Napaskiak 7 27.4 4.1 4.1 + 2.09 0.76 0.76 +0.32 6 6 + 3.9 Togiak 10 30.8 4.3 4.1 + 1.46 1.54 1.65 +0.55 4 4 + 1.6 Scammon Bay 2 31.5 4.5 4.5 + 2.50 0.20 0.20 +0.20 12 12 + 5.0 All Group I.V 152 31.7 2.6 2.3 + 0.27 0.76 0.83 +0.08 9 10 + 1.0 White U. S. Males 31.7 13.2 .77 17 1 Standard error of the mean is included in the observed values. Source: https://www.industrydocuments.ucsf.edu/docsizznc0227 40 41 these two villages more nearly resemble men from group IV villages, and (2) Periodontal disease the villages are similarly isolated. Shungnak is located near the head- waters of the Kobuk River about 100 air miles east of Kotzebue, and For the whole world population periodontal disease probably Little Diomede is an island in Bering Strait near the boundary with outranks dental caries in importance. Commonly called "pyorrhea, this Soviet Russia. disease attacks the soft and hard tissues supporting the teeth in the dental arch so that they loosen, become painful and ineffective in Age-corrected scores are more appropriate for comparisons between chewing, and are eventually lost. In this study periodontal disease villages, and observed scores for comparison with findings for white was assessed by two measures the periodontal index or score which is U.S. males. a morbidity index of present and active disease, and gingival recession, a cumulative measure reflecting past loss of tissue, particularly bone. (1) Dental caries There was no relation, in the total population, between group findings for either of these measures and group findings for dental caries. There was, as a rule, remarkably little variation in dental caries experience between men of a given age and village. The means for In 38 of the 55 villages periodontal scores (i.e., ratings of decayed, missing, filled (DMF) teeth of Eskimo men living in the seven present disease) were higher than would be expected on comparison with principal villages were slightly but unimportantly higher than those for scores for white males in the U.S., and in only five villages -- Mekoryuk, white U.S. males, rising with age in similar fashion. Means for men Scammon Bay, Fort Yukon, Tanunak and Shungnak were scores signifi- living in villages near these seven principal centers a.re about the same, cantly or importantly lower. The typical clinical picture was one of but show a tendency for caries experience to be lower in men of older age. moderate to severe gingivitis with widespread pocket formation, abundant This tendency becomes marked in the two successive groups; in each group oral debris, and heavy deposits of calculus, although some villages stood DMF means are progressively lower in progressively older groups of men. out as marked exceptions to this rule. Here, as in dental caries, there Since the DMF mean is a cumulative measure, this can occur only in popu- tended to be little variation between men from a given village. lations where caries prevalence is on the increase, and the patterns seen here suggest that this increase is occurring at a relatively rapid rate. 11 The recession score is a relatively weak population measure when young persons are studied, since gingival recession is rarely marked in The dental caries pattern cuts across ethnic boundaries; location for individuals prior to the middle and later years of life. Recession location, there is little difference in DMF means between Aleuts from findings for the whole groups were neither markedly nor importantly Unalaska and the Pribilofs, southern Eskimos from the region generally different from the patterns reported (by an independent team of observers) south of Alakanuk, northern Eskimos from the region generally north of for U.S. Army troops. Findings for the whole of group IV were, in fact, St. Michael, and Athabascan Indians from Fort Yukon. There is a loose significantly lower. tendency (possibly an artifact due to sampling variation) for DMF means in group III to increase from south to north, but there is no clear In men 35 years of age or older, however, recession scores as out- transition across an ethnic boundary. Neither does the term "isolation, " lined in Table 16 for the main groups are generally related to group as used here, denote lack of contact with other groups; in the course of caries scores. The series of differences shown might occur by chance summer migration nearly all of the men in groups III and IV leave their slightly less than once in one hundred trials. homes and live for a time in or near one of the principal villages. At this point in analysis no clear relationship between caries patterns and dietary habits or nutritional status has been developed. TABLE 16 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 GINGIVAL RECESSION SCORES, MEN 35 YEARS OF AGE OR OLDER, 1 The means for group DMF typically rise in essentially straight-line FIRST AND SECOND BATTALIONS fashion with age after permanent teeth begin to erupt at the age of six, gradually becoming asymptotic after the mean reaches a value Number Mean Mean of 15 to 18. Extrapolation of the present data suggest that after Group Examined Age Recession Score a generation, caries may become as prevalent in the group III vil- lages as in villages in or near the principal centers of population, I 15 41.9 39 + 1.7 and that caries in the group IV villages may rise to about the levels II 17 40.4 now seen in group III. If this occurs the disease will then present 31 + 6.9 a public health problem for these people quite as difficult as the III 68 41.2 28 + 3.3 present dental caries problem in the U.S. IV 57 40.5 17 + 2.0 White U.S. males 41.0 26 Source: tps://www.industrydocuments.ucst.edu/docs/zznc0227 42 43 IV - THE VILLAGE STUDIES Twice each year, in spring and fall, ships bring in supplies. Supplies for the year must be anticipated at this time, since the only 1. Bethel Area - the Situation in Akiak, Kasigluk, Napaskiak, Newktok recourse is to costly shipment by air from Anchorage. Mail order houses and Hooper Bay have an active year-round business in this area. An adult education class in one village had as two of its projects the following 1) how Bethel is the principal trading center of a large area of south- to write an order to a mail order house; 2) how to fill out a U.S. income western Alaska which includes most of the lower Yukon and Kuskokwim River tax return. areas. The town is on the Kuskokwim River at the head of deep water navigation. It is the air terminal for the only outside contact of the In Eskimo villages the dogs are an essential part of the economy, area during eight months of the year. The population is mixed white and for they are the only beasts of burden. Wood, one of the few sources Eskimo people. An electric service, high school and many other small- of fuel, must be hauled long distances from the river bottoms. People town facilities are available. travel and supplies are hauled by dog sled. Some freighting for cash income is done with dogs. The average size of a team is five dogs. In winter the main occupation of many Eskimos in this area is Fish are fed to them at variable times and in limited amounts so the trapping for mink, beaver and muskrat. In summer many find temporary dogs are generally thin and ravenous. They eat snow for water, snatching work in canneries on Bristol Bay. In some cases almost the entire able- it as they run. The Kuskokwim dogs are small, averaging 30 to 50 pounds, bodied population is transported to these canneries for a period of six and are nondescript in appearance. The dog population is threatened with weeks or more. Those who remain behind in the villages catch herring, canine distemper because of inadequate immunization. smelt, pike, whitefish and salmon for their own use. The larger fish are filleted and air-dried for the winter cache, to be consumed by both The population counts for the villages included in the Bethel por- dogs and humans. The tundra is dotted with small ponds and sloughs tion of the study and the numbers given clinical examinations in this which are a source of whitefish, ling cod, blackfish and needlefish. survey are shown in Table 2. The sampling within the villages was done Often these fish are eaten raw, and are thus a source of tapeworm with the help of the resident teacher; who selected one or two adolescent infestation. boys as runners. They were instructed to bring into the schoolroom entire families, including all ages. The selection of families and their Hooper Bay and Newktok are sealing communities of coastal Eskimos. order of appearance was not controlled. Clinical appraisals were done on Since the seal kill is variable and uncertain depending upon the movement all persons 2 years old and over. Blood and urine samples were obtained of the pack ice and tolerable sealing weather, this food supply is un- from all persons 6 years of age and over, until 50 blood samples had been certain. The coastal Eskimos collect seal pokes, inverted seal skins obtained in each village. At the end of the day the villagers were filled with seal oil, which they take up the Kuskokwim for sale and advised to bring forward the people who were sick or those with medical barter to the river communities. The subcutaneous fat of newly complaints who had not previously been seen. These persons were not butchered seal is cut into small portions about one by three inches in included in the nutritional appraisal The invitation invariably pro- size and pressed into the inverted seal skin (which has had all the duced an assorted clinic. No assessment was made of the number who apertures, except the anus, tied off with string). After the poke is stayed away from the nutritional appraisals deliberately. In Hooper filled with these small pieces of blubber, it is plugged and left inside Bay most of the men were away sealing. In Kasigluk many men had gone the Eskimo house at moderately high room temperatures and the oil is for wood. thus gradually rendered. When the contents of the poke have been re- moved, a sponge-like connective tissue residue representing the original The presence of a school and one or more teachers has had an stroma in which the oil was contained is left within the poke. This is important influence upon the Eskimo communities. While introduction of considered a food delicacy. No applied heat is used in the rendering a school has generally caused the villages to increase in size and thus process. The tendency of the seal poke to collapse as oil is withdrawn often overburdened the available food supply it has also stimulated the for use maintains a minimum of air within and probably delays rancidity. acculturization of the community. Community leaders who have whi te On some occasions other foods, such as partially dried salmon or herring, customs, clothing, food and ideas have no doubt been important models are placed in seal oil in the poke and stored for considerable periods. for emulation. The school lunch programs, the mail which comes once or Salmonberries, blueberries and wild greens may be stored in a seal poke twice a week, the radio communication with the Alaska Native Health or in barrels without the oil. Service Hospital each evening and the formal instruction in English with material and methods very like those of schools in the rest of the United A seal poke weighing 100 pounds may bring $140 and will last a States all increasingly influence the life and health of the Eskimo family a year. Seal oil is used as a major ingredient of such dishes people. There is a large age gradient in the use of English in the as agutuk (Eskimo ice cream) or oknuk (soup). Other foods, especially Bethel area; almost all school children speak English, but only rarely dried fish, may be dipped into it at serving time. Hunters are con- do adults over 40 years of age. vinced that it is more calorific than other foods and it is thought essential for a trip in intense cold. Source: s://www.industrydocuments.ucsf.edu/docsizznc0227 45 44 Bureau of Indian Affairs School Program for about eight years. Vi tami There are no physicians permanently located in the villages although These administration is more recent. No active keratitis was seen in this there are three physicians associated with the hospital in Bethel. indi- village but there were many children with the corneal scars which are physicians, a dentist and an x-ray technician visit the villages attributed to phlyctenular keratoconjunctivitis (PKC). The lesion was vidually at irregular intervals of several months. The x-ray technician films especially common in children over 7 years of age. Dry skin on the carries a portable x-ray machine which is largely used for chest extensor surfaces and mild follicular hyperkeratosis were seen occasionally in a tuberculosis control program. Public health nurses also visit the in children 8 to 16 years of age. The condition of the teeth varied villages at irregular intervals. A sanitary engineer of the Alaskan the markedly. Caries were rampant in many families, involving both deciduous Department of Health is presently working in certain villages of and permanent teeth. People past 30 tended to have worn but intact and Bethel area in order to improve the water supply. noncarious teeth (see Figure VII). In most villages the teacher is the medical representative who mans A man in his 40's was seen with incipient cardiac failure and a the two-way radio contact. The costs of transportation to Bethel, loud aortic diastolic murmur, probably a result of rheumatic heart Anchorage, or even to other states for medical treatment are borne by disease. A middle-aged woman with typical active rheumatoid arthritis patient, if that is possible; by the ANHS, if it is not. Since the was examined. distances the are great such trips are expensive. Midwifery is done by women in the villages except for those areas near the Bethel hospital The 77 clinical appraisals done in Akiak indicated the calorie where some women may prefer to go for delivery when possible. About supply was adequate, and that there had been a large incidence of 225 babies are delivered annually to native women in the Bethel hospital. phlyctenular keratoconjunctivitis in the past, although no acute cases were seen. Follicular changes suggested a mild or borderline vitamin A The largest single health problem in the villages is tuberculosis. deficiency. Both the caries and the corneal scarring seen in this About 7 to 10 percent of the Eskimo population is being treated with village suggested a familial pattern of prevalence. drug therapy for this disease. In Akiak, for example, 13 of 130 people in records indicate that 38 other villagers have received this therapy the village were receiving chemotherapy in August 1958 and the Kasigluk is a village of 227 Eskimos about 35 miles west of Bethel on the tundra, a few miles from the Johnson River. The latter is an lation and about one tenth of one percent of the population dies of since 1954. The annual incidence is now about one percent of the popu- abundant source of fish in the summer. Nunapitchuk, a somewhat larger village, is four miles away across a small lake. Kasigluk has been tuberculosis each year. The first figure has been reduced by one half, moved in recent times from a location six miles north to be better ac- the second by four fifths since 1952(8). The trends are shown in cessible by boat. The village has a typical onion-turreted Russian Church and a smaller Moravian Church. There are many Russian names in Figure II. the village and people with Mongoloid faces and light hazel eyes. The Akiak is a community of 130 people on the Kuskokwim River about in people seemed poor but were generally clean. The men showed signs of 30 miles upstream from Bethel. Most of the people were dressed recent use of their steam baths, a custom which is thought by some to excellent furs and mukluks, and there was evidence of a plentiful food be a Russian importation but is more likely an intrinsic part of the Eskimo culture. supply. There were no signs of caloric deficiency. Some obese women past These people at Kasigluk must go long distances to the Kuskokwim 30 years of age were seen. There were many children with draining ears flats for wood. The dogs were lean but strong; a team of five brought and impetigo was common, especially in children. One child with ex- in a load of green poles weighing 300 to 400 pounds. The village has tensive bronchitis and fever was given sulfa drug therapy. a poor water supply, consisting only of melted ice from nearby ponds. An epidemic of dysentery had occurred in this village during the two Each school child receives a hot lunch and a therapeutic multivitamin weeks prior to the survey team visit. The school children receive tablet every dayl/. The lunch program has been in effect in the lunches and a multivitamir tablet each school day. New mothers also receive vitamin solutions for the babies and iron pills for themselves, but the teacher was uncertain that these materials are used. The Contents of Multivitamin Tablet: calóric intake of the people seemed adequate. 1 Vitamin A - 5,000 U.S.P. units Ascorbic acid - 50 mg. Vitamin D - 500 U.S.P. units Vitamin E - 5 I.U. Impetigo was common, and several children were put on courses of Thiamine mononitrate - 3 mg. Calcium carbonate - 250 mg. penicillin for treatment. The dispensation of sulfonamide ointment Ferrous sulfate - 234 mg. Riboflavin - 3 mg. which is usually applied over the crusts is useless and possibly harmful. Pyridoxine hydrochloride - 0.5 mg. Potassium iodide - 0.15 mg. Two instances of atopic eczema were seen in children. Corneal scars Potassium sulfate - 5 mg. were not common and were generally seen in subjects 10 years of age and Vitamin B12 - 2 mcg. Copper sulfate - 1 mg. over but not in younger children, and no active phlyctenular Folic acid - 100 mcg. Niacinamide - 25 mg. Magnesium oxide - 6 mg. Calcium pantothenate - 5 mg. Zinc sulfate - 1.5 mg. Source: 47 keratoconjunctivitis was seen. The teeth were generally carious in the FIGURE VIII children, and worn but intact in people past 30. Some skin dryness was noted in children but no follicular hyperkeratosis was seen. One woman of 40 with aortic insufficiency and mitral stenosis was examined. A recent history of migratory arthritis was elicited in one youth. He showed no signs of carditis. Prophylactic penicillin was recommended. Napaskiak is a village of 152 persons on the south bank of the Kuskokwim River eight miles below Bethel. It has close contact with Bethel. Two other Eskimo villages are in the vicinity -- Oscarville, across the river, and Napakiak, down river. River fishing is the attraction. Napaskiak has been moved in recent-times from a nearby and ancient site that had become susceptible to flooding due to channel changes of the river. Napaskiak has one of the few remaining "medicine men" or shaman (Frontispiece). The role of this man in the communi ty' health could not be determined. There were great extremes in the families here, some being thin, while others were well fed. The thin families were usually dirty. The teacher gives 60 children their lunch at 8:30 a.m. Half then go home and return for an afternoon teaching session. The others remain for the morning session. All students receive a multivitamin tablet in school each day. This village has been included in a tuberculosis prophylaxis pro- gram since early 1958. A program for control of tuberculosis by ambulatory chemotherapy was begun in 1953 as a result of a recommendation of the Pittsburgh Health Survey(7) to the Secretary of the Interior. At the time of its inception the program was ambulatory because there DENTAL ATTRITION IN A 32-YEAR-OLD - were not enough hospital beds for all those needing the therapy. When ESKIMO WOMAN more beds were available more of those who needed hospital treatment were admitted. The prophylactic control study mentioned at the begin- ning of this paragraph was started in 1958 as a separate project under the direction of Dr. George Comstock, Tuberculosis Control Program, Bureau of State Services of the U.S. Public Health Service. This is a research study on the prophylactic use of isoniazid being conducted in selected parts of the U.S., Alaska and Puerto Rico. Every person in the villages selected for the study is given medication each day for one year, half receiving isoniazid at a level of about 5 mg per kilogram of body weight and half receiving a placebo. All told about 0,000 people are participating in this study. It is hoped to measure the suppressive action of such medication upon the incidence of tuberculosis. No signs of isoniazid-induced seborrhea or dermatitis were seen in this or any village, although perhaps as many as 10 percent of the total native population are on isoniazid therapy. The teeth were carious in Napaskiak except among people over 40 years of age. Exceptions to this were seen in a few Kipnuk women who had come here from the coast after marriage and generally had fine teeth. Again several cases of atopic eczema were seen. The teacher believes it is increasing in frequency. The males showed signs of the effects of taking steam baths (petechiae on the backs and shoulders), Source: ittps://www.industrydocuments.ucsf.edu/docs/zznc022 48 49 but the women and children did not. Petechiae occurred commonly among The school lunch program and daily vitamin pill are administered older male children and adults but was uncommon in children under 10. here. Because of exceptionally good sealing, the people appeared pros- No active keratitis was seen. Corneal scarring seemed to occur in perous and adequately nourished. There were many plump women and families; dry skin and follicular changes were uncommon. The adult children. Teeth were good but worn in people past 20 years of age and women often seemed pale. Tongue papillation was good. An old man with carious in many children. There were many corneal scars, again seen in aortic stenosis was examined but heart murmurs were generally rare. families and generally in people 12 to 20 years old. Children under A sick baby was brought back with the party to the Bethel Hospital and 12 were not often so affected. Many of the women were pregnant. Some a diagnosis of meningococcal meningitis was confirmed. After a stormy evidence of hypochondriasis was noted in adults. There was a single course she recovered. Prophylactic sulfadiazine seemed to prevent instance of goiter, a large soft gland in a 40 year old woman who had additional cases in the village. This treatment was arranged by radio a history of thyrotoxicosis treated with N-propylthiouracil. Scleral communication from Bethel after the bacteriologic diagnosis was thickening in the palpebral fissures and pingueculae were noted in many established. individuals. Here as in the other villages it was apparent that dental fillings meant tuberculosis because almost the only people who had had Newktok is an isolated village of 121 coastal Eskimos about 120 dental care were those who had gone outside for tuberculosis therapy miles west of Bethel on the tundra, a few miles from Baird Inlet and the Bering Sea. The nearest postoffice is at Tanunak, 40 miles to the 2. Kotzebue Area - the Situation in Noatak, Point Hope, Shishmaref, southwest on Nelson Island. There were many sod houses in the village. Allakaket and Huslia The people at Newktok seemed very primitive; their faces were The Kotzebue phase of the present study centered among the northern Mongoloid with prominent epicanthal folds. Very few could speak English. or Arctic Eskimos who are for present purposes considered to be in Their clothing was worn and poor. Both people and dogs were thin. The ethnic area III (see Figure III). The Kotzebue study also included sleds were hand-hewn and lashed together with thongs. In one sod house observations in two Indian villages in the mountains of the middle Yukon the children were seen to scoop a frozen blackfish out of a tub in the region lying in area IV. anteroom and swallow it with a minimum of chewing. The lids were off the cans containing flour and sugar, and the contents were spread about The Eskimos north of Norton Sound (Nome) are much more sparsely the table top as though the children had been eating directly from the distributed. The principal activity of the males is hunting, and seal, cans. Since this was the first tolerable weather for a week, the men walrus and several species of whale are the chief game. The Eskimos were away sealing. along the Arctic coast find the whale kill highly variable since it depends strictly upon weather and hunting conditions. Polar bear have Many of the children in this village were grossly underfed, and always been important not only as a source of food for man and dogs, but pale and thin. Several families were heavily infested vith head lice. also as a source of income from sale of skins. St. Lawrence Island has With a few exceptions, the teeth were excellent. There were several an abundant supply of walrus in the spring, a good source of both meat slightly but definitely enlarged thyroid glands observed but no gross and ivory. The people of St. Lawrence Island, Diomede Island and King goiters. Many children had marked follicular hyperkeratosis and many Island are well known for their fine ivory carving which provides them others had dry skin. There were several adults with Bitot's spots. with an important part of their cash income. The materials they make No signs of water-soluble vitamin deficiency or of scurvy were seen. are taken to Nome in the summer and marketed. Hooper Bay is an ancient Eskimo settlement on the Bering Sea south The Arctic fox is trapped on the ice pack for its fur but neither of Cape Romanzof, with a population of 430. It is located on two low this nor any other land carnivore is used for food except in dire hills at the tip of a spit of land which encloses Hooper Bay from the emergency. The polar bear is a partial exception, for its meat is often north. The main source of livelihood is the sea, especially sealing. eaten, although the liver seems never to be eaten and is widely regarded There are many dog teams for hauling the skin boats and meat to and from as poisonous. There is a collection of recent evidence to support the the open water a few miles away. Water is obtained by melting ice from idea that polar bear liver is, in fact, poisonous for human consumption. a fresh-water pond a few miles back of the village on the tundra. Fuel Dr. William Rausch of the Arctic Health Research Center on one occasion is obtained from driftwood which is now plentiful, coming largely from ate 100 grams of polar bear liver and immediately became ill. Dr. the mouth of the Yukon which lies to the north. The houses are well Edward Scott of the same institution fed polar bear liver to white mice built but without a semblance of orderly arrangement either among houses and an equivalent amount of vitamin A from fish oil to a control group or within them. The indoor temperatures and humidity are very high. of mice. Both groups of mice died (19). The concept of the toxicity of These, together with many unwashed Eskimos, unbutchered seals, drying polar bear liver and that it is due to an excessive vitamin A content skins and oozing seal oil pokes, produce an overpowering atmosphere for is widely accepted in scientific circles in Alaska. a white person. Source: https://www.industrydocuments.ucsi.edu/docsizznc022 50 51 The Indian villages, Huslia and Allakaket, which were included in before he goes out on the ice pack for the day, or takes no more than a the present study, are settlements on the Koyukuk River. These people cup of tea or coffee. He believes eating would make him sluggish, less are Athabascan Indians who range through the forested and mountainous agile and less acute. Since he may stay out one to three days under areas of northwestern Alaska. Their principal activity is trapping rigorous conditions of activity and temperature, it is clear that he has beaver, mink and muskrat. The beavers are taken through holes in the both great stamina and efficient gluconeogenesis. When he returns he ice in the late winter and spring with snares which are baited with takes a very large meal. This ability to carry on while fasting may be willow twigs. Each trapper is allowed a seasonal limit of 20 beavers which average $40 per pelt. The beaver is a large animal weighing 30 related physiologically to the ability to consume a very high fat, high protein, low carbohydrate diet. It may also be a factor in prohibiting to 60 pounds, and is widely used for food. The meat is said to resemble youths (who might be more susceptible to ketosis) from going out on the pork. The skins are stretched flat in an almost perfect circle for ice pack. drying and are hauled about in large wafer-like stacks wrapped in burlap. The sampling procedures in the Kotzebue area were carried out as Caribou are migratory animals taken seasonally and somewhat unpre- described for the Bethel study above. Clinical studies were done on dictably. Their meat is dried in the sun for storage in caches and the all persons 2 years of age and over; blood and urine samples were ob- skins are widely used for clothing. tained from all persons 6 years and over, the urine samples being clean catch samples. In the Kotzebue area those members of the National Guard Fish are taken from the rivers with nets or fish wheels, a white who were home were excluded from the village examinations in order for man's invention and a useful one, for -- powered by the current -- it them to be seen at Camp Denali with their battalion. scoops up the teeming fish and deposits them in a tub requiring the fisherman only to empty the tub once he has properly placed the wheel Noatak is a village of 300 Eskimos on the Noatak River 60 niles and the diversionary fence. north of Kotzebue. The food supply at Noatak is largely caribou which are hunted inland on the tundra, fish from the Noatak River, and seal The northern Eskimos have been more exposed to the white man than and beluga whale from Kotzebue Sound. The teacher at Noatak gives each have the southern Eskimos through efforts of 18th century sailors to school child a lunch and a vitamin pill every school day. The principal find a Northwest Passage, and subsequently through the extensive whaling clinical impairments found here were carious teeth and follicular activities which took place in the Arctic Ocean. Contacts with sailing hyperkeratosis. ships reached a maximum in the middle of the 19th century. Possibly as a consequence, the northern Eskimos are advanced at least a generation Point Hope, which the natives call Tigara, often experiences severe over the Kuskokwim people in their cultural adaptation to the white race. Almost all speak English; they tend more strongly to adopt white men's weather. It is the main polar bear-hunting area for sportsmen, an clothing and habits of food and often have noticeable admixtures of white activity which is a source of income for the Eskimos. A typical polar blood as reflected in coloration and conformation. The northern Eskimos bear hunt has facetiously been described as follows: The sportsman are larger and less Asiatic-appearing than the southern Eskimos, although pays $2, ,500 and is guaranteed a bear. The hunter and his pilot go out there are many exceptions to this generalization. Some of the village over the ice pack in a light plane until they spot a bear which they sites, such as that at Shishmaref Inlet, are very old, dating back 500 pursue in the plane until it falls exhausted on the ice. They then years or more. The attraction of these sites can only have been their land, shoot the bear and take the skin. The sport seems more expensive than dangerous. convenience to the essential food supply. Eskimo villages are sometimes moved, but generally only to a better food supply. The main articles in the diet at Point Hope are seal and whale meat with some bear meat and fish. Caribou are taken in the fall and Hunting on the ice pack is a dangerous occupation and the extent of this danger varies in different areas depending upon currents and weather winter. The whale meat collected in the spring is cut up and stored conditions. In the Hooper Bay area young men do not go on the hunting in pits in the permafrost for later use. This natural refrigeration expeditions until they are about 18 years of age. North of Bering Strait and not the perpetual cold, for the summers are actually quite warm they. go at 15 years. Since these boys are physically well developed at is the basis for the legendary test of salesmanship in Alaska. A few Eskimos do have refrigerators, especially the traders. Many Eskimos 15 years it appears that a maturation of judgment is recognized as es- sential. The active hunters are men 20 through 45 years, older hunters have outboard motors. Almost every Eskimo boy dreams of becoming an airplane pilot. The men are clever mechanics and are said to have being rare. fashioned broken motor parts from ivory or bone when metal replacements were unavailable. These Eskimo men stripped down resemble professional athletes. They are heavily muscled, relaxed and loose-jointed, and have the ap- pearance of finely trained men. Unlike the white man's concept of Sod houses are common in Point Hope. Alaskan Eskimos never build snow igloos except to amuse visitors from the outside and the results preparation for a physical ordeal, the Eskimo either does not eat are often ludicrous. Whale ribs are often used for rafters for sod houses. No village planning is discernible. Snow drifts range up to 25 feet after a storm and the children slide down these on short baleen skis. Source: https://www.industrydocuments.ucst.edu/docsizznc0227 52 The children receive a school lunch and a daily multivitamin tablet. Clinical examinations here revealed many carious teeth and much follicular hyperkeratosis. Shishmaref is a village of 200 people on a small island just off Shishmaref Inlet. The principal food is seal, which was plentiful during the winter preceding the survey, since the pack ice had been pushed toward the Siberian side by favorable winds. Some fish are also available. Many carious teeth were seen here and there was much dental attrition. Follicular hyperkeratosis was common. A school lunch and multivitamin pill are given to the children. Allakaket is an Indian village of 100 people 150 miles north of Tanana. It consists of 10 to 15 log cabins, a school and an Episcopal Church. The main occupations and food sources are moose hunting, fishing and beaver snaring with a wire loop snare. The trap lines are 50 to 150 miles in length. The calorie supply seemed limited in this village. The teeth were carious and follicular hyperkeratosis was common. Some filiform atrophy of the tongue was also noted, although it was of mild degree. No evidence of goiter was seen. One 18 month old child with rickets was seen here. Huslia is an Indian village of 137 people. The diet consists mainly of beaver, dried fish, moose and caribou. Moose meat is much like beef in form and flavor while caribou is distinctive, resembling mutton. The calorie intake at Huslia seemed marginal, since many people were thin and the children appeared stunted. Follicular hyper- keratosis was common. The teeth were carious. This is the home of the most f'amous sled dog racer in Alaska, George Atla, known as the "Huslia Hustler. The schools in these two Indian villages do not give the children school lunches or vitamin supplements. 3. Clinical Findings in the Villages Since the men in the National Guard had recently come from the villages they were also representative of those nutritional environments. However, the 713 men came from 55 villages. The number from each vil- lage was thus so small that no useful purpose was served by relating them to their village of origin. An exception is Point Barrow, from which there were 69 men in the Guard. Throughout the evaluation of the data this axis of analysis has been considered, however (see Table 10, which presents selected clinical findings for men in the two battalions according to their area of origin). A summary of the clinical findings in the villages is shown in Table 17. The northern and southern areas are shown separately, but all ages and both sexes are combined. This summary emphasizes certain negative findings. There was no scurvy and no gross inanition, although in certain villages, especially Newktok, the people seemed by their thinness to be Source: https:/lwww.industrydocuments.ucsi.edu/docsizznc0227 TABLE 17 ESKIMO AND INDIAN VILLAGES IN ALASKA, 1958, PERCENT PREVALENCE OF CLINICAL FINDINGS Bethel Area - Examiner # 1 Kotzebue Area - Examiner # 2 Villages / 1 2 3 4 5 Total 6 7 8 9 10 Total Number Examined 76 94 81 59 96 406 69 88 77 75 90 399 Suspected Tuberculosis Disease 30.3 10.6 7.4 8.5 12.5 13.8 5.8 10.2 6.5 6.7 2.2 6.3 General Good 82.9 87.2 79.0 66.1 82.3 80.5 98.6 100.0 98.7 98.7 100.0 99.2 Appearance Fair 17.1 9.6 14.8 25.4 16.7 16.0 1.4 0.0 1.3 1.3 0.0 0.8 Poor 0.0 3.2 6.2 8.5 1.0 3.4 0.0 0.0 0.0 0.0 0.0 0.0 Hair Staring hair 0.0 0.0 0.0 18.6 0.0 2.7 0.0 0.0 0.0 0.0 0.0 0.0 Glands Thyroid 3.9 0.0 2.5 10.2 4.2 3.7 1.4 0.0 0.0 0.0 0.0 0.3 Enlarged Submaxillary 0.0 1.1 0.0 0.0 0.0 0.2 5.8 6.8 3.9 1.3 2.2 4.0 Nasolabial seborrhea 0.0 0.0 0.0 0.0 0.0 0.0 5.8 2.3 2.6 0.0 1.1 2.3 54 Skin- Other seborrhea 0.0 0.0 1.2 0.0 0.0 0.2 1.4 0.0 1.3 0.0 0.0 0.5 Face & Neck Erythema 14.5 25.5 7.4 61.0 17.7 23.2 11.6 21.6 33.8 5.3 3.3 15.0 Pigmentation 0.0 2.1 2.5 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 Thickened conjunctivae 7.9 6.4 16.0 13.6 15.6 11.8 7.2 5.7 10.4 8.0 11.1 8.5 Pingueculae 31.6 31.9 22.2 27.1 28.1 28.3 34.8 27.3 28.6 29.3 14.4 26.3 Bitot's spots 0.0 0.0 0.0 3.4 0.0 0.5 0.0 0.0 0.0 0.0 0.0 0.0 Eyes Circumcorneal injection 0.0 0.0 0.0 0.0 1.0 0.2 0.0 1.1 0.0 0.0 0.0 0.3 Conjunctival injection 3.9 0.0 2.5 5.1 1.0 2.2 0.0 5.7 0.0 0.0 0.0 1.3 Blepharitis 0.0 0.0 0.0 8.5 0.0 1.2 0.0 2.3 0.0 0.0 0.0 0.5 Corneal scarring 21.1 12.8 11.1 20.3 9.4 14.3 8.7 5.7 5.2 4.0 7.8 6.3 Angular lesions 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Lips Angular scars 0.0 0.0 0.0 1.7 0.0 0.2 2.9 0.0 0.0 0.0 0.0 0.5 Cheilosis 0.0 0.0 1.2 0.0 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 TABLE 17 (continued) Filiform atrophy, sl. 9.2 6.4 9.9 13.6 6.2 8.6 7.2 4.5 2.6 12.0 5.6 6.3 Filiform atrophy, mod. 3.9 0.0 2.5 1.7 0.0 1.5 0.0 0.0 0.0 2.7 0.0 0.5 Fungiform atrophy 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Papillary hypertrophy 0.0 0.0 0.0 0.0 1.0 0.2 1.4 2.3 1.3 0.0 1.1 1.3 Furrows 1.3 7.4 9.9 3.4 3.1 5.2 4.3 2.3 2.6 2.7 1.1 2.5 Tongue Fissures, erosions, ulcers 1.3 1.1 1.2 0.0 0.0 0.7 0.0 0.0 0.0 0.0 0.0 0.0 Serrations or swellings 0.0 6.4 3.7 0.0 0.0 2.2 0.0 0.0 0.0 1.3 3.3 1.0 Red, tip, or lat. margins 3.9 4.3 4.9 0.0 0.0 2.7 0.0 0.0 0.0 0.0 0.0 0.0 Geographic tongue 1.3 0.0 1.2 0.0 3.1 1.2 2.9 0.0 3.9 0.0 0.0 1.3 Red or swollen 1.3 3.2 9.9 8.5 7.3 5.9 17.4 2.3 7.8 13.3 18.9 11.8 Gums Atrophy or recession 9.2 8.5 16.0 1.7 5.2 8.4 23.2 19.3 27.3 17.3 18.9 21.1 Bleeding gums 0.0 0.0 0.0 0.0 0.0 0.0 1.4 0.0 0.0 0.0 4.4 1.3 Unfilled caries 30.3 60.6 48.1 23.7 31.2 40.1 31.9 40.9 58.4 34.7 47.8 43.1 Filled caries 17.1 9.6 13.6 0.0 12.5 11.1 46.4 23.9 11.7 9.3 13.3 20.3 No carious teeth -5550.031.944.476.357.350.223.237.529.957.3 41.1 38.1 Tee th Caries, filled or 1-2 13.2 7.4 6.2 3.4 7.3 7.6 24.6 18.2 28.6 21.3 22.2 22.8 unfilled 3-4 18.4 36.2 24.7 11.9 24.0 24.1 23.2 23.9 20.8 14.7 22.2 21.1 SS 5+ 11.8 23.4 23.5 8.5 11.5 16.3 24.6 18.2 18.2 6.7 14.4 16.3 Edentulous 6.6 1.1 1.2 0.0 0.0 1.7 4.3 2.3 2.6 0.0 0.0 1.8 Worn 30.3 33.0 35.8 23.7 29.2 30.8 14.5 12.5 27.3 12.0 6.7 14.3 0.0 0.0 Fluorosis 0.0 0.0 0.0 0.0 1.0 0.2 0.0 0.0 0.0 0.0 Malposition 2.6 1.1 12.3 6.8 12.5 7.1 0.0 0.0 1.3 0.0 0.0 0.3 Follicular hyperkeratosis 3.9 1.1 1.2 10.2 0.0 2.7 40.6 34.1 20.8 20.0 45.6 32.6 10.4 0.0 0.0 0.0 0.0 0.0 0.0 Xerosis 19.7 21.3 11.1 22.0 16.5 Skin- Acneform eruption 0.0 1.1 1.2 0.0 2.1 1.0 0.0 0.0 1.3 0.0 1.1 0.5 Thickened press. points 1.3 2.1 0.0 0.0 0.0 0.7 0.0 0.0 1.3 0.0 0.0 0.3 General 0.0 0.0 1.0 0.5 0.0 0.0 0.0 0.0 0.0 0.0 Purpura or petechia 0.0 1.1 Hyperpigmentation 2.6 0.0 0.0 0.0 3.1 1.2 0.0 1.1 0.0 0.0 0.0 0.3 Abdomen Hepatomegalia 0.0 0.0 2.5 5.1 0.0 1.2 Examination of abdomen and Lower extremities omitted. Lower Extremities Loss of ankle jerk 1.3 0.0 1.2 1.7 0.0 0.7 1 No findings of enlarged parotids, xerophthalmia, magenta tongue, "scorbutic-type' gums, crackled skin, pellagrous 2) Villages referred to by number: Southern Eskimos: 1. Akiak 2. Kasigluk 3. Napaskiak 4. Newktok 5. Hooper Bay lesions, splenomegalia, ascites, or calf tenderness. Scrotal dermatitis not examined for Northern Eskimos: 6. Noatak 7. Point Hope 8. Shishmaref Athabascan Indians: 9. Huslia 10. Allakaket Source. Ittps://www.industrydocuments.ucsf.edu/docs/zznc022

Mention the heading of first age group mentioned under "Calorie allowances"?

mgxh0227

mgxh0227_p0, mgxh0227_p1, mgxh0227_p2, mgxh0227_p3, mgxh0227_p4, mgxh0227_p5, mgxh0227_p6, mgxh0227_p7, mgxh0227_p8, mgxh0227_p9, mgxh0227_p10

25 YEARS, 25 years

SCIENTIFIC BASES FOR THE RECOMMENDED ALLOWANCE 47 L CALORIES dedail (over) Calorie allowances have been established in all previous editions of Recommended Dietary Allowances with the objective of provision of energy in amounts sufficient when consumed over an extended period to maintain body weight or rates of growth at levels most conducive to well being and health. This general principle is reaffirmed and allowances have been carefully reevaluated with consideration of the results of a large number of investigations of human energy requirements. Qalorie állowances were modified in the last revision of had been Recommended Dietary Allowances to conform with certain standards and conditions established by the Food and Agricultural Organization of the United Nations through its International 8 Committee on Calorie Requirements + A second FAO Report on Calorie Requirements has recently been published in which a number of modifications have been made in the specification 9. of calorie requirements I. These have been considered in the preparation of this revision of Recommended Dietary Allowances. Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 2 - In specifying requirements for calories for individuals, the FAO committee utilized the device of the "reference" man and woman, both aged 25 and living in a temperate climate with a mean annual external of 10 degrees Centigrade. The weight of the "reference man" was given as 65 kilograms and was 55 kólograms for the "reference woman". Recommended Dietary Allowances adapted the same basis of reference in its 1953 revision. These characteristics cannot be considered average 10 for the young adult population of the United States, however. Therefore, in the present statement certain adaptations have been made to permit establishment of reference conditions more nearly conforming with United States standards of body size and living conditions. The "reference" man is again taken as of age 25 but the weight is given as 70 kólograms which would seem to be more nearly descriptive of the average young male in this population. Similarly, the "reference" woman is described as being 25 years of age but weighing 58 kólograms. Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 3 - Another modification is to establish allowances assuming that individuals are living in an environment with a mean environ- o C mental temperature of 20 degrees centigrade rather than the lower temperature given by FAO. This would again seem to be a more realistic description of the mean environmental temperature of most of the population of the United States. Both man and woman are presumed to lead a vigorous, healthy life and to be moderately active physically, with occupations which could not be described either as sedentary or as hard physical labor. The man would be likely to be in light industry or employed as delivery man, painter or outdoor salesman. The woman might be homemaker, saleswoman or bench worker in a factory. The daily allowances/ as derived for the "reference man" is 3200 calories and for the "reference" woman is 2300 calories. It should be realized that adjustments must be made in calorie allowances when individuals or population averages differ from the "reference" in characteristics of age, body Source: https://www.industrydocuments.ucst.edu/docs/mgxh0227 - 4 - size, climate or activity. Procedures for these adjustments are described below. Adjustments of Calories for Age - - Energy requirements decline progressively after the years of early adulthood, because of a decrease in basal metabolic rate as well as lessened physical activity. It is proposed that calorie allowances be reduced by 3 per cent per decade between ages 30 and 50 and by 7.5 per cent per decade from age 50 to 70. A further decreasement of 10 per cent is recommended for the years from 70 to 80. These adjustments are in accord with 9 FAO recommendations X Accordingly, the calórie allowances at age 45 are 6 per cent less than at age 25 and at age 65 are 21 per cent less (See Tolile II ). Adjustment for Body Size - - Calorie allowances must be adjusted for the variations in energy requirements which result from differences in body size. Therefore, in utilizing the allowances giver in the table, larger allowances must be Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 5 - derived for individuals of body size greater than indicated for the reference man and woman and smaller allowances should be prescribed for those of smaller size. In adapting allowances for differences in size, weight may be used as a basis provided the subjects are not overweight or underweight. Maximum body length (height) is usually attained by age 20 or shortly there- after, but in the United States the average person tends to continue to gain in body weight until about 60 years of age. Life insurance and other data indicate that these weight gains are undesirable and that the most favorable health expectation is associated with conditions under which weight as normally achieved by age 25 or 30 is maintained throughout later bife. Therefore, in these recommendations the calorie allowances for adults pertain not to actual body weight of individuals or groups but to desirable body weight (the average weight separd of individuals of given height at age 25). Table I may be used as a guide for this use and adaptation. Heights and weights Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 TABLE II Individuals Marious Calorie / allowances for men of Marred Body Weights and age 15 (as meanenvermental temperature 32 of 20 Centegrade and assuming moderate physics activity I MEN Calorie allowances Deserable Weight Kelogram Pounds 25 years 45 years 65 years 50 110 2500 2350 1950 55 121 2700 2550 2150 60 132 2850 2700 2250 65 143 3000 2800 2350 70 154 3200 3000 2550 75 165 3400 3200 2700 80 176 3550 3350 2800 85 187 3700 3500 2900 Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227 (tableth Calorie Allowanes for Women of Various Body Weight and age WOMEN 63 Deserable Weight Cultrie allowares 22 45 58 Pounds 70 Kelograms 25 years 45 15 years 65 years 40 88 1750 1650 1400 45 99 1900 1800 1500 50 110 2050 1950 1600 5T5 121 2200 2050 1750 58 128 2:300 2200 1800 60 132 2350 2200 1850 65 143 2500 2350 2000 70 154 2600 2450 2050 75 165 2750 2600 2150 Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 6 - usually as recorded include usual clothing worn indoors and shoes with one-inch - heels. ( Quest Table altop of page 5 To adapt calorie allowances for individuals whose weight and height are different from those of the reference man and a woman, the following formulae have been utilized 1, Calorie allowance for men - - - 815 + 36.6 W* Calorie allowance for women - - 580 + 31.1 W* * W = desirable body weight in kilograms By such adaptation the allowances for 25 year old men weighing 50, 60 and 80 kilograms would be 2500, 2850, and 3550 calories respectively. Women of the same age weighing 40, 50, 60 and 70 kilograms would receive 1750, 2050, 2350, and 2600 calories respectively. Adjustment by weight in pounds to other body sizes may be facilitated by reference to Table II . (Insert Table II) Adjustment of Calories for Climate - Standard conditions for estimating calorie allowances include mean environmental C temperature of 20° centigrade rather than 10° centigrade as Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227 - 7 - established by the FAO committee which was utilized in the 1953 revision of Recommended Dietary Allowances. It seems probable that most persons in the United States live in an environment with a mean temperature of approximately 20° centigrade. Most are protected against the effects of cold by warm clothes, central heating and heated means of transportation. Many also live and work in ir-conditioned atmospheres so that the effects of high temperatures are partially but not so completely ameliorated. If the external temperature varies widely from the standard, 2 corrections in calorie allowances may be made. For lower tempera- tures there is need for an increase in allowance. To accomplish increased this the allowance should be /reduced/by 5% for the first ten C degree centigrade decrease from the standard of 20° centigrade and by 3% for each additional ten degree decrease. Similarly, allowances should be reduced for high environmental temperatures and the reduction should be 5% for each increase of ten degrees Source: https://wwww.industrydocuments.ucsf.edu/docs/mgxh0227 - 8 - centigrade above the standard temperature, (20%). These adjustments are devised specifically for application to differences in mean annual temperature, but they may well serve for adjustment to seasonal differences as well. In various parts of the United States the difference in mean winter and summer temperatures may range from 10 degrees C to centegrade 30 degrees C. This would indicate corrections of from 5 to 15 per cent in the calorie allowances according to conditions. It should be observed that all adjustments for climate pre- suppose an ordinary amount of actual exposure to the climate. For persons spending most of their time out of doors, these adjustments may be insufficient, particularly during winter in the Northern and Central States. It is obvious that people who spend almost all their time in well heated buildings during the winter will not need the extra food calories required by individuals less effectively sheltered. When applying these adjustments of allowances for individuals or groups, duration Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 9 - of exposure to outside weather should be ascertained and taken into account. Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227

Provide the first "Calorie allowances" value given under 45 years?

mgxh0227

mgxh0227_p0, mgxh0227_p1, mgxh0227_p2, mgxh0227_p3, mgxh0227_p4, mgxh0227_p5, mgxh0227_p6, mgxh0227_p7, mgxh0227_p8, mgxh0227_p9, mgxh0227_p10

2350

SCIENTIFIC BASES FOR THE RECOMMENDED ALLOWANCE 47 L CALORIES dedail (over) Calorie allowances have been established in all previous editions of Recommended Dietary Allowances with the objective of provision of energy in amounts sufficient when consumed over an extended period to maintain body weight or rates of growth at levels most conducive to well being and health. This general principle is reaffirmed and allowances have been carefully reevaluated with consideration of the results of a large number of investigations of human energy requirements. Qalorie állowances were modified in the last revision of had been Recommended Dietary Allowances to conform with certain standards and conditions established by the Food and Agricultural Organization of the United Nations through its International 8 Committee on Calorie Requirements + A second FAO Report on Calorie Requirements has recently been published in which a number of modifications have been made in the specification 9. of calorie requirements I. These have been considered in the preparation of this revision of Recommended Dietary Allowances. Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 2 - In specifying requirements for calories for individuals, the FAO committee utilized the device of the "reference" man and woman, both aged 25 and living in a temperate climate with a mean annual external of 10 degrees Centigrade. The weight of the "reference man" was given as 65 kilograms and was 55 kólograms for the "reference woman". Recommended Dietary Allowances adapted the same basis of reference in its 1953 revision. These characteristics cannot be considered average 10 for the young adult population of the United States, however. Therefore, in the present statement certain adaptations have been made to permit establishment of reference conditions more nearly conforming with United States standards of body size and living conditions. The "reference" man is again taken as of age 25 but the weight is given as 70 kólograms which would seem to be more nearly descriptive of the average young male in this population. Similarly, the "reference" woman is described as being 25 years of age but weighing 58 kólograms. Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 3 - Another modification is to establish allowances assuming that individuals are living in an environment with a mean environ- o C mental temperature of 20 degrees centigrade rather than the lower temperature given by FAO. This would again seem to be a more realistic description of the mean environmental temperature of most of the population of the United States. Both man and woman are presumed to lead a vigorous, healthy life and to be moderately active physically, with occupations which could not be described either as sedentary or as hard physical labor. The man would be likely to be in light industry or employed as delivery man, painter or outdoor salesman. The woman might be homemaker, saleswoman or bench worker in a factory. The daily allowances/ as derived for the "reference man" is 3200 calories and for the "reference" woman is 2300 calories. It should be realized that adjustments must be made in calorie allowances when individuals or population averages differ from the "reference" in characteristics of age, body Source: https://www.industrydocuments.ucst.edu/docs/mgxh0227 - 4 - size, climate or activity. Procedures for these adjustments are described below. Adjustments of Calories for Age - - Energy requirements decline progressively after the years of early adulthood, because of a decrease in basal metabolic rate as well as lessened physical activity. It is proposed that calorie allowances be reduced by 3 per cent per decade between ages 30 and 50 and by 7.5 per cent per decade from age 50 to 70. A further decreasement of 10 per cent is recommended for the years from 70 to 80. These adjustments are in accord with 9 FAO recommendations X Accordingly, the calórie allowances at age 45 are 6 per cent less than at age 25 and at age 65 are 21 per cent less (See Tolile II ). Adjustment for Body Size - - Calorie allowances must be adjusted for the variations in energy requirements which result from differences in body size. Therefore, in utilizing the allowances giver in the table, larger allowances must be Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 5 - derived for individuals of body size greater than indicated for the reference man and woman and smaller allowances should be prescribed for those of smaller size. In adapting allowances for differences in size, weight may be used as a basis provided the subjects are not overweight or underweight. Maximum body length (height) is usually attained by age 20 or shortly there- after, but in the United States the average person tends to continue to gain in body weight until about 60 years of age. Life insurance and other data indicate that these weight gains are undesirable and that the most favorable health expectation is associated with conditions under which weight as normally achieved by age 25 or 30 is maintained throughout later bife. Therefore, in these recommendations the calorie allowances for adults pertain not to actual body weight of individuals or groups but to desirable body weight (the average weight separd of individuals of given height at age 25). Table I may be used as a guide for this use and adaptation. Heights and weights Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 TABLE II Individuals Marious Calorie / allowances for men of Marred Body Weights and age 15 (as meanenvermental temperature 32 of 20 Centegrade and assuming moderate physics activity I MEN Calorie allowances Deserable Weight Kelogram Pounds 25 years 45 years 65 years 50 110 2500 2350 1950 55 121 2700 2550 2150 60 132 2850 2700 2250 65 143 3000 2800 2350 70 154 3200 3000 2550 75 165 3400 3200 2700 80 176 3550 3350 2800 85 187 3700 3500 2900 Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227 (tableth Calorie Allowanes for Women of Various Body Weight and age WOMEN 63 Deserable Weight Cultrie allowares 22 45 58 Pounds 70 Kelograms 25 years 45 15 years 65 years 40 88 1750 1650 1400 45 99 1900 1800 1500 50 110 2050 1950 1600 5T5 121 2200 2050 1750 58 128 2:300 2200 1800 60 132 2350 2200 1850 65 143 2500 2350 2000 70 154 2600 2450 2050 75 165 2750 2600 2150 Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 6 - usually as recorded include usual clothing worn indoors and shoes with one-inch - heels. ( Quest Table altop of page 5 To adapt calorie allowances for individuals whose weight and height are different from those of the reference man and a woman, the following formulae have been utilized 1, Calorie allowance for men - - - 815 + 36.6 W* Calorie allowance for women - - 580 + 31.1 W* * W = desirable body weight in kilograms By such adaptation the allowances for 25 year old men weighing 50, 60 and 80 kilograms would be 2500, 2850, and 3550 calories respectively. Women of the same age weighing 40, 50, 60 and 70 kilograms would receive 1750, 2050, 2350, and 2600 calories respectively. Adjustment by weight in pounds to other body sizes may be facilitated by reference to Table II . (Insert Table II) Adjustment of Calories for Climate - Standard conditions for estimating calorie allowances include mean environmental C temperature of 20° centigrade rather than 10° centigrade as Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227 - 7 - established by the FAO committee which was utilized in the 1953 revision of Recommended Dietary Allowances. It seems probable that most persons in the United States live in an environment with a mean temperature of approximately 20° centigrade. Most are protected against the effects of cold by warm clothes, central heating and heated means of transportation. Many also live and work in ir-conditioned atmospheres so that the effects of high temperatures are partially but not so completely ameliorated. If the external temperature varies widely from the standard, 2 corrections in calorie allowances may be made. For lower tempera- tures there is need for an increase in allowance. To accomplish increased this the allowance should be /reduced/by 5% for the first ten C degree centigrade decrease from the standard of 20° centigrade and by 3% for each additional ten degree decrease. Similarly, allowances should be reduced for high environmental temperatures and the reduction should be 5% for each increase of ten degrees Source: https://wwww.industrydocuments.ucsf.edu/docs/mgxh0227 - 8 - centigrade above the standard temperature, (20%). These adjustments are devised specifically for application to differences in mean annual temperature, but they may well serve for adjustment to seasonal differences as well. In various parts of the United States the difference in mean winter and summer temperatures may range from 10 degrees C to centegrade 30 degrees C. This would indicate corrections of from 5 to 15 per cent in the calorie allowances according to conditions. It should be observed that all adjustments for climate pre- suppose an ordinary amount of actual exposure to the climate. For persons spending most of their time out of doors, these adjustments may be insufficient, particularly during winter in the Northern and Central States. It is obvious that people who spend almost all their time in well heated buildings during the winter will not need the extra food calories required by individuals less effectively sheltered. When applying these adjustments of allowances for individuals or groups, duration Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 9 - of exposure to outside weather should be ascertained and taken into account. Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227

Provide the first "Calorie allowances" value given under 65 years?

mgxh0227

mgxh0227_p0, mgxh0227_p1, mgxh0227_p2, mgxh0227_p3, mgxh0227_p4, mgxh0227_p5, mgxh0227_p6, mgxh0227_p7, mgxh0227_p8, mgxh0227_p9, mgxh0227_p10

1950

SCIENTIFIC BASES FOR THE RECOMMENDED ALLOWANCE 47 L CALORIES dedail (over) Calorie allowances have been established in all previous editions of Recommended Dietary Allowances with the objective of provision of energy in amounts sufficient when consumed over an extended period to maintain body weight or rates of growth at levels most conducive to well being and health. This general principle is reaffirmed and allowances have been carefully reevaluated with consideration of the results of a large number of investigations of human energy requirements. Qalorie állowances were modified in the last revision of had been Recommended Dietary Allowances to conform with certain standards and conditions established by the Food and Agricultural Organization of the United Nations through its International 8 Committee on Calorie Requirements + A second FAO Report on Calorie Requirements has recently been published in which a number of modifications have been made in the specification 9. of calorie requirements I. These have been considered in the preparation of this revision of Recommended Dietary Allowances. Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 2 - In specifying requirements for calories for individuals, the FAO committee utilized the device of the "reference" man and woman, both aged 25 and living in a temperate climate with a mean annual external of 10 degrees Centigrade. The weight of the "reference man" was given as 65 kilograms and was 55 kólograms for the "reference woman". Recommended Dietary Allowances adapted the same basis of reference in its 1953 revision. These characteristics cannot be considered average 10 for the young adult population of the United States, however. Therefore, in the present statement certain adaptations have been made to permit establishment of reference conditions more nearly conforming with United States standards of body size and living conditions. The "reference" man is again taken as of age 25 but the weight is given as 70 kólograms which would seem to be more nearly descriptive of the average young male in this population. Similarly, the "reference" woman is described as being 25 years of age but weighing 58 kólograms. Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 3 - Another modification is to establish allowances assuming that individuals are living in an environment with a mean environ- o C mental temperature of 20 degrees centigrade rather than the lower temperature given by FAO. This would again seem to be a more realistic description of the mean environmental temperature of most of the population of the United States. Both man and woman are presumed to lead a vigorous, healthy life and to be moderately active physically, with occupations which could not be described either as sedentary or as hard physical labor. The man would be likely to be in light industry or employed as delivery man, painter or outdoor salesman. The woman might be homemaker, saleswoman or bench worker in a factory. The daily allowances/ as derived for the "reference man" is 3200 calories and for the "reference" woman is 2300 calories. It should be realized that adjustments must be made in calorie allowances when individuals or population averages differ from the "reference" in characteristics of age, body Source: https://www.industrydocuments.ucst.edu/docs/mgxh0227 - 4 - size, climate or activity. Procedures for these adjustments are described below. Adjustments of Calories for Age - - Energy requirements decline progressively after the years of early adulthood, because of a decrease in basal metabolic rate as well as lessened physical activity. It is proposed that calorie allowances be reduced by 3 per cent per decade between ages 30 and 50 and by 7.5 per cent per decade from age 50 to 70. A further decreasement of 10 per cent is recommended for the years from 70 to 80. These adjustments are in accord with 9 FAO recommendations X Accordingly, the calórie allowances at age 45 are 6 per cent less than at age 25 and at age 65 are 21 per cent less (See Tolile II ). Adjustment for Body Size - - Calorie allowances must be adjusted for the variations in energy requirements which result from differences in body size. Therefore, in utilizing the allowances giver in the table, larger allowances must be Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 5 - derived for individuals of body size greater than indicated for the reference man and woman and smaller allowances should be prescribed for those of smaller size. In adapting allowances for differences in size, weight may be used as a basis provided the subjects are not overweight or underweight. Maximum body length (height) is usually attained by age 20 or shortly there- after, but in the United States the average person tends to continue to gain in body weight until about 60 years of age. Life insurance and other data indicate that these weight gains are undesirable and that the most favorable health expectation is associated with conditions under which weight as normally achieved by age 25 or 30 is maintained throughout later bife. Therefore, in these recommendations the calorie allowances for adults pertain not to actual body weight of individuals or groups but to desirable body weight (the average weight separd of individuals of given height at age 25). Table I may be used as a guide for this use and adaptation. Heights and weights Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 TABLE II Individuals Marious Calorie / allowances for men of Marred Body Weights and age 15 (as meanenvermental temperature 32 of 20 Centegrade and assuming moderate physics activity I MEN Calorie allowances Deserable Weight Kelogram Pounds 25 years 45 years 65 years 50 110 2500 2350 1950 55 121 2700 2550 2150 60 132 2850 2700 2250 65 143 3000 2800 2350 70 154 3200 3000 2550 75 165 3400 3200 2700 80 176 3550 3350 2800 85 187 3700 3500 2900 Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227 (tableth Calorie Allowanes for Women of Various Body Weight and age WOMEN 63 Deserable Weight Cultrie allowares 22 45 58 Pounds 70 Kelograms 25 years 45 15 years 65 years 40 88 1750 1650 1400 45 99 1900 1800 1500 50 110 2050 1950 1600 5T5 121 2200 2050 1750 58 128 2:300 2200 1800 60 132 2350 2200 1850 65 143 2500 2350 2000 70 154 2600 2450 2050 75 165 2750 2600 2150 Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 6 - usually as recorded include usual clothing worn indoors and shoes with one-inch - heels. ( Quest Table altop of page 5 To adapt calorie allowances for individuals whose weight and height are different from those of the reference man and a woman, the following formulae have been utilized 1, Calorie allowance for men - - - 815 + 36.6 W* Calorie allowance for women - - 580 + 31.1 W* * W = desirable body weight in kilograms By such adaptation the allowances for 25 year old men weighing 50, 60 and 80 kilograms would be 2500, 2850, and 3550 calories respectively. Women of the same age weighing 40, 50, 60 and 70 kilograms would receive 1750, 2050, 2350, and 2600 calories respectively. Adjustment by weight in pounds to other body sizes may be facilitated by reference to Table II . (Insert Table II) Adjustment of Calories for Climate - Standard conditions for estimating calorie allowances include mean environmental C temperature of 20° centigrade rather than 10° centigrade as Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227 - 7 - established by the FAO committee which was utilized in the 1953 revision of Recommended Dietary Allowances. It seems probable that most persons in the United States live in an environment with a mean temperature of approximately 20° centigrade. Most are protected against the effects of cold by warm clothes, central heating and heated means of transportation. Many also live and work in ir-conditioned atmospheres so that the effects of high temperatures are partially but not so completely ameliorated. If the external temperature varies widely from the standard, 2 corrections in calorie allowances may be made. For lower tempera- tures there is need for an increase in allowance. To accomplish increased this the allowance should be /reduced/by 5% for the first ten C degree centigrade decrease from the standard of 20° centigrade and by 3% for each additional ten degree decrease. Similarly, allowances should be reduced for high environmental temperatures and the reduction should be 5% for each increase of ten degrees Source: https://wwww.industrydocuments.ucsf.edu/docs/mgxh0227 - 8 - centigrade above the standard temperature, (20%). These adjustments are devised specifically for application to differences in mean annual temperature, but they may well serve for adjustment to seasonal differences as well. In various parts of the United States the difference in mean winter and summer temperatures may range from 10 degrees C to centegrade 30 degrees C. This would indicate corrections of from 5 to 15 per cent in the calorie allowances according to conditions. It should be observed that all adjustments for climate pre- suppose an ordinary amount of actual exposure to the climate. For persons spending most of their time out of doors, these adjustments may be insufficient, particularly during winter in the Northern and Central States. It is obvious that people who spend almost all their time in well heated buildings during the winter will not need the extra food calories required by individuals less effectively sheltered. When applying these adjustments of allowances for individuals or groups, duration Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 9 - of exposure to outside weather should be ascertained and taken into account. Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227

What is the number of observations in trial 1?

zznc0227

zznc0227_p0, zznc0227_p1, zznc0227_p2, zznc0227_p3, zznc0227_p4, zznc0227_p5, zznc0227_p6, zznc0227_p7, zznc0227_p8, zznc0227_p9, zznc0227_p10, zznc0227_p11, zznc0227_p12, zznc0227_p13, zznc0227_p14, zznc0227_p15, zznc0227_p16, zznc0227_p17, zznc0227_p18, zznc0227_p19, zznc0227_p20, zznc0227_p21, zznc0227_p22, zznc0227_p23, zznc0227_p24, zznc0227_p25, zznc0227_p26, zznc0227_p27, zznc0227_p28, zznc0227_p29, zznc0227_p30, zznc0227_p31, zznc0227_p32, zznc0227_p33, zznc0227_p34, zznc0227_p35

368

Alaska An Appraisal of the Health and Nutritional Status of the Eskimo A REPORT BY THE INTERDEPARTMENTAL COMMITTEE ON NUTRITION FOR NATIONAL DEFENSE AUGUST 1959 OF ASSISTANT SECRETARY OF DEFENSE WASHINGTON 25, D.C. HEALTH AND MEDICAL, August 31, 1959 On behalf of the Interdepartmental Committee on Nutrition for National Defense (ICNND), it is my pleasure to transmit this report, An Appraisal of the Health and Nutritional Status of the Eskimo in Alaska. The clinical and biochemical phases of the survey, conducted in March-April 1958, included the Eskimo National Guardsmen and a random sampling of eight Eskimo and two Indian villages. This was a cooperative undertaking of the ICNND with the Arctic Health Research Center, the Division of Indian Health of the U. S. Department of Health, Education, and Welfare, the Alaska Command of the U. S. Armed Forces, and the Alaska National Guard. A detailed report of the dietary studies conducted in the ten Alaskan villages will be published at a future date by the Arctic Health Research Center. Dr. Christine Heller of the Arctic Health Research Center is continuing these investigations. The evaluation of the dietary intake, customs, and habits of these few remaining native villages will enable a much more meaningful evaluation of the clinical data. The Alaskan aboriginal people have and will continue to have a remarkably successful adaptation to their environ- ment and unique food supply. The purpose of this study was to establish a baseline of nutritional appraisal in order to evaluate in future years the effects of cultural transition in relation to health. Continued assistance to provide medical and dental care, housing, and economic development is most essential. I wish to call your attention to the general conclusions of this report on page 118. Frankisterry Frank B. Berry, M. D. Source: https://www.industrydocuments.ucst.edu/docsizznc022 V INTERDEPARTMENTAL COMMITTEE ON NUTRITION FOR NATIONAL DEFENSE Department of Defense: Dr. Frank B. Berry, Assistant Secretary of Defense (Health and Medical), Chairman Dr. E. H. Cushing, Deputy Assistant Secretary of Defense (Health and Medical) Brig. Gen. Sheldon S. Brownton, USAF (MC) Army: Dr. John B. Youmans Lt. Col. William J. Wilson, MC Navy: Dr. Howard T. Karsner Rear Admiral Calvin B. Galloway, MC Air Force: Major George W. Powell, MC Department of State: Mr. Walter M. Rudolph Department of Agriculture: Mr. Clarence M. Purves Dr. Hazel K. Stiebeling Department of Health, Education, and Welfare: Dr. Floyd S. Daft Dr. H. van Zile Hyde International Cooperation Administration: Dr. Eugene P. Campbell Dr. Katharine Holtzclaw Atomic Energy Commission: Dr. James L. Liverman Secretariat Dr. Arnold E. Schaefer, Executive Director Dr. Ernest M. Parrott, Deputy Executive Director Dr. Arthur G. Peterson, Agricultural Economist Consultants Dr. William F. Ashe Dr. William J. Darby Dr. William McGanity Dr. S. Bayne-Jones Dr. Cyrus E. French Dr. William N. Pearson Dr. M. K. Bennett Dr. Wendell H. Griffith Dr. Herbert Pollack Dr. George H. Berryman Dr. David B. Hand Dr. W. H. Sebrell, Jr. Mr. Edwin B. Bridgforth Dr. D. Mark Hegsted Dr. Fredrick J. Stare Dr. Joseph S. Butts Dr. Norman Jolliffe Dr. Philip L. White Dr. Gerald F. Combs Dr. z. I. Kertesz Dr. Robert R. Williams Dr. L. A. Maynard Source: https:llwww.industrydocuments.ucsi.edu/docsizznc022 VII VI LIST OF FIGURES TABLE OF CONTENTS Page Page Title Number Part I Preface XI Frontispiece Guzema Wassilie, Medicine Man at Napaskiak 1. Administrative History XI 2. Acknowledgments XI Figure I Northern Cultural Areas and Tundra Region Facing 1 3. Objectives XIII 4. Explanatory Addendum XIII Figure II Tuberculosis Mortality for Alaska by Race, 11 1952-1957 Part II Introduction 1 1. The Cultural Background 1 Figure III Principal Ethnographic Divisions of Alaska, 14 2. Demographic Factors 4 and the Villages Studied 3. Health Facilities 7 4. General Plan of Study 13 Figure IV Plan of the Study with Numbers Examined 16 5. Clinical Calibration Studies 15 Figure V Enlargement of the Submaxillary Glands 30 Part III Native Men in the National Guard 20 1. The Population Studied 20 Figure VI Pigmentary Changes in a Young Eskimo Man 31 2. Clinical Findings 21 3. The Dental Study 34 Figure VII Dental Attrition in a 32-Year-Old Eskimo 46 Woman Part IV The Village Studies 42 1. Bethel Area - The Situation in Akiak, Kasigluk, Figure VIII Height by Age and Sex, Eskimo Villages, 1958, 42 Compared to Canadian Population 61 Napaskiak, Newktok and Hooper Bay 2. Kotzebue Area - The Situation in Noatak, Point Hope, Shishmaref, Allakaket and Hislia 49 Figure IX Weight by Age and Sex, Eskimo Villages, 1958, 62 3. Clinical Findings in the Villages 52 Compared to Canadian Population 4. Discussion of Clinical Findings 67 Eskimo and Indian Villages in Alaska, 1958, Figure X Part V Dietary Measurements 72 Blood Pressures and Pulse Rates, by Age 65 1. National Guardsmen - Camp Denali (Ft. Richardson) 72 2. Villages (Preliminary) 74 Figure XI Eskimo and Indian Villages in Alaska, 1958, 3. Discussion 91 Arm and Scapula Skinfold Thickness, by 70 Age and Sex Part VI Biochemical Findings 99 1. Methods 100 2. Results 100 3. Discussion 111 4. Summary 118 Part VII General Conclusions 120 Part VIII Specific Recommendations 121 Part IX Appendices 122 A - Criteria for Oral Examinations 122 B - Food Consumption, Males - Alaska, 1956-1958 124 C - Food Patterns by Village 134 D - National Research Council, Recommended Dietary Allowances 160 Bibliography 161 Source: ttps://www.industrydocuments.ucst.edu/docs zznc022 VIII IX LIST OF TABLES LIST OF TABLES (continued) Table Title Page Table Title Page Introduction Table 1 The Village Studies Eskimos, Indians and Aleuts in Alaska in 1950 1 Table 17 Eskimo and Indian Villages in Alaska, 1958; Percent 2 Alaska: Characterization of the Villages in the Study, Prevalence of Clinical Findings 54-55 and the Size of the Samples Examined, 1958 6 18 Eskimo and Indian Villages in Alaska, 1958; Percent 3 Eskimo Men, Alaska National Guard, 1958; Clinical Prevalence, Selected Clinical Findings by Age Calibration Studies 17 and Sex 57 4 Eskimo Men, Alaska National Guard, 1958; Summary of 19a Eskimos and Athabascan Indians in Alaska, 1958; Calibration Studies for the Clinical Examinations 19 Percentage of "Standard Weight" by Age and Sex 58 19b Eskimos and Athabascan Indians in Alaska, 1958; Native Men in the National Guard Table 5 "Obesity" in Adults by Age and Sex 59 Eskimo Men, Alaska National Guard, 1958, by Battalion; 20 Average Height and Weight of Eskimos and Athabascan Origin, Age, Height, Weight, Weight Status, Skinfolds, Indians in Alaska, 1958, Compared to Canadian Blood Pressure and Pulse 22 1953 Survey 60 6 Eskimo Men, Alaska National Guard, 1958, by Battalion 21 Eskimo and Indian Villages in Alaska, 1958; Pulse and Age; Height, Weight, Weight Status, Skinfolds, (Mean + S.E.) by Age, for Villages by Ethnographic Blood Pressure and Pulse 23 Groups 64 7 Eskimo Men, Alaska National Guard, 1958, by Battalion, 22 Eskimo Men, Alaska National Guard, 1958, by Battalion; Blood Pressure (Mean + Standard Error) by Height 23 Blood Pressure and Pulse Measurements, by Examiner 66 8 Eskimo Men, Alaska National Guard, 1958, by Battalion; 23 Eskimo and Indian Villages in Alaska, 1958; Blood Percent Prevalence of Clinical Findings, by Examiner 26-27 9 Pressure (Mean + S.E.) by Age, for Villages by Eskimo Men, Alaska National Guard, 1958, by Battalion Ethnographic Groups 68 and Age; Percent Prevalence of Selected Clinical 24 Eskimo and Indian Villages in Alaska, 1958; Arm and Findings 28 10 Scapula Skinfold Thickness by Age and Sex, for Eskimo Men, Alaska National Guard, 1958, by Region of Villages by Ethnographic Groups 69 Origin; Age, Height, Weight, Weight Status, Blood Pressure and Selected Clinical Findings 29 11 Dietary Measurements Relation of Clinical Signs and Biochemical Findings, Table 25 Eskimo Men, Alaska National Guard, Ft. Richardson, 1958; Serum Vitamin A, Alaska, 1958 33 12 Food Consumption from the Mess Hall Alone, Average Relation of Clinical Signs and Biochemical Findings, Per Man Per Day 72 Serum Vitamin C, Alaska, 1958 34 26 13 Eskimo Men, Alaska National Guard, Ft. Richardson, 1958; Eskimo Men, Alaska National Guard, 1958; Comparison of Plate Waste, Average Per Man Per Day 73 Dental Caries and Periodontal Status of 713 Eskimo 27 Eskimo Men, Alaska National Guard, Ft Richardson, 1958; Guardsmen with 1,400 White Male Residents of Birmingham Food Consumption from all Sources, Average Per Man and Baltimore 35 14 Per Day 73 Eskimo Men, Alaska National Guard, 1958; Mean Numbers of 28 Nutrient Composition of Recipes for Eskimo Dishes, as Decayed, Missing, or Filled Permanent Teeth in Four Calculated 75-81 Groups from the First and Second Battalions 36 15 29 Chemical Composition of Alaskan Foods, 1958 83-87 Eskimo Men, Alaska National Guard, 1958; Oral Status of 30 Food Consumption of Men in Villages, Alaska, 1956-1958 89 Members of First and Second Battalions 37-39 16 31 Food Consumption of Alaskan and Indian Men by Villages, Eskimo Men, Alaska National Guard, 1958; Gingival 1956-1958 90 Recession Scores, Men 35 Years of Age or Older, First 32 and Second Battalions Fat Content of Commonly Eaten Meats 93 41 33 Guide to Interpretation of Nutrient Intake Data 94 Source: https://www.industrydocuments.ucst.edu/docsizznc0227 X XI LIST OF TABLES (continued) I PREFACE Table Title Page 1. Administrative History Biochemical Findings A program of research on the nutritional status of Alaskan natives Table 34a Alaska, Nutrition Survey, March 1958; Biochemical has been under way in the Arctic Health Research Center, Anchorage, Findings, for National Guard and Villages, by Alaska, for several years. The present study arose from the interests Sex and Age Groups; Total Serum Protein and of the Department of Defense. Hematology 101 34b Alaska, Nutrition Survey, March 1958; Biochemical At a meeting of the Interdepartmental Committee on Nutrition for Findings, for National Guard and Villages, by National Defense (ICNND) 28 May 1956, Dr. Frank B. Berry reported that Sex and Age Groups; Serum Vitamin c, A and Carotene 102 the Secretary of Defense had inquired if the ICNND would be interested 34c Alaska, Nutrition Survey, March 1958; Biochemical in conducting a nutrition survey of the Alaskan natives. This proposal Findings, for National Guard and Villages, by was considered favorably by the Committee, and the Secretariat was Sex and Age Groups; Total Fatty Acids, Phospholipids authorized to explore the possibilities further. Discussions were held and Cholesterol 103 with Dr. Jack Haldeman, Chief, General Health Service, Public Health 34d Alaska, Nutrition Survey, March 1958; Biochemical Service, Department of Health, Education, and Welfare (HEW) and Dr. Findings, for National Guard and Villages, by John C. Cutler, Program Officer, Bureau of State Services, HEW. Toward Sex and Age Groups; Urinary Excretions 104 the end of 1956, the Committee received a formal request from the 35 Alaska, Nutrition Survey, March 1958; Comparison of Arctic Health Research Center for assistance in financing and con- Methods for Determination of N'Methylnicotinamide 106 ducting a nutrition survey of the Alaska National Guardsmen while they 36a Alaska, Nutrition Survey, March 1958; Total Serum were in their annual encampment in Anchorage and also in completing a Protein and Hematology by Village, for Men, Women survey of the inhabitants of ten native villages. The Commi ttee and Children 107 appointed an ad hoc group, with representatives from the General Health 36b Alaska, Nutrition Survey, March 1958; Serum Vitamin c, Service, Bureau of State Services and the Division of Indian Health of A and Carotene, by Village 108 the Public Health Service; and including Dr. E. M. Scott of the Arctic 36c Alaska, Nutrition Survey, March 1958; Mean Blood Fat Health Research Center, Anchorage, and Dr. John B. Youmans, Consultant Levels, by Village and Age 109 to the ICNND, to meet in April 1957 to draft a proposal for Committee 36d Alaska, Nutrition Survey, March 1958; Urinary Excretions action. by Villages, for Men, Women and Children 110 37 Alaska, Nutrition Survey, March 1958; Mean Blood Fat At a meeting in May 1957 the Committee agreed to serve as a co- Levels, by Survey Area and by Age 114 ordinating and sponsoring agency for a nutrition survey of the two 38 Alaska, Nutrition Survey, March 1958; Urinary Excretions National Guard Battalions during their 1958 encampment and a clinical of B-Vitamins, Village Areas, by Age and Sex 116 and biochemical survey of the inhabitants of the ten native villages 39 Alaska, Nutrition Survey, March 1958; Biochemical in which the Arctic Health Research Center, with the aid of the Findings, by Reproductive Status, Eskimo Villagers Division of Indian Health, had been conducting a survey of food intake in the Bethel Area 117 and dietary habits. 40 Suggested Guide to Interpretation of Biochemical Data 119 2. Acknowledgments Many people have contributed to the work of this study. The names are arranged here according to their respective organizations. Arctic Health Research Center, Anchorage, Alaska Dr. A. B. Colyar - Director, Arctic Health Research Center Alaska National Guard Brig. General Thomas P. Carroll, Adjutant General, Alaska National Guard Major William H. Crawford, Commander, First Scout Battalion Major Harry E. Voelker, Commander, Second Scout Battalion Source: ittps://www.industrydocuments.ucst.edu/docsizznc022 XII XIII Alaska Native Health Service Team Members (continued) Dr. Joseph A. Gallagher - Area Officer in Charge, Anchorage Mrs. Isabelle V. Griffith - Chemist, Arctic Health Research Center Dr. Robert I. Frazier - Medical Officer, Kotzebue Miss Anna J. Pitney - Chemist, Arctic Health Research Center Dr. Elmer E. Gaede - Medical Officer, Tanana Mr. Lyndon Sikes - Chemist, Arctic Health Research Center Dr. William A. Brownlee - Medical Officer, Bethel Dr. Milton Silverman - Biochemist, n/ National Institutes of Health Dr. Albert L. Russell - Dentist, National Institutes of Health Village Teachers Mr. Carl L. White - Statistician, National Institute of Health M/Sgt. Dale o. Starr - NCO in Charge, Dispensary, Fort Richardson Mr. and Mrs. Roman W. Kinney, Akiak M/Sgt. Harold G. Coffman - X-ray Technician, Dispensary, Fort Richardson Mr. and Mrs. Emil Kowalczyk, Kasigluk SP-5 Ronald J. Murphy - Technician, Dispensary, Fort Richardson Mrs. Mary McDougall, Napaskiak Mr. and Mrs. John F. Gordon, Hooper Bay 3. Objectives Mrs. Ida A. Hunter, Newktok Mr. and Mrs. Fred G. Fisher, Point Hope The extent of success of the adaptation of the Eskimo to a uniquely Mr. and Mrs. Russell McLaughlin, Shishmaref limited and precarious food supply in a harsh environment has been a Mr. and Mrs. Walter A. Ortman, Allakaket challenging question to physiologists for over a century. Arctic ex- Mr. and Mrs. Ley M. Kahl, Huslia plorers have often discussed this problem and some have taken highly Mr. and Mrs. S. William Benton, Noatak controversial positions based on their estimates either of the merits of the Eskimo dietary regimen or the status of the natives' health. U.S. Military Organizations - Alaskan Command The present study was undertaken to investigate this question in co- operation with the Arctic Health Research Center (AHRC) of the Lt. General Frank A. Armstrong, USAF - Commander in Chief, Alaskan Command Department of Health, Education, and Welfare, the Alaska Command of Maj. General G. C. Mudgett - Commander, U.S. Army, Alaska the U.S. Armed Forces, and the Alaska National Guard. Brig. General John R. Copenhaver - USAF Surgeon, Alaskan Command Colonel Sterrett E. Dietrich - U.S. Army, Surgeon Members of the AHRC with the support of the Indian Health Service Lt. Colonel Wade F. Heritage - U.S. Army, Deputy Surgeon have been conducting systematic studies of the dietary habits of the Lt. Colonel George D. Pleasants - Post Surgeon, Ft. Richardson Eskimo and, in particular, their hematological disorders. The present work was intended to complement those studies. The work described here Finally, the subjects themselves should be complimented for their was designed to evaluate the nutritional status of the Eskimo of all pleasant welcomes, patient forbearance and altogether cheerful and ages and both sexes by carrying out physical appraisals and biochemical intelligent willingness to help with the tasks at hand. measurements of specific nutrients in blood and urine. These data were then to be evaluated along with the dietary evaluations and food Team Members analyses made available by continuing studies of the Arctic Health Research Center. Additional measurements of consumption of food in Dr. John B. Youmans - Field Director, Army Medical Research and Develop- the mess halls were made among the native members of the Armed Forces ment Command Lt. Colonel Laurence M. Hursh - Director, 1 Army Medical Research and 4. Explanatory Addendum Nutrition Laboratory Dr. Edward M. Scott - Deputy Director, Arctic Health Research Center Since the present study was done and much of the report was written Dr. George V. Mann - Clinician, National Institutes of Health before or during the emergence of Alaska as the 49th state, there may Mr. C. Frank Consolazio - Biochemist, Army Medical Research and be descriptions herein or references to agencies or procedures which Nutritio; Laboratory have been superseded by new organizational arrangements. SP-3 Edward J. Sheehan - Technician, Army Medical Research and Nutrition Laboratory Pfc. Jay M. Jamison - Technician, 1 Army Medical Research and Nutrition Laboratory Dr. Donald B. Kettlecamp - Clinician, Alaska Native Health Service Dr. Ruth Coffin - Clinician, 2 Alaska Native Health Service 2 Field Team Member, Bethel party. Dr. Christine A. Heller - Nutritionist, 1 Arctic Health Research Center 1/ Field Team Member, Kotzebue party. Field Team Member, Bethel party. Source: htps.//www.industrydocuments.ucsi.edu/docsizznc022 1 30 60 40 50 50 of II - INTRODUCTION in 50 Alex 1. The Cultural Background The Eskimos, Indians and Aleuts of Alaska vary widely in their U 2 cultural traditions and present day mode of living. At the time or or the white man's arrival, the Eskimos occupied all the northern and western coasts of Alaska, and lived on the southern coast as far east a as Prince William Sound and on Kodiak Island. The Eskimos were divided culturally into a Northern group, the Thule culture, and a Southern group, the Old Bering culture, with the dividing line situated on 8 80 Norton Sound in the vicinity of Unalakleet. Northern Eskimos still a speak the same language as the Siberian, Canadian and Greenland Eskimos, E while the Southern Eskimo language is quite different. The Aleuts originally occupied the western half of the Alaska Peninsula and the Aleutian Islands. Thlingit Indians lived in southeast Alaska, while AND 06 Athabascan Indians occupied the interior regions of the territory. The map in Figure I shows these regions while Table 1 gives the population of these cultural groups in 1950. I 000 TABLE 1 ESKIMOS, INDIANS AND ALEUTS IN ALASKA IN 1950 Population Median Age 10 Eskimos 15,882 17.7 Athabascan Indians 6,783 -- Aleuts 3,892 17.9 20 Source: U.S. Census of Population, 1950, Vol. II, Parts 51- COAST 53. (1) The Eskimo culture in North America has been traced back through the Christian era. The "Thule" culture based on whaling seems to have of spread eastward from Alaska to Greenland during the period 500 to 1000 .D. In the saga of Eric the Red, reference is made to "skraelings" NEWARK (Eskimos) in Labrador in 1003. Possibly because of the disappearance 3MR of whales from the Central Arctic, a deviant culture based on fishing AIO and sealing spread back to Alaska. These migrations appear to account a for the presence of a single, primitive, Stone Age people with a com- : mon language and tools who occupied the 6,000 miles from Alaska to Greenland when Rink explored the latter area in about 1850. The oldest Eskimo culture is the "old Bering" culture which flourished on both 50 sides of the Bering Strait. This culture was based on the hunting of 60 21 0 00 00 00 fish and sea mammals. In Eurasia the Arctic culture was based on reindeer breeding, as in Lapland, except for a limited area of Eskimo culture on the Chukchi peninsula (2), The Eskimos, like the American Indians, are of Mongoloid ethnic origin. Eskimo skulls are narrow and oblong with a definite sagittal ridge. The lower jaws and maxillary bones are highly developed and Source: https://www.industrydocuments.ucsf.edu/docsizznc0227 2 3 prominent. The skin, hair, epicanthal folds and lumbar pigment testify to their Mongoloid origin. In contrast to the Negro the It is important to recognize that Alaskan Eskimos are not nomadic Eskimos have narrow noses. As in the American Indian, blood group people: They live in one or a few permanent homesites or campsites type o predominates among the Eskimos. Most of the sod houses have now been replaced by small frame or log structures. In one village in 1953 there were 36 houses with 47 rooms. The present study was concerned primarily with the two groups The floor space per fami ly was 227 square feet or an average of 51 square feet per person (3) Often these frame houses are poorly insu- of Eskimos, defined by geographic areas, and to a lesser extent with Athabascan Indians and Aleuts. In order to understand the situation lated and are therefore more difficult to heat adequately in winter of these people today it is important to review the primitive con- than were the primitive sod houses. ditions under which they once lived, since all of them are now in transition between the primitive and a modern way of life. This Each village had its own seasonal schedule for hunting and fishing, transition began in the 18th century for the Aleuts with their intro- but as in all hunting-fishing economies, there was a large element of duction to the Russian explorers and traders who followed Vitus Bering chance in this activity. The welfare of the people who depended on into their territory. For the Indians and Eskimos the transition hunting and fishing for food, clothing and fuel fluctuated accordingly. began later and at different times for different groups. The coastal Through the summer most Eskimo and Indian families found it necessary Eskimos who lived on marine mammals were exposed to the whit whalers to move from place to place in search of their supply of food. This and explorers of the 18th and 19th centuries, while some of the was particularly necessary for the tundral people who often traveled inland Eskimo and Indian villages have had important contact with considerable distances from the village in order to obtain sufficient white culture only during the past 60 years. The extent of accultu- food. These campsites, usually family affairs, were visited year after ration is thus variable. year as long as they yielded food. Almost all edible foods were eaten, and since food resources varied in different regions, there were wide Eskimos have managed by a number of ingenious methods to maintain geographic differences in diets. their numbers and to carry on a marginal existence under exceptionally adverse conditions. In order to survive in the Arctic, they have had There were three general types of Eskimo diets under the conditions to utilize every available resource. The primary consideration for of the primitive culture (2). On the northern and northwestern coasts the location of an Eskimo or Indian village in Alaska was the available of Alaska, Eskimos were primarily dependent on sea mammals -- seal, food, fuel and water supply. The population balance in such an walrus and whale -- for food. Farther south, chief dependence was on economy was important since overpopulation meant hunger and sometimes fish, while smaller numbers of interior Eskimos lived on land mammals, starvation. When the population became too large for the available primarily on caribou. In none of these areas was there total depen- food supply or if the food supply became scarce because of persistently dence on any one type of food. Use of fish was universal, while unfavorable weather conditions or some other accident of nature, shellfish, birds, birds' eggs, small mammals (including hares, porcupine, family groups would break away and try to find a more favorable place rabbits, muskrats, mink and beaver), berries, roots and green plants to establish themselves. were eaten when available. In retrospect these diets would seem to have had certain things in common. All of them were probably very high Winter homes were half buried in the ground and made of logs or in protein, moderate to high in fat content, and they contained very whale ribs covered with sod. The walls and ceiling of the main living little carbohydrate. They were beasonally low in ascorbic acid, and room were often lined with split driftwood, vegetable matting or skins. must have been on occasion deficient in calories. Such diets, however, Existing examples of these homes, when well constructed, are surpris- had no known nutritional disadvantages and no known advantages except ingly comfortable and can be heated with a minimum of fuel. They are, that they are generally believed responsible for the fact that Eskimo however, dark and small. Such houses were usually buili at permanent teeth were very nearly free of caries. The Eskimo did not usually have living sites and were then occupied only in the winter when they could a choice of foods from which to make a selection. Instead, his problem be kept reasonably free from condensation and seepage. In the spring, was the fundamental one of assuring a continuity of food and to this with the coming of the thaw, many of them became untenable. Because problem he devoted his energy, intelligence and ingenuity. of dampness of the house and because of the necessity to search for food, the people moved out of the sod huts into tents at camp sites, often at considerable distances from the village. In the early days, 1 tents were made of animal skins secured tightly over a willow frame. The tundra is the vast, treeless area of western and northern Alaska. For many years now the great majority of Eskimos have used canvas It is generally flat, dotted with ponds and sloughs and underlaid tents. Even today, though a family may not wish to move away from wi th permafrost. The vegetation in the summer consists of low shrubs the village for sealing or other activities, they will often move out and grasses and in the winter the surface may be buried to a depth of their winter residence into a tent pitched nearby. of several feet with snow. The winds pack and drift this snow almost continually. An approximate outline of the tundra is shown in Figure I. Source: tps:/lwww.industrydocuments.ucsi.edu/docs zznc0227 4 5 2. Demographic Factors creation of schools, stores, churches and postoffices in some villages Eskimos today live on a combination of foods obtained from the has tended to attract native families and to enlarge the villages, traditional sources and foods bought from stores. The latter are for whereas many small villages listed in 1950 are no longer in existence. the most part cereals and sugars. Some of the factors which presently affect the food habits of Eskimos are as follows: Eskimos seemed to accept Christianity readily and today every village has at least one church which is an important part of the social Eskimos now live at a low economic level. In a study made in life. Denomination of the churches is shown in Table 2 for the villages 1955(4), the estimated annual per capita cash income in 23 Eskimo vil- included in the present study. lages ranged from $69 to $475. Unless the Eskimo lives in one of the larger towns and has some education, he has little or no opportunit ty Schools have been in existence in Alaska for many years, but there for a job with a steady income. The income for a village comes from was never enough money to provide one for each of the smaller villages, a variety of sources. Fishing for profit provides income for many and until the past ten years there was little opportunity for a high families in the Bristol Bay area and at the mouth of the Yukon. While school education except in towns with a permanent white population. such fishing may require considerable capital for a boat, the profits Village schools (formerly called "Territorial Schools") are operated are large if the fishing is good. However, the trend in recent years by the State or by the Bureau of Indian Affairs (BIA). In recent years has been toward smaller catches of salmon. Some men from villages in the latter agency has started a special type of school -- The Instruc- the Kuskokwim area obtain employment in the canneries on Bristol Bay. tional Aid School in certain villages. In these schools the village The pay is high, averaging $600 for the month or six weeks when the furnishes the building, and a teacher is provided by the Bureau of cannery operates. Trapping provides part of the income of most vil- Indian Affairs. Such teachers are often not fully qualified. lages. Fur prices are now low, however, and only mink, muskrat and beaver are profitable enough to encourage the effort involved in Stores or trading posts were established in Alaska by the Russians, trapping. Twenty mink, 700 muskrat, or 20 beaver would represent a and traders have since been an important part of village life. Starting good year's trapping for one man in some areas. Generally, however, in the late 1930's, the Bureau of Indian Affairs helped to establish fewer than this are obtained. During the 1957-58 season, average cooperative stores in many of the large villages. There are several market prices for mink were $30, muskrat $0.25 and beaver $25. communities, however, which still have no store, and people must go varying distances for supplies. The typical village store has a very Service in the National Guard produces an appreciable proportion limited stock of supplies and limited storage facilities. In the of the total income in the villages. In addition, a few Eskimos work usual case, there is no place for storage where freezing can be on river barges in the summer or as storekeepers or janitors. Crafts, avoided in the winter or where food can be kept frozen in the summer. such as ivory carving, basket weaving and making of souvenirs, provide some income for Eskimos. A major source of income in all villages is The water supply of the Eskimo and Indian is traditionally the welfare. A large number of Eskimos are eligible for various forms of nearest river, lake, or pond. A hole is cut in the ice in winter to public assistance including Old Age Assistance and Aid-to-Dependent- dip water, or cakes of ice are cut, hauled on sleds to the home and Children. Welfare payments amount to between one fifth and one third then melted for use. Melting of ice is difficult in most areas because of the cash income in most communities. In four of the villages of the fuel shortage. The usual method of obtaining water in the included in the present survey, mean per capita income in 1955 (4) was winter is with a tank or barrel of ice in a corner of the house near estimated as follows: the stove. The room temperature slowly melts this ice and the water is drawn off from the bottom. The difficulty of obtaining uncontami- Village Mean Income Percent of Income nated ice plus this melting process may contribute to the prevalence per Capita from Welfare of enteric diseases. The true prevalence of these diseases has been difficult to measure since they occur sporadically and require long- Napaskiak $173 28 term surveillance for measurement. In Napaskiak, one of the villages in the present study, an investigation was made which indicated a Akiak 475 32 Kasigluk 138 35 seasonal variation in the prevalence of diarrhea(5). The high level Hooper Bay 137 30 occurred in the summer and affected especially the children under 10 years of age (6). The infection rates for Endamoeba histolytica The population in Alaska is sparse and the communities are small. and Diphylobothrium sp. were found to be 8.6 and 34.5 percent, respectively. In 1950 about 80 percent of the 287 places named in the census had fewer than 199 persons (1). This smallness was probably originally related to the availability of food in the surrounding area. The Most of the coastal people have to depend on driftwood for their fuel. Some portions of the coast have a good supply but in others this wood is almost nonexistent In some villages, where seal are Source: https://www.industrydocuments.ucsi.edu/docsizznc022 TABLE 2 ALASKA: CHARACTERIZATION OF THE VILLAGES IN THE STUDY, AND THE SIZE OF THE SAMPLES EXAMINED, 1958 Name Type Popu- No. of Persons Churches School Store or Distance Distance lation Examined to Nearest Store to Hospital Allakaket Indian 120 75 Episcopalian State Co-op. 150 miles Akiak Southern 187 76 Moravian Bureau of 1 Trader + 20 miles Eskimo Indian Affairs Co-op. Hooper Bay Southern 435 96 Roman Catholic Bureau of 2 Traders + 155 miles Eskimo Swedish Covenant Indian Affairs Co-op. Huslia Indian 145 90 Episcopalian State Trader 135 miles Kasigluk Southern 180 94 Russian Orthodox Bureau of (None) 35 miles Eskimo Moravian Indian Affairs (4 miles) Napaskiak Southern 137 81 Russian Orthodox Bureau of (None) 6 miles 6 Eskimo Indian Affairs (1 mile) Newktok Southern 118 59 Roman Catholic Bureau of 3 Traders 115 miles Eskimo Indian Affairs Instructional Aid Noatak Northern 400 69 Friends Bureau of Co-op. 50 miles Eskimo Indian Affairs Point Hope Northern 315 88 Episcopalian Bureau of Co-op. 150 mi les Eskimo Indian Affairs Shi shmaref Northern 200 77 Lutheran Bureau of Co-op. 110 mi les Eskimo Indian Affairs Totals 2,237 805 8 9 Village Complaint included experts in anthropology, nursing care, medical social services, tuberculosis control, hospital and medical care, sanitation, laboratory Hooper Bay 1. A woman, eight months pregnant, with pain, services and mental health. fever and dysuria suggesting pyelitis. Members of the party traveled through the major areas of Alaska. 2. A young man rith fever and malaise con- The observations were generally more concerned with the health organiza- sidered to be "flu. " tions and demographic and environmental conditions than with clinical problems. The study was done at a critical time, because in July 1955 3. A young boy with penile swelling and the responsibility for the health problems of the natives of Alaska was urinary obstruction, considered to be transferred by Public Law 568 from the Bureau of Indian Affairs of the balanitis. Department of the Interior to the Department of .Health, Education, and Welfare. The Pittsburgh report thus reflects the conditions of an older 4. A woman with pleurisy. system. Tanunak 1. An 18 month old child with a swollen and When Secretary Seward purchased Alaska in 1867, the contract wit] inflamed throat. the Czar stipulated, "The uncivilized tribes will be subject to such laws and regulations as the United States may from time to time adopt Pilot Station 1. A man with obstipation. in regard to aboriginal tribes of that country." Health services and regulations were almost nonexistent until 1914 when a medical program 2. A child with extensive eczema. was established in the Bureau of Education which was then the only governmental agency directly concerned with the natives. In 1916 this o 3. A fever of 105` F. in a 4 month old baby - Bureau established a migratory medical boat on the Yukon, but during no localizing signs of infection. the first summer the physician, Dr. J. W. Houston, fell overboard and was drowned. Small health surveys indicated that tuberculosis, syphilis Goodnews Bay 1. A woman with "flu." and "trachoma" were common. There is now reason to doubt that trachoma did, in fact, exist. 2. The supply of drugs very low. The first hospital for natives was built in Juneau in 1916. In Kipnuk 1. Query from the doctor concerning the con- 1931 when the Office of Indian Affairs assumed responsibility there dition of a patient with tuberculosis were five Alaska Native Health Service (ANHS) hospitals for the Alaskan recently returned to the village on Indians and Eskimos with six doctors and 15 nurses for the entire isoniazid therapy. population. There are now five general hospitals under the U.S. Public Health Service and these are located at Point Barrow, Bethel, 2. Query about the three villagers who were Kanakanak, Kotzebue and Tanana. There are, in addition, two medical sent to Bethel last month for medical care. centers, one at Anchorage and another at Mt. Edgecumbe in southeastern What are their conditions? Alaska near Sitka. Some specialized care, as for tuberculosis and mental disease, is obtained by contract in hospitals both in and outside Mountain Village 1. Query for news about a man recently sent Alaska. The 1958 budget of the Division of Indian Health, Public Health to the Anchorage Hospital. Service, for Alaska was: Scammon Bay 1. A 14 year old girl with pain in the right Activity lower abdomen, vomiting and with fever. Hospital Operations $ 8,702,000 A general description of the ecological and social factors which Contract Patient Care 694,000 bear upon the health problems in western Alaska has been outlined in the Field Health 784,000 report of a survey carried out in 1953-54 by the Graduate School of Management Services 122,000 Public Health of the University of Pittsburgh (7). The Department of the Interior, which was then responsible for the health problems and pro- Total $10,302,000 grams in the nátive population of Alaska, invited the faculty of the School of Public Health of the University of Pittsburgh to survey the situation and make suggestions for improvement. In the summers of 1953 and 1954 such a survey was carried out by medical specialists. These Source: https://www.industrydocuments.ucst.edu/docsizznc022 FIGURE II TUBERCULOSIS MORTALITY FOR ALASKA BY RACE 1952-- 1957 I50 140 130 WHITE 120 ESKIMO 110 INDIAN ALEUT 100 90 80 70 60 50 40 30 20 10 O NITION NITTION Sis 000000 or 13 The birth rates of racial groups in Alaska in 1956 are shown here (9) : Whites 32 per 1,000 population Eskimos, Indians, Aleuts 52 per 1,000 population The burden of disease in Alaska in 1950 and today bears a remark- able resemblance to that recorded for the United States in 1900. The opportunity for the application of modern medical skills and knowledge is obvious. "Native Alaska" could and should be made an almost ideal laboratory workshop for teaching, research and service. 4. General Plan of Study A large proportion of the able-bodied Eskimo men are members of two battalions of a National Guard Reserve Unit which is brought to Camp Denali (at Fort Richardson near Anchorage) each year for a two-week training period. In good weather when the widely scattered villages are accessible the men are often away on sealing expedition or tending traplines, so the period of National Guard duty offered a unique op- portunity to study these Eskimo men. This was also an economical way of assembling data on people from many widely separated villages. It was fortuitous that the Guard training period occurred in late winter when native food supplies might be expected to be diminished and limited, thus placing the nutritional status of the people at a low ebb. The clinical and biochemical methods used were those described in the "Manual for Nutrition Surveys" of the ICNND(10) Clinical observa- tions were recorded on data cards for the "detailed clinical examination. No abbreviated clinical examinations were done. The neurological, cardiovascular and abdominal examinations and the skinfold measurements were made by two members of the Alaska Native Health Service medical staff. Battalion 2 of the Eskimo Guardsmen arrived at Anchorage on March 1 and 2, 1958. The noncommissioned officers had arrived two weeks earlier. This unit comprises men from southwestern Alaska including the Aleutian chain and the Bering Sea islands except St. Lawrence and King Islands. Bethel and the Kuskokwim valley may be considered as its center. The men come from as far south as Dillingham, from west to Unalaska and the Pribilofs, and from north to Hooper Bay and the lower Yukon. They include two distinct ethnic groups, the Eskimos -- both inland and coastal -- and the Aleuts, who are few in number (Figure III). These men were examined during three days at Camp Denali. The group of examiners was then divided into two sections. One team proceeded to Bethel on March 7. In the following ten days they studied five villages in that area. A second team went to Kotzebue on March 7 where they undertook studies in five villages of that region. Upon completion of these field studies the two parties returned to Camp Denali and on March 24-27 examined Battalion 1 of the Eskimo Guardsmen. These men were assembled from the northern villages of Alaska extending from Barter Island near the Canadian border to Nome Source: https:llwww.industrydocuments.ucsi.edu/docsizznc0227 FIGURE III PRINCIPAL ETHNOGRAPHIC DIVISIONS OF ALASKA, AND THE VILLAGES STUDIED Pt. Barrow Point Hopee 52 Woatak 3 so I. Aleuts East Cape Shishmaref Allakaket 2. Southern Eskimos 3. Northern Eskimos 3 Huslia 4. Athabascan Indians River Nome (ukon Foirbanks 5. Thlingit, Tsimshian, St Lowrence and Haida Indians 14 Island Hooper Bay Newktok Kosigluk (Anchorage Nunivak Bethel Napaskiak Island 2 Juneau e Pribilof Bristol 8 Isls. Bay Kodiak Island 5 goo chain 08.. & joint 50 150 250 I I Miles pure 15 230 16 17 FIGURE IV TABLE 3 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 PLAN OF THE STUDY WITH NUMBERS CLINICAL CALIBRATION STUDIES 1/ EXAMINED (1) (2) (3) (4) Replicates Trials Bn 2 Bn 1 Total Duplicates N 16 N 20 A N 16 N 32 N 68 Examiner No. 1 - + + - + + - + + - + + Classification No. 2 - + + - - + + - - + + - + + Attribute BATTALION 2 General appearance 21 13 3 - - 16 4 - - 26 6 - - 55 13 - - Thyroid enlarged 16 - - - 19 - 1 - 26 1 4 1 61 1 5 1 B =20 Submaxillary enlarged 16 - - - 18 1 1 - 29 - - N = 323 3 63 1 4 - Nasolabial seborrhea 16 - - - 17 - 2 1 32 - - - 65 - 2 1 BETHEL KOTZEBUE Other seborrhea 16 - - - 20 - 28 - 4 - 64 - 4 - Erythema head 14 1 - 1 13 4 3 28 2 2 55 7 - 6 AREA AREA Pigmentation - head 14 2 - - 20 - - 28 3 1 62 5 - 1 Thickened conjunctivae 15 1 - 16 4 - 21 6 1 4 52 11 1 4 AKIAK NOATAK Pingueculae - 2 4 10 - 2 18 9 4 4 15 9 8 8 43 76 69 (6) Bitot's spots 15 - 1 - 19 - 1 - 32 - - - 66 - 2 - (I) Conjunctival injection 16 - - - 19 1 - - 26 4 2 - 61 5 2 - Angular scars 14 1 1 - 17 - 3 - 32 - - - 63 1 4 - Cheilosis 16 - - 19 - 1 - 32 - - - 67 - 1 - Filiform strophy, KASIGLUK PT. HOPE slight 16 - - 16 - 4 - 30 - 2 - 62 - 6 e 94 88 Glossal furrows 16 - - 15 4 1 23 5 2 2 54 9 2 3 (2) (7) Red gums 16 - - - 11 - 7 2 30 - 1 1 57 - 8 3 Swollen gums 16 - - 13 6 1 29 - 3 - 58 - 9 1 Gum recession 6 2 1 7 3 1 12 4 19 1 8 4 28 42 1 15 Unfilled caries 7 3 6 14 2 4 12 3 6 11 33 8 6 21 Worn teeth 1 8 1 6 2 3 1 14 16 5 2 9 19 16 4 29 NAPASKIAK SHISH MAREF Follicular 8I 77 hyperkeratosis 15 1 - - - (8) 15 5 28 - 4 58 10 - (3) Xerosis 16 - - 19 1 - - 28 3 1 - 63 4 1 - Acne 15 1 - - 18 1 - 1 25 2 2 3 58 4 2 4 The 43 items recorded for the detailed examination which were used exclusively NEWKTOK ALLA KAKET in the Alaska Survey have been abridged here to include only the 23 items which (4) 59 75 showed sufficient prevalence of a sign to allow comparison of observers. (9) 2/ Positive means less than "good general appearance.' HOOPER BAY HUSLIA 96 90 (5) (10) BATTALION I C N=32 N = 390 Source: https://www.industrydocuments.ucsi.edu/docsizznc022 18 19 follicular hyperkeratosis is an important area of dyscalibration. It will be shown later that this particular examiner difference is partially accounted for by an assignment of lesions by examiner 2 to follicular TABLE 4 hyperkeratosis whereas examiner 1 assigned similar conditions to xerosis. ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 A similar estimate of examiner difference was carried out with the Battalion 1 men after the survey parties returned from the village SUMMARY OF CALIBRATION STUDIES FOR THE CLINICAL EXAMINATIONS-/ surveys (column 3 in Table 3). The extent of the differences between examiners is both large and important. If the average difference between examiners in percent of subjects in which they disagree for all items is obtained for Battalion 2 and Battalion 1, the averages are respectively Number Examiner's Reaction of 16.6 N=25 and 14.0 N=25. There is no clear indication of a trend of Disagree examiner difference. For the total duplicate examinations (68 in all, Trial Observations Agree Positive No. 1 + No. 2 + Agree Negative column 4, Table 3), the examiners exceed 15 percent divergence for N % N % N % N % thickened conjunctivae and pingueculae, glossal furrows, gum atrophy and recession, unfilled caries, worn teeth and dental malposition. The Trial 1 368 30 8.2 24 6.5 92.4 289 78.6 divergence on follicular hyperkeratosis is just at 15 percent, but one 460 examiner identified all of these (N=10) whereas the other examiner Battalion 2 49 10.7 28 6.1 44 9.6 319 69.5 diagnosed 4 subjects with xerosis, not indicated by the first. These data are further condensed in Table 4. The secular consistency of the Battalion 1 736 53 7.2 45 6.1 49 6.7 557 75.6 examiners is notable. These clinical calibration studies were done on 5 percent of the Totals 1564 132 8.4 97 6.2 102 6.5 1165 74.5 subjects studied at Camp Denali. This approach will always be limited by the scarcity of clinical material showing a range of manifestations for many of the important clinical signs. The problem then is one of measuring the ability of individuals to fix their criteria for recogni - tion of threshold levels of clinical signs. It appears that a more Conclusion - In 1564 observations recorded in duplicate after independent rigorous set of definitions should be used. It is also necessary that evaluation by examiner 1 and examiner 2: more extensive estimates of observer differences be made. The present data suggest that perhaps 10 percent of all the clinical appraisals Both agree positive findings in 8% should have been replicates, and this process should have been arranged Both agree negative findings 75% to measure self-duplication as well as inter-examiner duplication. Disagree 13% With examiner 1 positive 6.2% The present studies appear to disqualify observation of thickened With examiner 2 positive 6.5% conjunctivae, pingueculae and follicular hyperkeratosis because of observational imprecision. The dental information will need to come from the independent dental examination. 1 Using the 23 items shown in Table 3. Source: https:/lwww.industrydocuments.ucsf.edu/docs/zznc0227 20 21 III - NATIVE MEN IN THE NATIONAL GUARD 2. Clinical Findings 1. The Population Studied The general impression of physical appearance obtained from casual observation of the two battalions was that these men were active, rugged, The Eskimo Guardsmen represent the majority of all the able-bodied deeply tanned and well-conditioned. They were short in stature, with Eskimo men in Alaska. They appear to find membership in the Alaska "Oriental" faces, short limbs and long trunks, and they generally had a National Guard (ANG) attractive because the service furnishes a cash mesomorphic body type. The men in Battalion 1 who came from northwestern income and also it supplies a pleasant social diversion for them. Alaska seemed somewhat taller, obesity was more frequent among them, and they more commonly had lighter eyes, hair and skin than the men in It appears that no medical screening is done in the villages when Battalion 2. The men in Battalion 1 were also more at ease, better ac- the groups are assembled for the annual duty at Anchorage. It is likely quainted with English, and their behavior was more like that of American that known tuberculosis and obvious crippling or chronic disease are troops. The height-weight measurements bear out some of these observa- causes for rejection, but the men are generally sworn in and assembled tions. A summary of the height, weight, skinfold, blood pressure and in Anchorage before application of the usual medical standards for mil- pulse measurements is shown in Table 5. itary acceptance (11). The frequency and severity of grossly visible defects strongly suggested that these battalions were composed of "able- The relationship of weight to age is shown in Table 6. The small bodied volunteers" who had not been subjected to effective medical gains of weight with age are in contrast to the usual findings in white screening. In Battalion 2, four cases of active pulmonary tuberculosis males in the United States. As noted above the men from northwestern were diagnosed by symptoms and x-ray among the 350 men present. Alaska (Battalion 1) were a little taller than those in Battalion 2, but no important trends were demonstrated. In particular, there is no The Division of Tuberculosis Control of the Alaska Department of evidence that Eskimo men are taller as their race becomes acculturated. Health, as part of its tuberculosis case finding mechanism, has three These data also indicate there is very little obesity. (It should be itinerant x-ray technicians who travel to villages of known high incidence remembered in using the U.S. Medico-Actuarial Tables of Standard Weight (13) to take chest x-rays of all available inhabitants. Active and probably that an appreciable increase of weight with age is incorporated in the active cases diagnosed in this manner, as well as by laboratory or "standard weight. The fall of percent "standard weight" with age clinical means, are placed under medical supervision, and their known shown in Table 18a is thus largely an artifact due to the use of these contacts are also examined. In 1958 this program identified 44 new J.S. reference tables(13). The percent distribution of men exceeding the active cases throughout Alaska among the Eskimos and Indians(la calculated "standard weight" is shown in Table 5. The physical appearance of these men suggests that the percent "standard weight" in excess of 100 The noneffective rates at Camp Denali among the Eskimo National is often an artifact due to excessive bone and muscle mass; that is, the Guardsmen were not made available. Since the survey examination consequence of high activity rather than of fat deposits. Body composi- facility was also the battalion dispensary, it was observed that from tion data on these people are not available, but body composition may 8 to 30 men appeared for sick call each morning from a battalion have some relevance to the physiological problem of adaptation to a cold strength of about 400. During the work with each battalion small epi- environment. This interpretation of the small elevation of percent demics of what seemed to be a contagious respiratory disease occurred "standard weight" is also supported by the relation of weight to age a few days after the men arrived in camp. This was variously called shown for the village groups in Figure IX where the weights are es- "flu,' "pneumonia" and "measles" by the orderlies. The medical facil- sentially constant after age 25 to 29. ities available to these men were the same as those for all U.S. military personnel in Alaska. These facilities and the local mess and The pulse rates have little clinical interest, although there was sanitary facilities would not be expected to have any lasting effect, evidence for important observer differences. however, since the men are in camp for only 14 days. As is usually true of blood pressure data, the observers showed a There is no question that duty with the Alaska National Guard has predilection for the end digits o, 5, and even numbers. For example, an important impact on these men, especially those from the Bethel area 76 percent of the diastolic blood pressures were recorded with a zero where acculturization has been slower. The Eskimos acceptance of end digit and 82 percent of the systolic pressures recorded ended with military food, clothing, customs and equipment is immediate and total. zero. This recording artifact requires a careful selection of groups They are sometimes said to dislike beans and they often find cheese in the analysis and also influences the positioning of an arbitrary revolting, but mess sergeants find they eat anything offered them and criterion of normalcy because it will affect the distribution of they eat this completely. It has been said that the word "Eskimo, subgroups. which means "one who eats raw meat" in the Athabascan language, would be more appropriately called "one who eats everything. " The mean systolic blood pressures are remarkably constant with age (Table 6). Furthermore, the number of men with systolic pressure of 160 or over comprises a very small percentage (8 men, 1.1 percent) Source: https://www.industrydocuments.ucsf.edu/docs/zznc0227 S 22 TABLE 6 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION AND AGE HEIGHT, WEIGHT, WEIGHT STATUS, SKINFOLDS, BLOOD PRESSURE & PULSE Battalion 2 Battalion 1 Age (years) Age (years) 17-19 20-39 40-54 Total 17-19 20-39 40-54 Total Number examined 21 255 47 323 42 318 30 390 I/ Height (inches) 65.5+0.4 64.5+0.1 63.8+0.3 64.5+0.1 65.8+0.3 66.2+0.1 65.840.4 66.2+0.1 Weight (pounds) 1/ 140 + 3 141 + 1 144 + 2 142 + 1 140 + 2 150 + 3 150 + 3 149 + 1 % of "Standard Weight" 108 + 2 104 +1 1 102 + 1 104+1 107 + 1 106 + 1 100 + 1 106 + 1 Median Arm 6.3 5.9 5.4 5.9 8.9 6.7 7.1 6.9 Skinfold Thickness Scapula 8.3 7.7 7.6 7.8 10.7 9.5 8.8 9.7 (mm) 23 Systolic Blood Pressure (mm Hg) 17 125 + 4 126 + 1 122 + 2 125 + 1 119 + 2 121 + 1 120 + 3 121 + 1 Diastolic Blood Pressure (mm Hg) I/ 73 + 2 73 + 1 72 + 2 67 + 1 67 + 2 70 + 1 74 + 1 70 + 1 % with B.P. > 140/90 0.0 6. 6.4 5.9 0.0 1.9 0.0 1.5 Pulse (beats/minute) 78 2 78 + 1 74 + 1 78 1 79 + 2 77 + 1 76 + 1 77 + 1 1/ Mean + Standard Error. TABLE 7 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION BLOOD PRESSURE (Mean I Standard Error), BY HEIGHT Height (inches) 59-63 64-67 68-73 Systolic Bn 2 122.3 + 1.4 127.1 + 1.1 127.8 + 3.0 Blood Pressure (mm Hg) Bn 1 117.6 + 2.1 119.7 + 0.9 125.1 I 1.5 Diastolic Bn 2 70.7 + 1.0 73.0 + 1.0 75.2 + 1.9 Blood Pressure (mm Hg) Bn 1 67.4 + 1.6 69.9 + 0.6 70.5 + 1.1 24 of the entire group examined. In neither group was there a significant number of men with diastolic pressures over 90 mm Hg and there were only five men with pressures over 100 mm. Since these were casual blood pressure measurements taken under moderately stressful conditions they may be presumed to be high estimates. They suggest that hypertensive heart disease is not an important problem among these men. Rodahl has also made this observation This fact is of particular interest because of the high protein diet which these men seem to have. It is of some interest that when systolic blood pressure is considered for each battalion by inch of height a definite trend is observed for higher mean pressure with increasing height. Grouping and comparing heights reveals mean differences as shown in Table 7. Diastolic pressures re- veal a similar trend. It may be concluded that the observed blood pressure readings reveal little or no signs of high blood pressure as an indicator of cardiovascular disease and that the minor fluctuations of blood pressure observed are reasonably related to small differences of a.m thickness. The absence of hypertension among the Eskimos may be of some importance in relation to the problem of causation of hyper- tensive heart disease among white cultures. The summary of other clinical findings for the Eskimo Guardsmen is shown in Tables 8, 9 and 10. The data are shown for the battalions separately (Table 8) because they seem to represent two distinct popu- lations. The examiners are also distinguished because of the procedural divergencies demonstrated above. Certain selected clinical signs are presented by battalion and age in Table 9 and by ethnographic origin in Table 10. The significant findings are as follows: No important prevalence of goiter was observed in the men of Battalion 2 but an average prevalence of 10 percent was seen in Bat- talion 1. These were, without exception, small goiters which were judged to be enlarged either with nodules or symmetrically. A 9.9 percent incidence of goiter was found among northern Eskimos, and 14.3 percent of the Athabascan Indians had enlarged thyroid glands. No instance of thyrotoxicosis was seen. The prevalence of enlarged sali- vary glands was low; the glands were not grossly enlarged and the sign did not seem important (Figure v). Erythema of the exposed parts was common, but this could be adequately explained by the known degree of exposure to sun, cold and wind. It was noted particularly among the Eskimos (Table 10). The late cutaneous results of cold injury which the men describe collectively as "ice" re- semble x-ray injury, with cicatrization, depilation and dilatation of venules. Excessive pigmentation of exposed parts was also common in the older men and was sometimes dramatic about the face. Over the trunk and especially the back it assumed a mottled effect with an irregular depo- sition of pigment (Figure VI). This change strongly resembled the erythema ab igne more often seen about the shins in some U.S. rural populations. In these people this sign, restricted to males, is probably related to the "kashim" or sweat bath procedure. Source: ttps://www.industrydocuments.ucsf.edu/docs/zznc0227 TABLE 8 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION PERCENT PREVALENCE OF CLINICAL FINDINGS , BY EXAMINER II Battalion 2 Battalion 1 Total Examiner Examiner Examiner # 1 # 2 Total # 1 # 2 Total # 1 # 2 Total Number examined 155 168 323 211 179 390 366 347 713 Suspected Disease Tuberculosis 3.9 1.8 2.8 1.9 3.9 2.8 2.7 2.9 2.8 Good 85.8 100.0 93.2 83.4 98.9 90.5 84.4 99.4 91.7 General Appearance Fair 12.9 0.0 6.2 16.1 1.1 9.2 14.8 0.6 7.9 Poor 1.3 0.0 0.6 0.5 0.0 0.3 0.8 0.0 0.4 Hair Staring hair 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Thyroid 0.7 1.2 0.9 11.4 8.9 10.3 6.8 5.2 6.0 Glands Enlarged Submaxillary 2.6 2.4 2.5 2.4 5.0 3.6 2.5 3.7 3.1 Nasolabial seborrhea 0.0 5.4 2.8 0.5 2.2 1.3 0.3 3.7 2.0 Other seborrhea 0.0 1.8 0.9 2.4 7.3 4.6 1.4 4.6 2.9 Skin - Face & Neck Erythema, face/neck 21.9 6.0 13.6 13.7 7.8 11.0 17.2 6.9 12,2 26 Pigmentation, face/neck 5.8 0.6 3.1 3.8 7.8 5.6 4.6 4.3 4.5 Thickened conjunctivae 11.0 1.2 5.9 31.8 19.0 25.9 23.0 10.4 16.8 Pingueculae 84.5 57.7 70.6 61.1 54.7 58.2 71.0 56.2 63.8 Bitot' spots 1.3 0.6 0.9 0.0 0.0 0.0 0.5 0.3 0.4 Eyes Circumcorneal injection 0.0 0.6 0.3 0.0 0.6 0.3 0.0 0.6 0.3 Conjunctival injection 4.5 0.0 2.2 9.0 3.4 6.4 7.1 1.7 4.5 Blepharitis 0.0 0.0 0.0 0.5 0.0 0.3 0.3 0.0 0.1 Corneal scarring 6.5 9.5 8.0 4.3 2.2 3.3 5.2 5.8 5.5 Angular lesions 0.7 0.0 0.3 0.5 1.7 1.0 0.5 0.9 0.7 Lips Angular scars 3.2 5.4 4.3 0.0 0.0 0.0 1.4 2.6 2.0 Cheilosis 0.0 1.2 0.6 0.0 0.0 0.0 0.0 0.6 0.3 Filiform atrophy, s1. 0.7 13.1 7.1 9.5 10.6 10.0 5.7 11.8 8.7 Filiform atrophy, mod. 1.3 1.8 1.5 2.8 2.8 2.8 2.2 2.3 2.2 Fungiform atrophy 2.6 0.0 1.2 0.0 0.0 0.0 1.1 0.0 0.6 Tongue Papillary hypertrophy 1.3 1.2 1.2 0.0 1.1 0.5 0.5 1.2 0.8 Furrows 7.1 1.2 4.0 12.8 6.7 10.0 10.4 4.0 7.3 Fissures, erosions, ulcers 2.6 0.0 1.2 1.4 0.0 0.8 1.9 0.0 1.0 Serrations or swellings 5.8 8.9 7.4 1.9 9.5 5.4 3.6 9.2 6.3 Red, tip or lat. margins 3.2 0.0 1.5 7.6 1.1 4.6 5.7 0.6 3.2 Geographic tongue 1.3 0.0 0.6 2.4 1.1 1.8 1.9 0.6 1.3 TABLE 8 (Cont inued) Red or swollen gums 9.7 25.6 18.0 5.2 14.0 9.2 7.1 19.6 13.2 Gums Atrophy or recession, pap. 40.0 66.7 53.9 23.7 43.6 32.8 30.6 54.8 42.4 Bleeding gums 0.0 2.4 1.2 0.0 0.0 0.0 0.0 1.2 0.6 Unfilled caries 27.0 20.9 23.8 42.2 44.1 43.1 36.8 34.4 35.6 Filled caries 10.4 12.4 11.5 30.8 45.3 37.4 23.6 31.5 27.4 Carious teeth, 0 62.6 65.1 63.9 32.7 20.1 26.9 43.3 39.0 41.2 " " 1-2 13.0 14.0 Teeth , 13.5 16.1 31.8 23.3 15.0 24.4 19.6 " " , 3-4 15.7 9.3 12.3 20.4 21.8 21.0 18.7 16.6 17.7 " " , 5+ 7.0 7.0 7.0 26.1 24.0 25.1 19.3 16.9 18.1 Edentulous 1.7 4.7 3.3 4.7 2.2 3.6 3.7 3.2 3.5 Worn 60.0 45.7 52.5 34.1 30.2 32.3 43.3 36.7 40.1 Fluorosis 0.0 0.0 0.0 1.4 2.2 1.8 0.9 1.3 1.1 Malposition 7.8 4.7 6.1 19,9 5.0 13.1 15.6 4.9 10.4 Follicular hyperkeratosis 3.9 11.3 7.7 0.0 10.6 4.9 1.6 11.0 6.2 22 Xerosis 1.3 0.0 0.6 14.2 0.6 7.9 8.7 0.3 4.6 Acneform eruption 5.2 1.8 3.4 9.0 5.0 7.2 7.4 3.5 5.5 Skin General Scrotal dermatitis 0.0 0.0 0.0 0.5 1.1 0.8 0.3 0.6 0.4 Thickened pressure points 1.3 0.0 0.6 1.4 5.6 3.3 1.4 2.9 2.1 Purpura or petechiae 0.6 0.0 0.3 0.0 0.0 0.0 0.3 0.0 0.1 Hyperpigmentation 0.0 2.4 1.2 1.9 0.6 1.3 1.1 1.4 1.3 Abdomen Hepatomegalia 0.0 2.4 1.2 0.5 0.0 0.3 0.3 1.2 0.7 Vibration sensation absent 1.3 0.0 0.6 0.0 0.0 0.0 0.5 0.0 0.3 Lower Extremities Loss of ankle jerk 0.6 0.6 0.6 0.5 0.0 0.3 0.5 0.3 0.4 1/ No findings of enlarged parotids, xerophthalmia, magenta tongue, "scorbutic-type"gums, crackled skin, pellagrous lesions, splenomegalia, ascites, or calf tenderness. Findings of 1 case each of glossitis, perifolliculosis and depigmentation of hair also omitted. Source: https://www.industrydocuments.ucsf.edu/docs/zznc022) TABLE 9 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION AND AGE PERCENT PREVALENCE OF SELECTED CLINICAL FINDINGS Battalion 2 Battalion 1 Age (years) Age (years) 17-19 20-39 40-54 Total 17-19 20-39 40-54 Total Number examined 21 255 47 323 42 318 30 390 Suspected Disease Tuberculosis 4.8 2.4 4.3 2.8 4.8 2.8 0.0 2.8 Good 90.5 92.9 95.8 93.2 83.3 91.5 90.0 90.5 General Appearance Fair 9.5 6.7 2.1 6.2 14.3 8.5 10.0 9.2 Poor 0.0 0.4 2.1 0.6 2.4 0.0 0.0 0.3 Thyroid 0.0 0.8 2.1 0.9 9.5 9.7 16.7 10.3 Glands Enlarged Submaxillary 0.0 2.7 2.1 2.5 0.0 3.5 10.0 3.6 Nasolabial seborrhea 4.8 3.1 0.0 2.8 4.8 0.9 0.0 1.3 Skin - Face & Neck Erythema, face/neck 9.5 13.7 14.9 13.6 2.4 12.3 10.0 11.0 Pigmentation, face/neck 4.8 2.7 4.3 3.1 2.4 6.3 3.3 5.6 2 8 Thickened conjunctivae 0.0 6.3 6.4 5.9 11.9 26.4 40.0 25.9 Pingueculae 38.1 69.4 91.5 70.6 23.8 61.0 76.7 58.2 Eyes Conjunctival injection 0.0 2.4 2.1 2.2 11.9 5.7 6.7 6.4 Corneal scarring 0.0 8.6 8.5 8.0 7.1 2.5 6.7 3.3 Filiform atrophy, s1. 0.0 7.8 6.4 7.1 14.3 9.7 6.7 10.0 " " mod. 0.0 1.6 2.1 1.5 0.0 2.8 6.7 2.8 , Tongue Furrows 0.0 3.5 8.5 4.0 9.5 10.4 6.7 10.0 Serrations and swellings 0.0 7.5 10.6 7.4 0.0 6.3 3.3 5.4 Red, tip, or lat. margins 0.0 1.6 2.1 1.5 4.8 5.0 0.0 4.6 Geographic tongue 4.8 0.4 0.0 0.6 2.4 1.9 0.0 1.8 Red or swollen gums 0.0 17.3 29.8 18.0 7.1 10.4 0.0 9.2 Gums Atrophy or recession 54.9 66.0 53.9 14.3 33.6 50.0 32.8 No carious teeth 36.8 64.6 75.0 63.9 14.3 26.7 46.7 26.9 Caries, filled 1-2 15.8 13.8 11.1 13.5 19.0 23.3 30.0 23.3 Teeth or unfilled 3+ 47.4 19.0 5.6 19.3 66.7 45.9 20.0 46.2 Edentulous 0.0 2.6 8.3 3.3 0.0 4.1 3.3 3.6 Worn 15.8 48.7 91.7 52.5 2.4 31.8 80.0 32.3 Follicular hyperkeratosis 9.5 8.6 2.1 7.7 7.1 4.7 3.3 4.9 Skin General Xerosis 0.0 0.8 0.0 0.6 7.1 8.2 6.7 7.9 Acneform eruption 9.5 3.5 0.0 3.4 11.9 6.6 6.7 7.2 29 PUEW ONNOVI VNWN w 006 oanoww wava NW the WNY PPOOP- compa FUN NWF oaitor JNWF via 3.6 over NFL OF JNN boing 00 0 FOUOND FOOUOD TE 000wooowwe coovoo ING HUYAN FN WNWWN- NVIN ONIXS ONnOX V NI SHONVHO GHL HO IA A 32 33 Thickening of the conjunctivae, especially in the palpebral fissures, because of the tendency of Eskimos to show a normocytic anemia of unknown occurred commonly in the men and was difficult to judge. In general, it cause(3). No true glossitis was seen. The other glossal changes are was diagnosed as present if lateral orbital pressure, through the lid, considered unimportant; the glossal serrations may possibly reflect a would cause definite folds to appear. Similarly, pingueculae of one thick muscular tongue, developed by vigorous eating habits. or both palpebral fissures were both common and extensive. These sometimes The dental data gathered by the clinicians are of interest in protruded between the closed lids medially and were dry and lichenified on the surface. Although over half the men showed these ocular lesions, demonstrating the need for a specialized appraisal of oral manifesta- it seemed they could be reasonably attributed to environmental irritation tions. The clinicians did suspect both age and geographic gradients rather than to nutritional causes. An age analysis (Table 9) conforms for dental caries (Tables 9 and 10). The extent of dental attrition with this interpretation, the prevalence increasing regularly with age. was remarkable and strongly age-related. Fluorosis, even though rarely The incidence was greatest among Eskimos from southern Alaska. diagnosed, seems to have been mistaken for hereditary hypoplasia of enamel. Results of the dental study are presented on pages 33-40. The Bitot's spots seen were rare, in the early examinations, and are in retrospect only suggestive of vitamin A deficiency. However, other Both follicular hyperkeratosis and xerosis were seen and probably corroborative evidence will be discussed in the section on the villages. often confused by two examiners (see discussion above). In Table 11 is shown a. summary of these clinical findings along with the rare Conjunctival injection was noted in 11.9 percent of men 17 to 19 diagnosis of Bitot's spots. The latter cannot be taken as conclusive years of age in Battalion 1 (Table 9), and in 26.7 percent of northern evidence of past or present vitamin A deficiency, but they do require Eskimos, and 19 percent of Athabascan Indians. This is attributed to biochemical evaluation. The lack of correlation between presence of environmental trauma rather than nutritional deficiency. Bitot's spots and serum vitamin A levels shown in Table 11 illustrates the imprecision of this clinical attribute as an indicator of vitamin A nutriture. Corneal scarring represents an important cause of morbidity among the Eskimos. No signs of trachoma were seen in the present studies. Neither were there evidences of "snow blindness, although there were several young people in the villages who had active phlyctenular kerato- TABLE 11 conjunctivitis (PKC) with typical photophobia. The exact nature of snow blindness seems not to be established. Whether there is a distinct entity, precipitated by excessive light and without corneal ulceration, RELATION OF CLINICAL SIGNS AND BIOCHEMICAL FINDINGS, is not clear. Certainly the Eskimos have been making and using narrow SERUM VITAMIN A, ALASKA, 1958 aperture "glasses" for many centuries, since these tools have been (Serum Vitamin A in micrograms per 100 ml. Mean + standard error) excavated by archeologists. Nevertheless, the occurrence of PKC has been very common in these people as judged by the presence of residual scars, Villages and it is a continuing, although lessening, medical problem. The causa- tion is not established, but it appears at least as probable that dietary National Guard Bethel Area Kotzebue Area factors are important as that the doctrinal assignment of cause to No. Serum A No. Serum A No. Serum A tuberculosis is true (15,16). The evidence indicates that while tubercu- losis is often associated with PKC this is not invariably the case. In Total Survey 574 37 + 1 196 31 + 1 220 29 + 1 the present study the frequency of corneal scars was somewhat greater among Battalion 2 men from the less acculturated area of southwestern Persons with follicular Alaska than in Battalion 1 (Tables 8 and 10). However, both groups had hyperkeratosis 34 37 + 2 7 28 + 7 69 30 + 1 significant numbers of men with such scars. Casual observation suggested an age gradient, the lesions being more common in older men than in young Persons with xerosis 30 38 + 2 26 35 + 3 o men. An analysis of the prevalence of this stigma by age and battalion is shown in Table 9. These questions will be considered again with the Persons with Bitot's village data. spots 3 40 + 13 2 12 + 10 o Angular scars were rarely seen in Battalion 2 and none were observed 1/ Two of five subjects recorded as having Bitot's spots had serum vitamin in Battalion 1. Slight filiform atrophy of the tongue was occasionally A levels below 20 mcg/100 ml; this is not a significant difference reported. Moderate atrophy, being more consistent, is better considered. (P= . 16). About two percent of the men showed this lesion to the latter degree. A moderate degree of filiform atrophy was found in 5.3 percent of the Aleuts and 3.2 percent of northern Eskimos. The finding is of interest Source: Ittps://www.industrydocuments.ucsf.edu/docs/zznc227 34 35 A similar comment may be made in regard to the lack of evidence of in field studies of fluoride-caries relations. The race and exact age of a relationship of serum ascorbic acid levels to the presence of red or the examinee and the village from which he came were unknown to the ob- swollen and bleeding gums (see Table 12). server at the time of examination. b. Results TABLE 12 The criteria used to appraise the conditions reported here are RELATION OF CLINICAL SIGNS AND BIOCHEMICAL FINDINGS, described in Appendix A. For the entire group of Alaskan males the life- SERUM VITAMIN C, ALASKA, 1958 time caries experience was generally lower, and diseases of the periodontal tissues generally were more prevalent and severe, than in approximately (Serum Vitamin C in milligrams per 100 ml. Mean + standard error) 1,400 white males examined in Baltimore (17) and in Birmingham(18) in the United States. The caries experience in these two latter groups is con- Villages sidered to be moderate, and periodontal conditions possibly typical, for National Guard Bethel Area Kotzebue Area U.S. white males in general. These specific data were selected as a basis for comparison because the same criteria and methods were used as No. Serum C No. Serum C No. Serum C in Alaska, and because the Alaska examiner participated in all three Total Survey 648 .52 + .01 222 .40 + .02 208 .47 + .02 studies. Comparative findings are shown in Table 13. Persons with red or swollen gums 86 .56+.03 18 .42 + .06 37 .49 + .03 TABLE 13 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 Persons with bleeding gums 4 .65 + .04 o 3 .44 + .06 COMPARISON OF DENTAL CARIES AND PERIODONTAL STATUS OF 713 ESKIMO GUARDSMEN WITH 1, 400 WHITE MALE RESIDENTS OF BIRMINGHAM AND BALTIMORE Mean Numbers of Decayed, In summary, the important clinical findings consisted of occasional Missing and Filled Per- thyroid enlargement in Battalion 1 and among northern Eskimos and Numbers manent Teeth per Man Mean Periodontal Scores 1/ Athabascan Indians, rare Bitot's spots, xerosis, phlyctenular corneal Age Examined Baltimore- Baltimore- scarring, markedly extensive and variable caries, attrition of the teeth (years) Alaska Birmingham Alaska Birmingham Alaska and periodontal disease, and cutaneous hyperpigmentation. The important negative findings were the lack of signs of inanition, anemia, or cardio- 15-19 63 11.3 10.2 .43 .40 vascular disease, or of specific signs of deficiency of B-vitamins or 20-29 359 12.9 9.5 .66 .69 protein. The most serious medical problems observed were the high 30-39 214 13.3 7.7 .82 1.39 prevalence of infectious diseases, especially tuberculosis, the frequency 40-49 68 15.8 6.3 1.25 1.44 of corneal scars and the generally poor teeth. Many of the observed 50-59 9 19.5 9.8 1.73 1.06 defects suggested strong age and geographic patterns which promise to enlighten the search for causation. Nonetheless, these men appeared fit 1/ The periodontal score for each individual is the average for the and rugged and in better physical condition than one might expect to teeth present in the mouth. The criteria for scoring are given in find in a group of U.S. Caucasian recruits. Appendix A. 3. The Dental Study This comparison is useful, however, only for general orientation of the a. Methods findings. There were four independent and geographically distinct pat- terns of dental caries experience, as measured by mean numbers of decayed, All of the dental examinations were carried out by a single missing and filled permanent teeth per man. These patterns are sum- observer. The men were seated in a portable dental chair under a standard, marized in Table 14. color-corrected examination light. Dental mouth mirrors and explorers were employed. Observations were dictated in code to an experienced recorder, who entered the data for each man upon an individual examination card separate from that used for the rest of the clinical observations and originally designed in the National Institute of Dental Research for use Source: https://www.industrydocuments.ucsf.edu/docs/zznc0227 25-34 15-24 OF se TABLE 15 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 ORAL STATUS OF MEMBERS OF FIRST AND SECOND BATTALIONS : Mean DMF Teeth : Mean Periodontal Score : Mean Recession Score Number Mean Age Age : Age Village Examined Age : Adjusted Observed1 : Adjusted Observed: : Adjusted Observed 1/ Group I: principal centers of population Bethel 14 26.6 11.0 7.9 + 1.89 0.63 0.65 + 0.20 8 7 + 3.0 Barrow 69 26.0 13.1 13.6 + 0.90 1.11 0.89 + 0.15 18 14 + 2.5 Kotzebue 19 26.2 14.2 14.2 + 1.63 1.96 1.12 + 0.51 30 18 + 7.5 Dillingham 7 22.1 15.7 12.1 + 2.97 0.21 0.37 + 0.27 0 0 Unalaska 12 25.8 16.7 15.5 + 1.76 1.40 0.80 + 0.38 12 8 + 3.5 Nome 17 22.1 17.1 14.5 + 1.82 1.02 065 + 0.16 6 8 + 6.6 St. Paul 26 31.8 20.2 20.6 + 1.27 1.34 1.34 + 0.39 16 16 + 4.7 All Group I 164 26.5 14.9 14.5 + 0.60 1.22 0.90 + .11 17 12 + 1.7 White U. S. Males 26.5 13.0 .69 13 37 Group II: villages near the principal centers of population Noatak 22 29.0 11.3 11.8 + 1.85 0.68 0.69 + 0.20 10 11 + 3.1 Deering 3 29.5 12.7 13.0 + 4.93 0.84 1.47 + 1.27 15 15 +11.8 Tuluksak 8 33.1 12.8 11.1 + 2.36 1.59 1.59 + 0.46 18 18 + 7.6 Wainwright 17 28.8 13.3 13.2 + 2.01 1.49 1.57 + 0.50 27 28 + 7.9 Napaskiak 14 26.8 13.9 14.2 + 1.98 1.29 1.24 + 0.31 18 13 + 5.3 Akiak 6 30.7 14.5 15.0 + 4.24 1.36 1.26 + 0.62 17 15 +14.1 White Mountain 5 30.7 15.3 14.8 + 2.22 0.71 0.90 + 0.16 7 10 + 5.7 Shishmaref 8 31.6 15.4 13.8 + 3.41 0.44 0.59 + 0.41 12 12 + 4.0 Unalakleet 13 28.5 15.6 16.2 + 2.43 0.86 0.90 + 0.47 25 23 +11.7 Elim 2 29.5 17.0 17.0 + 1.00 0.75 0.75 + 0.65 8 8 + 3.0 Shaktoolik 2 33.5 21.5 21.5 + 1.50 0.41 1.15 + 1.15 21 29 +29.0 All Group II 100 29.4 13.6 13.7 + 0.81 1.04 1.08 + 0.14 17 17 + 2.5 White U. S. Males 29.4 13.1 0.74 15 TABLE 15 (Continued) ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 ORAL STATUS OF MEMBERS OF FIRST AND SECOND BATTALIONS Group III: relatively remote villages, except those in the Yukon-Kuskokwim - delta area Shungnak 16 29.1 2.1 1.8 + 0.59 0.37 0.34 + 0.12 3 4 + 2.1 Little Diomede 7 29.2 3.3 4.4 + 0.90 1.32 1.01 + 0.67 19 16 + 10.0 Kasigluk 7 26.9 5.4 5.4 + 1.15 0.56 0.77 + 0.22 5 4 + 1.9 Akiachak 16 30.7 5.5 5.1 + 0.83 1.38 1.60 + 0.21 14 16 + 6.1 Barter Island 5 31.7 5.6 5.6 + 2.34 0.45 0.46 + 0.29 9 9 + 5.3 Alakanuk 16 32.1 5.9 5.3 + 1.21 1.59 1.88 + 0.47 10 13 + 4.0 Teller 9 27.9 5.9 5.6 + 1.51 0.58 0.54 + 0.22 12 11 + 3.9 Koyuk 4 23.8 6.1 6.5 + 3.23 2.04 2.05 + 0.53 11 12 + 12.0 Kwethluk 17 31.3 6.2 5.1 + 1.40 1.37 1.57 + 0.37 12 14 + 4.3 Stebbins 12 33.4 6.2 6.7 + 1.81 1.35 1.68 + 0.36 26 34 + 8.7 Selawik 14 29.5 6.3 6.6 + 1.48 0.49 0.50 + 0.12 10 10 + 4.6 Meade River 4 25.5 6.6 6.8 + 3.04 0.52 0.55 + 0.42 5 5 + 4.8 Eek 14 28.7 6.8 6.9 + 1.78 0.92 0.89 + 0.20 8 7 + 2.6 Mountain Village 14 36.7 6.8 7.5 + 1.61 0.78 0.94 + 0.28 15 20 + 4.6 Wales 5 43.9 6.8 6.8 + 1.32 1.22 1.22 + 0.49 30 30 + 11.8 Kivalina 11 26.8 7.9 7.7 + 1.91 1.81 1.31 + 0.56 28 19 + 9.9 Gambell 22 27.6 8.4 9.2 + 1.46 1.30 0.96 + 0.30 19 16 + 4.2 Kiana 8 22.8 8.8 7.4 + 2.71 0.34 0.36 + 0.15 4 3 + 1.5 Noorvik 11 26.3 8.9 9.0 + 2.64 0.78 0.55 + 0.25 2 1 + 0.8 Fort Yukon 21 28.3 9.2 9.0 + 1.46 0.36 0.32 + 0.17 9 4 + 2.3 Savoonga 27 25.7 9.3 8.4 + 1.08 0.88 0.70 + 0.20 17 13 + 2.6 King Island 5 33.5 9.6 9.4 + 2.79 1.37 1.40 + 0.32 13 15 + 6.7 St. Michael 12 29.2 9.6 9.6 + 1.63 1.64 1.72 + 0.45 27 28 + 9.3 Point Hope 20 32.0 10.4 10.1 + 1.57 1.18 1.20 + 0.32 14 15 + 4.7 All Group III 297 29.6 7.1 7.1 +1 .35 1.00 1.00 + .07 13 13 + 1.1 White U. S. Males 29.6 13.1 .74 15 1/ Standard error of the mean is included in the observed values. TABLE 15 (Continued) ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 ORAL STATUS OF MEMBERS OF FIRST AND SECOND BATTALIONS : Mean DMF Teeth : Mean Periodontal Score : Mean Recession Score Number Mean : Age : Age : Age Village Examined Age : Adjusted Observed 1/ : Adjusted Observed 1/ : Adjusted Observed Group IV: villages in the Yukon-Kuskokwim delta area Newktok 5 28.5 0 0 0.93 0.82 +0.52 12 11 + 9.2 Chevak 6 29.3 0.4 0.2 + 0.16 0.96 1.02 +0.25 16 18 + 6.2 Tanunak 11 37.8 0.4 0.6 + 0.36 0.23 0.31 +0.16 9 13 + 3.2 Mekoryuk 15 37.4 0.6 0.9 + 0.38 0.03 0.02 +0.01 4 5 + 2.0 Chefornak 5 22.3 1.1 0.4 + 0.40 0.90 0.38 +0.31 16 6 + 6.0 Kwillingnak 20 30.9 1.8 1.5 + 0.42 1.06 1.06 +0.19 10 11 + 2.4 Kipnuk 13 30.8 2,1 2.0 + 0.60 0.65 0.71 +0.17 15 15 + 4.7 Hooper Bay 25 30.8 3.3 3.3 + 0.88 0.73 0.88 + 0.28 10 13 + 3,1 Tuntutulial: 11 30.1 3.4 3.2 + 0.98 1.39 1.32 +0.29 12 13 + 4.6 Quinhagak 22 33.0 3.7 3.4 + 0.76 0.97 0.95 +0.17 6 7 + 2.1 Napaskiak 7 27.4 4.1 4.1 + 2.09 0.76 0.76 +0.32 6 6 + 3.9 Togiak 10 30.8 4.3 4.1 + 1.46 1.54 1.65 +0.55 4 4 + 1.6 Scammon Bay 2 31.5 4.5 4.5 + 2.50 0.20 0.20 +0.20 12 12 + 5.0 All Group I.V 152 31.7 2.6 2.3 + 0.27 0.76 0.83 +0.08 9 10 + 1.0 White U. S. Males 31.7 13.2 .77 17 1 Standard error of the mean is included in the observed values. Source: https://www.industrydocuments.ucsf.edu/docsizznc0227 40 41 these two villages more nearly resemble men from group IV villages, and (2) Periodontal disease the villages are similarly isolated. Shungnak is located near the head- waters of the Kobuk River about 100 air miles east of Kotzebue, and For the whole world population periodontal disease probably Little Diomede is an island in Bering Strait near the boundary with outranks dental caries in importance. Commonly called "pyorrhea, this Soviet Russia. disease attacks the soft and hard tissues supporting the teeth in the dental arch so that they loosen, become painful and ineffective in Age-corrected scores are more appropriate for comparisons between chewing, and are eventually lost. In this study periodontal disease villages, and observed scores for comparison with findings for white was assessed by two measures the periodontal index or score which is U.S. males. a morbidity index of present and active disease, and gingival recession, a cumulative measure reflecting past loss of tissue, particularly bone. (1) Dental caries There was no relation, in the total population, between group findings for either of these measures and group findings for dental caries. There was, as a rule, remarkably little variation in dental caries experience between men of a given age and village. The means for In 38 of the 55 villages periodontal scores (i.e., ratings of decayed, missing, filled (DMF) teeth of Eskimo men living in the seven present disease) were higher than would be expected on comparison with principal villages were slightly but unimportantly higher than those for scores for white males in the U.S., and in only five villages -- Mekoryuk, white U.S. males, rising with age in similar fashion. Means for men Scammon Bay, Fort Yukon, Tanunak and Shungnak were scores signifi- living in villages near these seven principal centers a.re about the same, cantly or importantly lower. The typical clinical picture was one of but show a tendency for caries experience to be lower in men of older age. moderate to severe gingivitis with widespread pocket formation, abundant This tendency becomes marked in the two successive groups; in each group oral debris, and heavy deposits of calculus, although some villages stood DMF means are progressively lower in progressively older groups of men. out as marked exceptions to this rule. Here, as in dental caries, there Since the DMF mean is a cumulative measure, this can occur only in popu- tended to be little variation between men from a given village. lations where caries prevalence is on the increase, and the patterns seen here suggest that this increase is occurring at a relatively rapid rate. 11 The recession score is a relatively weak population measure when young persons are studied, since gingival recession is rarely marked in The dental caries pattern cuts across ethnic boundaries; location for individuals prior to the middle and later years of life. Recession location, there is little difference in DMF means between Aleuts from findings for the whole groups were neither markedly nor importantly Unalaska and the Pribilofs, southern Eskimos from the region generally different from the patterns reported (by an independent team of observers) south of Alakanuk, northern Eskimos from the region generally north of for U.S. Army troops. Findings for the whole of group IV were, in fact, St. Michael, and Athabascan Indians from Fort Yukon. There is a loose significantly lower. tendency (possibly an artifact due to sampling variation) for DMF means in group III to increase from south to north, but there is no clear In men 35 years of age or older, however, recession scores as out- transition across an ethnic boundary. Neither does the term "isolation, " lined in Table 16 for the main groups are generally related to group as used here, denote lack of contact with other groups; in the course of caries scores. The series of differences shown might occur by chance summer migration nearly all of the men in groups III and IV leave their slightly less than once in one hundred trials. homes and live for a time in or near one of the principal villages. At this point in analysis no clear relationship between caries patterns and dietary habits or nutritional status has been developed. TABLE 16 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 GINGIVAL RECESSION SCORES, MEN 35 YEARS OF AGE OR OLDER, 1 The means for group DMF typically rise in essentially straight-line FIRST AND SECOND BATTALIONS fashion with age after permanent teeth begin to erupt at the age of six, gradually becoming asymptotic after the mean reaches a value Number Mean Mean of 15 to 18. Extrapolation of the present data suggest that after Group Examined Age Recession Score a generation, caries may become as prevalent in the group III vil- lages as in villages in or near the principal centers of population, I 15 41.9 39 + 1.7 and that caries in the group IV villages may rise to about the levels II 17 40.4 now seen in group III. If this occurs the disease will then present 31 + 6.9 a public health problem for these people quite as difficult as the III 68 41.2 28 + 3.3 present dental caries problem in the U.S. IV 57 40.5 17 + 2.0 White U.S. males 41.0 26 Source: tps://www.industrydocuments.ucst.edu/docs/zznc0227 42 43 IV - THE VILLAGE STUDIES Twice each year, in spring and fall, ships bring in supplies. Supplies for the year must be anticipated at this time, since the only 1. Bethel Area - the Situation in Akiak, Kasigluk, Napaskiak, Newktok recourse is to costly shipment by air from Anchorage. Mail order houses and Hooper Bay have an active year-round business in this area. An adult education class in one village had as two of its projects the following 1) how Bethel is the principal trading center of a large area of south- to write an order to a mail order house; 2) how to fill out a U.S. income western Alaska which includes most of the lower Yukon and Kuskokwim River tax return. areas. The town is on the Kuskokwim River at the head of deep water navigation. It is the air terminal for the only outside contact of the In Eskimo villages the dogs are an essential part of the economy, area during eight months of the year. The population is mixed white and for they are the only beasts of burden. Wood, one of the few sources Eskimo people. An electric service, high school and many other small- of fuel, must be hauled long distances from the river bottoms. People town facilities are available. travel and supplies are hauled by dog sled. Some freighting for cash income is done with dogs. The average size of a team is five dogs. In winter the main occupation of many Eskimos in this area is Fish are fed to them at variable times and in limited amounts so the trapping for mink, beaver and muskrat. In summer many find temporary dogs are generally thin and ravenous. They eat snow for water, snatching work in canneries on Bristol Bay. In some cases almost the entire able- it as they run. The Kuskokwim dogs are small, averaging 30 to 50 pounds, bodied population is transported to these canneries for a period of six and are nondescript in appearance. The dog population is threatened with weeks or more. Those who remain behind in the villages catch herring, canine distemper because of inadequate immunization. smelt, pike, whitefish and salmon for their own use. The larger fish are filleted and air-dried for the winter cache, to be consumed by both The population counts for the villages included in the Bethel por- dogs and humans. The tundra is dotted with small ponds and sloughs tion of the study and the numbers given clinical examinations in this which are a source of whitefish, ling cod, blackfish and needlefish. survey are shown in Table 2. The sampling within the villages was done Often these fish are eaten raw, and are thus a source of tapeworm with the help of the resident teacher; who selected one or two adolescent infestation. boys as runners. They were instructed to bring into the schoolroom entire families, including all ages. The selection of families and their Hooper Bay and Newktok are sealing communities of coastal Eskimos. order of appearance was not controlled. Clinical appraisals were done on Since the seal kill is variable and uncertain depending upon the movement all persons 2 years old and over. Blood and urine samples were obtained of the pack ice and tolerable sealing weather, this food supply is un- from all persons 6 years of age and over, until 50 blood samples had been certain. The coastal Eskimos collect seal pokes, inverted seal skins obtained in each village. At the end of the day the villagers were filled with seal oil, which they take up the Kuskokwim for sale and advised to bring forward the people who were sick or those with medical barter to the river communities. The subcutaneous fat of newly complaints who had not previously been seen. These persons were not butchered seal is cut into small portions about one by three inches in included in the nutritional appraisal The invitation invariably pro- size and pressed into the inverted seal skin (which has had all the duced an assorted clinic. No assessment was made of the number who apertures, except the anus, tied off with string). After the poke is stayed away from the nutritional appraisals deliberately. In Hooper filled with these small pieces of blubber, it is plugged and left inside Bay most of the men were away sealing. In Kasigluk many men had gone the Eskimo house at moderately high room temperatures and the oil is for wood. thus gradually rendered. When the contents of the poke have been re- moved, a sponge-like connective tissue residue representing the original The presence of a school and one or more teachers has had an stroma in which the oil was contained is left within the poke. This is important influence upon the Eskimo communities. While introduction of considered a food delicacy. No applied heat is used in the rendering a school has generally caused the villages to increase in size and thus process. The tendency of the seal poke to collapse as oil is withdrawn often overburdened the available food supply it has also stimulated the for use maintains a minimum of air within and probably delays rancidity. acculturization of the community. Community leaders who have whi te On some occasions other foods, such as partially dried salmon or herring, customs, clothing, food and ideas have no doubt been important models are placed in seal oil in the poke and stored for considerable periods. for emulation. The school lunch programs, the mail which comes once or Salmonberries, blueberries and wild greens may be stored in a seal poke twice a week, the radio communication with the Alaska Native Health or in barrels without the oil. Service Hospital each evening and the formal instruction in English with material and methods very like those of schools in the rest of the United A seal poke weighing 100 pounds may bring $140 and will last a States all increasingly influence the life and health of the Eskimo family a year. Seal oil is used as a major ingredient of such dishes people. There is a large age gradient in the use of English in the as agutuk (Eskimo ice cream) or oknuk (soup). Other foods, especially Bethel area; almost all school children speak English, but only rarely dried fish, may be dipped into it at serving time. Hunters are con- do adults over 40 years of age. vinced that it is more calorific than other foods and it is thought essential for a trip in intense cold. Source: s://www.industrydocuments.ucsf.edu/docsizznc0227 45 44 Bureau of Indian Affairs School Program for about eight years. Vi tami There are no physicians permanently located in the villages although These administration is more recent. No active keratitis was seen in this there are three physicians associated with the hospital in Bethel. indi- village but there were many children with the corneal scars which are physicians, a dentist and an x-ray technician visit the villages attributed to phlyctenular keratoconjunctivitis (PKC). The lesion was vidually at irregular intervals of several months. The x-ray technician films especially common in children over 7 years of age. Dry skin on the carries a portable x-ray machine which is largely used for chest extensor surfaces and mild follicular hyperkeratosis were seen occasionally in a tuberculosis control program. Public health nurses also visit the in children 8 to 16 years of age. The condition of the teeth varied villages at irregular intervals. A sanitary engineer of the Alaskan the markedly. Caries were rampant in many families, involving both deciduous Department of Health is presently working in certain villages of and permanent teeth. People past 30 tended to have worn but intact and Bethel area in order to improve the water supply. noncarious teeth (see Figure VII). In most villages the teacher is the medical representative who mans A man in his 40's was seen with incipient cardiac failure and a the two-way radio contact. The costs of transportation to Bethel, loud aortic diastolic murmur, probably a result of rheumatic heart Anchorage, or even to other states for medical treatment are borne by disease. A middle-aged woman with typical active rheumatoid arthritis patient, if that is possible; by the ANHS, if it is not. Since the was examined. distances the are great such trips are expensive. Midwifery is done by women in the villages except for those areas near the Bethel hospital The 77 clinical appraisals done in Akiak indicated the calorie where some women may prefer to go for delivery when possible. About supply was adequate, and that there had been a large incidence of 225 babies are delivered annually to native women in the Bethel hospital. phlyctenular keratoconjunctivitis in the past, although no acute cases were seen. Follicular changes suggested a mild or borderline vitamin A The largest single health problem in the villages is tuberculosis. deficiency. Both the caries and the corneal scarring seen in this About 7 to 10 percent of the Eskimo population is being treated with village suggested a familial pattern of prevalence. drug therapy for this disease. In Akiak, for example, 13 of 130 people in records indicate that 38 other villagers have received this therapy the village were receiving chemotherapy in August 1958 and the Kasigluk is a village of 227 Eskimos about 35 miles west of Bethel on the tundra, a few miles from the Johnson River. The latter is an lation and about one tenth of one percent of the population dies of since 1954. The annual incidence is now about one percent of the popu- abundant source of fish in the summer. Nunapitchuk, a somewhat larger village, is four miles away across a small lake. Kasigluk has been tuberculosis each year. The first figure has been reduced by one half, moved in recent times from a location six miles north to be better ac- the second by four fifths since 1952(8). The trends are shown in cessible by boat. The village has a typical onion-turreted Russian Church and a smaller Moravian Church. There are many Russian names in Figure II. the village and people with Mongoloid faces and light hazel eyes. The Akiak is a community of 130 people on the Kuskokwim River about in people seemed poor but were generally clean. The men showed signs of 30 miles upstream from Bethel. Most of the people were dressed recent use of their steam baths, a custom which is thought by some to excellent furs and mukluks, and there was evidence of a plentiful food be a Russian importation but is more likely an intrinsic part of the Eskimo culture. supply. There were no signs of caloric deficiency. Some obese women past These people at Kasigluk must go long distances to the Kuskokwim 30 years of age were seen. There were many children with draining ears flats for wood. The dogs were lean but strong; a team of five brought and impetigo was common, especially in children. One child with ex- in a load of green poles weighing 300 to 400 pounds. The village has tensive bronchitis and fever was given sulfa drug therapy. a poor water supply, consisting only of melted ice from nearby ponds. An epidemic of dysentery had occurred in this village during the two Each school child receives a hot lunch and a therapeutic multivitamin weeks prior to the survey team visit. The school children receive tablet every dayl/. The lunch program has been in effect in the lunches and a multivitamir tablet each school day. New mothers also receive vitamin solutions for the babies and iron pills for themselves, but the teacher was uncertain that these materials are used. The Contents of Multivitamin Tablet: calóric intake of the people seemed adequate. 1 Vitamin A - 5,000 U.S.P. units Ascorbic acid - 50 mg. Vitamin D - 500 U.S.P. units Vitamin E - 5 I.U. Impetigo was common, and several children were put on courses of Thiamine mononitrate - 3 mg. Calcium carbonate - 250 mg. penicillin for treatment. The dispensation of sulfonamide ointment Ferrous sulfate - 234 mg. Riboflavin - 3 mg. which is usually applied over the crusts is useless and possibly harmful. Pyridoxine hydrochloride - 0.5 mg. Potassium iodide - 0.15 mg. Two instances of atopic eczema were seen in children. Corneal scars Potassium sulfate - 5 mg. were not common and were generally seen in subjects 10 years of age and Vitamin B12 - 2 mcg. Copper sulfate - 1 mg. over but not in younger children, and no active phlyctenular Folic acid - 100 mcg. Niacinamide - 25 mg. Magnesium oxide - 6 mg. Calcium pantothenate - 5 mg. Zinc sulfate - 1.5 mg. Source: 47 keratoconjunctivitis was seen. The teeth were generally carious in the FIGURE VIII children, and worn but intact in people past 30. Some skin dryness was noted in children but no follicular hyperkeratosis was seen. One woman of 40 with aortic insufficiency and mitral stenosis was examined. A recent history of migratory arthritis was elicited in one youth. He showed no signs of carditis. Prophylactic penicillin was recommended. Napaskiak is a village of 152 persons on the south bank of the Kuskokwim River eight miles below Bethel. It has close contact with Bethel. Two other Eskimo villages are in the vicinity -- Oscarville, across the river, and Napakiak, down river. River fishing is the attraction. Napaskiak has been moved in recent-times from a nearby and ancient site that had become susceptible to flooding due to channel changes of the river. Napaskiak has one of the few remaining "medicine men" or shaman (Frontispiece). The role of this man in the communi ty' health could not be determined. There were great extremes in the families here, some being thin, while others were well fed. The thin families were usually dirty. The teacher gives 60 children their lunch at 8:30 a.m. Half then go home and return for an afternoon teaching session. The others remain for the morning session. All students receive a multivitamin tablet in school each day. This village has been included in a tuberculosis prophylaxis pro- gram since early 1958. A program for control of tuberculosis by ambulatory chemotherapy was begun in 1953 as a result of a recommendation of the Pittsburgh Health Survey(7) to the Secretary of the Interior. At the time of its inception the program was ambulatory because there DENTAL ATTRITION IN A 32-YEAR-OLD - were not enough hospital beds for all those needing the therapy. When ESKIMO WOMAN more beds were available more of those who needed hospital treatment were admitted. The prophylactic control study mentioned at the begin- ning of this paragraph was started in 1958 as a separate project under the direction of Dr. George Comstock, Tuberculosis Control Program, Bureau of State Services of the U.S. Public Health Service. This is a research study on the prophylactic use of isoniazid being conducted in selected parts of the U.S., Alaska and Puerto Rico. Every person in the villages selected for the study is given medication each day for one year, half receiving isoniazid at a level of about 5 mg per kilogram of body weight and half receiving a placebo. All told about 0,000 people are participating in this study. It is hoped to measure the suppressive action of such medication upon the incidence of tuberculosis. No signs of isoniazid-induced seborrhea or dermatitis were seen in this or any village, although perhaps as many as 10 percent of the total native population are on isoniazid therapy. The teeth were carious in Napaskiak except among people over 40 years of age. Exceptions to this were seen in a few Kipnuk women who had come here from the coast after marriage and generally had fine teeth. Again several cases of atopic eczema were seen. The teacher believes it is increasing in frequency. The males showed signs of the effects of taking steam baths (petechiae on the backs and shoulders), Source: ittps://www.industrydocuments.ucsf.edu/docs/zznc022 48 49 but the women and children did not. Petechiae occurred commonly among The school lunch program and daily vitamin pill are administered older male children and adults but was uncommon in children under 10. here. Because of exceptionally good sealing, the people appeared pros- No active keratitis was seen. Corneal scarring seemed to occur in perous and adequately nourished. There were many plump women and families; dry skin and follicular changes were uncommon. The adult children. Teeth were good but worn in people past 20 years of age and women often seemed pale. Tongue papillation was good. An old man with carious in many children. There were many corneal scars, again seen in aortic stenosis was examined but heart murmurs were generally rare. families and generally in people 12 to 20 years old. Children under A sick baby was brought back with the party to the Bethel Hospital and 12 were not often so affected. Many of the women were pregnant. Some a diagnosis of meningococcal meningitis was confirmed. After a stormy evidence of hypochondriasis was noted in adults. There was a single course she recovered. Prophylactic sulfadiazine seemed to prevent instance of goiter, a large soft gland in a 40 year old woman who had additional cases in the village. This treatment was arranged by radio a history of thyrotoxicosis treated with N-propylthiouracil. Scleral communication from Bethel after the bacteriologic diagnosis was thickening in the palpebral fissures and pingueculae were noted in many established. individuals. Here as in the other villages it was apparent that dental fillings meant tuberculosis because almost the only people who had had Newktok is an isolated village of 121 coastal Eskimos about 120 dental care were those who had gone outside for tuberculosis therapy miles west of Bethel on the tundra, a few miles from Baird Inlet and the Bering Sea. The nearest postoffice is at Tanunak, 40 miles to the 2. Kotzebue Area - the Situation in Noatak, Point Hope, Shishmaref, southwest on Nelson Island. There were many sod houses in the village. Allakaket and Huslia The people at Newktok seemed very primitive; their faces were The Kotzebue phase of the present study centered among the northern Mongoloid with prominent epicanthal folds. Very few could speak English. or Arctic Eskimos who are for present purposes considered to be in Their clothing was worn and poor. Both people and dogs were thin. The ethnic area III (see Figure III). The Kotzebue study also included sleds were hand-hewn and lashed together with thongs. In one sod house observations in two Indian villages in the mountains of the middle Yukon the children were seen to scoop a frozen blackfish out of a tub in the region lying in area IV. anteroom and swallow it with a minimum of chewing. The lids were off the cans containing flour and sugar, and the contents were spread about The Eskimos north of Norton Sound (Nome) are much more sparsely the table top as though the children had been eating directly from the distributed. The principal activity of the males is hunting, and seal, cans. Since this was the first tolerable weather for a week, the men walrus and several species of whale are the chief game. The Eskimos were away sealing. along the Arctic coast find the whale kill highly variable since it depends strictly upon weather and hunting conditions. Polar bear have Many of the children in this village were grossly underfed, and always been important not only as a source of food for man and dogs, but pale and thin. Several families were heavily infested vith head lice. also as a source of income from sale of skins. St. Lawrence Island has With a few exceptions, the teeth were excellent. There were several an abundant supply of walrus in the spring, a good source of both meat slightly but definitely enlarged thyroid glands observed but no gross and ivory. The people of St. Lawrence Island, Diomede Island and King goiters. Many children had marked follicular hyperkeratosis and many Island are well known for their fine ivory carving which provides them others had dry skin. There were several adults with Bitot's spots. with an important part of their cash income. The materials they make No signs of water-soluble vitamin deficiency or of scurvy were seen. are taken to Nome in the summer and marketed. Hooper Bay is an ancient Eskimo settlement on the Bering Sea south The Arctic fox is trapped on the ice pack for its fur but neither of Cape Romanzof, with a population of 430. It is located on two low this nor any other land carnivore is used for food except in dire hills at the tip of a spit of land which encloses Hooper Bay from the emergency. The polar bear is a partial exception, for its meat is often north. The main source of livelihood is the sea, especially sealing. eaten, although the liver seems never to be eaten and is widely regarded There are many dog teams for hauling the skin boats and meat to and from as poisonous. There is a collection of recent evidence to support the the open water a few miles away. Water is obtained by melting ice from idea that polar bear liver is, in fact, poisonous for human consumption. a fresh-water pond a few miles back of the village on the tundra. Fuel Dr. William Rausch of the Arctic Health Research Center on one occasion is obtained from driftwood which is now plentiful, coming largely from ate 100 grams of polar bear liver and immediately became ill. Dr. the mouth of the Yukon which lies to the north. The houses are well Edward Scott of the same institution fed polar bear liver to white mice built but without a semblance of orderly arrangement either among houses and an equivalent amount of vitamin A from fish oil to a control group or within them. The indoor temperatures and humidity are very high. of mice. Both groups of mice died (19). The concept of the toxicity of These, together with many unwashed Eskimos, unbutchered seals, drying polar bear liver and that it is due to an excessive vitamin A content skins and oozing seal oil pokes, produce an overpowering atmosphere for is widely accepted in scientific circles in Alaska. a white person. Source: https://www.industrydocuments.ucsi.edu/docsizznc022 50 51 The Indian villages, Huslia and Allakaket, which were included in before he goes out on the ice pack for the day, or takes no more than a the present study, are settlements on the Koyukuk River. These people cup of tea or coffee. He believes eating would make him sluggish, less are Athabascan Indians who range through the forested and mountainous agile and less acute. Since he may stay out one to three days under areas of northwestern Alaska. Their principal activity is trapping rigorous conditions of activity and temperature, it is clear that he has beaver, mink and muskrat. The beavers are taken through holes in the both great stamina and efficient gluconeogenesis. When he returns he ice in the late winter and spring with snares which are baited with takes a very large meal. This ability to carry on while fasting may be willow twigs. Each trapper is allowed a seasonal limit of 20 beavers which average $40 per pelt. The beaver is a large animal weighing 30 related physiologically to the ability to consume a very high fat, high protein, low carbohydrate diet. It may also be a factor in prohibiting to 60 pounds, and is widely used for food. The meat is said to resemble youths (who might be more susceptible to ketosis) from going out on the pork. The skins are stretched flat in an almost perfect circle for ice pack. drying and are hauled about in large wafer-like stacks wrapped in burlap. The sampling procedures in the Kotzebue area were carried out as Caribou are migratory animals taken seasonally and somewhat unpre- described for the Bethel study above. Clinical studies were done on dictably. Their meat is dried in the sun for storage in caches and the all persons 2 years of age and over; blood and urine samples were ob- skins are widely used for clothing. tained from all persons 6 years and over, the urine samples being clean catch samples. In the Kotzebue area those members of the National Guard Fish are taken from the rivers with nets or fish wheels, a white who were home were excluded from the village examinations in order for man's invention and a useful one, for -- powered by the current -- it them to be seen at Camp Denali with their battalion. scoops up the teeming fish and deposits them in a tub requiring the fisherman only to empty the tub once he has properly placed the wheel Noatak is a village of 300 Eskimos on the Noatak River 60 niles and the diversionary fence. north of Kotzebue. The food supply at Noatak is largely caribou which are hunted inland on the tundra, fish from the Noatak River, and seal The northern Eskimos have been more exposed to the white man than and beluga whale from Kotzebue Sound. The teacher at Noatak gives each have the southern Eskimos through efforts of 18th century sailors to school child a lunch and a vitamin pill every school day. The principal find a Northwest Passage, and subsequently through the extensive whaling clinical impairments found here were carious teeth and follicular activities which took place in the Arctic Ocean. Contacts with sailing hyperkeratosis. ships reached a maximum in the middle of the 19th century. Possibly as a consequence, the northern Eskimos are advanced at least a generation Point Hope, which the natives call Tigara, often experiences severe over the Kuskokwim people in their cultural adaptation to the white race. Almost all speak English; they tend more strongly to adopt white men's weather. It is the main polar bear-hunting area for sportsmen, an clothing and habits of food and often have noticeable admixtures of white activity which is a source of income for the Eskimos. A typical polar blood as reflected in coloration and conformation. The northern Eskimos bear hunt has facetiously been described as follows: The sportsman are larger and less Asiatic-appearing than the southern Eskimos, although pays $2, ,500 and is guaranteed a bear. The hunter and his pilot go out there are many exceptions to this generalization. Some of the village over the ice pack in a light plane until they spot a bear which they sites, such as that at Shishmaref Inlet, are very old, dating back 500 pursue in the plane until it falls exhausted on the ice. They then years or more. The attraction of these sites can only have been their land, shoot the bear and take the skin. The sport seems more expensive than dangerous. convenience to the essential food supply. Eskimo villages are sometimes moved, but generally only to a better food supply. The main articles in the diet at Point Hope are seal and whale meat with some bear meat and fish. Caribou are taken in the fall and Hunting on the ice pack is a dangerous occupation and the extent of this danger varies in different areas depending upon currents and weather winter. The whale meat collected in the spring is cut up and stored conditions. In the Hooper Bay area young men do not go on the hunting in pits in the permafrost for later use. This natural refrigeration expeditions until they are about 18 years of age. North of Bering Strait and not the perpetual cold, for the summers are actually quite warm they. go at 15 years. Since these boys are physically well developed at is the basis for the legendary test of salesmanship in Alaska. A few Eskimos do have refrigerators, especially the traders. Many Eskimos 15 years it appears that a maturation of judgment is recognized as es- sential. The active hunters are men 20 through 45 years, older hunters have outboard motors. Almost every Eskimo boy dreams of becoming an airplane pilot. The men are clever mechanics and are said to have being rare. fashioned broken motor parts from ivory or bone when metal replacements were unavailable. These Eskimo men stripped down resemble professional athletes. They are heavily muscled, relaxed and loose-jointed, and have the ap- pearance of finely trained men. Unlike the white man's concept of Sod houses are common in Point Hope. Alaskan Eskimos never build snow igloos except to amuse visitors from the outside and the results preparation for a physical ordeal, the Eskimo either does not eat are often ludicrous. Whale ribs are often used for rafters for sod houses. No village planning is discernible. Snow drifts range up to 25 feet after a storm and the children slide down these on short baleen skis. Source: https://www.industrydocuments.ucst.edu/docsizznc0227 52 The children receive a school lunch and a daily multivitamin tablet. Clinical examinations here revealed many carious teeth and much follicular hyperkeratosis. Shishmaref is a village of 200 people on a small island just off Shishmaref Inlet. The principal food is seal, which was plentiful during the winter preceding the survey, since the pack ice had been pushed toward the Siberian side by favorable winds. Some fish are also available. Many carious teeth were seen here and there was much dental attrition. Follicular hyperkeratosis was common. A school lunch and multivitamin pill are given to the children. Allakaket is an Indian village of 100 people 150 miles north of Tanana. It consists of 10 to 15 log cabins, a school and an Episcopal Church. The main occupations and food sources are moose hunting, fishing and beaver snaring with a wire loop snare. The trap lines are 50 to 150 miles in length. The calorie supply seemed limited in this village. The teeth were carious and follicular hyperkeratosis was common. Some filiform atrophy of the tongue was also noted, although it was of mild degree. No evidence of goiter was seen. One 18 month old child with rickets was seen here. Huslia is an Indian village of 137 people. The diet consists mainly of beaver, dried fish, moose and caribou. Moose meat is much like beef in form and flavor while caribou is distinctive, resembling mutton. The calorie intake at Huslia seemed marginal, since many people were thin and the children appeared stunted. Follicular hyper- keratosis was common. The teeth were carious. This is the home of the most f'amous sled dog racer in Alaska, George Atla, known as the "Huslia Hustler. The schools in these two Indian villages do not give the children school lunches or vitamin supplements. 3. Clinical Findings in the Villages Since the men in the National Guard had recently come from the villages they were also representative of those nutritional environments. However, the 713 men came from 55 villages. The number from each vil- lage was thus so small that no useful purpose was served by relating them to their village of origin. An exception is Point Barrow, from which there were 69 men in the Guard. Throughout the evaluation of the data this axis of analysis has been considered, however (see Table 10, which presents selected clinical findings for men in the two battalions according to their area of origin). A summary of the clinical findings in the villages is shown in Table 17. The northern and southern areas are shown separately, but all ages and both sexes are combined. This summary emphasizes certain negative findings. There was no scurvy and no gross inanition, although in certain villages, especially Newktok, the people seemed by their thinness to be Source: https:/lwww.industrydocuments.ucsi.edu/docsizznc0227 TABLE 17 ESKIMO AND INDIAN VILLAGES IN ALASKA, 1958, PERCENT PREVALENCE OF CLINICAL FINDINGS Bethel Area - Examiner # 1 Kotzebue Area - Examiner # 2 Villages / 1 2 3 4 5 Total 6 7 8 9 10 Total Number Examined 76 94 81 59 96 406 69 88 77 75 90 399 Suspected Tuberculosis Disease 30.3 10.6 7.4 8.5 12.5 13.8 5.8 10.2 6.5 6.7 2.2 6.3 General Good 82.9 87.2 79.0 66.1 82.3 80.5 98.6 100.0 98.7 98.7 100.0 99.2 Appearance Fair 17.1 9.6 14.8 25.4 16.7 16.0 1.4 0.0 1.3 1.3 0.0 0.8 Poor 0.0 3.2 6.2 8.5 1.0 3.4 0.0 0.0 0.0 0.0 0.0 0.0 Hair Staring hair 0.0 0.0 0.0 18.6 0.0 2.7 0.0 0.0 0.0 0.0 0.0 0.0 Glands Thyroid 3.9 0.0 2.5 10.2 4.2 3.7 1.4 0.0 0.0 0.0 0.0 0.3 Enlarged Submaxillary 0.0 1.1 0.0 0.0 0.0 0.2 5.8 6.8 3.9 1.3 2.2 4.0 Nasolabial seborrhea 0.0 0.0 0.0 0.0 0.0 0.0 5.8 2.3 2.6 0.0 1.1 2.3 54 Skin- Other seborrhea 0.0 0.0 1.2 0.0 0.0 0.2 1.4 0.0 1.3 0.0 0.0 0.5 Face & Neck Erythema 14.5 25.5 7.4 61.0 17.7 23.2 11.6 21.6 33.8 5.3 3.3 15.0 Pigmentation 0.0 2.1 2.5 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 Thickened conjunctivae 7.9 6.4 16.0 13.6 15.6 11.8 7.2 5.7 10.4 8.0 11.1 8.5 Pingueculae 31.6 31.9 22.2 27.1 28.1 28.3 34.8 27.3 28.6 29.3 14.4 26.3 Bitot's spots 0.0 0.0 0.0 3.4 0.0 0.5 0.0 0.0 0.0 0.0 0.0 0.0 Eyes Circumcorneal injection 0.0 0.0 0.0 0.0 1.0 0.2 0.0 1.1 0.0 0.0 0.0 0.3 Conjunctival injection 3.9 0.0 2.5 5.1 1.0 2.2 0.0 5.7 0.0 0.0 0.0 1.3 Blepharitis 0.0 0.0 0.0 8.5 0.0 1.2 0.0 2.3 0.0 0.0 0.0 0.5 Corneal scarring 21.1 12.8 11.1 20.3 9.4 14.3 8.7 5.7 5.2 4.0 7.8 6.3 Angular lesions 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Lips Angular scars 0.0 0.0 0.0 1.7 0.0 0.2 2.9 0.0 0.0 0.0 0.0 0.5 Cheilosis 0.0 0.0 1.2 0.0 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 TABLE 17 (continued) Filiform atrophy, sl. 9.2 6.4 9.9 13.6 6.2 8.6 7.2 4.5 2.6 12.0 5.6 6.3 Filiform atrophy, mod. 3.9 0.0 2.5 1.7 0.0 1.5 0.0 0.0 0.0 2.7 0.0 0.5 Fungiform atrophy 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Papillary hypertrophy 0.0 0.0 0.0 0.0 1.0 0.2 1.4 2.3 1.3 0.0 1.1 1.3 Furrows 1.3 7.4 9.9 3.4 3.1 5.2 4.3 2.3 2.6 2.7 1.1 2.5 Tongue Fissures, erosions, ulcers 1.3 1.1 1.2 0.0 0.0 0.7 0.0 0.0 0.0 0.0 0.0 0.0 Serrations or swellings 0.0 6.4 3.7 0.0 0.0 2.2 0.0 0.0 0.0 1.3 3.3 1.0 Red, tip, or lat. margins 3.9 4.3 4.9 0.0 0.0 2.7 0.0 0.0 0.0 0.0 0.0 0.0 Geographic tongue 1.3 0.0 1.2 0.0 3.1 1.2 2.9 0.0 3.9 0.0 0.0 1.3 Red or swollen 1.3 3.2 9.9 8.5 7.3 5.9 17.4 2.3 7.8 13.3 18.9 11.8 Gums Atrophy or recession 9.2 8.5 16.0 1.7 5.2 8.4 23.2 19.3 27.3 17.3 18.9 21.1 Bleeding gums 0.0 0.0 0.0 0.0 0.0 0.0 1.4 0.0 0.0 0.0 4.4 1.3 Unfilled caries 30.3 60.6 48.1 23.7 31.2 40.1 31.9 40.9 58.4 34.7 47.8 43.1 Filled caries 17.1 9.6 13.6 0.0 12.5 11.1 46.4 23.9 11.7 9.3 13.3 20.3 No carious teeth -5550.031.944.476.357.350.223.237.529.957.3 41.1 38.1 Tee th Caries, filled or 1-2 13.2 7.4 6.2 3.4 7.3 7.6 24.6 18.2 28.6 21.3 22.2 22.8 unfilled 3-4 18.4 36.2 24.7 11.9 24.0 24.1 23.2 23.9 20.8 14.7 22.2 21.1 SS 5+ 11.8 23.4 23.5 8.5 11.5 16.3 24.6 18.2 18.2 6.7 14.4 16.3 Edentulous 6.6 1.1 1.2 0.0 0.0 1.7 4.3 2.3 2.6 0.0 0.0 1.8 Worn 30.3 33.0 35.8 23.7 29.2 30.8 14.5 12.5 27.3 12.0 6.7 14.3 0.0 0.0 Fluorosis 0.0 0.0 0.0 0.0 1.0 0.2 0.0 0.0 0.0 0.0 Malposition 2.6 1.1 12.3 6.8 12.5 7.1 0.0 0.0 1.3 0.0 0.0 0.3 Follicular hyperkeratosis 3.9 1.1 1.2 10.2 0.0 2.7 40.6 34.1 20.8 20.0 45.6 32.6 10.4 0.0 0.0 0.0 0.0 0.0 0.0 Xerosis 19.7 21.3 11.1 22.0 16.5 Skin- Acneform eruption 0.0 1.1 1.2 0.0 2.1 1.0 0.0 0.0 1.3 0.0 1.1 0.5 Thickened press. points 1.3 2.1 0.0 0.0 0.0 0.7 0.0 0.0 1.3 0.0 0.0 0.3 General 0.0 0.0 1.0 0.5 0.0 0.0 0.0 0.0 0.0 0.0 Purpura or petechia 0.0 1.1 Hyperpigmentation 2.6 0.0 0.0 0.0 3.1 1.2 0.0 1.1 0.0 0.0 0.0 0.3 Abdomen Hepatomegalia 0.0 0.0 2.5 5.1 0.0 1.2 Examination of abdomen and Lower extremities omitted. Lower Extremities Loss of ankle jerk 1.3 0.0 1.2 1.7 0.0 0.7 1 No findings of enlarged parotids, xerophthalmia, magenta tongue, "scorbutic-type' gums, crackled skin, pellagrous 2) Villages referred to by number: Southern Eskimos: 1. Akiak 2. Kasigluk 3. Napaskiak 4. Newktok 5. Hooper Bay lesions, splenomegalia, ascites, or calf tenderness. Scrotal dermatitis not examined for Northern Eskimos: 6. Noatak 7. Point Hope 8. Shishmaref Athabascan Indians: 9. Huslia 10. Allakaket Source. Ittps://www.industrydocuments.ucsf.edu/docs/zznc022

Provide the first "Calorie allowances" value given under 25 years?

mgxh0227

mgxh0227_p0, mgxh0227_p1, mgxh0227_p2, mgxh0227_p3, mgxh0227_p4, mgxh0227_p5, mgxh0227_p6, mgxh0227_p7, mgxh0227_p8, mgxh0227_p9, mgxh0227_p10

2500

SCIENTIFIC BASES FOR THE RECOMMENDED ALLOWANCE 47 L CALORIES dedail (over) Calorie allowances have been established in all previous editions of Recommended Dietary Allowances with the objective of provision of energy in amounts sufficient when consumed over an extended period to maintain body weight or rates of growth at levels most conducive to well being and health. This general principle is reaffirmed and allowances have been carefully reevaluated with consideration of the results of a large number of investigations of human energy requirements. Qalorie állowances were modified in the last revision of had been Recommended Dietary Allowances to conform with certain standards and conditions established by the Food and Agricultural Organization of the United Nations through its International 8 Committee on Calorie Requirements + A second FAO Report on Calorie Requirements has recently been published in which a number of modifications have been made in the specification 9. of calorie requirements I. These have been considered in the preparation of this revision of Recommended Dietary Allowances. Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 2 - In specifying requirements for calories for individuals, the FAO committee utilized the device of the "reference" man and woman, both aged 25 and living in a temperate climate with a mean annual external of 10 degrees Centigrade. The weight of the "reference man" was given as 65 kilograms and was 55 kólograms for the "reference woman". Recommended Dietary Allowances adapted the same basis of reference in its 1953 revision. These characteristics cannot be considered average 10 for the young adult population of the United States, however. Therefore, in the present statement certain adaptations have been made to permit establishment of reference conditions more nearly conforming with United States standards of body size and living conditions. The "reference" man is again taken as of age 25 but the weight is given as 70 kólograms which would seem to be more nearly descriptive of the average young male in this population. Similarly, the "reference" woman is described as being 25 years of age but weighing 58 kólograms. Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 3 - Another modification is to establish allowances assuming that individuals are living in an environment with a mean environ- o C mental temperature of 20 degrees centigrade rather than the lower temperature given by FAO. This would again seem to be a more realistic description of the mean environmental temperature of most of the population of the United States. Both man and woman are presumed to lead a vigorous, healthy life and to be moderately active physically, with occupations which could not be described either as sedentary or as hard physical labor. The man would be likely to be in light industry or employed as delivery man, painter or outdoor salesman. The woman might be homemaker, saleswoman or bench worker in a factory. The daily allowances/ as derived for the "reference man" is 3200 calories and for the "reference" woman is 2300 calories. It should be realized that adjustments must be made in calorie allowances when individuals or population averages differ from the "reference" in characteristics of age, body Source: https://www.industrydocuments.ucst.edu/docs/mgxh0227 - 4 - size, climate or activity. Procedures for these adjustments are described below. Adjustments of Calories for Age - - Energy requirements decline progressively after the years of early adulthood, because of a decrease in basal metabolic rate as well as lessened physical activity. It is proposed that calorie allowances be reduced by 3 per cent per decade between ages 30 and 50 and by 7.5 per cent per decade from age 50 to 70. A further decreasement of 10 per cent is recommended for the years from 70 to 80. These adjustments are in accord with 9 FAO recommendations X Accordingly, the calórie allowances at age 45 are 6 per cent less than at age 25 and at age 65 are 21 per cent less (See Tolile II ). Adjustment for Body Size - - Calorie allowances must be adjusted for the variations in energy requirements which result from differences in body size. Therefore, in utilizing the allowances giver in the table, larger allowances must be Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 5 - derived for individuals of body size greater than indicated for the reference man and woman and smaller allowances should be prescribed for those of smaller size. In adapting allowances for differences in size, weight may be used as a basis provided the subjects are not overweight or underweight. Maximum body length (height) is usually attained by age 20 or shortly there- after, but in the United States the average person tends to continue to gain in body weight until about 60 years of age. Life insurance and other data indicate that these weight gains are undesirable and that the most favorable health expectation is associated with conditions under which weight as normally achieved by age 25 or 30 is maintained throughout later bife. Therefore, in these recommendations the calorie allowances for adults pertain not to actual body weight of individuals or groups but to desirable body weight (the average weight separd of individuals of given height at age 25). Table I may be used as a guide for this use and adaptation. Heights and weights Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 TABLE II Individuals Marious Calorie / allowances for men of Marred Body Weights and age 15 (as meanenvermental temperature 32 of 20 Centegrade and assuming moderate physics activity I MEN Calorie allowances Deserable Weight Kelogram Pounds 25 years 45 years 65 years 50 110 2500 2350 1950 55 121 2700 2550 2150 60 132 2850 2700 2250 65 143 3000 2800 2350 70 154 3200 3000 2550 75 165 3400 3200 2700 80 176 3550 3350 2800 85 187 3700 3500 2900 Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227 (tableth Calorie Allowanes for Women of Various Body Weight and age WOMEN 63 Deserable Weight Cultrie allowares 22 45 58 Pounds 70 Kelograms 25 years 45 15 years 65 years 40 88 1750 1650 1400 45 99 1900 1800 1500 50 110 2050 1950 1600 5T5 121 2200 2050 1750 58 128 2:300 2200 1800 60 132 2350 2200 1850 65 143 2500 2350 2000 70 154 2600 2450 2050 75 165 2750 2600 2150 Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 6 - usually as recorded include usual clothing worn indoors and shoes with one-inch - heels. ( Quest Table altop of page 5 To adapt calorie allowances for individuals whose weight and height are different from those of the reference man and a woman, the following formulae have been utilized 1, Calorie allowance for men - - - 815 + 36.6 W* Calorie allowance for women - - 580 + 31.1 W* * W = desirable body weight in kilograms By such adaptation the allowances for 25 year old men weighing 50, 60 and 80 kilograms would be 2500, 2850, and 3550 calories respectively. Women of the same age weighing 40, 50, 60 and 70 kilograms would receive 1750, 2050, 2350, and 2600 calories respectively. Adjustment by weight in pounds to other body sizes may be facilitated by reference to Table II . (Insert Table II) Adjustment of Calories for Climate - Standard conditions for estimating calorie allowances include mean environmental C temperature of 20° centigrade rather than 10° centigrade as Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227 - 7 - established by the FAO committee which was utilized in the 1953 revision of Recommended Dietary Allowances. It seems probable that most persons in the United States live in an environment with a mean temperature of approximately 20° centigrade. Most are protected against the effects of cold by warm clothes, central heating and heated means of transportation. Many also live and work in ir-conditioned atmospheres so that the effects of high temperatures are partially but not so completely ameliorated. If the external temperature varies widely from the standard, 2 corrections in calorie allowances may be made. For lower tempera- tures there is need for an increase in allowance. To accomplish increased this the allowance should be /reduced/by 5% for the first ten C degree centigrade decrease from the standard of 20° centigrade and by 3% for each additional ten degree decrease. Similarly, allowances should be reduced for high environmental temperatures and the reduction should be 5% for each increase of ten degrees Source: https://wwww.industrydocuments.ucsf.edu/docs/mgxh0227 - 8 - centigrade above the standard temperature, (20%). These adjustments are devised specifically for application to differences in mean annual temperature, but they may well serve for adjustment to seasonal differences as well. In various parts of the United States the difference in mean winter and summer temperatures may range from 10 degrees C to centegrade 30 degrees C. This would indicate corrections of from 5 to 15 per cent in the calorie allowances according to conditions. It should be observed that all adjustments for climate pre- suppose an ordinary amount of actual exposure to the climate. For persons spending most of their time out of doors, these adjustments may be insufficient, particularly during winter in the Northern and Central States. It is obvious that people who spend almost all their time in well heated buildings during the winter will not need the extra food calories required by individuals less effectively sheltered. When applying these adjustments of allowances for individuals or groups, duration Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 9 - of exposure to outside weather should be ascertained and taken into account. Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227

Mention the first "KILOGRAM" value mentioned under "Desirable Weight"?

mgxh0227

mgxh0227_p0, mgxh0227_p1, mgxh0227_p2, mgxh0227_p3, mgxh0227_p4, mgxh0227_p5, mgxh0227_p6, mgxh0227_p7, mgxh0227_p8, mgxh0227_p9, mgxh0227_p10

50

SCIENTIFIC BASES FOR THE RECOMMENDED ALLOWANCE 47 L CALORIES dedail (over) Calorie allowances have been established in all previous editions of Recommended Dietary Allowances with the objective of provision of energy in amounts sufficient when consumed over an extended period to maintain body weight or rates of growth at levels most conducive to well being and health. This general principle is reaffirmed and allowances have been carefully reevaluated with consideration of the results of a large number of investigations of human energy requirements. Qalorie állowances were modified in the last revision of had been Recommended Dietary Allowances to conform with certain standards and conditions established by the Food and Agricultural Organization of the United Nations through its International 8 Committee on Calorie Requirements + A second FAO Report on Calorie Requirements has recently been published in which a number of modifications have been made in the specification 9. of calorie requirements I. These have been considered in the preparation of this revision of Recommended Dietary Allowances. Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 2 - In specifying requirements for calories for individuals, the FAO committee utilized the device of the "reference" man and woman, both aged 25 and living in a temperate climate with a mean annual external of 10 degrees Centigrade. The weight of the "reference man" was given as 65 kilograms and was 55 kólograms for the "reference woman". Recommended Dietary Allowances adapted the same basis of reference in its 1953 revision. These characteristics cannot be considered average 10 for the young adult population of the United States, however. Therefore, in the present statement certain adaptations have been made to permit establishment of reference conditions more nearly conforming with United States standards of body size and living conditions. The "reference" man is again taken as of age 25 but the weight is given as 70 kólograms which would seem to be more nearly descriptive of the average young male in this population. Similarly, the "reference" woman is described as being 25 years of age but weighing 58 kólograms. Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 3 - Another modification is to establish allowances assuming that individuals are living in an environment with a mean environ- o C mental temperature of 20 degrees centigrade rather than the lower temperature given by FAO. This would again seem to be a more realistic description of the mean environmental temperature of most of the population of the United States. Both man and woman are presumed to lead a vigorous, healthy life and to be moderately active physically, with occupations which could not be described either as sedentary or as hard physical labor. The man would be likely to be in light industry or employed as delivery man, painter or outdoor salesman. The woman might be homemaker, saleswoman or bench worker in a factory. The daily allowances/ as derived for the "reference man" is 3200 calories and for the "reference" woman is 2300 calories. It should be realized that adjustments must be made in calorie allowances when individuals or population averages differ from the "reference" in characteristics of age, body Source: https://www.industrydocuments.ucst.edu/docs/mgxh0227 - 4 - size, climate or activity. Procedures for these adjustments are described below. Adjustments of Calories for Age - - Energy requirements decline progressively after the years of early adulthood, because of a decrease in basal metabolic rate as well as lessened physical activity. It is proposed that calorie allowances be reduced by 3 per cent per decade between ages 30 and 50 and by 7.5 per cent per decade from age 50 to 70. A further decreasement of 10 per cent is recommended for the years from 70 to 80. These adjustments are in accord with 9 FAO recommendations X Accordingly, the calórie allowances at age 45 are 6 per cent less than at age 25 and at age 65 are 21 per cent less (See Tolile II ). Adjustment for Body Size - - Calorie allowances must be adjusted for the variations in energy requirements which result from differences in body size. Therefore, in utilizing the allowances giver in the table, larger allowances must be Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 5 - derived for individuals of body size greater than indicated for the reference man and woman and smaller allowances should be prescribed for those of smaller size. In adapting allowances for differences in size, weight may be used as a basis provided the subjects are not overweight or underweight. Maximum body length (height) is usually attained by age 20 or shortly there- after, but in the United States the average person tends to continue to gain in body weight until about 60 years of age. Life insurance and other data indicate that these weight gains are undesirable and that the most favorable health expectation is associated with conditions under which weight as normally achieved by age 25 or 30 is maintained throughout later bife. Therefore, in these recommendations the calorie allowances for adults pertain not to actual body weight of individuals or groups but to desirable body weight (the average weight separd of individuals of given height at age 25). Table I may be used as a guide for this use and adaptation. Heights and weights Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 TABLE II Individuals Marious Calorie / allowances for men of Marred Body Weights and age 15 (as meanenvermental temperature 32 of 20 Centegrade and assuming moderate physics activity I MEN Calorie allowances Deserable Weight Kelogram Pounds 25 years 45 years 65 years 50 110 2500 2350 1950 55 121 2700 2550 2150 60 132 2850 2700 2250 65 143 3000 2800 2350 70 154 3200 3000 2550 75 165 3400 3200 2700 80 176 3550 3350 2800 85 187 3700 3500 2900 Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227 (tableth Calorie Allowanes for Women of Various Body Weight and age WOMEN 63 Deserable Weight Cultrie allowares 22 45 58 Pounds 70 Kelograms 25 years 45 15 years 65 years 40 88 1750 1650 1400 45 99 1900 1800 1500 50 110 2050 1950 1600 5T5 121 2200 2050 1750 58 128 2:300 2200 1800 60 132 2350 2200 1850 65 143 2500 2350 2000 70 154 2600 2450 2050 75 165 2750 2600 2150 Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 6 - usually as recorded include usual clothing worn indoors and shoes with one-inch - heels. ( Quest Table altop of page 5 To adapt calorie allowances for individuals whose weight and height are different from those of the reference man and a woman, the following formulae have been utilized 1, Calorie allowance for men - - - 815 + 36.6 W* Calorie allowance for women - - 580 + 31.1 W* * W = desirable body weight in kilograms By such adaptation the allowances for 25 year old men weighing 50, 60 and 80 kilograms would be 2500, 2850, and 3550 calories respectively. Women of the same age weighing 40, 50, 60 and 70 kilograms would receive 1750, 2050, 2350, and 2600 calories respectively. Adjustment by weight in pounds to other body sizes may be facilitated by reference to Table II . (Insert Table II) Adjustment of Calories for Climate - Standard conditions for estimating calorie allowances include mean environmental C temperature of 20° centigrade rather than 10° centigrade as Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227 - 7 - established by the FAO committee which was utilized in the 1953 revision of Recommended Dietary Allowances. It seems probable that most persons in the United States live in an environment with a mean temperature of approximately 20° centigrade. Most are protected against the effects of cold by warm clothes, central heating and heated means of transportation. Many also live and work in ir-conditioned atmospheres so that the effects of high temperatures are partially but not so completely ameliorated. If the external temperature varies widely from the standard, 2 corrections in calorie allowances may be made. For lower tempera- tures there is need for an increase in allowance. To accomplish increased this the allowance should be /reduced/by 5% for the first ten C degree centigrade decrease from the standard of 20° centigrade and by 3% for each additional ten degree decrease. Similarly, allowances should be reduced for high environmental temperatures and the reduction should be 5% for each increase of ten degrees Source: https://wwww.industrydocuments.ucsf.edu/docs/mgxh0227 - 8 - centigrade above the standard temperature, (20%). These adjustments are devised specifically for application to differences in mean annual temperature, but they may well serve for adjustment to seasonal differences as well. In various parts of the United States the difference in mean winter and summer temperatures may range from 10 degrees C to centegrade 30 degrees C. This would indicate corrections of from 5 to 15 per cent in the calorie allowances according to conditions. It should be observed that all adjustments for climate pre- suppose an ordinary amount of actual exposure to the climate. For persons spending most of their time out of doors, these adjustments may be insufficient, particularly during winter in the Northern and Central States. It is obvious that people who spend almost all their time in well heated buildings during the winter will not need the extra food calories required by individuals less effectively sheltered. When applying these adjustments of allowances for individuals or groups, duration Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 9 - of exposure to outside weather should be ascertained and taken into account. Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227

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1564

Alaska An Appraisal of the Health and Nutritional Status of the Eskimo A REPORT BY THE INTERDEPARTMENTAL COMMITTEE ON NUTRITION FOR NATIONAL DEFENSE AUGUST 1959 OF ASSISTANT SECRETARY OF DEFENSE WASHINGTON 25, D.C. HEALTH AND MEDICAL, August 31, 1959 On behalf of the Interdepartmental Committee on Nutrition for National Defense (ICNND), it is my pleasure to transmit this report, An Appraisal of the Health and Nutritional Status of the Eskimo in Alaska. The clinical and biochemical phases of the survey, conducted in March-April 1958, included the Eskimo National Guardsmen and a random sampling of eight Eskimo and two Indian villages. This was a cooperative undertaking of the ICNND with the Arctic Health Research Center, the Division of Indian Health of the U. S. Department of Health, Education, and Welfare, the Alaska Command of the U. S. Armed Forces, and the Alaska National Guard. A detailed report of the dietary studies conducted in the ten Alaskan villages will be published at a future date by the Arctic Health Research Center. Dr. Christine Heller of the Arctic Health Research Center is continuing these investigations. The evaluation of the dietary intake, customs, and habits of these few remaining native villages will enable a much more meaningful evaluation of the clinical data. The Alaskan aboriginal people have and will continue to have a remarkably successful adaptation to their environ- ment and unique food supply. The purpose of this study was to establish a baseline of nutritional appraisal in order to evaluate in future years the effects of cultural transition in relation to health. Continued assistance to provide medical and dental care, housing, and economic development is most essential. I wish to call your attention to the general conclusions of this report on page 118. Frankisterry Frank B. Berry, M. D. Source: https://www.industrydocuments.ucst.edu/docsizznc022 V INTERDEPARTMENTAL COMMITTEE ON NUTRITION FOR NATIONAL DEFENSE Department of Defense: Dr. Frank B. Berry, Assistant Secretary of Defense (Health and Medical), Chairman Dr. E. H. Cushing, Deputy Assistant Secretary of Defense (Health and Medical) Brig. Gen. Sheldon S. Brownton, USAF (MC) Army: Dr. John B. Youmans Lt. Col. William J. Wilson, MC Navy: Dr. Howard T. Karsner Rear Admiral Calvin B. Galloway, MC Air Force: Major George W. Powell, MC Department of State: Mr. Walter M. Rudolph Department of Agriculture: Mr. Clarence M. Purves Dr. Hazel K. Stiebeling Department of Health, Education, and Welfare: Dr. Floyd S. Daft Dr. H. van Zile Hyde International Cooperation Administration: Dr. Eugene P. Campbell Dr. Katharine Holtzclaw Atomic Energy Commission: Dr. James L. Liverman Secretariat Dr. Arnold E. Schaefer, Executive Director Dr. Ernest M. Parrott, Deputy Executive Director Dr. Arthur G. Peterson, Agricultural Economist Consultants Dr. William F. Ashe Dr. William J. Darby Dr. William McGanity Dr. S. Bayne-Jones Dr. Cyrus E. French Dr. William N. Pearson Dr. M. K. Bennett Dr. Wendell H. Griffith Dr. Herbert Pollack Dr. George H. Berryman Dr. David B. Hand Dr. W. H. Sebrell, Jr. Mr. Edwin B. Bridgforth Dr. D. Mark Hegsted Dr. Fredrick J. Stare Dr. Joseph S. Butts Dr. Norman Jolliffe Dr. Philip L. White Dr. Gerald F. Combs Dr. z. I. Kertesz Dr. Robert R. Williams Dr. L. A. Maynard Source: https:llwww.industrydocuments.ucsi.edu/docsizznc022 VII VI LIST OF FIGURES TABLE OF CONTENTS Page Page Title Number Part I Preface XI Frontispiece Guzema Wassilie, Medicine Man at Napaskiak 1. Administrative History XI 2. Acknowledgments XI Figure I Northern Cultural Areas and Tundra Region Facing 1 3. Objectives XIII 4. Explanatory Addendum XIII Figure II Tuberculosis Mortality for Alaska by Race, 11 1952-1957 Part II Introduction 1 1. The Cultural Background 1 Figure III Principal Ethnographic Divisions of Alaska, 14 2. Demographic Factors 4 and the Villages Studied 3. Health Facilities 7 4. General Plan of Study 13 Figure IV Plan of the Study with Numbers Examined 16 5. Clinical Calibration Studies 15 Figure V Enlargement of the Submaxillary Glands 30 Part III Native Men in the National Guard 20 1. The Population Studied 20 Figure VI Pigmentary Changes in a Young Eskimo Man 31 2. Clinical Findings 21 3. The Dental Study 34 Figure VII Dental Attrition in a 32-Year-Old Eskimo 46 Woman Part IV The Village Studies 42 1. Bethel Area - The Situation in Akiak, Kasigluk, Figure VIII Height by Age and Sex, Eskimo Villages, 1958, 42 Compared to Canadian Population 61 Napaskiak, Newktok and Hooper Bay 2. Kotzebue Area - The Situation in Noatak, Point Hope, Shishmaref, Allakaket and Hislia 49 Figure IX Weight by Age and Sex, Eskimo Villages, 1958, 62 3. Clinical Findings in the Villages 52 Compared to Canadian Population 4. Discussion of Clinical Findings 67 Eskimo and Indian Villages in Alaska, 1958, Figure X Part V Dietary Measurements 72 Blood Pressures and Pulse Rates, by Age 65 1. National Guardsmen - Camp Denali (Ft. Richardson) 72 2. Villages (Preliminary) 74 Figure XI Eskimo and Indian Villages in Alaska, 1958, 3. Discussion 91 Arm and Scapula Skinfold Thickness, by 70 Age and Sex Part VI Biochemical Findings 99 1. Methods 100 2. Results 100 3. Discussion 111 4. Summary 118 Part VII General Conclusions 120 Part VIII Specific Recommendations 121 Part IX Appendices 122 A - Criteria for Oral Examinations 122 B - Food Consumption, Males - Alaska, 1956-1958 124 C - Food Patterns by Village 134 D - National Research Council, Recommended Dietary Allowances 160 Bibliography 161 Source: ttps://www.industrydocuments.ucst.edu/docs zznc022 VIII IX LIST OF TABLES LIST OF TABLES (continued) Table Title Page Table Title Page Introduction Table 1 The Village Studies Eskimos, Indians and Aleuts in Alaska in 1950 1 Table 17 Eskimo and Indian Villages in Alaska, 1958; Percent 2 Alaska: Characterization of the Villages in the Study, Prevalence of Clinical Findings 54-55 and the Size of the Samples Examined, 1958 6 18 Eskimo and Indian Villages in Alaska, 1958; Percent 3 Eskimo Men, Alaska National Guard, 1958; Clinical Prevalence, Selected Clinical Findings by Age Calibration Studies 17 and Sex 57 4 Eskimo Men, Alaska National Guard, 1958; Summary of 19a Eskimos and Athabascan Indians in Alaska, 1958; Calibration Studies for the Clinical Examinations 19 Percentage of "Standard Weight" by Age and Sex 58 19b Eskimos and Athabascan Indians in Alaska, 1958; Native Men in the National Guard Table 5 "Obesity" in Adults by Age and Sex 59 Eskimo Men, Alaska National Guard, 1958, by Battalion; 20 Average Height and Weight of Eskimos and Athabascan Origin, Age, Height, Weight, Weight Status, Skinfolds, Indians in Alaska, 1958, Compared to Canadian Blood Pressure and Pulse 22 1953 Survey 60 6 Eskimo Men, Alaska National Guard, 1958, by Battalion 21 Eskimo and Indian Villages in Alaska, 1958; Pulse and Age; Height, Weight, Weight Status, Skinfolds, (Mean + S.E.) by Age, for Villages by Ethnographic Blood Pressure and Pulse 23 Groups 64 7 Eskimo Men, Alaska National Guard, 1958, by Battalion, 22 Eskimo Men, Alaska National Guard, 1958, by Battalion; Blood Pressure (Mean + Standard Error) by Height 23 Blood Pressure and Pulse Measurements, by Examiner 66 8 Eskimo Men, Alaska National Guard, 1958, by Battalion; 23 Eskimo and Indian Villages in Alaska, 1958; Blood Percent Prevalence of Clinical Findings, by Examiner 26-27 9 Pressure (Mean + S.E.) by Age, for Villages by Eskimo Men, Alaska National Guard, 1958, by Battalion Ethnographic Groups 68 and Age; Percent Prevalence of Selected Clinical 24 Eskimo and Indian Villages in Alaska, 1958; Arm and Findings 28 10 Scapula Skinfold Thickness by Age and Sex, for Eskimo Men, Alaska National Guard, 1958, by Region of Villages by Ethnographic Groups 69 Origin; Age, Height, Weight, Weight Status, Blood Pressure and Selected Clinical Findings 29 11 Dietary Measurements Relation of Clinical Signs and Biochemical Findings, Table 25 Eskimo Men, Alaska National Guard, Ft. Richardson, 1958; Serum Vitamin A, Alaska, 1958 33 12 Food Consumption from the Mess Hall Alone, Average Relation of Clinical Signs and Biochemical Findings, Per Man Per Day 72 Serum Vitamin C, Alaska, 1958 34 26 13 Eskimo Men, Alaska National Guard, Ft. Richardson, 1958; Eskimo Men, Alaska National Guard, 1958; Comparison of Plate Waste, Average Per Man Per Day 73 Dental Caries and Periodontal Status of 713 Eskimo 27 Eskimo Men, Alaska National Guard, Ft Richardson, 1958; Guardsmen with 1,400 White Male Residents of Birmingham Food Consumption from all Sources, Average Per Man and Baltimore 35 14 Per Day 73 Eskimo Men, Alaska National Guard, 1958; Mean Numbers of 28 Nutrient Composition of Recipes for Eskimo Dishes, as Decayed, Missing, or Filled Permanent Teeth in Four Calculated 75-81 Groups from the First and Second Battalions 36 15 29 Chemical Composition of Alaskan Foods, 1958 83-87 Eskimo Men, Alaska National Guard, 1958; Oral Status of 30 Food Consumption of Men in Villages, Alaska, 1956-1958 89 Members of First and Second Battalions 37-39 16 31 Food Consumption of Alaskan and Indian Men by Villages, Eskimo Men, Alaska National Guard, 1958; Gingival 1956-1958 90 Recession Scores, Men 35 Years of Age or Older, First 32 and Second Battalions Fat Content of Commonly Eaten Meats 93 41 33 Guide to Interpretation of Nutrient Intake Data 94 Source: https://www.industrydocuments.ucst.edu/docsizznc0227 X XI LIST OF TABLES (continued) I PREFACE Table Title Page 1. Administrative History Biochemical Findings A program of research on the nutritional status of Alaskan natives Table 34a Alaska, Nutrition Survey, March 1958; Biochemical has been under way in the Arctic Health Research Center, Anchorage, Findings, for National Guard and Villages, by Alaska, for several years. The present study arose from the interests Sex and Age Groups; Total Serum Protein and of the Department of Defense. Hematology 101 34b Alaska, Nutrition Survey, March 1958; Biochemical At a meeting of the Interdepartmental Committee on Nutrition for Findings, for National Guard and Villages, by National Defense (ICNND) 28 May 1956, Dr. Frank B. Berry reported that Sex and Age Groups; Serum Vitamin c, A and Carotene 102 the Secretary of Defense had inquired if the ICNND would be interested 34c Alaska, Nutrition Survey, March 1958; Biochemical in conducting a nutrition survey of the Alaskan natives. This proposal Findings, for National Guard and Villages, by was considered favorably by the Committee, and the Secretariat was Sex and Age Groups; Total Fatty Acids, Phospholipids authorized to explore the possibilities further. Discussions were held and Cholesterol 103 with Dr. Jack Haldeman, Chief, General Health Service, Public Health 34d Alaska, Nutrition Survey, March 1958; Biochemical Service, Department of Health, Education, and Welfare (HEW) and Dr. Findings, for National Guard and Villages, by John C. Cutler, Program Officer, Bureau of State Services, HEW. Toward Sex and Age Groups; Urinary Excretions 104 the end of 1956, the Committee received a formal request from the 35 Alaska, Nutrition Survey, March 1958; Comparison of Arctic Health Research Center for assistance in financing and con- Methods for Determination of N'Methylnicotinamide 106 ducting a nutrition survey of the Alaska National Guardsmen while they 36a Alaska, Nutrition Survey, March 1958; Total Serum were in their annual encampment in Anchorage and also in completing a Protein and Hematology by Village, for Men, Women survey of the inhabitants of ten native villages. The Commi ttee and Children 107 appointed an ad hoc group, with representatives from the General Health 36b Alaska, Nutrition Survey, March 1958; Serum Vitamin c, Service, Bureau of State Services and the Division of Indian Health of A and Carotene, by Village 108 the Public Health Service; and including Dr. E. M. Scott of the Arctic 36c Alaska, Nutrition Survey, March 1958; Mean Blood Fat Health Research Center, Anchorage, and Dr. John B. Youmans, Consultant Levels, by Village and Age 109 to the ICNND, to meet in April 1957 to draft a proposal for Committee 36d Alaska, Nutrition Survey, March 1958; Urinary Excretions action. by Villages, for Men, Women and Children 110 37 Alaska, Nutrition Survey, March 1958; Mean Blood Fat At a meeting in May 1957 the Committee agreed to serve as a co- Levels, by Survey Area and by Age 114 ordinating and sponsoring agency for a nutrition survey of the two 38 Alaska, Nutrition Survey, March 1958; Urinary Excretions National Guard Battalions during their 1958 encampment and a clinical of B-Vitamins, Village Areas, by Age and Sex 116 and biochemical survey of the inhabitants of the ten native villages 39 Alaska, Nutrition Survey, March 1958; Biochemical in which the Arctic Health Research Center, with the aid of the Findings, by Reproductive Status, Eskimo Villagers Division of Indian Health, had been conducting a survey of food intake in the Bethel Area 117 and dietary habits. 40 Suggested Guide to Interpretation of Biochemical Data 119 2. Acknowledgments Many people have contributed to the work of this study. The names are arranged here according to their respective organizations. Arctic Health Research Center, Anchorage, Alaska Dr. A. B. Colyar - Director, Arctic Health Research Center Alaska National Guard Brig. General Thomas P. Carroll, Adjutant General, Alaska National Guard Major William H. Crawford, Commander, First Scout Battalion Major Harry E. Voelker, Commander, Second Scout Battalion Source: ittps://www.industrydocuments.ucst.edu/docsizznc022 XII XIII Alaska Native Health Service Team Members (continued) Dr. Joseph A. Gallagher - Area Officer in Charge, Anchorage Mrs. Isabelle V. Griffith - Chemist, Arctic Health Research Center Dr. Robert I. Frazier - Medical Officer, Kotzebue Miss Anna J. Pitney - Chemist, Arctic Health Research Center Dr. Elmer E. Gaede - Medical Officer, Tanana Mr. Lyndon Sikes - Chemist, Arctic Health Research Center Dr. William A. Brownlee - Medical Officer, Bethel Dr. Milton Silverman - Biochemist, n/ National Institutes of Health Dr. Albert L. Russell - Dentist, National Institutes of Health Village Teachers Mr. Carl L. White - Statistician, National Institute of Health M/Sgt. Dale o. Starr - NCO in Charge, Dispensary, Fort Richardson Mr. and Mrs. Roman W. Kinney, Akiak M/Sgt. Harold G. Coffman - X-ray Technician, Dispensary, Fort Richardson Mr. and Mrs. Emil Kowalczyk, Kasigluk SP-5 Ronald J. Murphy - Technician, Dispensary, Fort Richardson Mrs. Mary McDougall, Napaskiak Mr. and Mrs. John F. Gordon, Hooper Bay 3. Objectives Mrs. Ida A. Hunter, Newktok Mr. and Mrs. Fred G. Fisher, Point Hope The extent of success of the adaptation of the Eskimo to a uniquely Mr. and Mrs. Russell McLaughlin, Shishmaref limited and precarious food supply in a harsh environment has been a Mr. and Mrs. Walter A. Ortman, Allakaket challenging question to physiologists for over a century. Arctic ex- Mr. and Mrs. Ley M. Kahl, Huslia plorers have often discussed this problem and some have taken highly Mr. and Mrs. S. William Benton, Noatak controversial positions based on their estimates either of the merits of the Eskimo dietary regimen or the status of the natives' health. U.S. Military Organizations - Alaskan Command The present study was undertaken to investigate this question in co- operation with the Arctic Health Research Center (AHRC) of the Lt. General Frank A. Armstrong, USAF - Commander in Chief, Alaskan Command Department of Health, Education, and Welfare, the Alaska Command of Maj. General G. C. Mudgett - Commander, U.S. Army, Alaska the U.S. Armed Forces, and the Alaska National Guard. Brig. General John R. Copenhaver - USAF Surgeon, Alaskan Command Colonel Sterrett E. Dietrich - U.S. Army, Surgeon Members of the AHRC with the support of the Indian Health Service Lt. Colonel Wade F. Heritage - U.S. Army, Deputy Surgeon have been conducting systematic studies of the dietary habits of the Lt. Colonel George D. Pleasants - Post Surgeon, Ft. Richardson Eskimo and, in particular, their hematological disorders. The present work was intended to complement those studies. The work described here Finally, the subjects themselves should be complimented for their was designed to evaluate the nutritional status of the Eskimo of all pleasant welcomes, patient forbearance and altogether cheerful and ages and both sexes by carrying out physical appraisals and biochemical intelligent willingness to help with the tasks at hand. measurements of specific nutrients in blood and urine. These data were then to be evaluated along with the dietary evaluations and food Team Members analyses made available by continuing studies of the Arctic Health Research Center. Additional measurements of consumption of food in Dr. John B. Youmans - Field Director, Army Medical Research and Develop- the mess halls were made among the native members of the Armed Forces ment Command Lt. Colonel Laurence M. Hursh - Director, 1 Army Medical Research and 4. Explanatory Addendum Nutrition Laboratory Dr. Edward M. Scott - Deputy Director, Arctic Health Research Center Since the present study was done and much of the report was written Dr. George V. Mann - Clinician, National Institutes of Health before or during the emergence of Alaska as the 49th state, there may Mr. C. Frank Consolazio - Biochemist, Army Medical Research and be descriptions herein or references to agencies or procedures which Nutritio; Laboratory have been superseded by new organizational arrangements. SP-3 Edward J. Sheehan - Technician, Army Medical Research and Nutrition Laboratory Pfc. Jay M. Jamison - Technician, 1 Army Medical Research and Nutrition Laboratory Dr. Donald B. Kettlecamp - Clinician, Alaska Native Health Service Dr. Ruth Coffin - Clinician, 2 Alaska Native Health Service 2 Field Team Member, Bethel party. Dr. Christine A. Heller - Nutritionist, 1 Arctic Health Research Center 1/ Field Team Member, Kotzebue party. Field Team Member, Bethel party. Source: htps.//www.industrydocuments.ucsi.edu/docsizznc022 1 30 60 40 50 50 of II - INTRODUCTION in 50 Alex 1. The Cultural Background The Eskimos, Indians and Aleuts of Alaska vary widely in their U 2 cultural traditions and present day mode of living. At the time or or the white man's arrival, the Eskimos occupied all the northern and western coasts of Alaska, and lived on the southern coast as far east a as Prince William Sound and on Kodiak Island. The Eskimos were divided culturally into a Northern group, the Thule culture, and a Southern group, the Old Bering culture, with the dividing line situated on 8 80 Norton Sound in the vicinity of Unalakleet. Northern Eskimos still a speak the same language as the Siberian, Canadian and Greenland Eskimos, E while the Southern Eskimo language is quite different. The Aleuts originally occupied the western half of the Alaska Peninsula and the Aleutian Islands. Thlingit Indians lived in southeast Alaska, while AND 06 Athabascan Indians occupied the interior regions of the territory. The map in Figure I shows these regions while Table 1 gives the population of these cultural groups in 1950. I 000 TABLE 1 ESKIMOS, INDIANS AND ALEUTS IN ALASKA IN 1950 Population Median Age 10 Eskimos 15,882 17.7 Athabascan Indians 6,783 -- Aleuts 3,892 17.9 20 Source: U.S. Census of Population, 1950, Vol. II, Parts 51- COAST 53. (1) The Eskimo culture in North America has been traced back through the Christian era. The "Thule" culture based on whaling seems to have of spread eastward from Alaska to Greenland during the period 500 to 1000 .D. In the saga of Eric the Red, reference is made to "skraelings" NEWARK (Eskimos) in Labrador in 1003. Possibly because of the disappearance 3MR of whales from the Central Arctic, a deviant culture based on fishing AIO and sealing spread back to Alaska. These migrations appear to account a for the presence of a single, primitive, Stone Age people with a com- : mon language and tools who occupied the 6,000 miles from Alaska to Greenland when Rink explored the latter area in about 1850. The oldest Eskimo culture is the "old Bering" culture which flourished on both 50 sides of the Bering Strait. This culture was based on the hunting of 60 21 0 00 00 00 fish and sea mammals. In Eurasia the Arctic culture was based on reindeer breeding, as in Lapland, except for a limited area of Eskimo culture on the Chukchi peninsula (2), The Eskimos, like the American Indians, are of Mongoloid ethnic origin. Eskimo skulls are narrow and oblong with a definite sagittal ridge. The lower jaws and maxillary bones are highly developed and Source: https://www.industrydocuments.ucsf.edu/docsizznc0227 2 3 prominent. The skin, hair, epicanthal folds and lumbar pigment testify to their Mongoloid origin. In contrast to the Negro the It is important to recognize that Alaskan Eskimos are not nomadic Eskimos have narrow noses. As in the American Indian, blood group people: They live in one or a few permanent homesites or campsites type o predominates among the Eskimos. Most of the sod houses have now been replaced by small frame or log structures. In one village in 1953 there were 36 houses with 47 rooms. The present study was concerned primarily with the two groups The floor space per fami ly was 227 square feet or an average of 51 square feet per person (3) Often these frame houses are poorly insu- of Eskimos, defined by geographic areas, and to a lesser extent with Athabascan Indians and Aleuts. In order to understand the situation lated and are therefore more difficult to heat adequately in winter of these people today it is important to review the primitive con- than were the primitive sod houses. ditions under which they once lived, since all of them are now in transition between the primitive and a modern way of life. This Each village had its own seasonal schedule for hunting and fishing, transition began in the 18th century for the Aleuts with their intro- but as in all hunting-fishing economies, there was a large element of duction to the Russian explorers and traders who followed Vitus Bering chance in this activity. The welfare of the people who depended on into their territory. For the Indians and Eskimos the transition hunting and fishing for food, clothing and fuel fluctuated accordingly. began later and at different times for different groups. The coastal Through the summer most Eskimo and Indian families found it necessary Eskimos who lived on marine mammals were exposed to the whit whalers to move from place to place in search of their supply of food. This and explorers of the 18th and 19th centuries, while some of the was particularly necessary for the tundral people who often traveled inland Eskimo and Indian villages have had important contact with considerable distances from the village in order to obtain sufficient white culture only during the past 60 years. The extent of accultu- food. These campsites, usually family affairs, were visited year after ration is thus variable. year as long as they yielded food. Almost all edible foods were eaten, and since food resources varied in different regions, there were wide Eskimos have managed by a number of ingenious methods to maintain geographic differences in diets. their numbers and to carry on a marginal existence under exceptionally adverse conditions. In order to survive in the Arctic, they have had There were three general types of Eskimo diets under the conditions to utilize every available resource. The primary consideration for of the primitive culture (2). On the northern and northwestern coasts the location of an Eskimo or Indian village in Alaska was the available of Alaska, Eskimos were primarily dependent on sea mammals -- seal, food, fuel and water supply. The population balance in such an walrus and whale -- for food. Farther south, chief dependence was on economy was important since overpopulation meant hunger and sometimes fish, while smaller numbers of interior Eskimos lived on land mammals, starvation. When the population became too large for the available primarily on caribou. In none of these areas was there total depen- food supply or if the food supply became scarce because of persistently dence on any one type of food. Use of fish was universal, while unfavorable weather conditions or some other accident of nature, shellfish, birds, birds' eggs, small mammals (including hares, porcupine, family groups would break away and try to find a more favorable place rabbits, muskrats, mink and beaver), berries, roots and green plants to establish themselves. were eaten when available. In retrospect these diets would seem to have had certain things in common. All of them were probably very high Winter homes were half buried in the ground and made of logs or in protein, moderate to high in fat content, and they contained very whale ribs covered with sod. The walls and ceiling of the main living little carbohydrate. They were beasonally low in ascorbic acid, and room were often lined with split driftwood, vegetable matting or skins. must have been on occasion deficient in calories. Such diets, however, Existing examples of these homes, when well constructed, are surpris- had no known nutritional disadvantages and no known advantages except ingly comfortable and can be heated with a minimum of fuel. They are, that they are generally believed responsible for the fact that Eskimo however, dark and small. Such houses were usually buili at permanent teeth were very nearly free of caries. The Eskimo did not usually have living sites and were then occupied only in the winter when they could a choice of foods from which to make a selection. Instead, his problem be kept reasonably free from condensation and seepage. In the spring, was the fundamental one of assuring a continuity of food and to this with the coming of the thaw, many of them became untenable. Because problem he devoted his energy, intelligence and ingenuity. of dampness of the house and because of the necessity to search for food, the people moved out of the sod huts into tents at camp sites, often at considerable distances from the village. In the early days, 1 tents were made of animal skins secured tightly over a willow frame. The tundra is the vast, treeless area of western and northern Alaska. For many years now the great majority of Eskimos have used canvas It is generally flat, dotted with ponds and sloughs and underlaid tents. Even today, though a family may not wish to move away from wi th permafrost. The vegetation in the summer consists of low shrubs the village for sealing or other activities, they will often move out and grasses and in the winter the surface may be buried to a depth of their winter residence into a tent pitched nearby. of several feet with snow. The winds pack and drift this snow almost continually. An approximate outline of the tundra is shown in Figure I. Source: tps:/lwww.industrydocuments.ucsi.edu/docs zznc0227 4 5 2. Demographic Factors creation of schools, stores, churches and postoffices in some villages Eskimos today live on a combination of foods obtained from the has tended to attract native families and to enlarge the villages, traditional sources and foods bought from stores. The latter are for whereas many small villages listed in 1950 are no longer in existence. the most part cereals and sugars. Some of the factors which presently affect the food habits of Eskimos are as follows: Eskimos seemed to accept Christianity readily and today every village has at least one church which is an important part of the social Eskimos now live at a low economic level. In a study made in life. Denomination of the churches is shown in Table 2 for the villages 1955(4), the estimated annual per capita cash income in 23 Eskimo vil- included in the present study. lages ranged from $69 to $475. Unless the Eskimo lives in one of the larger towns and has some education, he has little or no opportunit ty Schools have been in existence in Alaska for many years, but there for a job with a steady income. The income for a village comes from was never enough money to provide one for each of the smaller villages, a variety of sources. Fishing for profit provides income for many and until the past ten years there was little opportunity for a high families in the Bristol Bay area and at the mouth of the Yukon. While school education except in towns with a permanent white population. such fishing may require considerable capital for a boat, the profits Village schools (formerly called "Territorial Schools") are operated are large if the fishing is good. However, the trend in recent years by the State or by the Bureau of Indian Affairs (BIA). In recent years has been toward smaller catches of salmon. Some men from villages in the latter agency has started a special type of school -- The Instruc- the Kuskokwim area obtain employment in the canneries on Bristol Bay. tional Aid School in certain villages. In these schools the village The pay is high, averaging $600 for the month or six weeks when the furnishes the building, and a teacher is provided by the Bureau of cannery operates. Trapping provides part of the income of most vil- Indian Affairs. Such teachers are often not fully qualified. lages. Fur prices are now low, however, and only mink, muskrat and beaver are profitable enough to encourage the effort involved in Stores or trading posts were established in Alaska by the Russians, trapping. Twenty mink, 700 muskrat, or 20 beaver would represent a and traders have since been an important part of village life. Starting good year's trapping for one man in some areas. Generally, however, in the late 1930's, the Bureau of Indian Affairs helped to establish fewer than this are obtained. During the 1957-58 season, average cooperative stores in many of the large villages. There are several market prices for mink were $30, muskrat $0.25 and beaver $25. communities, however, which still have no store, and people must go varying distances for supplies. The typical village store has a very Service in the National Guard produces an appreciable proportion limited stock of supplies and limited storage facilities. In the of the total income in the villages. In addition, a few Eskimos work usual case, there is no place for storage where freezing can be on river barges in the summer or as storekeepers or janitors. Crafts, avoided in the winter or where food can be kept frozen in the summer. such as ivory carving, basket weaving and making of souvenirs, provide some income for Eskimos. A major source of income in all villages is The water supply of the Eskimo and Indian is traditionally the welfare. A large number of Eskimos are eligible for various forms of nearest river, lake, or pond. A hole is cut in the ice in winter to public assistance including Old Age Assistance and Aid-to-Dependent- dip water, or cakes of ice are cut, hauled on sleds to the home and Children. Welfare payments amount to between one fifth and one third then melted for use. Melting of ice is difficult in most areas because of the cash income in most communities. In four of the villages of the fuel shortage. The usual method of obtaining water in the included in the present survey, mean per capita income in 1955 (4) was winter is with a tank or barrel of ice in a corner of the house near estimated as follows: the stove. The room temperature slowly melts this ice and the water is drawn off from the bottom. The difficulty of obtaining uncontami- Village Mean Income Percent of Income nated ice plus this melting process may contribute to the prevalence per Capita from Welfare of enteric diseases. The true prevalence of these diseases has been difficult to measure since they occur sporadically and require long- Napaskiak $173 28 term surveillance for measurement. In Napaskiak, one of the villages in the present study, an investigation was made which indicated a Akiak 475 32 Kasigluk 138 35 seasonal variation in the prevalence of diarrhea(5). The high level Hooper Bay 137 30 occurred in the summer and affected especially the children under 10 years of age (6). The infection rates for Endamoeba histolytica The population in Alaska is sparse and the communities are small. and Diphylobothrium sp. were found to be 8.6 and 34.5 percent, respectively. In 1950 about 80 percent of the 287 places named in the census had fewer than 199 persons (1). This smallness was probably originally related to the availability of food in the surrounding area. The Most of the coastal people have to depend on driftwood for their fuel. Some portions of the coast have a good supply but in others this wood is almost nonexistent In some villages, where seal are Source: https://www.industrydocuments.ucsi.edu/docsizznc022 TABLE 2 ALASKA: CHARACTERIZATION OF THE VILLAGES IN THE STUDY, AND THE SIZE OF THE SAMPLES EXAMINED, 1958 Name Type Popu- No. of Persons Churches School Store or Distance Distance lation Examined to Nearest Store to Hospital Allakaket Indian 120 75 Episcopalian State Co-op. 150 miles Akiak Southern 187 76 Moravian Bureau of 1 Trader + 20 miles Eskimo Indian Affairs Co-op. Hooper Bay Southern 435 96 Roman Catholic Bureau of 2 Traders + 155 miles Eskimo Swedish Covenant Indian Affairs Co-op. Huslia Indian 145 90 Episcopalian State Trader 135 miles Kasigluk Southern 180 94 Russian Orthodox Bureau of (None) 35 miles Eskimo Moravian Indian Affairs (4 miles) Napaskiak Southern 137 81 Russian Orthodox Bureau of (None) 6 miles 6 Eskimo Indian Affairs (1 mile) Newktok Southern 118 59 Roman Catholic Bureau of 3 Traders 115 miles Eskimo Indian Affairs Instructional Aid Noatak Northern 400 69 Friends Bureau of Co-op. 50 miles Eskimo Indian Affairs Point Hope Northern 315 88 Episcopalian Bureau of Co-op. 150 mi les Eskimo Indian Affairs Shi shmaref Northern 200 77 Lutheran Bureau of Co-op. 110 mi les Eskimo Indian Affairs Totals 2,237 805 8 9 Village Complaint included experts in anthropology, nursing care, medical social services, tuberculosis control, hospital and medical care, sanitation, laboratory Hooper Bay 1. A woman, eight months pregnant, with pain, services and mental health. fever and dysuria suggesting pyelitis. Members of the party traveled through the major areas of Alaska. 2. A young man rith fever and malaise con- The observations were generally more concerned with the health organiza- sidered to be "flu. " tions and demographic and environmental conditions than with clinical problems. The study was done at a critical time, because in July 1955 3. A young boy with penile swelling and the responsibility for the health problems of the natives of Alaska was urinary obstruction, considered to be transferred by Public Law 568 from the Bureau of Indian Affairs of the balanitis. Department of the Interior to the Department of .Health, Education, and Welfare. The Pittsburgh report thus reflects the conditions of an older 4. A woman with pleurisy. system. Tanunak 1. An 18 month old child with a swollen and When Secretary Seward purchased Alaska in 1867, the contract wit] inflamed throat. the Czar stipulated, "The uncivilized tribes will be subject to such laws and regulations as the United States may from time to time adopt Pilot Station 1. A man with obstipation. in regard to aboriginal tribes of that country." Health services and regulations were almost nonexistent until 1914 when a medical program 2. A child with extensive eczema. was established in the Bureau of Education which was then the only governmental agency directly concerned with the natives. In 1916 this o 3. A fever of 105` F. in a 4 month old baby - Bureau established a migratory medical boat on the Yukon, but during no localizing signs of infection. the first summer the physician, Dr. J. W. Houston, fell overboard and was drowned. Small health surveys indicated that tuberculosis, syphilis Goodnews Bay 1. A woman with "flu." and "trachoma" were common. There is now reason to doubt that trachoma did, in fact, exist. 2. The supply of drugs very low. The first hospital for natives was built in Juneau in 1916. In Kipnuk 1. Query from the doctor concerning the con- 1931 when the Office of Indian Affairs assumed responsibility there dition of a patient with tuberculosis were five Alaska Native Health Service (ANHS) hospitals for the Alaskan recently returned to the village on Indians and Eskimos with six doctors and 15 nurses for the entire isoniazid therapy. population. There are now five general hospitals under the U.S. Public Health Service and these are located at Point Barrow, Bethel, 2. Query about the three villagers who were Kanakanak, Kotzebue and Tanana. There are, in addition, two medical sent to Bethel last month for medical care. centers, one at Anchorage and another at Mt. Edgecumbe in southeastern What are their conditions? Alaska near Sitka. Some specialized care, as for tuberculosis and mental disease, is obtained by contract in hospitals both in and outside Mountain Village 1. Query for news about a man recently sent Alaska. The 1958 budget of the Division of Indian Health, Public Health to the Anchorage Hospital. Service, for Alaska was: Scammon Bay 1. A 14 year old girl with pain in the right Activity lower abdomen, vomiting and with fever. Hospital Operations $ 8,702,000 A general description of the ecological and social factors which Contract Patient Care 694,000 bear upon the health problems in western Alaska has been outlined in the Field Health 784,000 report of a survey carried out in 1953-54 by the Graduate School of Management Services 122,000 Public Health of the University of Pittsburgh (7). The Department of the Interior, which was then responsible for the health problems and pro- Total $10,302,000 grams in the nátive population of Alaska, invited the faculty of the School of Public Health of the University of Pittsburgh to survey the situation and make suggestions for improvement. In the summers of 1953 and 1954 such a survey was carried out by medical specialists. These Source: https://www.industrydocuments.ucst.edu/docsizznc022 FIGURE II TUBERCULOSIS MORTALITY FOR ALASKA BY RACE 1952-- 1957 I50 140 130 WHITE 120 ESKIMO 110 INDIAN ALEUT 100 90 80 70 60 50 40 30 20 10 O NITION NITTION Sis 000000 or 13 The birth rates of racial groups in Alaska in 1956 are shown here (9) : Whites 32 per 1,000 population Eskimos, Indians, Aleuts 52 per 1,000 population The burden of disease in Alaska in 1950 and today bears a remark- able resemblance to that recorded for the United States in 1900. The opportunity for the application of modern medical skills and knowledge is obvious. "Native Alaska" could and should be made an almost ideal laboratory workshop for teaching, research and service. 4. General Plan of Study A large proportion of the able-bodied Eskimo men are members of two battalions of a National Guard Reserve Unit which is brought to Camp Denali (at Fort Richardson near Anchorage) each year for a two-week training period. In good weather when the widely scattered villages are accessible the men are often away on sealing expedition or tending traplines, so the period of National Guard duty offered a unique op- portunity to study these Eskimo men. This was also an economical way of assembling data on people from many widely separated villages. It was fortuitous that the Guard training period occurred in late winter when native food supplies might be expected to be diminished and limited, thus placing the nutritional status of the people at a low ebb. The clinical and biochemical methods used were those described in the "Manual for Nutrition Surveys" of the ICNND(10) Clinical observa- tions were recorded on data cards for the "detailed clinical examination. No abbreviated clinical examinations were done. The neurological, cardiovascular and abdominal examinations and the skinfold measurements were made by two members of the Alaska Native Health Service medical staff. Battalion 2 of the Eskimo Guardsmen arrived at Anchorage on March 1 and 2, 1958. The noncommissioned officers had arrived two weeks earlier. This unit comprises men from southwestern Alaska including the Aleutian chain and the Bering Sea islands except St. Lawrence and King Islands. Bethel and the Kuskokwim valley may be considered as its center. The men come from as far south as Dillingham, from west to Unalaska and the Pribilofs, and from north to Hooper Bay and the lower Yukon. They include two distinct ethnic groups, the Eskimos -- both inland and coastal -- and the Aleuts, who are few in number (Figure III). These men were examined during three days at Camp Denali. The group of examiners was then divided into two sections. One team proceeded to Bethel on March 7. In the following ten days they studied five villages in that area. A second team went to Kotzebue on March 7 where they undertook studies in five villages of that region. Upon completion of these field studies the two parties returned to Camp Denali and on March 24-27 examined Battalion 1 of the Eskimo Guardsmen. These men were assembled from the northern villages of Alaska extending from Barter Island near the Canadian border to Nome Source: https:llwww.industrydocuments.ucsi.edu/docsizznc0227 FIGURE III PRINCIPAL ETHNOGRAPHIC DIVISIONS OF ALASKA, AND THE VILLAGES STUDIED Pt. Barrow Point Hopee 52 Woatak 3 so I. Aleuts East Cape Shishmaref Allakaket 2. Southern Eskimos 3. Northern Eskimos 3 Huslia 4. Athabascan Indians River Nome (ukon Foirbanks 5. Thlingit, Tsimshian, St Lowrence and Haida Indians 14 Island Hooper Bay Newktok Kosigluk (Anchorage Nunivak Bethel Napaskiak Island 2 Juneau e Pribilof Bristol 8 Isls. Bay Kodiak Island 5 goo chain 08.. & joint 50 150 250 I I Miles pure 15 230 16 17 FIGURE IV TABLE 3 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 PLAN OF THE STUDY WITH NUMBERS CLINICAL CALIBRATION STUDIES 1/ EXAMINED (1) (2) (3) (4) Replicates Trials Bn 2 Bn 1 Total Duplicates N 16 N 20 A N 16 N 32 N 68 Examiner No. 1 - + + - + + - + + - + + Classification No. 2 - + + - - + + - - + + - + + Attribute BATTALION 2 General appearance 21 13 3 - - 16 4 - - 26 6 - - 55 13 - - Thyroid enlarged 16 - - - 19 - 1 - 26 1 4 1 61 1 5 1 B =20 Submaxillary enlarged 16 - - - 18 1 1 - 29 - - N = 323 3 63 1 4 - Nasolabial seborrhea 16 - - - 17 - 2 1 32 - - - 65 - 2 1 BETHEL KOTZEBUE Other seborrhea 16 - - - 20 - 28 - 4 - 64 - 4 - Erythema head 14 1 - 1 13 4 3 28 2 2 55 7 - 6 AREA AREA Pigmentation - head 14 2 - - 20 - - 28 3 1 62 5 - 1 Thickened conjunctivae 15 1 - 16 4 - 21 6 1 4 52 11 1 4 AKIAK NOATAK Pingueculae - 2 4 10 - 2 18 9 4 4 15 9 8 8 43 76 69 (6) Bitot's spots 15 - 1 - 19 - 1 - 32 - - - 66 - 2 - (I) Conjunctival injection 16 - - - 19 1 - - 26 4 2 - 61 5 2 - Angular scars 14 1 1 - 17 - 3 - 32 - - - 63 1 4 - Cheilosis 16 - - 19 - 1 - 32 - - - 67 - 1 - Filiform strophy, KASIGLUK PT. HOPE slight 16 - - 16 - 4 - 30 - 2 - 62 - 6 e 94 88 Glossal furrows 16 - - 15 4 1 23 5 2 2 54 9 2 3 (2) (7) Red gums 16 - - - 11 - 7 2 30 - 1 1 57 - 8 3 Swollen gums 16 - - 13 6 1 29 - 3 - 58 - 9 1 Gum recession 6 2 1 7 3 1 12 4 19 1 8 4 28 42 1 15 Unfilled caries 7 3 6 14 2 4 12 3 6 11 33 8 6 21 Worn teeth 1 8 1 6 2 3 1 14 16 5 2 9 19 16 4 29 NAPASKIAK SHISH MAREF Follicular 8I 77 hyperkeratosis 15 1 - - - (8) 15 5 28 - 4 58 10 - (3) Xerosis 16 - - 19 1 - - 28 3 1 - 63 4 1 - Acne 15 1 - - 18 1 - 1 25 2 2 3 58 4 2 4 The 43 items recorded for the detailed examination which were used exclusively NEWKTOK ALLA KAKET in the Alaska Survey have been abridged here to include only the 23 items which (4) 59 75 showed sufficient prevalence of a sign to allow comparison of observers. (9) 2/ Positive means less than "good general appearance.' HOOPER BAY HUSLIA 96 90 (5) (10) BATTALION I C N=32 N = 390 Source: https://www.industrydocuments.ucsi.edu/docsizznc022 18 19 follicular hyperkeratosis is an important area of dyscalibration. It will be shown later that this particular examiner difference is partially accounted for by an assignment of lesions by examiner 2 to follicular TABLE 4 hyperkeratosis whereas examiner 1 assigned similar conditions to xerosis. ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 A similar estimate of examiner difference was carried out with the Battalion 1 men after the survey parties returned from the village SUMMARY OF CALIBRATION STUDIES FOR THE CLINICAL EXAMINATIONS-/ surveys (column 3 in Table 3). The extent of the differences between examiners is both large and important. If the average difference between examiners in percent of subjects in which they disagree for all items is obtained for Battalion 2 and Battalion 1, the averages are respectively Number Examiner's Reaction of 16.6 N=25 and 14.0 N=25. There is no clear indication of a trend of Disagree examiner difference. For the total duplicate examinations (68 in all, Trial Observations Agree Positive No. 1 + No. 2 + Agree Negative column 4, Table 3), the examiners exceed 15 percent divergence for N % N % N % N % thickened conjunctivae and pingueculae, glossal furrows, gum atrophy and recession, unfilled caries, worn teeth and dental malposition. The Trial 1 368 30 8.2 24 6.5 92.4 289 78.6 divergence on follicular hyperkeratosis is just at 15 percent, but one 460 examiner identified all of these (N=10) whereas the other examiner Battalion 2 49 10.7 28 6.1 44 9.6 319 69.5 diagnosed 4 subjects with xerosis, not indicated by the first. These data are further condensed in Table 4. The secular consistency of the Battalion 1 736 53 7.2 45 6.1 49 6.7 557 75.6 examiners is notable. These clinical calibration studies were done on 5 percent of the Totals 1564 132 8.4 97 6.2 102 6.5 1165 74.5 subjects studied at Camp Denali. This approach will always be limited by the scarcity of clinical material showing a range of manifestations for many of the important clinical signs. The problem then is one of measuring the ability of individuals to fix their criteria for recogni - tion of threshold levels of clinical signs. It appears that a more Conclusion - In 1564 observations recorded in duplicate after independent rigorous set of definitions should be used. It is also necessary that evaluation by examiner 1 and examiner 2: more extensive estimates of observer differences be made. The present data suggest that perhaps 10 percent of all the clinical appraisals Both agree positive findings in 8% should have been replicates, and this process should have been arranged Both agree negative findings 75% to measure self-duplication as well as inter-examiner duplication. Disagree 13% With examiner 1 positive 6.2% The present studies appear to disqualify observation of thickened With examiner 2 positive 6.5% conjunctivae, pingueculae and follicular hyperkeratosis because of observational imprecision. The dental information will need to come from the independent dental examination. 1 Using the 23 items shown in Table 3. Source: https:/lwww.industrydocuments.ucsf.edu/docs/zznc0227 20 21 III - NATIVE MEN IN THE NATIONAL GUARD 2. Clinical Findings 1. The Population Studied The general impression of physical appearance obtained from casual observation of the two battalions was that these men were active, rugged, The Eskimo Guardsmen represent the majority of all the able-bodied deeply tanned and well-conditioned. They were short in stature, with Eskimo men in Alaska. They appear to find membership in the Alaska "Oriental" faces, short limbs and long trunks, and they generally had a National Guard (ANG) attractive because the service furnishes a cash mesomorphic body type. The men in Battalion 1 who came from northwestern income and also it supplies a pleasant social diversion for them. Alaska seemed somewhat taller, obesity was more frequent among them, and they more commonly had lighter eyes, hair and skin than the men in It appears that no medical screening is done in the villages when Battalion 2. The men in Battalion 1 were also more at ease, better ac- the groups are assembled for the annual duty at Anchorage. It is likely quainted with English, and their behavior was more like that of American that known tuberculosis and obvious crippling or chronic disease are troops. The height-weight measurements bear out some of these observa- causes for rejection, but the men are generally sworn in and assembled tions. A summary of the height, weight, skinfold, blood pressure and in Anchorage before application of the usual medical standards for mil- pulse measurements is shown in Table 5. itary acceptance (11). The frequency and severity of grossly visible defects strongly suggested that these battalions were composed of "able- The relationship of weight to age is shown in Table 6. The small bodied volunteers" who had not been subjected to effective medical gains of weight with age are in contrast to the usual findings in white screening. In Battalion 2, four cases of active pulmonary tuberculosis males in the United States. As noted above the men from northwestern were diagnosed by symptoms and x-ray among the 350 men present. Alaska (Battalion 1) were a little taller than those in Battalion 2, but no important trends were demonstrated. In particular, there is no The Division of Tuberculosis Control of the Alaska Department of evidence that Eskimo men are taller as their race becomes acculturated. Health, as part of its tuberculosis case finding mechanism, has three These data also indicate there is very little obesity. (It should be itinerant x-ray technicians who travel to villages of known high incidence remembered in using the U.S. Medico-Actuarial Tables of Standard Weight (13) to take chest x-rays of all available inhabitants. Active and probably that an appreciable increase of weight with age is incorporated in the active cases diagnosed in this manner, as well as by laboratory or "standard weight. The fall of percent "standard weight" with age clinical means, are placed under medical supervision, and their known shown in Table 18a is thus largely an artifact due to the use of these contacts are also examined. In 1958 this program identified 44 new J.S. reference tables(13). The percent distribution of men exceeding the active cases throughout Alaska among the Eskimos and Indians(la calculated "standard weight" is shown in Table 5. The physical appearance of these men suggests that the percent "standard weight" in excess of 100 The noneffective rates at Camp Denali among the Eskimo National is often an artifact due to excessive bone and muscle mass; that is, the Guardsmen were not made available. Since the survey examination consequence of high activity rather than of fat deposits. Body composi- facility was also the battalion dispensary, it was observed that from tion data on these people are not available, but body composition may 8 to 30 men appeared for sick call each morning from a battalion have some relevance to the physiological problem of adaptation to a cold strength of about 400. During the work with each battalion small epi- environment. This interpretation of the small elevation of percent demics of what seemed to be a contagious respiratory disease occurred "standard weight" is also supported by the relation of weight to age a few days after the men arrived in camp. This was variously called shown for the village groups in Figure IX where the weights are es- "flu,' "pneumonia" and "measles" by the orderlies. The medical facil- sentially constant after age 25 to 29. ities available to these men were the same as those for all U.S. military personnel in Alaska. These facilities and the local mess and The pulse rates have little clinical interest, although there was sanitary facilities would not be expected to have any lasting effect, evidence for important observer differences. however, since the men are in camp for only 14 days. As is usually true of blood pressure data, the observers showed a There is no question that duty with the Alaska National Guard has predilection for the end digits o, 5, and even numbers. For example, an important impact on these men, especially those from the Bethel area 76 percent of the diastolic blood pressures were recorded with a zero where acculturization has been slower. The Eskimos acceptance of end digit and 82 percent of the systolic pressures recorded ended with military food, clothing, customs and equipment is immediate and total. zero. This recording artifact requires a careful selection of groups They are sometimes said to dislike beans and they often find cheese in the analysis and also influences the positioning of an arbitrary revolting, but mess sergeants find they eat anything offered them and criterion of normalcy because it will affect the distribution of they eat this completely. It has been said that the word "Eskimo, subgroups. which means "one who eats raw meat" in the Athabascan language, would be more appropriately called "one who eats everything. " The mean systolic blood pressures are remarkably constant with age (Table 6). Furthermore, the number of men with systolic pressure of 160 or over comprises a very small percentage (8 men, 1.1 percent) Source: https://www.industrydocuments.ucsf.edu/docs/zznc0227 S 22 TABLE 6 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION AND AGE HEIGHT, WEIGHT, WEIGHT STATUS, SKINFOLDS, BLOOD PRESSURE & PULSE Battalion 2 Battalion 1 Age (years) Age (years) 17-19 20-39 40-54 Total 17-19 20-39 40-54 Total Number examined 21 255 47 323 42 318 30 390 I/ Height (inches) 65.5+0.4 64.5+0.1 63.8+0.3 64.5+0.1 65.8+0.3 66.2+0.1 65.840.4 66.2+0.1 Weight (pounds) 1/ 140 + 3 141 + 1 144 + 2 142 + 1 140 + 2 150 + 3 150 + 3 149 + 1 % of "Standard Weight" 108 + 2 104 +1 1 102 + 1 104+1 107 + 1 106 + 1 100 + 1 106 + 1 Median Arm 6.3 5.9 5.4 5.9 8.9 6.7 7.1 6.9 Skinfold Thickness Scapula 8.3 7.7 7.6 7.8 10.7 9.5 8.8 9.7 (mm) 23 Systolic Blood Pressure (mm Hg) 17 125 + 4 126 + 1 122 + 2 125 + 1 119 + 2 121 + 1 120 + 3 121 + 1 Diastolic Blood Pressure (mm Hg) I/ 73 + 2 73 + 1 72 + 2 67 + 1 67 + 2 70 + 1 74 + 1 70 + 1 % with B.P. > 140/90 0.0 6. 6.4 5.9 0.0 1.9 0.0 1.5 Pulse (beats/minute) 78 2 78 + 1 74 + 1 78 1 79 + 2 77 + 1 76 + 1 77 + 1 1/ Mean + Standard Error. TABLE 7 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION BLOOD PRESSURE (Mean I Standard Error), BY HEIGHT Height (inches) 59-63 64-67 68-73 Systolic Bn 2 122.3 + 1.4 127.1 + 1.1 127.8 + 3.0 Blood Pressure (mm Hg) Bn 1 117.6 + 2.1 119.7 + 0.9 125.1 I 1.5 Diastolic Bn 2 70.7 + 1.0 73.0 + 1.0 75.2 + 1.9 Blood Pressure (mm Hg) Bn 1 67.4 + 1.6 69.9 + 0.6 70.5 + 1.1 24 of the entire group examined. In neither group was there a significant number of men with diastolic pressures over 90 mm Hg and there were only five men with pressures over 100 mm. Since these were casual blood pressure measurements taken under moderately stressful conditions they may be presumed to be high estimates. They suggest that hypertensive heart disease is not an important problem among these men. Rodahl has also made this observation This fact is of particular interest because of the high protein diet which these men seem to have. It is of some interest that when systolic blood pressure is considered for each battalion by inch of height a definite trend is observed for higher mean pressure with increasing height. Grouping and comparing heights reveals mean differences as shown in Table 7. Diastolic pressures re- veal a similar trend. It may be concluded that the observed blood pressure readings reveal little or no signs of high blood pressure as an indicator of cardiovascular disease and that the minor fluctuations of blood pressure observed are reasonably related to small differences of a.m thickness. The absence of hypertension among the Eskimos may be of some importance in relation to the problem of causation of hyper- tensive heart disease among white cultures. The summary of other clinical findings for the Eskimo Guardsmen is shown in Tables 8, 9 and 10. The data are shown for the battalions separately (Table 8) because they seem to represent two distinct popu- lations. The examiners are also distinguished because of the procedural divergencies demonstrated above. Certain selected clinical signs are presented by battalion and age in Table 9 and by ethnographic origin in Table 10. The significant findings are as follows: No important prevalence of goiter was observed in the men of Battalion 2 but an average prevalence of 10 percent was seen in Bat- talion 1. These were, without exception, small goiters which were judged to be enlarged either with nodules or symmetrically. A 9.9 percent incidence of goiter was found among northern Eskimos, and 14.3 percent of the Athabascan Indians had enlarged thyroid glands. No instance of thyrotoxicosis was seen. The prevalence of enlarged sali- vary glands was low; the glands were not grossly enlarged and the sign did not seem important (Figure v). Erythema of the exposed parts was common, but this could be adequately explained by the known degree of exposure to sun, cold and wind. It was noted particularly among the Eskimos (Table 10). The late cutaneous results of cold injury which the men describe collectively as "ice" re- semble x-ray injury, with cicatrization, depilation and dilatation of venules. Excessive pigmentation of exposed parts was also common in the older men and was sometimes dramatic about the face. Over the trunk and especially the back it assumed a mottled effect with an irregular depo- sition of pigment (Figure VI). This change strongly resembled the erythema ab igne more often seen about the shins in some U.S. rural populations. In these people this sign, restricted to males, is probably related to the "kashim" or sweat bath procedure. Source: ttps://www.industrydocuments.ucsf.edu/docs/zznc0227 TABLE 8 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION PERCENT PREVALENCE OF CLINICAL FINDINGS , BY EXAMINER II Battalion 2 Battalion 1 Total Examiner Examiner Examiner # 1 # 2 Total # 1 # 2 Total # 1 # 2 Total Number examined 155 168 323 211 179 390 366 347 713 Suspected Disease Tuberculosis 3.9 1.8 2.8 1.9 3.9 2.8 2.7 2.9 2.8 Good 85.8 100.0 93.2 83.4 98.9 90.5 84.4 99.4 91.7 General Appearance Fair 12.9 0.0 6.2 16.1 1.1 9.2 14.8 0.6 7.9 Poor 1.3 0.0 0.6 0.5 0.0 0.3 0.8 0.0 0.4 Hair Staring hair 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Thyroid 0.7 1.2 0.9 11.4 8.9 10.3 6.8 5.2 6.0 Glands Enlarged Submaxillary 2.6 2.4 2.5 2.4 5.0 3.6 2.5 3.7 3.1 Nasolabial seborrhea 0.0 5.4 2.8 0.5 2.2 1.3 0.3 3.7 2.0 Other seborrhea 0.0 1.8 0.9 2.4 7.3 4.6 1.4 4.6 2.9 Skin - Face & Neck Erythema, face/neck 21.9 6.0 13.6 13.7 7.8 11.0 17.2 6.9 12,2 26 Pigmentation, face/neck 5.8 0.6 3.1 3.8 7.8 5.6 4.6 4.3 4.5 Thickened conjunctivae 11.0 1.2 5.9 31.8 19.0 25.9 23.0 10.4 16.8 Pingueculae 84.5 57.7 70.6 61.1 54.7 58.2 71.0 56.2 63.8 Bitot' spots 1.3 0.6 0.9 0.0 0.0 0.0 0.5 0.3 0.4 Eyes Circumcorneal injection 0.0 0.6 0.3 0.0 0.6 0.3 0.0 0.6 0.3 Conjunctival injection 4.5 0.0 2.2 9.0 3.4 6.4 7.1 1.7 4.5 Blepharitis 0.0 0.0 0.0 0.5 0.0 0.3 0.3 0.0 0.1 Corneal scarring 6.5 9.5 8.0 4.3 2.2 3.3 5.2 5.8 5.5 Angular lesions 0.7 0.0 0.3 0.5 1.7 1.0 0.5 0.9 0.7 Lips Angular scars 3.2 5.4 4.3 0.0 0.0 0.0 1.4 2.6 2.0 Cheilosis 0.0 1.2 0.6 0.0 0.0 0.0 0.0 0.6 0.3 Filiform atrophy, s1. 0.7 13.1 7.1 9.5 10.6 10.0 5.7 11.8 8.7 Filiform atrophy, mod. 1.3 1.8 1.5 2.8 2.8 2.8 2.2 2.3 2.2 Fungiform atrophy 2.6 0.0 1.2 0.0 0.0 0.0 1.1 0.0 0.6 Tongue Papillary hypertrophy 1.3 1.2 1.2 0.0 1.1 0.5 0.5 1.2 0.8 Furrows 7.1 1.2 4.0 12.8 6.7 10.0 10.4 4.0 7.3 Fissures, erosions, ulcers 2.6 0.0 1.2 1.4 0.0 0.8 1.9 0.0 1.0 Serrations or swellings 5.8 8.9 7.4 1.9 9.5 5.4 3.6 9.2 6.3 Red, tip or lat. margins 3.2 0.0 1.5 7.6 1.1 4.6 5.7 0.6 3.2 Geographic tongue 1.3 0.0 0.6 2.4 1.1 1.8 1.9 0.6 1.3 TABLE 8 (Cont inued) Red or swollen gums 9.7 25.6 18.0 5.2 14.0 9.2 7.1 19.6 13.2 Gums Atrophy or recession, pap. 40.0 66.7 53.9 23.7 43.6 32.8 30.6 54.8 42.4 Bleeding gums 0.0 2.4 1.2 0.0 0.0 0.0 0.0 1.2 0.6 Unfilled caries 27.0 20.9 23.8 42.2 44.1 43.1 36.8 34.4 35.6 Filled caries 10.4 12.4 11.5 30.8 45.3 37.4 23.6 31.5 27.4 Carious teeth, 0 62.6 65.1 63.9 32.7 20.1 26.9 43.3 39.0 41.2 " " 1-2 13.0 14.0 Teeth , 13.5 16.1 31.8 23.3 15.0 24.4 19.6 " " , 3-4 15.7 9.3 12.3 20.4 21.8 21.0 18.7 16.6 17.7 " " , 5+ 7.0 7.0 7.0 26.1 24.0 25.1 19.3 16.9 18.1 Edentulous 1.7 4.7 3.3 4.7 2.2 3.6 3.7 3.2 3.5 Worn 60.0 45.7 52.5 34.1 30.2 32.3 43.3 36.7 40.1 Fluorosis 0.0 0.0 0.0 1.4 2.2 1.8 0.9 1.3 1.1 Malposition 7.8 4.7 6.1 19,9 5.0 13.1 15.6 4.9 10.4 Follicular hyperkeratosis 3.9 11.3 7.7 0.0 10.6 4.9 1.6 11.0 6.2 22 Xerosis 1.3 0.0 0.6 14.2 0.6 7.9 8.7 0.3 4.6 Acneform eruption 5.2 1.8 3.4 9.0 5.0 7.2 7.4 3.5 5.5 Skin General Scrotal dermatitis 0.0 0.0 0.0 0.5 1.1 0.8 0.3 0.6 0.4 Thickened pressure points 1.3 0.0 0.6 1.4 5.6 3.3 1.4 2.9 2.1 Purpura or petechiae 0.6 0.0 0.3 0.0 0.0 0.0 0.3 0.0 0.1 Hyperpigmentation 0.0 2.4 1.2 1.9 0.6 1.3 1.1 1.4 1.3 Abdomen Hepatomegalia 0.0 2.4 1.2 0.5 0.0 0.3 0.3 1.2 0.7 Vibration sensation absent 1.3 0.0 0.6 0.0 0.0 0.0 0.5 0.0 0.3 Lower Extremities Loss of ankle jerk 0.6 0.6 0.6 0.5 0.0 0.3 0.5 0.3 0.4 1/ No findings of enlarged parotids, xerophthalmia, magenta tongue, "scorbutic-type"gums, crackled skin, pellagrous lesions, splenomegalia, ascites, or calf tenderness. Findings of 1 case each of glossitis, perifolliculosis and depigmentation of hair also omitted. Source: https://www.industrydocuments.ucsf.edu/docs/zznc022) TABLE 9 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION AND AGE PERCENT PREVALENCE OF SELECTED CLINICAL FINDINGS Battalion 2 Battalion 1 Age (years) Age (years) 17-19 20-39 40-54 Total 17-19 20-39 40-54 Total Number examined 21 255 47 323 42 318 30 390 Suspected Disease Tuberculosis 4.8 2.4 4.3 2.8 4.8 2.8 0.0 2.8 Good 90.5 92.9 95.8 93.2 83.3 91.5 90.0 90.5 General Appearance Fair 9.5 6.7 2.1 6.2 14.3 8.5 10.0 9.2 Poor 0.0 0.4 2.1 0.6 2.4 0.0 0.0 0.3 Thyroid 0.0 0.8 2.1 0.9 9.5 9.7 16.7 10.3 Glands Enlarged Submaxillary 0.0 2.7 2.1 2.5 0.0 3.5 10.0 3.6 Nasolabial seborrhea 4.8 3.1 0.0 2.8 4.8 0.9 0.0 1.3 Skin - Face & Neck Erythema, face/neck 9.5 13.7 14.9 13.6 2.4 12.3 10.0 11.0 Pigmentation, face/neck 4.8 2.7 4.3 3.1 2.4 6.3 3.3 5.6 2 8 Thickened conjunctivae 0.0 6.3 6.4 5.9 11.9 26.4 40.0 25.9 Pingueculae 38.1 69.4 91.5 70.6 23.8 61.0 76.7 58.2 Eyes Conjunctival injection 0.0 2.4 2.1 2.2 11.9 5.7 6.7 6.4 Corneal scarring 0.0 8.6 8.5 8.0 7.1 2.5 6.7 3.3 Filiform atrophy, s1. 0.0 7.8 6.4 7.1 14.3 9.7 6.7 10.0 " " mod. 0.0 1.6 2.1 1.5 0.0 2.8 6.7 2.8 , Tongue Furrows 0.0 3.5 8.5 4.0 9.5 10.4 6.7 10.0 Serrations and swellings 0.0 7.5 10.6 7.4 0.0 6.3 3.3 5.4 Red, tip, or lat. margins 0.0 1.6 2.1 1.5 4.8 5.0 0.0 4.6 Geographic tongue 4.8 0.4 0.0 0.6 2.4 1.9 0.0 1.8 Red or swollen gums 0.0 17.3 29.8 18.0 7.1 10.4 0.0 9.2 Gums Atrophy or recession 54.9 66.0 53.9 14.3 33.6 50.0 32.8 No carious teeth 36.8 64.6 75.0 63.9 14.3 26.7 46.7 26.9 Caries, filled 1-2 15.8 13.8 11.1 13.5 19.0 23.3 30.0 23.3 Teeth or unfilled 3+ 47.4 19.0 5.6 19.3 66.7 45.9 20.0 46.2 Edentulous 0.0 2.6 8.3 3.3 0.0 4.1 3.3 3.6 Worn 15.8 48.7 91.7 52.5 2.4 31.8 80.0 32.3 Follicular hyperkeratosis 9.5 8.6 2.1 7.7 7.1 4.7 3.3 4.9 Skin General Xerosis 0.0 0.8 0.0 0.6 7.1 8.2 6.7 7.9 Acneform eruption 9.5 3.5 0.0 3.4 11.9 6.6 6.7 7.2 29 PUEW ONNOVI VNWN w 006 oanoww wava NW the WNY PPOOP- compa FUN NWF oaitor JNWF via 3.6 over NFL OF JNN boing 00 0 FOUOND FOOUOD TE 000wooowwe coovoo ING HUYAN FN WNWWN- NVIN ONIXS ONnOX V NI SHONVHO GHL HO IA A 32 33 Thickening of the conjunctivae, especially in the palpebral fissures, because of the tendency of Eskimos to show a normocytic anemia of unknown occurred commonly in the men and was difficult to judge. In general, it cause(3). No true glossitis was seen. The other glossal changes are was diagnosed as present if lateral orbital pressure, through the lid, considered unimportant; the glossal serrations may possibly reflect a would cause definite folds to appear. Similarly, pingueculae of one thick muscular tongue, developed by vigorous eating habits. or both palpebral fissures were both common and extensive. These sometimes The dental data gathered by the clinicians are of interest in protruded between the closed lids medially and were dry and lichenified on the surface. Although over half the men showed these ocular lesions, demonstrating the need for a specialized appraisal of oral manifesta- it seemed they could be reasonably attributed to environmental irritation tions. The clinicians did suspect both age and geographic gradients rather than to nutritional causes. An age analysis (Table 9) conforms for dental caries (Tables 9 and 10). The extent of dental attrition with this interpretation, the prevalence increasing regularly with age. was remarkable and strongly age-related. Fluorosis, even though rarely The incidence was greatest among Eskimos from southern Alaska. diagnosed, seems to have been mistaken for hereditary hypoplasia of enamel. Results of the dental study are presented on pages 33-40. The Bitot's spots seen were rare, in the early examinations, and are in retrospect only suggestive of vitamin A deficiency. However, other Both follicular hyperkeratosis and xerosis were seen and probably corroborative evidence will be discussed in the section on the villages. often confused by two examiners (see discussion above). In Table 11 is shown a. summary of these clinical findings along with the rare Conjunctival injection was noted in 11.9 percent of men 17 to 19 diagnosis of Bitot's spots. The latter cannot be taken as conclusive years of age in Battalion 1 (Table 9), and in 26.7 percent of northern evidence of past or present vitamin A deficiency, but they do require Eskimos, and 19 percent of Athabascan Indians. This is attributed to biochemical evaluation. The lack of correlation between presence of environmental trauma rather than nutritional deficiency. Bitot's spots and serum vitamin A levels shown in Table 11 illustrates the imprecision of this clinical attribute as an indicator of vitamin A nutriture. Corneal scarring represents an important cause of morbidity among the Eskimos. No signs of trachoma were seen in the present studies. Neither were there evidences of "snow blindness, although there were several young people in the villages who had active phlyctenular kerato- TABLE 11 conjunctivitis (PKC) with typical photophobia. The exact nature of snow blindness seems not to be established. Whether there is a distinct entity, precipitated by excessive light and without corneal ulceration, RELATION OF CLINICAL SIGNS AND BIOCHEMICAL FINDINGS, is not clear. Certainly the Eskimos have been making and using narrow SERUM VITAMIN A, ALASKA, 1958 aperture "glasses" for many centuries, since these tools have been (Serum Vitamin A in micrograms per 100 ml. Mean + standard error) excavated by archeologists. Nevertheless, the occurrence of PKC has been very common in these people as judged by the presence of residual scars, Villages and it is a continuing, although lessening, medical problem. The causa- tion is not established, but it appears at least as probable that dietary National Guard Bethel Area Kotzebue Area factors are important as that the doctrinal assignment of cause to No. Serum A No. Serum A No. Serum A tuberculosis is true (15,16). The evidence indicates that while tubercu- losis is often associated with PKC this is not invariably the case. In Total Survey 574 37 + 1 196 31 + 1 220 29 + 1 the present study the frequency of corneal scars was somewhat greater among Battalion 2 men from the less acculturated area of southwestern Persons with follicular Alaska than in Battalion 1 (Tables 8 and 10). However, both groups had hyperkeratosis 34 37 + 2 7 28 + 7 69 30 + 1 significant numbers of men with such scars. Casual observation suggested an age gradient, the lesions being more common in older men than in young Persons with xerosis 30 38 + 2 26 35 + 3 o men. An analysis of the prevalence of this stigma by age and battalion is shown in Table 9. These questions will be considered again with the Persons with Bitot's village data. spots 3 40 + 13 2 12 + 10 o Angular scars were rarely seen in Battalion 2 and none were observed 1/ Two of five subjects recorded as having Bitot's spots had serum vitamin in Battalion 1. Slight filiform atrophy of the tongue was occasionally A levels below 20 mcg/100 ml; this is not a significant difference reported. Moderate atrophy, being more consistent, is better considered. (P= . 16). About two percent of the men showed this lesion to the latter degree. A moderate degree of filiform atrophy was found in 5.3 percent of the Aleuts and 3.2 percent of northern Eskimos. The finding is of interest Source: Ittps://www.industrydocuments.ucsf.edu/docs/zznc227 34 35 A similar comment may be made in regard to the lack of evidence of in field studies of fluoride-caries relations. The race and exact age of a relationship of serum ascorbic acid levels to the presence of red or the examinee and the village from which he came were unknown to the ob- swollen and bleeding gums (see Table 12). server at the time of examination. b. Results TABLE 12 The criteria used to appraise the conditions reported here are RELATION OF CLINICAL SIGNS AND BIOCHEMICAL FINDINGS, described in Appendix A. For the entire group of Alaskan males the life- SERUM VITAMIN C, ALASKA, 1958 time caries experience was generally lower, and diseases of the periodontal tissues generally were more prevalent and severe, than in approximately (Serum Vitamin C in milligrams per 100 ml. Mean + standard error) 1,400 white males examined in Baltimore (17) and in Birmingham(18) in the United States. The caries experience in these two latter groups is con- Villages sidered to be moderate, and periodontal conditions possibly typical, for National Guard Bethel Area Kotzebue Area U.S. white males in general. These specific data were selected as a basis for comparison because the same criteria and methods were used as No. Serum C No. Serum C No. Serum C in Alaska, and because the Alaska examiner participated in all three Total Survey 648 .52 + .01 222 .40 + .02 208 .47 + .02 studies. Comparative findings are shown in Table 13. Persons with red or swollen gums 86 .56+.03 18 .42 + .06 37 .49 + .03 TABLE 13 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 Persons with bleeding gums 4 .65 + .04 o 3 .44 + .06 COMPARISON OF DENTAL CARIES AND PERIODONTAL STATUS OF 713 ESKIMO GUARDSMEN WITH 1, 400 WHITE MALE RESIDENTS OF BIRMINGHAM AND BALTIMORE Mean Numbers of Decayed, In summary, the important clinical findings consisted of occasional Missing and Filled Per- thyroid enlargement in Battalion 1 and among northern Eskimos and Numbers manent Teeth per Man Mean Periodontal Scores 1/ Athabascan Indians, rare Bitot's spots, xerosis, phlyctenular corneal Age Examined Baltimore- Baltimore- scarring, markedly extensive and variable caries, attrition of the teeth (years) Alaska Birmingham Alaska Birmingham Alaska and periodontal disease, and cutaneous hyperpigmentation. The important negative findings were the lack of signs of inanition, anemia, or cardio- 15-19 63 11.3 10.2 .43 .40 vascular disease, or of specific signs of deficiency of B-vitamins or 20-29 359 12.9 9.5 .66 .69 protein. The most serious medical problems observed were the high 30-39 214 13.3 7.7 .82 1.39 prevalence of infectious diseases, especially tuberculosis, the frequency 40-49 68 15.8 6.3 1.25 1.44 of corneal scars and the generally poor teeth. Many of the observed 50-59 9 19.5 9.8 1.73 1.06 defects suggested strong age and geographic patterns which promise to enlighten the search for causation. Nonetheless, these men appeared fit 1/ The periodontal score for each individual is the average for the and rugged and in better physical condition than one might expect to teeth present in the mouth. The criteria for scoring are given in find in a group of U.S. Caucasian recruits. Appendix A. 3. The Dental Study This comparison is useful, however, only for general orientation of the a. Methods findings. There were four independent and geographically distinct pat- terns of dental caries experience, as measured by mean numbers of decayed, All of the dental examinations were carried out by a single missing and filled permanent teeth per man. These patterns are sum- observer. The men were seated in a portable dental chair under a standard, marized in Table 14. color-corrected examination light. Dental mouth mirrors and explorers were employed. Observations were dictated in code to an experienced recorder, who entered the data for each man upon an individual examination card separate from that used for the rest of the clinical observations and originally designed in the National Institute of Dental Research for use Source: https://www.industrydocuments.ucsf.edu/docs/zznc0227 25-34 15-24 OF se TABLE 15 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 ORAL STATUS OF MEMBERS OF FIRST AND SECOND BATTALIONS : Mean DMF Teeth : Mean Periodontal Score : Mean Recession Score Number Mean Age Age : Age Village Examined Age : Adjusted Observed1 : Adjusted Observed: : Adjusted Observed 1/ Group I: principal centers of population Bethel 14 26.6 11.0 7.9 + 1.89 0.63 0.65 + 0.20 8 7 + 3.0 Barrow 69 26.0 13.1 13.6 + 0.90 1.11 0.89 + 0.15 18 14 + 2.5 Kotzebue 19 26.2 14.2 14.2 + 1.63 1.96 1.12 + 0.51 30 18 + 7.5 Dillingham 7 22.1 15.7 12.1 + 2.97 0.21 0.37 + 0.27 0 0 Unalaska 12 25.8 16.7 15.5 + 1.76 1.40 0.80 + 0.38 12 8 + 3.5 Nome 17 22.1 17.1 14.5 + 1.82 1.02 065 + 0.16 6 8 + 6.6 St. Paul 26 31.8 20.2 20.6 + 1.27 1.34 1.34 + 0.39 16 16 + 4.7 All Group I 164 26.5 14.9 14.5 + 0.60 1.22 0.90 + .11 17 12 + 1.7 White U. S. Males 26.5 13.0 .69 13 37 Group II: villages near the principal centers of population Noatak 22 29.0 11.3 11.8 + 1.85 0.68 0.69 + 0.20 10 11 + 3.1 Deering 3 29.5 12.7 13.0 + 4.93 0.84 1.47 + 1.27 15 15 +11.8 Tuluksak 8 33.1 12.8 11.1 + 2.36 1.59 1.59 + 0.46 18 18 + 7.6 Wainwright 17 28.8 13.3 13.2 + 2.01 1.49 1.57 + 0.50 27 28 + 7.9 Napaskiak 14 26.8 13.9 14.2 + 1.98 1.29 1.24 + 0.31 18 13 + 5.3 Akiak 6 30.7 14.5 15.0 + 4.24 1.36 1.26 + 0.62 17 15 +14.1 White Mountain 5 30.7 15.3 14.8 + 2.22 0.71 0.90 + 0.16 7 10 + 5.7 Shishmaref 8 31.6 15.4 13.8 + 3.41 0.44 0.59 + 0.41 12 12 + 4.0 Unalakleet 13 28.5 15.6 16.2 + 2.43 0.86 0.90 + 0.47 25 23 +11.7 Elim 2 29.5 17.0 17.0 + 1.00 0.75 0.75 + 0.65 8 8 + 3.0 Shaktoolik 2 33.5 21.5 21.5 + 1.50 0.41 1.15 + 1.15 21 29 +29.0 All Group II 100 29.4 13.6 13.7 + 0.81 1.04 1.08 + 0.14 17 17 + 2.5 White U. S. Males 29.4 13.1 0.74 15 TABLE 15 (Continued) ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 ORAL STATUS OF MEMBERS OF FIRST AND SECOND BATTALIONS Group III: relatively remote villages, except those in the Yukon-Kuskokwim - delta area Shungnak 16 29.1 2.1 1.8 + 0.59 0.37 0.34 + 0.12 3 4 + 2.1 Little Diomede 7 29.2 3.3 4.4 + 0.90 1.32 1.01 + 0.67 19 16 + 10.0 Kasigluk 7 26.9 5.4 5.4 + 1.15 0.56 0.77 + 0.22 5 4 + 1.9 Akiachak 16 30.7 5.5 5.1 + 0.83 1.38 1.60 + 0.21 14 16 + 6.1 Barter Island 5 31.7 5.6 5.6 + 2.34 0.45 0.46 + 0.29 9 9 + 5.3 Alakanuk 16 32.1 5.9 5.3 + 1.21 1.59 1.88 + 0.47 10 13 + 4.0 Teller 9 27.9 5.9 5.6 + 1.51 0.58 0.54 + 0.22 12 11 + 3.9 Koyuk 4 23.8 6.1 6.5 + 3.23 2.04 2.05 + 0.53 11 12 + 12.0 Kwethluk 17 31.3 6.2 5.1 + 1.40 1.37 1.57 + 0.37 12 14 + 4.3 Stebbins 12 33.4 6.2 6.7 + 1.81 1.35 1.68 + 0.36 26 34 + 8.7 Selawik 14 29.5 6.3 6.6 + 1.48 0.49 0.50 + 0.12 10 10 + 4.6 Meade River 4 25.5 6.6 6.8 + 3.04 0.52 0.55 + 0.42 5 5 + 4.8 Eek 14 28.7 6.8 6.9 + 1.78 0.92 0.89 + 0.20 8 7 + 2.6 Mountain Village 14 36.7 6.8 7.5 + 1.61 0.78 0.94 + 0.28 15 20 + 4.6 Wales 5 43.9 6.8 6.8 + 1.32 1.22 1.22 + 0.49 30 30 + 11.8 Kivalina 11 26.8 7.9 7.7 + 1.91 1.81 1.31 + 0.56 28 19 + 9.9 Gambell 22 27.6 8.4 9.2 + 1.46 1.30 0.96 + 0.30 19 16 + 4.2 Kiana 8 22.8 8.8 7.4 + 2.71 0.34 0.36 + 0.15 4 3 + 1.5 Noorvik 11 26.3 8.9 9.0 + 2.64 0.78 0.55 + 0.25 2 1 + 0.8 Fort Yukon 21 28.3 9.2 9.0 + 1.46 0.36 0.32 + 0.17 9 4 + 2.3 Savoonga 27 25.7 9.3 8.4 + 1.08 0.88 0.70 + 0.20 17 13 + 2.6 King Island 5 33.5 9.6 9.4 + 2.79 1.37 1.40 + 0.32 13 15 + 6.7 St. Michael 12 29.2 9.6 9.6 + 1.63 1.64 1.72 + 0.45 27 28 + 9.3 Point Hope 20 32.0 10.4 10.1 + 1.57 1.18 1.20 + 0.32 14 15 + 4.7 All Group III 297 29.6 7.1 7.1 +1 .35 1.00 1.00 + .07 13 13 + 1.1 White U. S. Males 29.6 13.1 .74 15 1/ Standard error of the mean is included in the observed values. TABLE 15 (Continued) ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 ORAL STATUS OF MEMBERS OF FIRST AND SECOND BATTALIONS : Mean DMF Teeth : Mean Periodontal Score : Mean Recession Score Number Mean : Age : Age : Age Village Examined Age : Adjusted Observed 1/ : Adjusted Observed 1/ : Adjusted Observed Group IV: villages in the Yukon-Kuskokwim delta area Newktok 5 28.5 0 0 0.93 0.82 +0.52 12 11 + 9.2 Chevak 6 29.3 0.4 0.2 + 0.16 0.96 1.02 +0.25 16 18 + 6.2 Tanunak 11 37.8 0.4 0.6 + 0.36 0.23 0.31 +0.16 9 13 + 3.2 Mekoryuk 15 37.4 0.6 0.9 + 0.38 0.03 0.02 +0.01 4 5 + 2.0 Chefornak 5 22.3 1.1 0.4 + 0.40 0.90 0.38 +0.31 16 6 + 6.0 Kwillingnak 20 30.9 1.8 1.5 + 0.42 1.06 1.06 +0.19 10 11 + 2.4 Kipnuk 13 30.8 2,1 2.0 + 0.60 0.65 0.71 +0.17 15 15 + 4.7 Hooper Bay 25 30.8 3.3 3.3 + 0.88 0.73 0.88 + 0.28 10 13 + 3,1 Tuntutulial: 11 30.1 3.4 3.2 + 0.98 1.39 1.32 +0.29 12 13 + 4.6 Quinhagak 22 33.0 3.7 3.4 + 0.76 0.97 0.95 +0.17 6 7 + 2.1 Napaskiak 7 27.4 4.1 4.1 + 2.09 0.76 0.76 +0.32 6 6 + 3.9 Togiak 10 30.8 4.3 4.1 + 1.46 1.54 1.65 +0.55 4 4 + 1.6 Scammon Bay 2 31.5 4.5 4.5 + 2.50 0.20 0.20 +0.20 12 12 + 5.0 All Group I.V 152 31.7 2.6 2.3 + 0.27 0.76 0.83 +0.08 9 10 + 1.0 White U. S. Males 31.7 13.2 .77 17 1 Standard error of the mean is included in the observed values. Source: https://www.industrydocuments.ucsf.edu/docsizznc0227 40 41 these two villages more nearly resemble men from group IV villages, and (2) Periodontal disease the villages are similarly isolated. Shungnak is located near the head- waters of the Kobuk River about 100 air miles east of Kotzebue, and For the whole world population periodontal disease probably Little Diomede is an island in Bering Strait near the boundary with outranks dental caries in importance. Commonly called "pyorrhea, this Soviet Russia. disease attacks the soft and hard tissues supporting the teeth in the dental arch so that they loosen, become painful and ineffective in Age-corrected scores are more appropriate for comparisons between chewing, and are eventually lost. In this study periodontal disease villages, and observed scores for comparison with findings for white was assessed by two measures the periodontal index or score which is U.S. males. a morbidity index of present and active disease, and gingival recession, a cumulative measure reflecting past loss of tissue, particularly bone. (1) Dental caries There was no relation, in the total population, between group findings for either of these measures and group findings for dental caries. There was, as a rule, remarkably little variation in dental caries experience between men of a given age and village. The means for In 38 of the 55 villages periodontal scores (i.e., ratings of decayed, missing, filled (DMF) teeth of Eskimo men living in the seven present disease) were higher than would be expected on comparison with principal villages were slightly but unimportantly higher than those for scores for white males in the U.S., and in only five villages -- Mekoryuk, white U.S. males, rising with age in similar fashion. Means for men Scammon Bay, Fort Yukon, Tanunak and Shungnak were scores signifi- living in villages near these seven principal centers a.re about the same, cantly or importantly lower. The typical clinical picture was one of but show a tendency for caries experience to be lower in men of older age. moderate to severe gingivitis with widespread pocket formation, abundant This tendency becomes marked in the two successive groups; in each group oral debris, and heavy deposits of calculus, although some villages stood DMF means are progressively lower in progressively older groups of men. out as marked exceptions to this rule. Here, as in dental caries, there Since the DMF mean is a cumulative measure, this can occur only in popu- tended to be little variation between men from a given village. lations where caries prevalence is on the increase, and the patterns seen here suggest that this increase is occurring at a relatively rapid rate. 11 The recession score is a relatively weak population measure when young persons are studied, since gingival recession is rarely marked in The dental caries pattern cuts across ethnic boundaries; location for individuals prior to the middle and later years of life. Recession location, there is little difference in DMF means between Aleuts from findings for the whole groups were neither markedly nor importantly Unalaska and the Pribilofs, southern Eskimos from the region generally different from the patterns reported (by an independent team of observers) south of Alakanuk, northern Eskimos from the region generally north of for U.S. Army troops. Findings for the whole of group IV were, in fact, St. Michael, and Athabascan Indians from Fort Yukon. There is a loose significantly lower. tendency (possibly an artifact due to sampling variation) for DMF means in group III to increase from south to north, but there is no clear In men 35 years of age or older, however, recession scores as out- transition across an ethnic boundary. Neither does the term "isolation, " lined in Table 16 for the main groups are generally related to group as used here, denote lack of contact with other groups; in the course of caries scores. The series of differences shown might occur by chance summer migration nearly all of the men in groups III and IV leave their slightly less than once in one hundred trials. homes and live for a time in or near one of the principal villages. At this point in analysis no clear relationship between caries patterns and dietary habits or nutritional status has been developed. TABLE 16 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 GINGIVAL RECESSION SCORES, MEN 35 YEARS OF AGE OR OLDER, 1 The means for group DMF typically rise in essentially straight-line FIRST AND SECOND BATTALIONS fashion with age after permanent teeth begin to erupt at the age of six, gradually becoming asymptotic after the mean reaches a value Number Mean Mean of 15 to 18. Extrapolation of the present data suggest that after Group Examined Age Recession Score a generation, caries may become as prevalent in the group III vil- lages as in villages in or near the principal centers of population, I 15 41.9 39 + 1.7 and that caries in the group IV villages may rise to about the levels II 17 40.4 now seen in group III. If this occurs the disease will then present 31 + 6.9 a public health problem for these people quite as difficult as the III 68 41.2 28 + 3.3 present dental caries problem in the U.S. IV 57 40.5 17 + 2.0 White U.S. males 41.0 26 Source: tps://www.industrydocuments.ucst.edu/docs/zznc0227 42 43 IV - THE VILLAGE STUDIES Twice each year, in spring and fall, ships bring in supplies. Supplies for the year must be anticipated at this time, since the only 1. Bethel Area - the Situation in Akiak, Kasigluk, Napaskiak, Newktok recourse is to costly shipment by air from Anchorage. Mail order houses and Hooper Bay have an active year-round business in this area. An adult education class in one village had as two of its projects the following 1) how Bethel is the principal trading center of a large area of south- to write an order to a mail order house; 2) how to fill out a U.S. income western Alaska which includes most of the lower Yukon and Kuskokwim River tax return. areas. The town is on the Kuskokwim River at the head of deep water navigation. It is the air terminal for the only outside contact of the In Eskimo villages the dogs are an essential part of the economy, area during eight months of the year. The population is mixed white and for they are the only beasts of burden. Wood, one of the few sources Eskimo people. An electric service, high school and many other small- of fuel, must be hauled long distances from the river bottoms. People town facilities are available. travel and supplies are hauled by dog sled. Some freighting for cash income is done with dogs. The average size of a team is five dogs. In winter the main occupation of many Eskimos in this area is Fish are fed to them at variable times and in limited amounts so the trapping for mink, beaver and muskrat. In summer many find temporary dogs are generally thin and ravenous. They eat snow for water, snatching work in canneries on Bristol Bay. In some cases almost the entire able- it as they run. The Kuskokwim dogs are small, averaging 30 to 50 pounds, bodied population is transported to these canneries for a period of six and are nondescript in appearance. The dog population is threatened with weeks or more. Those who remain behind in the villages catch herring, canine distemper because of inadequate immunization. smelt, pike, whitefish and salmon for their own use. The larger fish are filleted and air-dried for the winter cache, to be consumed by both The population counts for the villages included in the Bethel por- dogs and humans. The tundra is dotted with small ponds and sloughs tion of the study and the numbers given clinical examinations in this which are a source of whitefish, ling cod, blackfish and needlefish. survey are shown in Table 2. The sampling within the villages was done Often these fish are eaten raw, and are thus a source of tapeworm with the help of the resident teacher; who selected one or two adolescent infestation. boys as runners. They were instructed to bring into the schoolroom entire families, including all ages. The selection of families and their Hooper Bay and Newktok are sealing communities of coastal Eskimos. order of appearance was not controlled. Clinical appraisals were done on Since the seal kill is variable and uncertain depending upon the movement all persons 2 years old and over. Blood and urine samples were obtained of the pack ice and tolerable sealing weather, this food supply is un- from all persons 6 years of age and over, until 50 blood samples had been certain. The coastal Eskimos collect seal pokes, inverted seal skins obtained in each village. At the end of the day the villagers were filled with seal oil, which they take up the Kuskokwim for sale and advised to bring forward the people who were sick or those with medical barter to the river communities. The subcutaneous fat of newly complaints who had not previously been seen. These persons were not butchered seal is cut into small portions about one by three inches in included in the nutritional appraisal The invitation invariably pro- size and pressed into the inverted seal skin (which has had all the duced an assorted clinic. No assessment was made of the number who apertures, except the anus, tied off with string). After the poke is stayed away from the nutritional appraisals deliberately. In Hooper filled with these small pieces of blubber, it is plugged and left inside Bay most of the men were away sealing. In Kasigluk many men had gone the Eskimo house at moderately high room temperatures and the oil is for wood. thus gradually rendered. When the contents of the poke have been re- moved, a sponge-like connective tissue residue representing the original The presence of a school and one or more teachers has had an stroma in which the oil was contained is left within the poke. This is important influence upon the Eskimo communities. While introduction of considered a food delicacy. No applied heat is used in the rendering a school has generally caused the villages to increase in size and thus process. The tendency of the seal poke to collapse as oil is withdrawn often overburdened the available food supply it has also stimulated the for use maintains a minimum of air within and probably delays rancidity. acculturization of the community. Community leaders who have whi te On some occasions other foods, such as partially dried salmon or herring, customs, clothing, food and ideas have no doubt been important models are placed in seal oil in the poke and stored for considerable periods. for emulation. The school lunch programs, the mail which comes once or Salmonberries, blueberries and wild greens may be stored in a seal poke twice a week, the radio communication with the Alaska Native Health or in barrels without the oil. Service Hospital each evening and the formal instruction in English with material and methods very like those of schools in the rest of the United A seal poke weighing 100 pounds may bring $140 and will last a States all increasingly influence the life and health of the Eskimo family a year. Seal oil is used as a major ingredient of such dishes people. There is a large age gradient in the use of English in the as agutuk (Eskimo ice cream) or oknuk (soup). Other foods, especially Bethel area; almost all school children speak English, but only rarely dried fish, may be dipped into it at serving time. Hunters are con- do adults over 40 years of age. vinced that it is more calorific than other foods and it is thought essential for a trip in intense cold. Source: s://www.industrydocuments.ucsf.edu/docsizznc0227 45 44 Bureau of Indian Affairs School Program for about eight years. Vi tami There are no physicians permanently located in the villages although These administration is more recent. No active keratitis was seen in this there are three physicians associated with the hospital in Bethel. indi- village but there were many children with the corneal scars which are physicians, a dentist and an x-ray technician visit the villages attributed to phlyctenular keratoconjunctivitis (PKC). The lesion was vidually at irregular intervals of several months. The x-ray technician films especially common in children over 7 years of age. Dry skin on the carries a portable x-ray machine which is largely used for chest extensor surfaces and mild follicular hyperkeratosis were seen occasionally in a tuberculosis control program. Public health nurses also visit the in children 8 to 16 years of age. The condition of the teeth varied villages at irregular intervals. A sanitary engineer of the Alaskan the markedly. Caries were rampant in many families, involving both deciduous Department of Health is presently working in certain villages of and permanent teeth. People past 30 tended to have worn but intact and Bethel area in order to improve the water supply. noncarious teeth (see Figure VII). In most villages the teacher is the medical representative who mans A man in his 40's was seen with incipient cardiac failure and a the two-way radio contact. The costs of transportation to Bethel, loud aortic diastolic murmur, probably a result of rheumatic heart Anchorage, or even to other states for medical treatment are borne by disease. A middle-aged woman with typical active rheumatoid arthritis patient, if that is possible; by the ANHS, if it is not. Since the was examined. distances the are great such trips are expensive. Midwifery is done by women in the villages except for those areas near the Bethel hospital The 77 clinical appraisals done in Akiak indicated the calorie where some women may prefer to go for delivery when possible. About supply was adequate, and that there had been a large incidence of 225 babies are delivered annually to native women in the Bethel hospital. phlyctenular keratoconjunctivitis in the past, although no acute cases were seen. Follicular changes suggested a mild or borderline vitamin A The largest single health problem in the villages is tuberculosis. deficiency. Both the caries and the corneal scarring seen in this About 7 to 10 percent of the Eskimo population is being treated with village suggested a familial pattern of prevalence. drug therapy for this disease. In Akiak, for example, 13 of 130 people in records indicate that 38 other villagers have received this therapy the village were receiving chemotherapy in August 1958 and the Kasigluk is a village of 227 Eskimos about 35 miles west of Bethel on the tundra, a few miles from the Johnson River. The latter is an lation and about one tenth of one percent of the population dies of since 1954. The annual incidence is now about one percent of the popu- abundant source of fish in the summer. Nunapitchuk, a somewhat larger village, is four miles away across a small lake. Kasigluk has been tuberculosis each year. The first figure has been reduced by one half, moved in recent times from a location six miles north to be better ac- the second by four fifths since 1952(8). The trends are shown in cessible by boat. The village has a typical onion-turreted Russian Church and a smaller Moravian Church. There are many Russian names in Figure II. the village and people with Mongoloid faces and light hazel eyes. The Akiak is a community of 130 people on the Kuskokwim River about in people seemed poor but were generally clean. The men showed signs of 30 miles upstream from Bethel. Most of the people were dressed recent use of their steam baths, a custom which is thought by some to excellent furs and mukluks, and there was evidence of a plentiful food be a Russian importation but is more likely an intrinsic part of the Eskimo culture. supply. There were no signs of caloric deficiency. Some obese women past These people at Kasigluk must go long distances to the Kuskokwim 30 years of age were seen. There were many children with draining ears flats for wood. The dogs were lean but strong; a team of five brought and impetigo was common, especially in children. One child with ex- in a load of green poles weighing 300 to 400 pounds. The village has tensive bronchitis and fever was given sulfa drug therapy. a poor water supply, consisting only of melted ice from nearby ponds. An epidemic of dysentery had occurred in this village during the two Each school child receives a hot lunch and a therapeutic multivitamin weeks prior to the survey team visit. The school children receive tablet every dayl/. The lunch program has been in effect in the lunches and a multivitamir tablet each school day. New mothers also receive vitamin solutions for the babies and iron pills for themselves, but the teacher was uncertain that these materials are used. The Contents of Multivitamin Tablet: calóric intake of the people seemed adequate. 1 Vitamin A - 5,000 U.S.P. units Ascorbic acid - 50 mg. Vitamin D - 500 U.S.P. units Vitamin E - 5 I.U. Impetigo was common, and several children were put on courses of Thiamine mononitrate - 3 mg. Calcium carbonate - 250 mg. penicillin for treatment. The dispensation of sulfonamide ointment Ferrous sulfate - 234 mg. Riboflavin - 3 mg. which is usually applied over the crusts is useless and possibly harmful. Pyridoxine hydrochloride - 0.5 mg. Potassium iodide - 0.15 mg. Two instances of atopic eczema were seen in children. Corneal scars Potassium sulfate - 5 mg. were not common and were generally seen in subjects 10 years of age and Vitamin B12 - 2 mcg. Copper sulfate - 1 mg. over but not in younger children, and no active phlyctenular Folic acid - 100 mcg. Niacinamide - 25 mg. Magnesium oxide - 6 mg. Calcium pantothenate - 5 mg. Zinc sulfate - 1.5 mg. Source: 47 keratoconjunctivitis was seen. The teeth were generally carious in the FIGURE VIII children, and worn but intact in people past 30. Some skin dryness was noted in children but no follicular hyperkeratosis was seen. One woman of 40 with aortic insufficiency and mitral stenosis was examined. A recent history of migratory arthritis was elicited in one youth. He showed no signs of carditis. Prophylactic penicillin was recommended. Napaskiak is a village of 152 persons on the south bank of the Kuskokwim River eight miles below Bethel. It has close contact with Bethel. Two other Eskimo villages are in the vicinity -- Oscarville, across the river, and Napakiak, down river. River fishing is the attraction. Napaskiak has been moved in recent-times from a nearby and ancient site that had become susceptible to flooding due to channel changes of the river. Napaskiak has one of the few remaining "medicine men" or shaman (Frontispiece). The role of this man in the communi ty' health could not be determined. There were great extremes in the families here, some being thin, while others were well fed. The thin families were usually dirty. The teacher gives 60 children their lunch at 8:30 a.m. Half then go home and return for an afternoon teaching session. The others remain for the morning session. All students receive a multivitamin tablet in school each day. This village has been included in a tuberculosis prophylaxis pro- gram since early 1958. A program for control of tuberculosis by ambulatory chemotherapy was begun in 1953 as a result of a recommendation of the Pittsburgh Health Survey(7) to the Secretary of the Interior. At the time of its inception the program was ambulatory because there DENTAL ATTRITION IN A 32-YEAR-OLD - were not enough hospital beds for all those needing the therapy. When ESKIMO WOMAN more beds were available more of those who needed hospital treatment were admitted. The prophylactic control study mentioned at the begin- ning of this paragraph was started in 1958 as a separate project under the direction of Dr. George Comstock, Tuberculosis Control Program, Bureau of State Services of the U.S. Public Health Service. This is a research study on the prophylactic use of isoniazid being conducted in selected parts of the U.S., Alaska and Puerto Rico. Every person in the villages selected for the study is given medication each day for one year, half receiving isoniazid at a level of about 5 mg per kilogram of body weight and half receiving a placebo. All told about 0,000 people are participating in this study. It is hoped to measure the suppressive action of such medication upon the incidence of tuberculosis. No signs of isoniazid-induced seborrhea or dermatitis were seen in this or any village, although perhaps as many as 10 percent of the total native population are on isoniazid therapy. The teeth were carious in Napaskiak except among people over 40 years of age. Exceptions to this were seen in a few Kipnuk women who had come here from the coast after marriage and generally had fine teeth. Again several cases of atopic eczema were seen. The teacher believes it is increasing in frequency. The males showed signs of the effects of taking steam baths (petechiae on the backs and shoulders), Source: ittps://www.industrydocuments.ucsf.edu/docs/zznc022 48 49 but the women and children did not. Petechiae occurred commonly among The school lunch program and daily vitamin pill are administered older male children and adults but was uncommon in children under 10. here. Because of exceptionally good sealing, the people appeared pros- No active keratitis was seen. Corneal scarring seemed to occur in perous and adequately nourished. There were many plump women and families; dry skin and follicular changes were uncommon. The adult children. Teeth were good but worn in people past 20 years of age and women often seemed pale. Tongue papillation was good. An old man with carious in many children. There were many corneal scars, again seen in aortic stenosis was examined but heart murmurs were generally rare. families and generally in people 12 to 20 years old. Children under A sick baby was brought back with the party to the Bethel Hospital and 12 were not often so affected. Many of the women were pregnant. Some a diagnosis of meningococcal meningitis was confirmed. After a stormy evidence of hypochondriasis was noted in adults. There was a single course she recovered. Prophylactic sulfadiazine seemed to prevent instance of goiter, a large soft gland in a 40 year old woman who had additional cases in the village. This treatment was arranged by radio a history of thyrotoxicosis treated with N-propylthiouracil. Scleral communication from Bethel after the bacteriologic diagnosis was thickening in the palpebral fissures and pingueculae were noted in many established. individuals. Here as in the other villages it was apparent that dental fillings meant tuberculosis because almost the only people who had had Newktok is an isolated village of 121 coastal Eskimos about 120 dental care were those who had gone outside for tuberculosis therapy miles west of Bethel on the tundra, a few miles from Baird Inlet and the Bering Sea. The nearest postoffice is at Tanunak, 40 miles to the 2. Kotzebue Area - the Situation in Noatak, Point Hope, Shishmaref, southwest on Nelson Island. There were many sod houses in the village. Allakaket and Huslia The people at Newktok seemed very primitive; their faces were The Kotzebue phase of the present study centered among the northern Mongoloid with prominent epicanthal folds. Very few could speak English. or Arctic Eskimos who are for present purposes considered to be in Their clothing was worn and poor. Both people and dogs were thin. The ethnic area III (see Figure III). The Kotzebue study also included sleds were hand-hewn and lashed together with thongs. In one sod house observations in two Indian villages in the mountains of the middle Yukon the children were seen to scoop a frozen blackfish out of a tub in the region lying in area IV. anteroom and swallow it with a minimum of chewing. The lids were off the cans containing flour and sugar, and the contents were spread about The Eskimos north of Norton Sound (Nome) are much more sparsely the table top as though the children had been eating directly from the distributed. The principal activity of the males is hunting, and seal, cans. Since this was the first tolerable weather for a week, the men walrus and several species of whale are the chief game. The Eskimos were away sealing. along the Arctic coast find the whale kill highly variable since it depends strictly upon weather and hunting conditions. Polar bear have Many of the children in this village were grossly underfed, and always been important not only as a source of food for man and dogs, but pale and thin. Several families were heavily infested vith head lice. also as a source of income from sale of skins. St. Lawrence Island has With a few exceptions, the teeth were excellent. There were several an abundant supply of walrus in the spring, a good source of both meat slightly but definitely enlarged thyroid glands observed but no gross and ivory. The people of St. Lawrence Island, Diomede Island and King goiters. Many children had marked follicular hyperkeratosis and many Island are well known for their fine ivory carving which provides them others had dry skin. There were several adults with Bitot's spots. with an important part of their cash income. The materials they make No signs of water-soluble vitamin deficiency or of scurvy were seen. are taken to Nome in the summer and marketed. Hooper Bay is an ancient Eskimo settlement on the Bering Sea south The Arctic fox is trapped on the ice pack for its fur but neither of Cape Romanzof, with a population of 430. It is located on two low this nor any other land carnivore is used for food except in dire hills at the tip of a spit of land which encloses Hooper Bay from the emergency. The polar bear is a partial exception, for its meat is often north. The main source of livelihood is the sea, especially sealing. eaten, although the liver seems never to be eaten and is widely regarded There are many dog teams for hauling the skin boats and meat to and from as poisonous. There is a collection of recent evidence to support the the open water a few miles away. Water is obtained by melting ice from idea that polar bear liver is, in fact, poisonous for human consumption. a fresh-water pond a few miles back of the village on the tundra. Fuel Dr. William Rausch of the Arctic Health Research Center on one occasion is obtained from driftwood which is now plentiful, coming largely from ate 100 grams of polar bear liver and immediately became ill. Dr. the mouth of the Yukon which lies to the north. The houses are well Edward Scott of the same institution fed polar bear liver to white mice built but without a semblance of orderly arrangement either among houses and an equivalent amount of vitamin A from fish oil to a control group or within them. The indoor temperatures and humidity are very high. of mice. Both groups of mice died (19). The concept of the toxicity of These, together with many unwashed Eskimos, unbutchered seals, drying polar bear liver and that it is due to an excessive vitamin A content skins and oozing seal oil pokes, produce an overpowering atmosphere for is widely accepted in scientific circles in Alaska. a white person. Source: https://www.industrydocuments.ucsi.edu/docsizznc022 50 51 The Indian villages, Huslia and Allakaket, which were included in before he goes out on the ice pack for the day, or takes no more than a the present study, are settlements on the Koyukuk River. These people cup of tea or coffee. He believes eating would make him sluggish, less are Athabascan Indians who range through the forested and mountainous agile and less acute. Since he may stay out one to three days under areas of northwestern Alaska. Their principal activity is trapping rigorous conditions of activity and temperature, it is clear that he has beaver, mink and muskrat. The beavers are taken through holes in the both great stamina and efficient gluconeogenesis. When he returns he ice in the late winter and spring with snares which are baited with takes a very large meal. This ability to carry on while fasting may be willow twigs. Each trapper is allowed a seasonal limit of 20 beavers which average $40 per pelt. The beaver is a large animal weighing 30 related physiologically to the ability to consume a very high fat, high protein, low carbohydrate diet. It may also be a factor in prohibiting to 60 pounds, and is widely used for food. The meat is said to resemble youths (who might be more susceptible to ketosis) from going out on the pork. The skins are stretched flat in an almost perfect circle for ice pack. drying and are hauled about in large wafer-like stacks wrapped in burlap. The sampling procedures in the Kotzebue area were carried out as Caribou are migratory animals taken seasonally and somewhat unpre- described for the Bethel study above. Clinical studies were done on dictably. Their meat is dried in the sun for storage in caches and the all persons 2 years of age and over; blood and urine samples were ob- skins are widely used for clothing. tained from all persons 6 years and over, the urine samples being clean catch samples. In the Kotzebue area those members of the National Guard Fish are taken from the rivers with nets or fish wheels, a white who were home were excluded from the village examinations in order for man's invention and a useful one, for -- powered by the current -- it them to be seen at Camp Denali with their battalion. scoops up the teeming fish and deposits them in a tub requiring the fisherman only to empty the tub once he has properly placed the wheel Noatak is a village of 300 Eskimos on the Noatak River 60 niles and the diversionary fence. north of Kotzebue. The food supply at Noatak is largely caribou which are hunted inland on the tundra, fish from the Noatak River, and seal The northern Eskimos have been more exposed to the white man than and beluga whale from Kotzebue Sound. The teacher at Noatak gives each have the southern Eskimos through efforts of 18th century sailors to school child a lunch and a vitamin pill every school day. The principal find a Northwest Passage, and subsequently through the extensive whaling clinical impairments found here were carious teeth and follicular activities which took place in the Arctic Ocean. Contacts with sailing hyperkeratosis. ships reached a maximum in the middle of the 19th century. Possibly as a consequence, the northern Eskimos are advanced at least a generation Point Hope, which the natives call Tigara, often experiences severe over the Kuskokwim people in their cultural adaptation to the white race. Almost all speak English; they tend more strongly to adopt white men's weather. It is the main polar bear-hunting area for sportsmen, an clothing and habits of food and often have noticeable admixtures of white activity which is a source of income for the Eskimos. A typical polar blood as reflected in coloration and conformation. The northern Eskimos bear hunt has facetiously been described as follows: The sportsman are larger and less Asiatic-appearing than the southern Eskimos, although pays $2, ,500 and is guaranteed a bear. The hunter and his pilot go out there are many exceptions to this generalization. Some of the village over the ice pack in a light plane until they spot a bear which they sites, such as that at Shishmaref Inlet, are very old, dating back 500 pursue in the plane until it falls exhausted on the ice. They then years or more. The attraction of these sites can only have been their land, shoot the bear and take the skin. The sport seems more expensive than dangerous. convenience to the essential food supply. Eskimo villages are sometimes moved, but generally only to a better food supply. The main articles in the diet at Point Hope are seal and whale meat with some bear meat and fish. Caribou are taken in the fall and Hunting on the ice pack is a dangerous occupation and the extent of this danger varies in different areas depending upon currents and weather winter. The whale meat collected in the spring is cut up and stored conditions. In the Hooper Bay area young men do not go on the hunting in pits in the permafrost for later use. This natural refrigeration expeditions until they are about 18 years of age. North of Bering Strait and not the perpetual cold, for the summers are actually quite warm they. go at 15 years. Since these boys are physically well developed at is the basis for the legendary test of salesmanship in Alaska. A few Eskimos do have refrigerators, especially the traders. Many Eskimos 15 years it appears that a maturation of judgment is recognized as es- sential. The active hunters are men 20 through 45 years, older hunters have outboard motors. Almost every Eskimo boy dreams of becoming an airplane pilot. The men are clever mechanics and are said to have being rare. fashioned broken motor parts from ivory or bone when metal replacements were unavailable. These Eskimo men stripped down resemble professional athletes. They are heavily muscled, relaxed and loose-jointed, and have the ap- pearance of finely trained men. Unlike the white man's concept of Sod houses are common in Point Hope. Alaskan Eskimos never build snow igloos except to amuse visitors from the outside and the results preparation for a physical ordeal, the Eskimo either does not eat are often ludicrous. Whale ribs are often used for rafters for sod houses. No village planning is discernible. Snow drifts range up to 25 feet after a storm and the children slide down these on short baleen skis. Source: https://www.industrydocuments.ucst.edu/docsizznc0227 52 The children receive a school lunch and a daily multivitamin tablet. Clinical examinations here revealed many carious teeth and much follicular hyperkeratosis. Shishmaref is a village of 200 people on a small island just off Shishmaref Inlet. The principal food is seal, which was plentiful during the winter preceding the survey, since the pack ice had been pushed toward the Siberian side by favorable winds. Some fish are also available. Many carious teeth were seen here and there was much dental attrition. Follicular hyperkeratosis was common. A school lunch and multivitamin pill are given to the children. Allakaket is an Indian village of 100 people 150 miles north of Tanana. It consists of 10 to 15 log cabins, a school and an Episcopal Church. The main occupations and food sources are moose hunting, fishing and beaver snaring with a wire loop snare. The trap lines are 50 to 150 miles in length. The calorie supply seemed limited in this village. The teeth were carious and follicular hyperkeratosis was common. Some filiform atrophy of the tongue was also noted, although it was of mild degree. No evidence of goiter was seen. One 18 month old child with rickets was seen here. Huslia is an Indian village of 137 people. The diet consists mainly of beaver, dried fish, moose and caribou. Moose meat is much like beef in form and flavor while caribou is distinctive, resembling mutton. The calorie intake at Huslia seemed marginal, since many people were thin and the children appeared stunted. Follicular hyper- keratosis was common. The teeth were carious. This is the home of the most f'amous sled dog racer in Alaska, George Atla, known as the "Huslia Hustler. The schools in these two Indian villages do not give the children school lunches or vitamin supplements. 3. Clinical Findings in the Villages Since the men in the National Guard had recently come from the villages they were also representative of those nutritional environments. However, the 713 men came from 55 villages. The number from each vil- lage was thus so small that no useful purpose was served by relating them to their village of origin. An exception is Point Barrow, from which there were 69 men in the Guard. Throughout the evaluation of the data this axis of analysis has been considered, however (see Table 10, which presents selected clinical findings for men in the two battalions according to their area of origin). A summary of the clinical findings in the villages is shown in Table 17. The northern and southern areas are shown separately, but all ages and both sexes are combined. This summary emphasizes certain negative findings. There was no scurvy and no gross inanition, although in certain villages, especially Newktok, the people seemed by their thinness to be Source: https:/lwww.industrydocuments.ucsi.edu/docsizznc0227 TABLE 17 ESKIMO AND INDIAN VILLAGES IN ALASKA, 1958, PERCENT PREVALENCE OF CLINICAL FINDINGS Bethel Area - Examiner # 1 Kotzebue Area - Examiner # 2 Villages / 1 2 3 4 5 Total 6 7 8 9 10 Total Number Examined 76 94 81 59 96 406 69 88 77 75 90 399 Suspected Tuberculosis Disease 30.3 10.6 7.4 8.5 12.5 13.8 5.8 10.2 6.5 6.7 2.2 6.3 General Good 82.9 87.2 79.0 66.1 82.3 80.5 98.6 100.0 98.7 98.7 100.0 99.2 Appearance Fair 17.1 9.6 14.8 25.4 16.7 16.0 1.4 0.0 1.3 1.3 0.0 0.8 Poor 0.0 3.2 6.2 8.5 1.0 3.4 0.0 0.0 0.0 0.0 0.0 0.0 Hair Staring hair 0.0 0.0 0.0 18.6 0.0 2.7 0.0 0.0 0.0 0.0 0.0 0.0 Glands Thyroid 3.9 0.0 2.5 10.2 4.2 3.7 1.4 0.0 0.0 0.0 0.0 0.3 Enlarged Submaxillary 0.0 1.1 0.0 0.0 0.0 0.2 5.8 6.8 3.9 1.3 2.2 4.0 Nasolabial seborrhea 0.0 0.0 0.0 0.0 0.0 0.0 5.8 2.3 2.6 0.0 1.1 2.3 54 Skin- Other seborrhea 0.0 0.0 1.2 0.0 0.0 0.2 1.4 0.0 1.3 0.0 0.0 0.5 Face & Neck Erythema 14.5 25.5 7.4 61.0 17.7 23.2 11.6 21.6 33.8 5.3 3.3 15.0 Pigmentation 0.0 2.1 2.5 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 Thickened conjunctivae 7.9 6.4 16.0 13.6 15.6 11.8 7.2 5.7 10.4 8.0 11.1 8.5 Pingueculae 31.6 31.9 22.2 27.1 28.1 28.3 34.8 27.3 28.6 29.3 14.4 26.3 Bitot's spots 0.0 0.0 0.0 3.4 0.0 0.5 0.0 0.0 0.0 0.0 0.0 0.0 Eyes Circumcorneal injection 0.0 0.0 0.0 0.0 1.0 0.2 0.0 1.1 0.0 0.0 0.0 0.3 Conjunctival injection 3.9 0.0 2.5 5.1 1.0 2.2 0.0 5.7 0.0 0.0 0.0 1.3 Blepharitis 0.0 0.0 0.0 8.5 0.0 1.2 0.0 2.3 0.0 0.0 0.0 0.5 Corneal scarring 21.1 12.8 11.1 20.3 9.4 14.3 8.7 5.7 5.2 4.0 7.8 6.3 Angular lesions 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Lips Angular scars 0.0 0.0 0.0 1.7 0.0 0.2 2.9 0.0 0.0 0.0 0.0 0.5 Cheilosis 0.0 0.0 1.2 0.0 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 TABLE 17 (continued) Filiform atrophy, sl. 9.2 6.4 9.9 13.6 6.2 8.6 7.2 4.5 2.6 12.0 5.6 6.3 Filiform atrophy, mod. 3.9 0.0 2.5 1.7 0.0 1.5 0.0 0.0 0.0 2.7 0.0 0.5 Fungiform atrophy 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Papillary hypertrophy 0.0 0.0 0.0 0.0 1.0 0.2 1.4 2.3 1.3 0.0 1.1 1.3 Furrows 1.3 7.4 9.9 3.4 3.1 5.2 4.3 2.3 2.6 2.7 1.1 2.5 Tongue Fissures, erosions, ulcers 1.3 1.1 1.2 0.0 0.0 0.7 0.0 0.0 0.0 0.0 0.0 0.0 Serrations or swellings 0.0 6.4 3.7 0.0 0.0 2.2 0.0 0.0 0.0 1.3 3.3 1.0 Red, tip, or lat. margins 3.9 4.3 4.9 0.0 0.0 2.7 0.0 0.0 0.0 0.0 0.0 0.0 Geographic tongue 1.3 0.0 1.2 0.0 3.1 1.2 2.9 0.0 3.9 0.0 0.0 1.3 Red or swollen 1.3 3.2 9.9 8.5 7.3 5.9 17.4 2.3 7.8 13.3 18.9 11.8 Gums Atrophy or recession 9.2 8.5 16.0 1.7 5.2 8.4 23.2 19.3 27.3 17.3 18.9 21.1 Bleeding gums 0.0 0.0 0.0 0.0 0.0 0.0 1.4 0.0 0.0 0.0 4.4 1.3 Unfilled caries 30.3 60.6 48.1 23.7 31.2 40.1 31.9 40.9 58.4 34.7 47.8 43.1 Filled caries 17.1 9.6 13.6 0.0 12.5 11.1 46.4 23.9 11.7 9.3 13.3 20.3 No carious teeth -5550.031.944.476.357.350.223.237.529.957.3 41.1 38.1 Tee th Caries, filled or 1-2 13.2 7.4 6.2 3.4 7.3 7.6 24.6 18.2 28.6 21.3 22.2 22.8 unfilled 3-4 18.4 36.2 24.7 11.9 24.0 24.1 23.2 23.9 20.8 14.7 22.2 21.1 SS 5+ 11.8 23.4 23.5 8.5 11.5 16.3 24.6 18.2 18.2 6.7 14.4 16.3 Edentulous 6.6 1.1 1.2 0.0 0.0 1.7 4.3 2.3 2.6 0.0 0.0 1.8 Worn 30.3 33.0 35.8 23.7 29.2 30.8 14.5 12.5 27.3 12.0 6.7 14.3 0.0 0.0 Fluorosis 0.0 0.0 0.0 0.0 1.0 0.2 0.0 0.0 0.0 0.0 Malposition 2.6 1.1 12.3 6.8 12.5 7.1 0.0 0.0 1.3 0.0 0.0 0.3 Follicular hyperkeratosis 3.9 1.1 1.2 10.2 0.0 2.7 40.6 34.1 20.8 20.0 45.6 32.6 10.4 0.0 0.0 0.0 0.0 0.0 0.0 Xerosis 19.7 21.3 11.1 22.0 16.5 Skin- Acneform eruption 0.0 1.1 1.2 0.0 2.1 1.0 0.0 0.0 1.3 0.0 1.1 0.5 Thickened press. points 1.3 2.1 0.0 0.0 0.0 0.7 0.0 0.0 1.3 0.0 0.0 0.3 General 0.0 0.0 1.0 0.5 0.0 0.0 0.0 0.0 0.0 0.0 Purpura or petechia 0.0 1.1 Hyperpigmentation 2.6 0.0 0.0 0.0 3.1 1.2 0.0 1.1 0.0 0.0 0.0 0.3 Abdomen Hepatomegalia 0.0 0.0 2.5 5.1 0.0 1.2 Examination of abdomen and Lower extremities omitted. Lower Extremities Loss of ankle jerk 1.3 0.0 1.2 1.7 0.0 0.7 1 No findings of enlarged parotids, xerophthalmia, magenta tongue, "scorbutic-type' gums, crackled skin, pellagrous 2) Villages referred to by number: Southern Eskimos: 1. Akiak 2. Kasigluk 3. Napaskiak 4. Newktok 5. Hooper Bay lesions, splenomegalia, ascites, or calf tenderness. Scrotal dermatitis not examined for Northern Eskimos: 6. Noatak 7. Point Hope 8. Shishmaref Athabascan Indians: 9. Huslia 10. Allakaket Source. Ittps://www.industrydocuments.ucsf.edu/docs/zznc022

what is the association's awards subject to?

tlnf0227

tlnf0227_p13, tlnf0227_p14, tlnf0227_p15, tlnf0227_p16, tlnf0227_p17, tlnf0227_p18, tlnf0227_p19, tlnf0227_p20, tlnf0227_p21, tlnf0227_p22, tlnf0227_p23, tlnf0227_p24, tlnf0227_p25, tlnf0227_p26, tlnf0227_p27, tlnf0227_p28, tlnf0227_p29, tlnf0227_p30, tlnf0227_p31, tlnf0227_p32

annual renewal at the option of the Association, subject to annual renewal at the option of the Association, annual renewal at the option of the association

NOTES TO COMBINED FINANCIAL STATEMENTS American Heart Association, Inc. (National Center) (A) SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (B) TAX STATUS: Standards of Accounting and Reporting The Association is exempt from income taxes under Section STATEMENT OF SUPPORT, REVENUE AND EXPENSES AND CHANGES IN FUND BALANCES The Association follows the standards of accounting and 501(c)(3) of the U.S. Internal Revenue Code, has been determined to be an organization which is not a private YEAR ENDED JUNE 30, 1975 WITH COMPARATIVE TOTALS FOR 1974 financial reporting for voluntary health and welfare agencies prescribed by the National Health Council, the National foundation; and is qualified for the 50% charitable contributions Assembly of National Voluntary Health and Social Welfare deduction. Current Funds Building and Total All Funds Organization and United Way of America. These standards are inconformity with the recommendations of the American (C) NATIONAL CENTER CONSTRUCTION AND ELOCATION: Equipment Endowment Institute of Certified Public Accountants which became Inprior years, the Board of Directors authorized the construction Unrestricted Restricted Fund Fund 1975 1974 effective in fiscal 1975. In accordance with these standards, ofa National Center office building in Dallas, Texas, and expenditures for buildings and equipment and the fair value of designated funds for construction and relocation, PUBLIC SUPPORT AND REVENUE: donated equipment are capitalized Depreciation is recorded The National Center initiated the move to Dallas during the year Public support- over the estimated useful lives of the assets. Investments are ended June 30. 1975 and all estimated relocation costs have stated at cost. All contributions are considered available for the been accrued and charged to expense National Center share of campaign general programs of the Association, unless specifically The National Center obtained a $3,000,000 line of credit and a contributions and bequests (Notel) $14,215,881 $262,609 $ $ $14,478,490 $14,202,372 restricted by the donor. Interfund receivables and payables. commitment for an additional $1,000,000 line, with interest at the Contributions to building fund - - 22.948 - 22,948 35.731 arising from transactions which are to be completed after year- floating prime rate (7% at June 30. 1975). from a Dallas bank to end, have been eliminated finance construction and relocation costs. As of June 30. 1975. Contributed by affiliated organizations The amounts shown for 1974 in the accompanying financial the National Center was committed for approximately (net of their fund raising costs estimated statements are presented in accordance with the $1.600.000 of additional construction costs. at $40,046 in 1975 and $27,134 in 1974) - 294.458 - - 294,458 195.209 recommen dations of the American Institute of Certified Public Accountants. This financial information is included to provide a (D) LEGACIES IN PROCESS Total support from public 14,215,881 557.067 22.948 - 14,795,896 14.433.312 basis for comparison with 1975. and, other than for the balance The Association is the beneficiary under various wills and trust sheet. presents summarized totals only Accordingly. the 1974 agreements. the total realizable amount of which is not Fees and grants from governmental amounts are not intended to present all information necessary presently determinable Such amounts will be recorded when agencies - 222.927 - - 222.927 227.157 for a fair presentation in accordance with generally accepted clear title is established and the proceeds are measurable. accounting principles. Certain amounts for 1974 have been Other revenue reclassified to conform with the presentation used in the 1975 (E) ACCOUNTING CHANGES AND PRIOR YEAR financial statements. FINANCIAL STATEMENTS Membership dues council membership 91,060 - - - 91.060 72.615 Effective July 1974, the Association changed its accounting Program service fees 405,997 - - - 405.997 355.969 Awards and Grants policy to conform with the "Standards of Accounting and The Association's awards for research grants- in- aid, Financial Reporting for Voluntary Health and Welfare Investment income and miscellaneous investigators. fellowships and professional education generally Organizations as revised during fiscal 1975 (see Note. A) (Note 2) 1,575,186 7.224 26.978 - 1.609.388 1.575.147 cover a periodo of from one to five years. subject to annual Accordingly, in most instances the comparative financial Gains (losses) on investment transactions - (9.681) - renewal at the option of the Association The liability for awards information as of June 30. 1974has been retroactively restated (12,650) (22.331) 21.208 is recorded on an annual basis upon notification to the recipient to reflect these changes in accountir procedure. Where Total other revenue 2.072.243 (2,457) 26.978 (12,650) 2.084.114 2.024.939 at the time of approval or renewal (see Note E). restatement was not practicable or appropriate the cumulative Continuing awards and awards granted in the future will be effect of the change has been reflected in the current year's Total public support and revenue 16.288.124 777.537 49.926 (12,650) 17.102.937 16.685.408 made from the Current Unrestricted Fund Balance designated financial statements. for research of $13,199,697. from donor restricted funds of $4,778,050 and from contributions received in future years. (F) INVESTMENTS: All investments, other than endowment securities. are or a short- EXPENSES Available Funds- term basis. Income from nvestments carried in all funds is Program services The expenditures for each fiscal year are financed principally credited directly to Current Unrestricted Funds unless such Research 7.777.772 496,204 7.997 - 8.281.973 7,507,009 by funds received from the campaign of the previous year. income is restricted by the contributors. Accordingly, the campaign income shown in the Public health education 1.075.312 9,032 14,873 - 1,099,217 1,062,137 accompanying statement of support. revenue and expenses Professional education and training 2,481,862 203.967 27.983 - 2.713.812 2,483,811 and changes in fund balances will be available for research Community services 1,166,194 11.441 10.250 - 1,187,885 1.055.192 awards and for programs and operations budgeted for the ensuing fiscal year. Total program services 12,501,140 720,644 61.103 - 13.282.887 12.108.149 Designated for Program Supplementation Supporting services- and Contingencies- This portion of the Current Unrestricted Fund Balance. which Management and general 1,435,908 30,949 25,425 - 1.492.282 1,409,984 may be utilized by specific action of the various governing Fund raising 824,007 20,356 8.205 - 852.568 731.906 Boards is reserved for the continuity of the Association's general activities. its scientific research program and to meet Total supporting services 2,259,915 51,305 33.630 - 2,344,850 2.141.890 emergency demands. Total program and supporting services expenses 14,761,055 771,949 94,733 - 15.627.737 14.250.039 Excess (deficit) of public support and revenue over expenses, before relocation costs and cumulative effect of accounting change 1,527,069 5,588 (44.807) (12,650) 1.475.200 2,435,369 RELOCATION COSTS (Note 3) (1,277,070) - (15,010) - (1.292.080) - CUMULATIVE EFFECT OF ACCOUNTING CHANGE Research Expenses (Note 8) (549,278) - - - (549.278) - Excess (deficit) of public support and revenue over expenses (299.279) 5,588 (59.817) (12.650) (366.158) 2,435,369 OTHER CHANGES IN FUND BALANCES Property and equipment acquisitions from unrestricted funds (Notes and 8) (225,205) - 225.205 - - - FUND BALANCES. beginning of year 19.510.077 725,893 752,924 339.914 21.328.808 18.893.439 FUND BALANCES. end of year $18,985,593 $731,481 $918,312 $327,264 $20.962.650 $21,328,808 See accompanying notes to financial statements. 24 25 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 American Heart Association, Inc. (National Center) BALANCE SHEET - JUNE 30, 1975 AND 1974 ASSETS 1975 1974 LIABILITIES AND FUND BALANCES 1975 1974 CURRENT FUNDS-UNRESTRICTED CURRENT FUNDS-UNRESTRICTED CASH $ 930,505 $ 118,109 ACCOUNTS PAYABLE AND ACCRUED EXPENSES $ 772.814 $ 745.844 CERTIFICATES OF DEPOSIT AND U.S. TREASURY BILLS, at cost, ACCRUED RELOCATION COSTS (Note 3) 882.690 - which approximates market (Note 2) 13.502.628 13.591.866 UNEXPENDED BALANCE OF RESEARCH GRANTS IN AID, INVESTIGATORS, FELLOWSHIPS AND ACCRUED INVESTMENT INCOME 62,477 186.346 PROFESSIONAL EDUCATION AWARDS. payable within one year (Notes and 8) 8.073.496 6.840.212 DUE FROM AFFILIATES: NET UNEXPIRED SUBSCRIPTIONS TO PROFESSIONAL PUBLICATIONS 181,000 90,000 Campaign contributions (Notel) 12.145,466 11.569.365 9.910.000 7.676.056 Educational and campaign materials purchased 351.947 323.111 FUND BALANCE (Note 1): Notes receivable 206.435 89,500 Designated by the Board for - Programs and operations for the ensuing year (Note 6) 6.403.375 6,346,665 INVENTORY OF EDUCATIONAL AND CAMPAIGN MATERIALS, at first-in, first-out cost Research 9.302.317 8.562.338 or market, whichever is lower 1.131.422 945,053 Relocation (Note 3) - 1.000.000 National center (Note 3) 2.850.070 2.567.233 Program supplementation and contingencies 429.831 1.033.841 OTHER RECEIVABLES AND PREPAID EXPENSES 564,713 362.783 Total fund balance 18.985.593 19.510.077 $28,895,593 $27.186.133 $28,895,593 $27.186.133 CURRENT FUNDS-RESTRICTED CURRENT FUNDS RESTRICTED CASH $ 99,392 $ 67,573 FUND BALANCE: MARKETABLE SECURITIES, at cost, which approximates market (Note 2) 162,914 133.199 DUE FROM AFFILIATES: Designated by donors for - Campaign contributions 172.921 367,911 Research $ 462.291 $ 526.466 Cooperative research 233,001 116,735 Other 269,190 199,427 GRANTS RECEIVABLE 63.253 40,475 $ 731,481 $ 725,893 $ 731,481 $ 725.893 BUILDING AND EQUIPMENT FUND BUILDING AND EQUIPMENT FUND CASH $ - $ 18.304 CONSTRUCTIONNOTE PAYABLE (Note 3) $ 1,482,813 $ - CERTIFICATES OF DEPOSIT AND SHORT-TERM COMMERCIAL NOTES, at cost, which approximates market (Note 2) - 486,000 ACCRUED INVESTMENT INCOME - 8,280 FUND BALANCE: NATIONAL CENTER DEVELOPMENT COSTS (Notes 3 and 4) 2.300.875 110,773 Net investment in building and equipment 918,312 240.340 Unexpended-restricted - 512.584 EQUIPMENT at cost or appraised value, less accumulated depreciation of $418,157 in1975 and $323.424 in 1974 (Note 4) 100,250 129,567 Totalfund balance 918.312 752.924 $ 2,401,125 $ 752.924 $ 2,401,125 $ 752.924 ENDOWMENT FUND ENDOWMENT FUND ACCRUED INVESTMENT INCOME $ 4,785 $ 2,815 MARKETABLE SECURITIES, at cost. which approximates market (Note 2) 322,479 337,099 FUND BALANCE $ 327.264 $ 339.914 $ 327,264 $ 339,914 $ 327.264 $ 339.914 See accompanying notes to financial statements. 26 27 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 American Heart Association, Inc. (National Center) STATEMENT OF FUNCTIONAL EXPENSES YEAR ENDED JUNE 30, 1975 WITH COMPARATIVE TOTALS FOR 1974 Program Services Supporting Services Total Program and Supporting Services Public Professional Expenses Health Education Management Research Education and Training Community and Fund Services Total General Raising Total 1975 1974 Salaries $ 277.005 $ 515,137 $ 865.826 $ 424.613 $ 2.082.581 $ 698.175 $341.036 $1,039,211 $ 3.121.792 $ 2.915.012 Payroll taxes, etc. 16.999 31,020 47.283 23.186 118,488 35.984 19.699 55,683 174,171 168.782 Employee benefits (Note 5) 31.171 62.823 97.128 49.214 240.336 69,860 41.805 111.665 352.001 319.017 Occupancy 41,698 60,223 100.935 44.855 247.711 71.127 38.517 109.644 357.355 376.067 Telephone 14,644 31,040 41.362 24.303 111.349 35.962 20.608 56.570 167.919 156.686 Supplies 12,754 20.500 35.826 11,847 80.927 31,179 11.966 43,145 124.072 124.929 Rental and maintenance of equipment 15.595 21,426 39,439 13.335 89.795 30.951 12,531 43,482 133.277 101.195 Printing and publications (Notel) 20.977 120.726 283.838 65,473 491,014 41.352 124.600 165.952 656.966 490.356 Postage and shipping 10.773 19,167 29.963 12.254 72,157 19,195 11.641 30.836 102.993 121.637 Visual aids, films and media 1.202 90,573 25.233 178.886 295,894 7,210 64.706 71.916 367.810 314.125 Conferences, conventions and meetings: Travel 76.244 21.080 323,686 83.338 504.348 192,464 53.386 245.850 750.198 823.043 Other direct expenses - - 412.961 - 412.961 1,465 - 1,465 414.426 312.200 Other travel 12,177 29.356 55,008 49.810 146,351 80.269 37.344 117.613 263.964 266.990 Professional fees 892 33.224 18,071 22.385 74.572 65,139 45,602 110.741 185.313 135,422 Awards and grants (Note 8) 7,719,497 17.041 200,382 166.594 8.103.514 31,317 9.876 41.193 8.144.707 7.345.430 Other expenses 22,348 11,008 108.888 7.542 149.786 55.208 11.046 66.254 216.040 186.607 Total before depreciation and amortization 8.273.976 1.084.344 2.685.829 1.177.635 13.221.784 1,466,857 844.363 2.311.220 15.533.004 14.157.498 Depreciation and amortization (Notes 4 and 8) 7.997 14,873 27.983 10.250 61,103 25,425 8.205 33,630 94.733 92,541 Total functional expenses $8.281.973 $1,099,217 $2.713.812 $1,187,885 $13.282.887 $1,492,282 $852,568 $2,344,850 $15,627,737 $14,250.039 See accompanying notes to financial statements. 28 29 Source: :https://www.industrydocuments.ucsf.edu/docs/tInf0227 AUDITORS' REPORT AMERICAN HEART ASSOCIATION, INC. (NATIONAL CENTER) (2) INVESTMENTS All investments other than endowment securities. are on a short- To the Board of Directors of NOTES TO FINANCIAL STATEMENTS term basis. Income from investments carried in all funds is American Heart Association, Inc. credited directly to the Current Unrestricted Fund unless such (1) SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: income is restricted by the contributors We have examined the balance sheet of National Center- (3) NATIONAL CENTER: American Heart Association, Inc (National The accompanying financial statements reflect the accounts of In prior years the Board of Directors authorized the construction American Heart Association Inc. (National Center), and do not of a National Center in Dallas, Texas. and designated funds for Center a New York not-for-profi corporation) as include the accounts of affiliated associations which are construction and relocation of June 30, 1975. and the related statements of maintained individually by such associations Contribution are The Association initiated the move to Dallas during the year support, revenue and expenses and changes in received principally by the affiliated associations and are ended June 30. 1975. and all estimated relocation costs have shared with the National Center The National Center's share of fund balances and of functional expenses for the been accrued and charged to expense contributions and bequ jests reflected in these financial year then ended. We have also examined the statements for 1975 was $14,478 490 and $14.202 372 for 1974 The Association obtained a 3.000.000 line of credit and The related fund raising costs of affiliated associations were commitment for an additional $1,000.000 line with interest at the restated financial information for 1974 presented approximately $2.028.000 in 1975 and $1,869,000 in 1974. floating prime rate (7% at June 30 1975), from a Dallas bank to for comparative purposes. Our examinations finance construction and relocation costs. During 1975, an were made in accordance with generally Standards of Accounting and Reporting - average of $340.00 was outstanding under the line at an accepted auditing standards. and accordingly The Association follows the standards of accounting and average interest rate of 7.6%. The maximum balance outstanding was $1 1.482 813 Subsequent to year end additional included such tests of the accounting records financial reporting for voluntary health and welfare agencies prescribed by the National Health Council, the National draws were made on the line as construction on the building and such other auditing procedures as we Assembly of National Voluntary Health and Social Welfare progressed. The balance is due on July 1976 Alternative long considered necessary in the circumstances. Organizations and United Way of America. These standards are term financing methods are being considered As discussed in Notes and 8 to the financial in conformity with the recommendations of the American Asof June 30. 1975 the Association was committed for Institute of Certified Public Accountant which became approximately $1 600,000 of additional capital expenditures statements, the Association has changed its effective in fiscal 1975 (see Note 8) In accordance with these related to facilities of the National Center. methods of accounting for fringe benefits on standards expenditures for buildings and equipment and the research awards and for the costs of building and fair value of donated equipment are capitalized Depreciation (4) BUILDING AND EQUIPMENT: is recorded over the estimated useful lives of the assets. Depreciation of equipment is recorded on the straight line basis equipment additions and related depreciation. Investments are stated at cost All contributions are considered over the estimated useful lives of the assets. In our opinion, the accompanying financial available for the general programs of the Association unless No depreciation was recorded on the uncompleted National statements present fairly the financial position of specifically restricted by the donor. Interfund receivables and Center during 1975 will be depreciated on the straight line payables. arising from transactions which are to be completed basis over 40 years beginning December 1975 The building is American Heart Association, Inc (National after year end, have been eliminated situated or a donated leasehold The fair rental value of the Center) as of June 30, 1975, and its support, The amounts shown for 1974 in the accompanying financial leasehold will be recorded each year as a donation and revenue and expenses and changes in fund statements are presented in accordance with the corresponding expense when the building is put in service. balances for the year then ended, in conformity recommendation of the American Institute of Certified Public Accountants. This financial information is included to provide a (5) RETIREMENT PLAN: with generally accepted accounting principles. basis for comparison with 1975. and, other than for the balance The Association provides retirement benefits for substantially all In our opinion, except for the change (with which sheet. presents summarized totals only. Accordingly the 1974 employees and certain research awardees through individual amounts are not intended to present all information necessary annuities with Teachers Insurance and Annuity Association and we concur) in the method of accounting for fringe College Retirement iquities Fund Retirement benefits equal the benefits described in Note 8. the accounting for a fair presentation in accordance with generally accepted accounting principles In addition to the accounting changes amount accumulated to the imployees' individual credit at the principles were applied on a basis consistent with discussed in Note 8. certain amounts for 1974 have been date of retirement. All costs of the Plan are borne by the that of the preceding year, after giving reclassified to conform with the presentation used in the 1975 Association except that norder to increase benefits. a participant may at his election contribute a portion of his retroactive effect to the change (with which we financial statements. compensation The Plan costs to the Association for the years concur) in the method of accounting for building Awards and Grants- ended June 30. 1975 and 1974 were 4.000 and $266.000 for and equipment additions and related The Association's awards for research grants- in aid, employees and $325,000 and $316,000 for research awardees. depreciation discussed in Notes and 8. investigators. fellowships and professional education generally respectively cover a period of from one to five years, subject to annual The Pension Reform Act of 1974 requires the Association to Also, in our opinion, the financial information for renewal at oppion of the Association The liability for awards amend its Plan to conform with certain provisions of the Act. 1974, which has been restated for the change in is recorded on an annual basis upon notification to the recipient which will become effective in 1976. The Association estimates method of accounting for building and at the time of approval or renewal (see Note 8). that there will be no significant increase in the costs of the Plan equipment additions and related depreciation The aggregate contingent liability for payment of continuing as a result of the changes awards beyond the currently authorized year is estimated to be and is presented for comparative purposes (see S11 350 June 30. 1975. In addition, thirteen Career (6) OTHER COMMITMENTS: Notes and 8). presents fairly the information set Investigator Awards have been approved by the Board of The Association's lease agreements for office and warehouse forth therein. Directors providing salary and laboratory expenses for the space. which expire through 1979 provide for annual rental recipients, the aggregate contingent liability for such awards payments of $369 000 in 1976 (including $120,00 of unexpired Arthur Andersen & Co. (assuming payment to normal refirement date of each lease commitments on office space vacated in connection with Investigator) is estimated to be $6,000.000. Thus, the total the relocation. which has been expensed as discussed in Note Dallas, Texas, contingent liability for awards and grants at June 30. 1975 is 3). $14,500 in 1977 and $12,000 in 1978. December 5, 1975. estimated to be $17 .350.000. Continuing awards and awards granted in the future will be (7) TAX STATUS: The Association is exempt from income taxes under Section made from the Current Unrestricted Fund Balance designated for research of $9,302,317 from donor restricted funds 501(c)(3) of the U.S. Internal Revenue Code, has been determined to be an organization which not a private $462.29 and from contributions received in future years. foundation; and is qualified for the 50% charitable contributions Educational and Campaign Materials- deduction. Included in printing and publications expenses for 1975 and 1974 are net costs attributable to distribution of educational and (8) ACCOUNTING CHANGES AND PRIOR YEAR campaign materials and professiona pi oublications. The FINANCIAL STATEMENTS: Association absorbs costs for such items in excess of the Prior to July .1974. the costs of building and equipment amounts charged to affiliates and others. Amounts charged in additions were expensed in the Current Unrestricted Fund in the 1975 and 1974 were $2 919. 334, and $2,529,525; costs were year of acquisition. The cost and accumulated depreciation for $3.201.062 and $2 748 285. resulting in a net cost of $281,728 for major ecquisitions were recorded in the Building and 1975 and $218.760 for 1974, Equipment Fund. Straight line depreciation was reflected by charges to the Building and Equipment Fund balance. Designated for Program Supplementation Effective July 1974, the Association changed ifs accounting and Contingencies- policy to conform with the "Standards of Accounting and This portion of the Current Unrestricted Fund Balance. which may Financial Reporting for Voluntary Health and Welfare be utilized by specific action of the Board of Directors (see Note Organizations as revised during fiscal 1975 (see Note 1) 3). is reserved for the continuity of the Association' general Accordingly, the comparative financial information as of June activities, its scientific research program and to meet 30. 1974, has been retroactively restated to reflect this change in emergency demands. accounting procedure The effect of this change was to decrease expenditures and increase interfund transfers for the Available Funds- year ended June 30. 1974, by $23.508. The expenditures for each fiscal year are financed principally In years prior to fiscal 1975. fringe benefits related to research by funds received from the campaign of the previous year. awards were charged to expense as paid. Effective July 1974, Accordingly, the campaign income shown in the horder to reflect the total liability incurred as research awards accompanying statement of support, revenue and expenses are granted. the Association changed ifs policy to record and changes in fund balances will be available for research concurrently the estimated fringe benefits payable on research awards and for programs and operations budgeted for the awards with the basic award (see Note 1). The effect of this ensuing fiscal year. change was to increase expenses and unexpended awards payable for the year ended June 30. 1975. by $550,000. Had the Legacies in Process- Association consistently followed this policy in prior years. total The Association the beneficiary under various wills and trust program and supporting expenses for 1974 would have been agreements the total realizable amount of which not increased by approximately $64 000 and total fund balances presently determinable Such amounts will be recorded when would have been decreased by $549.278 31 clear title is established and the proceeds are measurable. 30 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 The American Heart Association The American Heart Association is comprised of 55 affiliates and ,996 local subdivisions of which 126 are chapters Each has its own volunteer leadership and operates within the policies of AHA. Eight Regional Heart Committees of the Board of Directors provide leadership and guidance through representative membership from the affiliates. GREAT PLAINS REGION Colorado Heart Association American Heart Association, Dakota Affiliate 4521 East Virginia Ave. Denver 1005 Twelfth Ave. S.E. Jamestown, N. Dakota Idaho Heart Association Iowa Heart Association 2309 Mountain View Drive, Suite TIO. Boise 3810 Ingersoll Ave. Des Moines Montana Heart Association Kansas Heart Association Professional Bldg. 510 1st Ave., North, Great Falls 5229 West 7th St. Topeka Oregon Heart Association Minnesota Heart Association 1500 S.W. 12th Ave Portland 4701 West 77th St. Minneapolis Utah Heart Association Missouri Heart Association 250 East 1st South, Salt Lake City 601 East Broadway, Columbia Washington State Heart Association Nebraska Heart Association 333 First Avenue West Seattle 3624 Farnam Omaha Wyoming Heart Association 217 West 18th St., Cheyenne MIDDLE ATLANTIC REGION Heart Association of Maryland SOUTHERN REGION 10 South St. Suite 100, Baltimore Alabama Heart Association North Carolina Heart Association 7061/2 South 29th St., Birmingham 1 Heart Circle, Chapel Hill Arkansas Heart Association South Carolina Heart Association 909 West 2nd St. Little Rock 2864 Devine St. Columbia Florida Heart Association Virginia Heart Association 2828 Central Ave. St Petersburg 316 East Clay St. Richmond Georgia Heart Association Washington (D.C.) Heart Association Broadview Plaza, Level C., 2581 Piedmont Rd. N.E., D. C. Medical Society Bldg. Atlanta 2007 Eye St. N.W. Washington, D.C. Louisiana Heart Association American Heart Association, West Virginia Affiliate 3303 Tulane Ave. New Orleans 211 35th St. S.E., Charleston Mississippi Heart Association 4830 East McWillie Circle, Jackson NEW ENGLAND REGION Oklahoma Heart Association Connecticut Heart Association 800 Northeast 15ths St., Oklahoma City 234 Murphy Road, Hartford Tennessee Heart Association Maine Heart Association Suite 308. 1720 West End Building. Nashville 20 Winter St., Augusta American Heart Association, SOUTHWEST REGION Massachusetts Affiliate American Heart Association, Arizona Affiliate 85 Devonshire St. Boston 1445 East Thomas. Phoenix New Hampshire Heart Association American Heart Association, California Affiliate 54 South State St., Concord 1370 Mission St. San Francisco Rhode Island Heart Association American Heart Association of Hawaii, Inc. 40 Broad St. Pawtucket 245 North Kukui St., Honolulu Vermont Heart Association American Heart Association, 56 Church St., Rutland Greater Los Angeles Affiliate 2405 West 8th St. Los Angeles NORTH CENTRAL REGION Nevada Heart Association Chicago Heart Association 455 West 5th St. Reno 22 West Madison St. Chicago New Mexico Heart Association Illinois Heart Association 142 Truman St., N.E. Suite D Albuquerque 1181 North Dirksen Parkway, Springfield American Heart Association, Texas Affiliate, Inc. American Heart Association, Indiana Affiliate, Inc. 860 North Highway 183. Austin 222 South Downey, Suite 222. Indianapolis Kentucky Heart Association UPPER ATLANTIC REGION 207 Speed Bldg. 333 Guthrie St., Louisville Delaware Heart Association Michigan Heart Association Independence Mall, Suite 46. 1601 Concord Pike. 16310 West Twelve Mile Rd. Southfield Wilmington American Heart Association, American Heart Association, New Jersey Affiliate Northeast Ohio Affiliate 1525 Morris Ave., Union 1689 East 115th St., Cleveland New York Heart Association American Heart Association, Ohio Affiliate 2 East 64th St. New York City 10 East Town St.: Room 506. Columbus American Heart Association, Wisconsin Heart Association New York State Affiliate 795 North Van Buren St., Milwaukee 3 West 29th St. New York City American Heart Association, Pennsylvania Affiliate NORTHWEST-ROCKY MOUNTAIN REGION 2743 North Front St. Harrisburg Alaska Heart Association Puerto Rico Heart Association 211 East 4th Ave., Anchorage Box 8215. Fernadez Juncos Station, Sanfurce 32 THE AMERICAN HEART ASSOCIATION 7320 Greenville Avenue Dallas, Texas 75231 This 1975 Annual Report was designed and written by the American Heart Association's Communications Division and, for the first time in Association history, was printed by the print production facility at the National Center. Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 American Heart Association Annual Report 1975 i This report to the public on the conduct of the American Heart Association program during 1975 is dedicated to the more than two million volunteers who are the lifeblood of the Association. They represent men and women from the grass roots of America who call on friends and neighbors in communities large and small to collect the dollars that finance the Association's work. And they include scientists, physicians, nurses and leaders of business, industry, law, the arts, and communications who sit on Boards, Councils, Committees and Task Forces to help set policies, develop programs and oversee their successful accomplishment. Without their freely-given time and skills we would not have been able to achieve the enormous strides of the past 25 years against cardiovascular disease. Indeed, without all of them, there would be no American Heart Association at all. Cover photo shows an echocardiogram of a patient's heart. Echocardiography is a relatively recent non-invasive technique, rapidly growing in use, which has made a major contribution to the diagnostic skills of the cardiologist. If aims ultra-high frequency sound waves through the chest wall to the target area of the heart. Returning echoes generate electrical impulses which are received and recorded by the echograph instrument. President's Message We know what the priorities and goals are: Research We still don't know the cause of coronary During the past year, the Association heart disease, even though heart attack death rates are declining; provided funds for the work of approximately We don't know the cause of 90 percent of 1,400 scientific investigators on all career all high blood pressure, though we have levels-to - assure that outstanding learned to control much of it; independent researchers may pursue We don't know the cause of primary original lines of thought to wherever they myocardial disease; and may lead, that the established investigator We still don't know why normal mothers has the means to complete his project and have babies with congenital heart disease. that younger scientists of promise have the Heart Association staff members and support they need to develop their skills. volunteers are rededicating themselves to unlocking more of these unknowns. We seek the support of all Americans so that the same sense of urgency that motivates us can have its expression in new and expanded programs. In the year covered by this report, the Our network of affiliates and chapters has American Heart Association allocated a steadily developed. Today it reaches into record amount of $18 million for heart thousands of communities involving citizen research, sending the total for such support volunteers, laymen, scientists, physicians, past the quarter billion dollar mark. During nurses and people from all walks of life in an the same period, there was confirmation that amalgam to cope with a complex of distinct the death rates from coronary disease had diseases generally referred to as turned downward. An analysis of these cardiovascular. closely watched statistics suggested that a Armies of distinguished scientists and combination of better prevention and more physicians, corps of non-medical personnel effective emergency treatment played an and more than two million volunteers form important role in this downtrend. the Heart Association. Much of the public There is reason to take satisfaction in funds donated to the Association support our contributions toward reaching these research scientists in their attempts to further milestones. But there is even more reason unlock the secrets of heart disease. Assisting to report that these achievements have in translating new medical knowledge from stimulated in us a new sense of urgency. We all sources into professional programs are have seen what dollars and dedication can about 10,000 scientists and physicians do. Yet, while heart and blood vessel forming 14 Scientific Councils, each diseases continue to impose an intolerable dedicated to a field of science or a medical health burden and economic cost on the specialty relating to heart disease. Through nation, we must do much more. their valuable guidance, the Association is in essence a micro-universify, developing and conducting hundreds of postgraduate medical courses across the country throughout the year to refine the skills of physicians and nurses and thus ensure better patient care. The Scientific Councils also are active in the development of programs for the general public, assuring that those programs are based on scientific fact and designed to educate Americans in the prevention of heart attack and stroke. In the pages that follow you will find highlights of our programs in the year covered by this report. Elliot Rapaport, M.D. President 2 If we are to make further inroads on the Professional Education enormous toll of death and disability caused by cardiovascular diseases, we must continue to help develop new scientific knowledge. This is at the foundation of all programs, professional and public, conducted by the Association. What increases our sense of urgency in this matter is that progress against cardiovascular disease, while rapid and progressive, must rely on one piece of new knowledge being gathered here atop another piece gathered elsewhere. We are forging a mosaic of hope and help. The results of research projects supported by AHA continue to find clinical expression in improvements in the diagnosis and treatment of heart disease. Two of the more significant advances reported during the past year are: The first significant decrease in mortality from coronary artery disease; There are hundreds of other bits and pieces A doubling of the number of patients with reported each year that may prove to be hypertension who have been recognized, put on therapy and had part of a new weapon in the war on heart their blood pressure controlled. disease. Biomedical investigators are facing Examples of research supported by the AHA up to the challenges. What we need are which promise to provide additional more of the means. Each of these new advances in overcoming heart disease approaches must be tried, tested and include: duplicated- in laboratories, on animals and Techniques for improved and earlier finally in humans- - before they can be recognition of heart attacks and the accepted as conclusive and beneficial and protection of injured heart muscle from added to the list of armaments. Knowledge gained through research is only progressive damage; as good as its application. With the Providing the means requires a new Recognition of the fundamental cellular acceleration in research in recent years has defect in a form of hereditary commitment from the public to support our come a steady increase in new information hypercholesterolemia, associated with a responsibility to do all in our power to help about cardiovascular diseases and new high incidence of heart attacks among gather and disseminate new knowledge. ways of treating and preventing such affected people in their 20's and 30's; The faster scientists can nail down disorders. This new knowledge often Development of sophisticated X-ray preliminary findings, the faster they can be techniques which will graphically becomes available at a pace swifter than applied to reducing suffering and death. demonstrate the intricate workings of the the busy cardiologist, coronary care nurse heart in the intact human; Simply put, the urgency is dollars to save or other health care specialists can be Proof that a prolonged regimen of diet lives. expected to seek it out and assimilate it. and exercise improve circulatory Aso result, a special sense of urgency derangements in the legs; stimulates us in development of our medical Application of new approaches to the recognition and treatment of education programs, to assure that they hypertension caused by decreased keep pace with advances in the field and blood flow to the kidneys; that they are geared to bringing new Improved diagnosis and therapy of research findings to the medical community thrombophlebitis in the legs, the source as quickly and as clearly as possible. of blood clots which cause 50,000 deaths each year in the U.S. Keystones for dissemination of valuable knowledge are the American Heart Association's 14 Scientific Councils, headed by many of the nation's foremost scientists and cardiovascular experts. Each of the Councils represents a special professional interest; together they reflect the broad scope of cardiovascular diseases and the concerns of the American Heart Association. They set the standards and conduct the professional activities of the Association. 4 5 The Councils conduct continuing education Public Education programs for their own members who total approximately 10,000. Reaching out to others A college professor in Baltimore, Maryland, in the medical community, the Councils are showed the AHA-produced film, active in the development of a wide range ``Hypertension: The Challenge of Diagnosis," of learning materials available to all to his biology class. One student was so 270 physicians and nurses. These include moved at learning hypertension or high pamphlets, newsletters, films, lecture series, blood pressure is a 'silent killer" that she 250 audio-visual aids and a group of scientific immediately urged her mother to undergo a journals which have a combined monthly long-delayed medical checkup. 230 circulation of more than 300,000. At the apex The examination revealed the woman of this activity is the annual Scientific indeed had high blood pressure, but thanks 210 Sessions, a meeting which attracts more than to a concerned daughter and a Heart 200 10,000 health professionals to exchange and Association message, her condition was 190 assess the year's new findings. brought to medical attention at an early 180 Affiliates and chapters of the Association time. 170 conduct hundreds of their own programs While that film was produced for 160 which bring together physicians and nurses professional education, it does show there on a community or state level, as contrasted are many ways of reaching the general 150 140 to Council-sponsored programs which are public with information vital to its welfare. conducted on a national basis. These 130 And the Association employs all means of 120 programs are not necessarily of interest just mass communication to alert Americans to / to the cardiologist, but are planned for the magnitude of the problem of heart 110 100 anyone concerned with better patient care disease; to what is known about factors that for prevention of heart disease and increase an individual's risk; and what one 90 80 management of patients. can do on his or her own and with a doctor's The Association constantly seeks to innovate help to change life styles moderately, 70 60 in its educational programs, as it has in control some easily identifiable health establishing research support programs conditions, and thus reduce that risk. 50 subsequently adopted elsewhere. Better The heart of this message includes these patient care is one of our goals and to get to major points: the crux of it, we conduct a unique Teaching If you have high blood pressure, follow Scholarship Program. This has a two-fold your doctor's orders and continue to take purpose: to raise standards of medication. undergraduate education for medical If you don't know whether you have high blood pressure, or suspect you might careers by creating a corps of unusually have it, visit your doctor. He can quickly, effective cardiology teachers, and thereby easily and painlessly find out. It usually on a day-to-day basis influence the has no set symptoms. So only a trained development of hundreds of students who person can tell. eventually will be in practice. This program If you smoke cigarettes, stop. has reached into medical schools across the If you eat foods rich in cholesterol and saturated fats, cut down on them. If you country and to date has supported 26 young don't know what they are, ask your Heart physicians, allowing them to devote virtually Association for booklets that tell you in all of their time to teaching and to plain, concise language. development of improved teaching If you that don't you exercise do become more regular active. basis, on a see If methods. you're middle-aged and/ have been leading a more than usual chair-borne existence, it would be wise to see your doctor before engaging in unaccustomed activity. 6 Community Programs Having just learned it in school, cardiopulmonary resuscitation was fresh in the mind of 13-year-old Lyn Kraft of Ventnor, N.J., the October night her father suffered a massive heart attack and lost consciousness. Lyn was able to maintain his breathing and heart beat for 10 minutes until medical help arrived. Usually, a victim of cardiac arrest who is denied oxygen for more than four to six minutes suffers brain damage. But today, Mr. Kraft is recovering, thanks to Lyn's prompt action, the CPR training she received from her school nurse, Marie Paludi, and to the South Jersey Shore Heart Chapter which certified Ms. Paludi in CPR which quickly proved its worth in that community. CPR is just one facet of a growing concept of area-wide comprehensive emergency pressure screening and control. This latter cardiac care systems being promoted by one has received particular emphasis the Association. But CPR's life-saving because there may be as many as 12 million potential has spurred us into teaching it to "hidden" cases of high blood pressure in this cadres of health professionals who, returning country; and among those known to be to their home areas or institutions, can afflicted, only one out of eight is receiving quickly train others-professionals and adequate medical care. public alike to provide basic emergency Other new efforts to improve and expand help wherever a life needs to be saved. community services include development of One example of this mushrooming effect: guidelines for medical management of last October, the Association conducted a teenagers with high levels of artery-clogging training course for 20 inspectors from the cholesterol in their blood; work on model Mining Enforcement and Safety programs applying principles of behavioral Minority Program Administration. Within two weeks, three of the science to risk reduction motivation; and a inspectors were conducting a course for 30 new film and stroke guide explaining the role Barrios, ghettos, isolated American Indian found heart disease, high blood pressure others- - other inspectors and of community hospitals in the optimum reservations. depressed rural villages. inner- and their devastating aftermaths, heart representatives from 24 industries covering a treatment of stroke victims, and then in city slums and other "out-of-the- attack and stroke, more so than in urban, seven-state area. They, in turn, are now returning them to as useful a life as modern mainstream" places- - all are synonymous higher income societies. prepared to train other groups. science makes possible. with minority groups, poverty and apathy. In recent years as more became known Where these elements exist, there also are In the past year, the Association distributed about the present concepts of programming more than 1.2 million copies of a booklet on for the total community and about the new standards in CPR, developed in concert relatively more serious impact of with the National Research Council-National cardiovascular diseases on isolated and Academy of Sciences. These went to health lower income groups, the Association professionals across the country and around began reaching out - to bring aid and the world. information to these groups and to encourage them to help design programs The same sense of urgency which underlies based on their urgent needs. our CPR activities, has prodded us into other community programming to motivate Starting in 1971, several national conferences Americans to reduce their risk of heart attack were sponsored by the Association to bring and stroke by making moderate changes in all interested organizations together. Today, life styles and controlling identifiable health Minority Involvement Working Group and a disorders. Poverty Planning and Development Fund These programs include smoking withdrawal Committee are working towards improving clinics, nutrition and diet instruction, the Association's program in the total community. rheumatic fever control, screening children for hidden heart disorders, stroke and heart Hand in hand with minority involvement in attack rehabilitation and high blood Association affairs has come a substantial 9 8 increase in programs of education and directors and in activities of state and local Major Awards Mrs. Alexander Ripley, Los Angeles. She prevention conducted jointly with those for Heart Associations. Thus, minority group Research Achievement Award, the "created an impressive record with the Heart whom the programs have been developed. leadership to further combat cardiovascular American Heart Association's highest award Cause in California and in the national The response has been impressive. Example: disease in these areas can be nurtured. for research accomplishment, to Arthur C. In South Dakota, at Standing Rock community," while encouraging other In 1975, AHA worked closely with the Guyton, M.D., in recognition of his brilliant, women's participation in that cause. Reservation alone, more than 5,000 Sioux Association of Black Cardiologists, the tireless research efforts spanning more than Moreover, she helped develop national are learning how to reduce their risk of heart National Medical Association composed of two decades, for his profound contributions attack and stroke. In Tulsa, Oklahoma, policies, and displayed organizational skills minority physicians, the National Congress of toward advancing knowledge of virtually Indians living in the urban area, are doing in planning annual meetings for the American Indians and the National every aspect of cardiovascular physiology, Association. likewise. Association of American Indian Physicians to and the influence his work had in stimulating Paul N. Yu, M.D., Professor of Medicine, Across the country, Heart Associations are encourage participation on regional, the efforts of other scientists. Dr. Guyton is University of Rochester (N.Y.) Medical Center. conducting high blood pressure screening affiliate and national boards and Professor and Chairman of the Department Dr. Yu, a former AHA president, "performed for blacks because this disease affects committees and on the Scientific Councils of of Physiology and Biophysics. University of brilliantly in the service of all elements of the blacks at double the rate of whites, and the Heart Association. Mississippi Medical Center. Association" for many years. Many of his usually with more devastating efforts have been directed toward consequences of heart attack and stroke. James B. Herrick Award, granted by the improving the quality of medical education When high blood pressure is detected, this Council on Clinical Cardiology to Lewis and the delivery of emergency cardiac program provides patients with follow-up Dexter, M.D., for outstanding achievement in care. resources for therapy and educational clinical cardiology. With almost 40 years programs. devoted to his field, he has "excelled in Howard W. Blakeslee Awards for Though critically important, educating advancing scientific knowledge, improving distinguished media communication minorities at the local level is only a part of the practice of cardiology. and in regarding cardiovascular diseases: the program's mission. Equally as important developing legions of medical students and JoAnn Ellison Rodgers of the "Baltimore News in reaching its objectives is achieving a scores of research fellows who today are American" for her four-part newspaper series higher degree of minority member making significant contributions of their own involvement in committees, boards of to cardiology.' Dr. Dexter is Professor of that comprehensively reported the rising incidence of heart disease in women. Medicine at Harvard University and Director of the Cardiovascular Laboratory at Peter Good Times, a CBS-TV weekly series Bent Brigham Hospital, Boston, featuring the episode "The Check Up.' This Massachusetts. particular telecast, aired May 8.1974, emphasized the importance of medical Gold Heart Awards honor those volunteers check ups for hypertension-prone black who have served with highest distinction in males. "Good Times" is produced by advancing the American Heart Association's Norman Lear and Tandem Productions. work. Recipients are: Andy Guthrie of WKYC-TVI News, Cleveland, Julius H. Comroe, Jr., M.D., Herzstein Professor Ohio, for his five-part report "The of Biology, University of California in San Ambulance Crisis: Who Will Come for You?" Francisco. As a scientist, he contributed If examined problems confronting importantly toward the enrichment of Cleveland's ambulance system, compared cardiovascular knowledge and improved it to those in other cities, and proposed clinical practice. Through his editorial solutions to these shortcomings. leadership, he brought "excellence" to AHA's scientific journal, "Circulation Research.' Elwood Ennis, Vice President, Griffenhagen- Kroeger, a management consultant firm in San Francisco. His knowledge of management procedures proved invaluable in establishing performance standards for AHA Affiliates and in developing personnel and training policies during his 20 years as a volunteer leader of the Association. 10 11 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 Joan Solomon, a science writer for Rose Pinneo, R.N., Associate Professor of Board Chairman's Message In 1975, we received 130 requests from young "Consumer Reports" magazine, for her Nursing, University of Rochester School of scientists for five-year Established article, "High Blood Pressure: What to Do Medicine and Dentistry, Rochester, New Investigatorships to support their heart When Your Numbers Are Up." Her story, York. research Monies were available to fund only according to competition judges, told the Richard H. C. Taylor, Richmond, Virginia. 32 of these qualified men and women. truth about the causes, diagnosis and Sam A. Threefoot, M.D., Assistant Dean and Moreover, we could support only 23 percent treatment of hypertension while dispelling Professor of Medicine, Medical College of of the over 400 Grants-in-Aid projects old myths about the disease. Georgia, Augusta. requested by investigators needing funding JoAnn Stichman and Jane Schoenberg for to perform vital heart research. Had the their book, "How to Survive Your Husband's Citation for Distinguished Service to dollars been available, more of these highly Heart Attack." The authors were cited for Research to: regarded people and projects would have "giving frank, full advice to women who David Bohr, M.D., Professor of Physiology, received funds from the Heart Association cope with a wide variety of new problems" University of Michigan, Ann Arbor. Inflation is also having undesirable effects on when facing heart attack crises. Jack Geer, M.D., Professor and Chairman, professional and public education Louis N. Katz Basic Science Research Department of Pathology, University of programs the Association conducts Alabama, Birmingham. nationwide. We are seeking both increased Prize for Young Investigators, to Kent Hermsmeyer, Ph.D., for demonstrating and Karlman Wasserman, M.D., Ph.D., Chief- fund-raising results and more cost-effective Respiratory Division, Harbor General programs to keep ahead of this specter of explaining an increased sensitivity of the Hospital, Torrance, California. shrinking dollars. blood vessels in high blood pressure to the hormone called norepinephrine. His Irwin Weiner, M.D., Professor and Chairman- Americans exhibited an increasing Additionally, we are working to cut research represents a significant advance Department of Pharmacology, State confidence in the American Heart operating costs and have done so. In this toward understanding how essential University, New York Upstate Medical Center, Association and its programs by contributing regard, the Executive Vice President's hypertension, a mysterious disease, gets Syracuse. record $59,951,245 in 1975. message on the following page explains some of the actions we have taken and started. Dr. Hermsmeyer is an Assistant However, the cost of "doing business" has Professor of Pharmacology at University of results already achieved. also reached all-time highs; the Association lowa College of Medicine in lowa City. has felt the impact of inflation as have other Through the years, past and present organizations. programs have proven their worth in Distinguished Achievement Award to contributing to reducing death and Irving S. Wright, M.D., Emeritus Clinical This new enemy in our war on heart disease is improving the quality of life. They have Professor of Medicine at Cornell University causing AHA dollars to shrink and is adding received increasing support from Medical College and Consulting Physician to our sense of urgency because it contributing individuals. to New York Hospital. Dr. Wright jeopardizes our ability to accelerate accomplished the "monumental task of progress through expanded programs. But they especially merit renewed consideration and more generous support bringing together, blending and presiding We feel inflation as a two-way stretch. Our from industry and business. over the work of the Inter-Society dollars don't buy as much research, education and community services. Yet Underlying this consideration should be the Commission for Heart Disease Resources. His fact that heart and blood vessel diseases leadership, knowledge, guidance and inflation makes increasing demands on us. Some of these demands grow out of cost the nation an estimated $22.7 billion understanding of human affairs resulted in the most effective collaboration among retrenchment in the federal government's annually. In addition to lost income and expenditures for medical care, 52,000,000 more than 200 experts representing the 29 research training program which affects the organizations and disciplines represented bright young scientist much more than it man-days of production are lost each year. Other 'hidden' costs such as losses in on the Commission." He is a foremost does the established researcher who has management skills, production know-how, authority on cardiovascular disease who other sources of support. These young personnel training and development, and pioneered in the study of thrombosis. scientists are turning to us for support in labor turn-over are difficult to determine, but greater numbers than before. are obviously significant. Awards of Merit for outstanding The Report on the Commission on Private contributions to development of the organization's national program to: Philanthropy and Public Needs has recommended that corporations set as a Donald S. Fredrickson, M.D., Director, minimum goal, to be reached no later than National Institutes of Health, Bethesda, 1980, the giving to charitable purposes of Maryland. two percent of pre-tax net income and that Robert J. Michtom, M.D., Rockville Centre, further studies of means to stimulate Long Island - -Associate Professor of corporate giving be pursued. Medicine, State University of New York, Stony Greater investment in our Heart program Brook. could turn out to be a long-term investment Robert H. Mitchell, M.D., Clinical Professor of in corporate health. Medicine, Texas Tech University School of Medicine, Lubbock, Texas. Richard D. Dotts Chairman 12 13 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 Executive Vice President's OFFICERS BOARD OF DIRECTORS Message Richard D. Dotts Walter H. Abelmann, M.D. Chairman of the Board Boston, Mass. As a meeting place and resource center for John T. Shepherd, M.D., D. Sc. William H. Ames, M.D. the dedicated workers of the American President St. Joseph, Mo. Heart Association, our new National Center now enables closer relationships and Harriet P. Dustan, M.D. John S. Andrews President-Elect Youngstown, Ohio communications with 55 Affiliates and 1,196 Philip P. Ardery Chapters and Units. It is also national Elliot Rapaport, M.D. Louisville, Ky. Immediate Past President headquarters of the Association. Adm. Philip F. Ashler Ross Reid Tallahassee, Fla. Planned and executed with long-term Immediate Past Chairman of the Board W. Gerald Austen, M.D. savings in mind, this relocation is but a part of the Association's strategy to refine VICE PRESIDENTS Boston. Mass. Philip P. Ardery Owen Beard, M.D. management practices and to implement Little Rock, Ark. economies and confront the challenge of Owen Beard, M.D. Rene Bine, Jr., M.D. fiscal restraint. John J. DeFeo, Ph.D. San Francisco, Calif. In this regard, am pleased to report that Mrs. Frank A. Dresslar, Jr. Miss Virginia Black, R.N. combined expenditures by the national Ham Jackson, M.D. Cheyenne, Wyo. office and all affiliates for fund raising and Kenneth W. Kihle, M.D. Reagan H. Bradford, Ph.D. Ira L. Lavin Oklahoma City, Okla. other overhead costs have been reduced John G. Martin Guy E. Bramon, Jr. dramatically from a high point of 30 percent Edward Meilman, M.D. Bloomfield, Conn. in the 1968 fiscal year to a low of 23 percent Nanette K. Wenger, M.D. Miss Grace Brown, R.N. in the fiscal year ending last June 30. Stanford Wessler, M.D. Riverdale, N.Y. To have curbed overhead while increasing James G. White, M.D. Jay D. Coffman, M.D. In 1975, the American Heart Association and expanding our program is a Boston, Mass. John S. Andrews William E. Conner, M.D. moved from New York to a newly- remarkable achievement, not only from a Treasurer Portland, Ore. constructed National Center in Dallas. management standpoint, but also for what it Mrs. M. Jeanne Pontious, R.N. B. Trent Cooper, M.D. Volunteer leaders of the Association contributed toward our public Secretary Roanoke, Ind. determined that a geographically central accountability. By practicing economies Robert J. Cruikshank location and modern facilities would bring and instituting other solid management Houston, Tx. about operating efficiency and economies. devices, the Heart Association has been Gordon Curren able to channel almost 80 cents of every Sisseton, S. Dak. This new building is the nerve center of our dollar spent into positive programs for the Vincent DeCristotaro voluntary mission to reduce premature death public's benefit. Providence, R.I. and disability from cardiovascular diseases. John J. DeFeo, Ph.D. If becomes the focal point of an By improving the processes of our planning Kingston, R.I. organization comprising 40,000 of America's and management systems, we are further Richard D. Dotts foremost scientists and physicians, 65,000 developing orderly mechanisms for doing Newport Beach, Calif. other key members and more than 2,000,000 an even better job and determining future Mrs. Frank A. Dresslar, Jr. citizen volunteers. priorities, objectives, and costs. Thus, we will Fresno, Calif. be increasingly able to approach the public Harriet P. Dustan, M.D. with targeted needs, rather than simply our Cleveland, Ohio overall program of research, education, and Robert R. Eddy community services. In this manner, am Concord, N.H. confident Americans will respond even more William H. Eells Columbus, Ohio positively. Blair D. Erb, M.D. Knoxville, Tenn. Allan L. Friedlich, M.D. William W. Moore Boston, Mass Emilio R. Giuliani, M.D. Executive Vice President Rochester, Minn. Samuel Goldfein, M.D. Tucson, Ariz. Judith Graham, M.D. Great Falls, Mont. Jared Grantham, M.D. Kansas City, Ks. 14 15 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 Robert Hay, M.D. C. Richard Newpher Gary Walkup, M.D. COUNCIL CHAIRMEN NATIONAL OFFICE STAFF Nampa, Idaho Cleveland, Ohio Fairbanks, Alaska Arteriosclerosis William W. Moore Robert N. Headley, M.D. Thomas R. Oglevie Nanette K. Wenger, M.D. William E. Conner, M.D. Executive Vice President Winston-Salem, N.C. Goodland, Ks. Atlanta, Ga. Portland, Ore. SPECIAL ASSISTANTS E. H. Heinrichs, M.D. Donald C. Overy, M.D. Stanford Wessler, M.D. Basic Science Dawn Bryan, Chief, Public Policy Watertown, S. Dak. Birmingham, Mich. New York, N.Y. Arnold Schwartz, Ph.D. and Government Affairs Jacob F. Hess, Jr. Raul Penagaricano James G. White, M.D. Carolina, P.R. Houston, Tex. James D. Lowe, Public Relations Canton, Ohio Minneapolis, Minn. Mrs. Haywood N. Hill J. Stephen Phalen, M.D. Robert W. Wissler, Ph.D., M.D. Cardiopulmonary Diseases Counsel Reno, Nev. Chicago, III. Gerard M. Turino, M.D. John T. Connolly Atlanta, Ga. Hon. Charles A. Pomeroy New York, N.Y. Deputy Vice President, Office of Operations Florencio A. Hipona, M.D. Richard A. Young, M.D. Portland, Me. Hagerstown, Md. Cardiovascular Disease in the Young Eugene J. Brennan Boston, Mass. Mrs. M. Jeanne Pontious, R.N. Paul N. Yu, M.D. Angelo V. Taranta, M.D. Director, Division of Fund Raising Edmund M. Hoffman Indianapolis, Ind. Rochester, N.Y. New York, N.Y. Leonard P. Cook Dallas, Tx. W. Gerald Rainer, M.D. Harry F. Zinsser, M.D. Cardiovascular Nursing Director, Division of Management Information Services Thomas B. Hogan Denver, Colo. Gladwyne. Pa Miss Grace E. Brown, R.N. Robert E. Killian New York, N.Y. Elliof Rapaport, M.D. Robert Levy, M.D. Riverdale, N.Y. Director, Division of Communications M. Harland Ison San Francisco, Calif. Bethesda, Md. Cardiovascular Radiology W. Timothy Mask Mobile, Ala. Ross Reid (Representing National Heart Florencio A. Hipona, M.D. Director, Division of Personnel and Training New York, N.Y. and Lung Institute) Ham Jackson, M.D. James Blozie Boston, Mass. Richard S. Ross, M.D. Richard E. Hurley, M.D. Ft. Morgan, Colo. Baltimore, Md. Hartford, Conn. Cardiovascular Surgery Deputy Vice President, Office of Medical Programs Harry I. Johnson, Jr., M.D. Mrs. Adria Rubin (Representing Society of Heart W. Gerald Austen, M.D. Joseph D. Goldstrich, M.D. Roanoke, Va. Association Professional Staff) Boston, Mass. Elmira, N.Y. Director, Division of Education and Community Programs James E. Kamas Circulation Clare J. Sanchez Curtis B. Nelson, Ph.D. Lincoln, Neb. Jay D. Coffman, M.D. Director, Division of Scientific Affairs William B. Kannel, M.D. Denver, Colo. Boston, Mass. Framingham, Mass. Donald E. Saunders, M.D. Norman M. Kaplan, M.D. Clinical Cardiology John W. Kendall Columbia, S.C. Deputy Vice President, Office of Research Programs Henry D. McIntosh, M.D. Portland, Ore. Samuel J. Castranova Elijah Saunders, M.D. Houston, Tex. Joseph H. Kern, Ph.D. Director, Division of Planning and Evaluation Baltimore, Md. Monroe, La. Epidemiology Arnold Schwartz, Ph.D. Howard Weisberg, Ph.D. Kenneth W. Kihle, M.D. William B. Kannel, M.D. Director, Division of Research Awards Bottineau, N. Dak. Houston, Tx. Framingham, Mass. Richard I. Schein Richard A. Koebler John T. Shepherd, M.D., D. Sc. High Blood Pressure Research Director, Division of Business Administration Springfield, III. Rochester, Minn. William H. Eells Ira L. Lavin Sam N. Sherman Columbus, Ohio Earl B. Beagle Phoenix, Ariz. Milwaukee, Wisc. President, Executive Board Southern Affiliate Services Coordinator Charles Levy, M.D. Sol Sherry, M.D. Louis Tobian, M.D. Jerry H. Bruner Wilmington, Del. Philadelphia, Pa. Minneapolis, Minn. Eastern Affiliate Services Coordinator W. Sexton Lewis, M.D. MartinD Shickman, M.D. Chairman, Executive Committee Warren L. Duntley Little Rock, Ark. Los Angeles, Calif. Medical Advisory Board Midwest Affiliate Services Coordinator W. Jefferson Lyon Robert G. Siekert, M.D. Kidney in Cardiovascular Disease Robert D. Moore Newark, N.J. Rochester, Minn. Jared Grantham, M.D. Western Affiliate Services Coordinator GermanE. Malaret, M.D. Ernest G. Spivey Kansas City, Ks. San Juan, P.R. Jackson, Miss. Stroke John G. Martin Robert A. Stewart Robert Siekert, M.D. Columbia, S.C. Seattle, Wash. Mrs. Ruby Massingale, R.N. Perry Sundust Rochester, Minn. Phoenix, Ariz. Thrombosis Seattle, Wash. Angelo V. Taranta, M.D. Stanford Wessler, M.D. John E. Mazuzan, Jr., M.D. Burlington, Vt. New York, N.Y. New York, N.Y. Paul N. McDaniel Thomas Tarnay, M.D. Honolulu, Hawaii Morgantown, W. Va. Henry D. McIntosh, M.D. B. W. (Jack) Taylor Houston, Tx. Mabank, Tx. William J. McManus Richard H. C. Taylor Washington, D.C. Richmond, Va. Edward Meilman, M.D. AlanF. Toronto, M.D. New Hyde Park, N.Y. Salt Lake City, Utah Franklin B. Moosnick, M.D. Gerard M. Turino, M.D. Lexington, Ky. New York, N.Y. Frank M. Mowry, M.D. Ray Uhlhorn Albuquerque, N.M. Council Bluffs, lowa 16 17 Source: https://www.industrydocuments.ucsf.edu/docs/tInf02 AMERICAN HEART ASSOCIATION, INC. and all affiliated Heart Associations Memorial Gifts Bequests and Planned Gifts COMBINED STATEMENT OF SUPPORT, REVENUE, AND EXPENSES AND CHANGES IN FUND BALANCES Many people find that the most fitting tribute Planned giving is an arrangement between YEAR ENDED JUNE 30, 1975 WITH COMPARATIVE TOTALS FOR 1974 to the memory of a victim of heart disease is a donor and the American Heart Association a memorial gift to the American Heart by which a gift of money or property is Land, Association. Memorials are an important irrevocably identified for use by the Building and Current Funds Equipment Endowment Total All Funds source of support in the fight against American Heart Association. Though the Unrestricted Restricted Fund Fund 1975 1974 premature heart deaths. All gifts are right to use the gift may be deferred, there PUBLIC SUPPORT AND REVENUE: promptly acknowledged both to the family can be immediate and future tax benefits to Public support- of the person honored and to the donor. To the donor. Received directly- make a memorial gift to the American Heart There are a variety of methods for planned Contributions $36,590,080 $1,112,214 $ 26,450 $ 52.605 $37,781,349 $37,793,548 Association, specify your name and address gifts including gifts of cash, appreciated Contributions to building fund - - 26,407 - 26.407 35.731 and the name and address of the family to Special events 2.852.307 82,443 6.175 - 2.940.925 2.285.195 property, such as securities or real estate, which acknowledgement should be sent. and of life insurance, outright or in trust. Your Legacies and bequests(Note D) 12.445.982 1.039.375 199.613 30.584 13.715.554 14.085.522 Send this information with your donation to attorney can advise you how to bring your Total received directly 51.888.369 2.234.032 258,645 83.189 54,464,235 54,199,996 your local American Heart Association estate plans up-to-date, and can assist you Received indirectly- affiliate or to the local chapter nearest you. to consider ways in which a planned gift to Allocated by federated fund the American Heart Association may not raising organizations 3.657.750 3.755 - - 3.661.505 2.996.352 only support its work, but may also help to Allocated by unassociated and improve your income, lessen taxes, and nonfederated fund-raising organizations (net of their fund-raising costs) 1.824.960 545 - - 1.825.505 1.724.621 reduce the costs of probate. Total received indirectly 5,482,710 4.300 - - 5,487,010 4.720.973 Legacies and bequests are among the most Total support from public 57.371.079 2.238.332 258,645 83.189 59.951.245 58.920.969 frequently used methods of perpetuating the work of the American Heart Association. The Fees and grants from governmental 2.720.683 1.968.633 following form can be used to name the agencies 782.950 1.936.133 1,600 - Association as beneficiary in your will: Other revenue- Membership dues individuals 314.194 - - - 314.194 285,483 "Igive to the American Heart Association, Inc. a corporation organized under the Not- Program service fees and net for-Profit Corporation Law of the State of New incidental revenue 935.930 81.704 - - 1.017.634 1,067,677 York and having its principal office at 7320 Investment income (Note F) 6.081.486 180.856 32,285 20.863 6.315.490 5.375.072 Greenville Avenue, Dallas, Texas 75231, the Gains (losses) on investment transactions (51.788) (32.585) (28.632) (12.650) (125.655) - sum of dollars, to be used for the general Miscellaneous revenue 101.359 206.168 (3.334) - 304.193 205.574 purpose of such corporation." Totalother revenue 7.381.181 436.143 319 8.213 7.825.856 6.933.806 Similar forms may be obtained from your Total public support and revenue 65,535,210 4.610.608 260.564 91,402 70.497.784 67.823.408 local Heart Association for your attorney's EXPENSES: convenience. Program services- For information regarding gifts or bequests Research 17,088,595 1,275,975 31.344 - 18.395.914 17.897.746 for specific program purposes contact the Public health education 8.999.125 369,020 156.127 - 9.524.272 8.377.183 American Heart Association or the Heart Professional education and training 8.334.006 554,203 165,401 1,000 9.054.610 8.361.679 Community services 10.143.520 1.519.202 217.264 1,000 11.880.986 10,079,542 Association in your community. Total program services 44.565.246 3.718.400 570.136 2.000 48.855.782 44.716.150 Supporting services- Management and general 7,040,155 26.946 137.137 - 7.204.238 6.907.590 Fund raising 8.790.353 34.992 122.674 - 8.948.019 8.303.264 Total supporting services 15,830,508 61.938 259.811 - 16.152.257 15.210.854 Total program and supporting services expenses 60.395.754 3.780.338 829.947 2,000 65.008.039 59.927.004 Excess (deficit) of public support and revenue over expenses, before relocation costs and cumulative effect of accounting changes 5,139,456 830.270 (569.383) 89.402 5,489,745 7.896.404 RELOCATION COSTS of National Center (Note C) (1.277.070) - (15,010) - (1.292.080) - CUMULATIVE EFFECT OF ACCOUNTING CHANGES (Note E) (1,210,740) 215.204 (116.471) (39.898) (1,151.905) 777,477 Excess (deficit) of public support and revenue over expenses 2.651.646 1.045.474 (700,864) 49.504 3.045.760 8.673.881 OTHER CHANGES IN FUND BALANCES Property and equipment acquisitions from unrestricted and other designated funds (1.425.839) (117.152) 1.566.351 (23.360) - - FUND BALANCES. beginning of year (Note E) 75.337.418 4.701.516 8.213.041 1.214.725 89.466.700 80.792.819 FUND BALANCES, end of year $76,563,225 $5,629,838 $9,078,528 $1,240,869 $92.512.460 $89,466.700 The accompanying notes to financial statements are an integral part of this statement. 18 19 Note: This statement has been prepared by the National Center from the individual certified audit report of each affiliated association and is not covered by the report of Arthur Andersen & Co. Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 American Heart Association, Inc. and all affiliated Heart Associations COMBINED BALANCE SHEET - JUNE 30, 1975 and 1974 ASSETS 1975 1974 LIABILITIES AND FUND BALANCES 1975 1974 CURRENT FUNDS-UNRESTRICTED CURRENT FUNDS UNRESTRICTED CASH: ACCOUNTS PAYABLE AND ACCRUED EXPENSES $ 1.706.284 $ 1.525.556 Checking accounts $ 6.381.182 $ 5.935.773 ACCRUED RELOCATION COSTS-NATIONAL CENTER (Note C) 882.690 - Savings accounts 17.682.249 18.692.730 UNEXPENDED BALANCE OF RESEARCH, PROFESSIONAL EDUCATION AND SHORT-TERM INVESTMENTS, at cost, which approximates market value (Note F) 60.778.388 55.235.818 COMMUNITY PROGRAM AWARDS (Note A) 9.748.704 7.553.522 SUPPORT AND REVENUE DESIGNATED FOR FUTURE PERIODS 1.555.263 938.084 ACCRUED INVESTMENT INCOME 490,477 552.221 13.892.941 10.017.162 ACCOUNTS RECEIVABLE: Federated and nonfederated fund-raising organizations 1.590.784 2.130.727 FUND BALANCES (Note A): Other 1.184.595 1.058.216 Designated by the governing Boards for - Budgetary expenditures for the year commencing Julyl 52.598.909 54.189.021 EDUCATIONAL AND CAMPAIGN MATERIALS HELD FOR USE, Research awards 13.199.697 11.929.597 at first-in, first-out cost or market, whichever is lower 1.652.612 1.327.873 National center construction and relocation 2.850.070 3.568.233 PREPAID EXPENSES 461,391 219.658 Undesignated, available for program supplementation and contingencies 7.914.549 5,650,567 OTHER ASSETS 234.488 201,564 Totalfund balances 76.563.225 75.337.418 $90,456,166 $85,354,580 $90,456,166 $85,354,580 CURRENT FUNDS RESTRICTED CURRENT FUNDS RESTRICTED ACCOUNTS PAYABLE AND ACCRUED EXPENSES $ 39.224 $ 105,502 CASH: UNEXPENDED BALANCE OF RESEARCH, PROFESSIONAL Checking accounts $ 318.394 $ 264,973 EDUCATION AND COMMUNITY PROGRAM AWARDS - 172.011 Savings accounts 2.013.132 2.539.891 SUPPORT AND REVENUE DESIGNATED FOR FUTURE PERIODS 145.118 293.320 184.342 570.833 SHORT-TERM INVESTMENTS, at cost, which approximates market value (Note F) 2.825.715 2.021.804 FUND BALANCES: ACCRUED INVESTMENT INCOME 6.818 3.250 Designated by donors for - Research 4.778.050 3.994.449 ACCOUNTS RECEIVABLE 483.216 210,620 Public health education 144.464 117.064 GRANTS RECEIVABLE 147,351 95,547 Professional education and training 107.746 88.968 Community services 599.578 501.035 OTHER ASSETS 19,554 136.264 Total fund balances 5.629.838 4.701.516 $ 5.814.180 $ 5.272.349 $ 5.814.180 $ 5.272.349 LAND, BUILDING AND EQUIPMENT FUND LAND, BUILDING AND EQUIPMENT FUND CASH $ 21.911 $ 18,304 ACCOUNTS PAYABLE $ 37.752 $ 68.856 CONSTRUCTIONLOAN PAYABLE (Note C) 1.482.813 - SHORT-TERM INVESTMENTS. at cost, which approximates market value (Note F) 20.812 488,500 MORTGAGES PAYABLE 1.540.184 1.096.228 ACCRUED INVESTMENT INCOME 1.579 8.280 3.060.749 1.165,084 FUND BALANCES: NATIONAL CENTER DEVELOPMENT COSTS (Note C) 2,300,875 110.773 Expended 9.034.226 7.697.957 LAND. BUILDINGS AND EQUIPMENT at cost or appraised value, Unexpended restricted 44.302 515.084 less accumulated depreciation 9,794,100 8.752.268 Total fund balances 9.078.528 8.213.041 $12.139.277 $ 9.378.125 $12.139.277 $ 9.378.125 ENDOWMENT FUND ENDOWMENT FUND CASH in savings accounts $ 385.505 $ 333.946 ACCOUNTS PAYABLE $ 44,661 $ - INVESTMENTS, at cost, which approximates market value (Note F) 900,025 880.779 FUND BALANCE 1.240.869 1.214.725 $ 1.285.530 $ 1.214.725 $ 1.285.530 $ 1.214.725 The accompanying notes to financial statements are an integral part of this balance sheet. Note: This statement has been prepared by the National Center from the individual certified audit report of each affiliated association and is not covered by the report of Arthur Andersen & Co. 20 21 Source: https:/lwww.industrydocuments.ucsf.edu/docs/tInf02 American Heart Association, Inc. and all affiliated Heart Associations COMBINED STATEMENT OF FUNCTIONAL EXPENSES YEAR ENDED JUNE 30, 1975 WITH COMPARATIVE TOTALS FOR 1974 Program Services Supporting Services Total Program and Supporting Services Public Professional Expenses Health Education Management Research Education and Training Community and Fund Services Total General Raising Total 1975 1974 Salaries $ 791,421 $4,833,323 $3,764,723 $ 5,725,938 $15,115,405 $3.765,345 $4,528,990 $ 8.294.335 $23,409,740 $20,917,005 Payroll taxes, etc. 53,500 334,117 254,143 384.260 1.026.020 253.746 310.182 563.928 1.589.948 1.432.357 Employee benefits 77.206 365.545 318.207 404.337 1,165,295 345,231 304.954 650.185 1.815.480 1.605.113 Occupancy 96.223 511.785 423.029 563.465 1,594,502 393.491 407.531 801.022 2.395.524 2.323.774 Telephone 40.996 304.919 214.760 323,898 884,573 221.510 345.597 567.107 1.451.680 1.286.031 Supplies 35.965 223.169 190.196 287,058 736.388 187.428 227.774 415.202 1.151.590 1.020.550 Rental and maintenance of equipment 23.967 106.289 109.257 183,007 422.520 99,581 95,136 194.717 617.237 871.647 Printing and publications 50,070 987.453 850.046 529.103 2.416.672 189,141 1.013.400 1.202.541 3.619.213 3.024.560 Postage and shipping 34.985 351.235 245.046 327.422 958.688 186.826 503.476 690.302 1.648.990 1.457.238 Visual aids, films and media 4,651 310,631 135,710 351,433 802.425 36.518 151,043 187,561 989.986 987.219 Conferences. conventions and meetings Travel 103.813 236.019 674,218 392.668 1.406.718 408.978 200.174 609,152 2.015.870 1.747.753 Other direct expenses 4,127 41.128 507,864 19,846 572.965 27.877 19.603 47,480 620,445 551.922 Other travel 42.417 373,461 331,209 491,350 1.238.437 284.371 342.287 626.658 1,865,095 1.744.814 Professional fees 10.346 140.320 83.182 503.975 737.823 453.700 208.965 662,665 1,400,488 1.073.466 Awards and grants to individuals and other organizations 16.947.136 94,491 580.932 946.035 18.568.594 3.902 4.628 8.530 18.577.124 17.733.614 Other expenses 47,747 154,260 206.687 229.927 638.621 209.456 161.605 371,061 1.009.682 1.282.876 Total before depreciation and amortization 18,364,570 9.368.145 8.889.209 11.663.722 48.285,646 7.067.101 8.825.345 15.892.446 64.178.092 59.059.939 Depreciation and amortization of buildings, equipment and improvements 31,344 156.127 165,401 217.264 570.136 137.137 122.674 259.811 829.947 867.065 Total functional expenses $18,395,914 $9,524,272 $9,054,610 $11,880,986 $48,855,782 $7.204.238 $8.948,019 $16,152,257 $65,008,039 $59,927,004 The accompanying notes to financial statements are an integral part of this statement Note: This statement has been prepared by the National Center from the individual certified audit report of each affiliated association and is not covered by the report of Arthur Andersen & Co. 22 23 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 NOTES TO COMBINED FINANCIAL STATEMENTS American Heart Association, Inc. (National Center) (A) SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (B) TAX STATUS: Standards of Accounting and Reporting The Association is exempt from income taxes under Section STATEMENT OF SUPPORT, REVENUE AND EXPENSES AND CHANGES IN FUND BALANCES The Association follows the standards of accounting and 501(c)(3) of the U.S. Internal Revenue Code: has been determined to be an organization which is not a private YEAR ENDED JUNE 30, 1975 WITH COMPARATIVE TOTALS FOR 1974 financial reporting for voluntary health and welfare agencies prescribed by the National Health Council. the National foundation; and is qualified for the 50% charitable contributions Assembly of National Voluntary Health and Social Welfare deduction. Current Funds Organizations and United Way of America. These standards are Building and Total All Funds inconformity with the recommendations of the American (C) NATIONAL CENTER CONSTRUCTION AND RELOCATION: Equipment Endowment Institute of Certified Public Accountants which became In prior years. the Board of Directors authorized the construction Unrestricted Restricted Fund Fund of a National Center office building in Dallas, Texas. and 1975 1974 effective in fiscal 1975. In accordance with these standards, expenditures for buildings and equipment and the fair value of designated funds for construction and relocation PUBLIC SUPPORT AND REVENUE: donated equipment are capitalized Depreciation is recorded The National Center initiated the move to Dallas during the year Public support- over the estimated useful lives of the assets. Investments are ended June 30. 1975. and all estimated relocation costs have stated at cost. All contribu utions are considered available for the been accrued and charged to expense National Center share of campaign general programs of the Association, unless specifically The National Center obtained a $3,000,000 line of credit and a contributions and bequests (Note 1) $14,215,881 $262,609 $ $ - $14,478,490 $14,202,372 restricted by the donor. Interfund receivables and payables. commitment for an additional $1,000,000 line, with interest at the arising from transactions which are to be completed after year- Contributions to building fund - - 22.948 - 22.948 35.731 floating prime rate (7% at June 30. 1975), from a Dallas bank to end. have been eliminated finance construction and relocation costs Asof June 30. 1975, Contributed by affiliated organizations The amounts shown for 1974 in the accompanying financial the National Center was committed for approximately (net of their fund raising costs estimated statements are presented in accordance withthe $1,600.000 of additional construction costs. recommendations of the American Institute of Certified Public at $40,046 in 1975 and $27,134 in 1974) - 294.458 - - 294.458 195.209 Accountants, This financial information included to provide a (D) LEGACIES IN PROCESS basis for comparison with 1975. and, other than for the balance The Association is the beneficiary under various wills and trust Total support from public 14.215.881 557.067 22.948 - 14.795.896 14.433.312 sheet presents summarized totals only, Accordingly, the 1974 agreements, the total realizable amount of which not Fees and grants from governmental amounts are not intended to present all information necessary presently determinable Such amounts will be recorded when for a fair presentation in accordance with generally accepted clear title is established and the proceeds are measurable. agencies - 222.927 - - 222.927 227.157 accounting principles. Certain amounts for 1974 have been reclassified to conform with the presentation used in the 1975 (E) ACCOUNTING CHANGES AND PRIOR YEAR Other revenue- financial statements FINANCIAL STATEMENTS Membership dues council membership 91,060 - - - 91,060 72,615 Effective July 1974 the Association changed its accounting Awards and Grants- Program service fees 405.997 - - - policy to conform with the "Standards of Accounting and 405.997 355.969 The Association's awards for research grants- in aid, Financial Reporting for Voluntary Health and Welfare Investment income and miscellaneous investigators. fellowships and professional education generally Organizations' as revised during fiscal 1975 (see Note A) (Note 2) 1,575,186 7.224 26.978 - cover a period of from one to five years, subject to annua 1.609.388 1.575.147 Accordingly, in most instances the comparative financial renewal at the option of the Association The liability for awards information as of June 30. 1974 has been retroactively restated Gains (losses) on investment transactions - (9.681) - (12,650) (22.331) 21.208 is recorded on an annual basis upon notification to the recipient to reflect these changes in accounting procedure Where at the time of approval or renewal (see Note E). restatement was not practicable or appropriate the cumulative Total other revenue 2.072.243 (2,457) 26.978 (12.650) 2.084.114 2.024.939 Continuing awards and awards granted in the future will be effect of the change has been reflected in the current year's financial statements, Total public support and revenue 16.288.124 777.537 49.926 (12.650) 17.102.937 16.685.408 made from the Current Unrestricted Fund Balance designated for research of $13,199,697. from donor restricted funds of $4,778,050 and from contributions received in future years. (F) INVESTMENTS All investments, other than endowment securities, are on a short- EXPENSES: Available Funds- term basis. Income from investments carried in all funds is Program services - The expenditures for each fiscal year are financed principally credited directly to Current Unrestricted Funds unless such income is restricted by the contributors. Research 7.777.772 496.204 7,997 - by funds received from the campaign of the previous year. 8.281.973 7.507.009 Accordingly, the campaign income shown in the Public health education 1.075.312 9,032 14.873 - 1.099.217 1.062.137 accompanying statementof support revenue and expenses Professional education and training 2.481.862 203.967 27.983 - and changes in fund balances will be available for research 2.713.812 2.483.811 awards and for programs and operations budgeted for the Community services 1.166.194 11,441 10.250 - 1.187.885 1.055.192 ensuing fiscal year. Total program services 12.501.140 720,644 61.103 - 13.282.887 12.108.149 Designated for Program Supplementation and Contingencies Supporting services- This portion of the Current Unrestricted Fund Balance. which Management and general 1,435,908 30.949 25,425 - 1.492.282 1.409.984 may be utilized by specific action of the various governing Fund raising 824,007 20.356 8.205 - Boards, is reserved for the continuity of the Association's general 852.568 731.906 activities. its scientific research program and to meet Total supporting services 2.259.915 51,305 33.630 - 2.344.850 2.141.890 emergency demands Total program and supporting services expenses 14.761.055 771.949 94.733 - 15.627.737 14.250.039 Excess (deficit) of public support and revenue over expenses, before relocation costs and cumulative effect of accounting change 1,527.069 5,588 (44,807) (12.650) 1.475.200 2,435,369 RELOCATION COSTS (Note 3) (1,277,070) - (15.010) - (1.292.080) - CUMULATIVE EFFECT OF ACCOUNTING CHANGE Research Expenses (Note 8) (549.278) - - - (549.278) - Excess (deficit) of public support and revenue over expenses (299.279) 5,588 (59.817) (12.650) (366.158) 2.435.369 OTHER CHANGES IN FUND BALANCES: Property and equipment acquisitions from unrestricted funds (Notes and 8) (225.205) - 225.205 - - - FUND BALANCES, beginning of year 19.510.077 725,893 752.924 339.914 21.328.808 18.893.439 FUND BALANCES, end of year $18,985,593 $731,481 $918.312 $327,264 $20.962.650 $21,328.808 See accompanying notes to financial statements. 24 25 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227

Mention the first "POUNDS" value mentioned under "Desirable Weight"?

mgxh0227

mgxh0227_p0, mgxh0227_p1, mgxh0227_p2, mgxh0227_p3, mgxh0227_p4, mgxh0227_p5, mgxh0227_p6, mgxh0227_p7, mgxh0227_p8, mgxh0227_p9, mgxh0227_p10

110

SCIENTIFIC BASES FOR THE RECOMMENDED ALLOWANCE 47 L CALORIES dedail (over) Calorie allowances have been established in all previous editions of Recommended Dietary Allowances with the objective of provision of energy in amounts sufficient when consumed over an extended period to maintain body weight or rates of growth at levels most conducive to well being and health. This general principle is reaffirmed and allowances have been carefully reevaluated with consideration of the results of a large number of investigations of human energy requirements. Qalorie állowances were modified in the last revision of had been Recommended Dietary Allowances to conform with certain standards and conditions established by the Food and Agricultural Organization of the United Nations through its International 8 Committee on Calorie Requirements + A second FAO Report on Calorie Requirements has recently been published in which a number of modifications have been made in the specification 9. of calorie requirements I. These have been considered in the preparation of this revision of Recommended Dietary Allowances. Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 2 - In specifying requirements for calories for individuals, the FAO committee utilized the device of the "reference" man and woman, both aged 25 and living in a temperate climate with a mean annual external of 10 degrees Centigrade. The weight of the "reference man" was given as 65 kilograms and was 55 kólograms for the "reference woman". Recommended Dietary Allowances adapted the same basis of reference in its 1953 revision. These characteristics cannot be considered average 10 for the young adult population of the United States, however. Therefore, in the present statement certain adaptations have been made to permit establishment of reference conditions more nearly conforming with United States standards of body size and living conditions. The "reference" man is again taken as of age 25 but the weight is given as 70 kólograms which would seem to be more nearly descriptive of the average young male in this population. Similarly, the "reference" woman is described as being 25 years of age but weighing 58 kólograms. Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 3 - Another modification is to establish allowances assuming that individuals are living in an environment with a mean environ- o C mental temperature of 20 degrees centigrade rather than the lower temperature given by FAO. This would again seem to be a more realistic description of the mean environmental temperature of most of the population of the United States. Both man and woman are presumed to lead a vigorous, healthy life and to be moderately active physically, with occupations which could not be described either as sedentary or as hard physical labor. The man would be likely to be in light industry or employed as delivery man, painter or outdoor salesman. The woman might be homemaker, saleswoman or bench worker in a factory. The daily allowances/ as derived for the "reference man" is 3200 calories and for the "reference" woman is 2300 calories. It should be realized that adjustments must be made in calorie allowances when individuals or population averages differ from the "reference" in characteristics of age, body Source: https://www.industrydocuments.ucst.edu/docs/mgxh0227 - 4 - size, climate or activity. Procedures for these adjustments are described below. Adjustments of Calories for Age - - Energy requirements decline progressively after the years of early adulthood, because of a decrease in basal metabolic rate as well as lessened physical activity. It is proposed that calorie allowances be reduced by 3 per cent per decade between ages 30 and 50 and by 7.5 per cent per decade from age 50 to 70. A further decreasement of 10 per cent is recommended for the years from 70 to 80. These adjustments are in accord with 9 FAO recommendations X Accordingly, the calórie allowances at age 45 are 6 per cent less than at age 25 and at age 65 are 21 per cent less (See Tolile II ). Adjustment for Body Size - - Calorie allowances must be adjusted for the variations in energy requirements which result from differences in body size. Therefore, in utilizing the allowances giver in the table, larger allowances must be Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 5 - derived for individuals of body size greater than indicated for the reference man and woman and smaller allowances should be prescribed for those of smaller size. In adapting allowances for differences in size, weight may be used as a basis provided the subjects are not overweight or underweight. Maximum body length (height) is usually attained by age 20 or shortly there- after, but in the United States the average person tends to continue to gain in body weight until about 60 years of age. Life insurance and other data indicate that these weight gains are undesirable and that the most favorable health expectation is associated with conditions under which weight as normally achieved by age 25 or 30 is maintained throughout later bife. Therefore, in these recommendations the calorie allowances for adults pertain not to actual body weight of individuals or groups but to desirable body weight (the average weight separd of individuals of given height at age 25). Table I may be used as a guide for this use and adaptation. Heights and weights Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 TABLE II Individuals Marious Calorie / allowances for men of Marred Body Weights and age 15 (as meanenvermental temperature 32 of 20 Centegrade and assuming moderate physics activity I MEN Calorie allowances Deserable Weight Kelogram Pounds 25 years 45 years 65 years 50 110 2500 2350 1950 55 121 2700 2550 2150 60 132 2850 2700 2250 65 143 3000 2800 2350 70 154 3200 3000 2550 75 165 3400 3200 2700 80 176 3550 3350 2800 85 187 3700 3500 2900 Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227 (tableth Calorie Allowanes for Women of Various Body Weight and age WOMEN 63 Deserable Weight Cultrie allowares 22 45 58 Pounds 70 Kelograms 25 years 45 15 years 65 years 40 88 1750 1650 1400 45 99 1900 1800 1500 50 110 2050 1950 1600 5T5 121 2200 2050 1750 58 128 2:300 2200 1800 60 132 2350 2200 1850 65 143 2500 2350 2000 70 154 2600 2450 2050 75 165 2750 2600 2150 Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 6 - usually as recorded include usual clothing worn indoors and shoes with one-inch - heels. ( Quest Table altop of page 5 To adapt calorie allowances for individuals whose weight and height are different from those of the reference man and a woman, the following formulae have been utilized 1, Calorie allowance for men - - - 815 + 36.6 W* Calorie allowance for women - - 580 + 31.1 W* * W = desirable body weight in kilograms By such adaptation the allowances for 25 year old men weighing 50, 60 and 80 kilograms would be 2500, 2850, and 3550 calories respectively. Women of the same age weighing 40, 50, 60 and 70 kilograms would receive 1750, 2050, 2350, and 2600 calories respectively. Adjustment by weight in pounds to other body sizes may be facilitated by reference to Table II . (Insert Table II) Adjustment of Calories for Climate - Standard conditions for estimating calorie allowances include mean environmental C temperature of 20° centigrade rather than 10° centigrade as Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227 - 7 - established by the FAO committee which was utilized in the 1953 revision of Recommended Dietary Allowances. It seems probable that most persons in the United States live in an environment with a mean temperature of approximately 20° centigrade. Most are protected against the effects of cold by warm clothes, central heating and heated means of transportation. Many also live and work in ir-conditioned atmospheres so that the effects of high temperatures are partially but not so completely ameliorated. If the external temperature varies widely from the standard, 2 corrections in calorie allowances may be made. For lower tempera- tures there is need for an increase in allowance. To accomplish increased this the allowance should be /reduced/by 5% for the first ten C degree centigrade decrease from the standard of 20° centigrade and by 3% for each additional ten degree decrease. Similarly, allowances should be reduced for high environmental temperatures and the reduction should be 5% for each increase of ten degrees Source: https://wwww.industrydocuments.ucsf.edu/docs/mgxh0227 - 8 - centigrade above the standard temperature, (20%). These adjustments are devised specifically for application to differences in mean annual temperature, but they may well serve for adjustment to seasonal differences as well. In various parts of the United States the difference in mean winter and summer temperatures may range from 10 degrees C to centegrade 30 degrees C. This would indicate corrections of from 5 to 15 per cent in the calorie allowances according to conditions. It should be observed that all adjustments for climate pre- suppose an ordinary amount of actual exposure to the climate. For persons spending most of their time out of doors, these adjustments may be insufficient, particularly during winter in the Northern and Central States. It is obvious that people who spend almost all their time in well heated buildings during the winter will not need the extra food calories required by individuals less effectively sheltered. When applying these adjustments of allowances for individuals or groups, duration Source: https://www.industrydocuments.ucsf.edu/docs/mgxh0227 - 9 - of exposure to outside weather should be ascertained and taken into account. Source: https:/lwww.industrydocuments.ucsf.edu/docs/mgxh0227

to which year is the statement compared to?

tlnf0227

tlnf0227_p13, tlnf0227_p14, tlnf0227_p15, tlnf0227_p16, tlnf0227_p17, tlnf0227_p18, tlnf0227_p19, tlnf0227_p20, tlnf0227_p21, tlnf0227_p22, tlnf0227_p23, tlnf0227_p24, tlnf0227_p25, tlnf0227_p26, tlnf0227_p27, tlnf0227_p28, tlnf0227_p29, tlnf0227_p30, tlnf0227_p31, tlnf0227_p32

1974

NOTES TO COMBINED FINANCIAL STATEMENTS American Heart Association, Inc. (National Center) (A) SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (B) TAX STATUS: Standards of Accounting and Reporting The Association is exempt from income taxes under Section STATEMENT OF SUPPORT, REVENUE AND EXPENSES AND CHANGES IN FUND BALANCES The Association follows the standards of accounting and 501(c)(3) of the U.S. Internal Revenue Code, has been determined to be an organization which is not a private YEAR ENDED JUNE 30, 1975 WITH COMPARATIVE TOTALS FOR 1974 financial reporting for voluntary health and welfare agencies prescribed by the National Health Council, the National foundation; and is qualified for the 50% charitable contributions Assembly of National Voluntary Health and Social Welfare deduction. Current Funds Building and Total All Funds Organization and United Way of America. These standards are inconformity with the recommendations of the American (C) NATIONAL CENTER CONSTRUCTION AND ELOCATION: Equipment Endowment Institute of Certified Public Accountants which became Inprior years, the Board of Directors authorized the construction Unrestricted Restricted Fund Fund 1975 1974 effective in fiscal 1975. In accordance with these standards, ofa National Center office building in Dallas, Texas, and expenditures for buildings and equipment and the fair value of designated funds for construction and relocation, PUBLIC SUPPORT AND REVENUE: donated equipment are capitalized Depreciation is recorded The National Center initiated the move to Dallas during the year Public support- over the estimated useful lives of the assets. Investments are ended June 30. 1975 and all estimated relocation costs have stated at cost. All contributions are considered available for the been accrued and charged to expense National Center share of campaign general programs of the Association, unless specifically The National Center obtained a $3,000,000 line of credit and a contributions and bequests (Notel) $14,215,881 $262,609 $ $ $14,478,490 $14,202,372 restricted by the donor. Interfund receivables and payables. commitment for an additional $1,000,000 line, with interest at the Contributions to building fund - - 22.948 - 22,948 35.731 arising from transactions which are to be completed after year- floating prime rate (7% at June 30. 1975). from a Dallas bank to end, have been eliminated finance construction and relocation costs. As of June 30. 1975. Contributed by affiliated organizations The amounts shown for 1974 in the accompanying financial the National Center was committed for approximately (net of their fund raising costs estimated statements are presented in accordance with the $1.600.000 of additional construction costs. at $40,046 in 1975 and $27,134 in 1974) - 294.458 - - 294,458 195.209 recommen dations of the American Institute of Certified Public Accountants. This financial information is included to provide a (D) LEGACIES IN PROCESS Total support from public 14,215,881 557.067 22.948 - 14,795,896 14.433.312 basis for comparison with 1975. and, other than for the balance The Association is the beneficiary under various wills and trust sheet. presents summarized totals only Accordingly. the 1974 agreements. the total realizable amount of which is not Fees and grants from governmental amounts are not intended to present all information necessary presently determinable Such amounts will be recorded when agencies - 222.927 - - 222.927 227.157 for a fair presentation in accordance with generally accepted clear title is established and the proceeds are measurable. accounting principles. Certain amounts for 1974 have been Other revenue reclassified to conform with the presentation used in the 1975 (E) ACCOUNTING CHANGES AND PRIOR YEAR financial statements. FINANCIAL STATEMENTS Membership dues council membership 91,060 - - - 91.060 72.615 Effective July 1974, the Association changed its accounting Program service fees 405,997 - - - 405.997 355.969 Awards and Grants policy to conform with the "Standards of Accounting and The Association's awards for research grants- in- aid, Financial Reporting for Voluntary Health and Welfare Investment income and miscellaneous investigators. fellowships and professional education generally Organizations as revised during fiscal 1975 (see Note. A) (Note 2) 1,575,186 7.224 26.978 - 1.609.388 1.575.147 cover a periodo of from one to five years. subject to annual Accordingly, in most instances the comparative financial Gains (losses) on investment transactions - (9.681) - renewal at the option of the Association The liability for awards information as of June 30. 1974has been retroactively restated (12,650) (22.331) 21.208 is recorded on an annual basis upon notification to the recipient to reflect these changes in accountir procedure. Where Total other revenue 2.072.243 (2,457) 26.978 (12,650) 2.084.114 2.024.939 at the time of approval or renewal (see Note E). restatement was not practicable or appropriate the cumulative Continuing awards and awards granted in the future will be effect of the change has been reflected in the current year's Total public support and revenue 16.288.124 777.537 49.926 (12,650) 17.102.937 16.685.408 made from the Current Unrestricted Fund Balance designated financial statements. for research of $13,199,697. from donor restricted funds of $4,778,050 and from contributions received in future years. (F) INVESTMENTS: All investments, other than endowment securities. are or a short- EXPENSES Available Funds- term basis. Income from nvestments carried in all funds is Program services The expenditures for each fiscal year are financed principally credited directly to Current Unrestricted Funds unless such Research 7.777.772 496,204 7.997 - 8.281.973 7,507,009 by funds received from the campaign of the previous year. income is restricted by the contributors. Accordingly, the campaign income shown in the Public health education 1.075.312 9,032 14,873 - 1,099,217 1,062,137 accompanying statement of support. revenue and expenses Professional education and training 2,481,862 203.967 27.983 - 2.713.812 2,483,811 and changes in fund balances will be available for research Community services 1,166,194 11.441 10.250 - 1,187,885 1.055.192 awards and for programs and operations budgeted for the ensuing fiscal year. Total program services 12,501,140 720,644 61.103 - 13.282.887 12.108.149 Designated for Program Supplementation Supporting services- and Contingencies- This portion of the Current Unrestricted Fund Balance. which Management and general 1,435,908 30,949 25,425 - 1.492.282 1,409,984 may be utilized by specific action of the various governing Fund raising 824,007 20,356 8.205 - 852.568 731.906 Boards is reserved for the continuity of the Association's general activities. its scientific research program and to meet Total supporting services 2,259,915 51,305 33.630 - 2,344,850 2.141.890 emergency demands. Total program and supporting services expenses 14,761,055 771,949 94,733 - 15.627.737 14.250.039 Excess (deficit) of public support and revenue over expenses, before relocation costs and cumulative effect of accounting change 1,527,069 5,588 (44.807) (12,650) 1.475.200 2,435,369 RELOCATION COSTS (Note 3) (1,277,070) - (15,010) - (1.292.080) - CUMULATIVE EFFECT OF ACCOUNTING CHANGE Research Expenses (Note 8) (549,278) - - - (549.278) - Excess (deficit) of public support and revenue over expenses (299.279) 5,588 (59.817) (12.650) (366.158) 2,435,369 OTHER CHANGES IN FUND BALANCES Property and equipment acquisitions from unrestricted funds (Notes and 8) (225,205) - 225.205 - - - FUND BALANCES. beginning of year 19.510.077 725,893 752,924 339.914 21.328.808 18.893.439 FUND BALANCES. end of year $18,985,593 $731,481 $918,312 $327,264 $20.962.650 $21,328,808 See accompanying notes to financial statements. 24 25 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 American Heart Association, Inc. (National Center) BALANCE SHEET - JUNE 30, 1975 AND 1974 ASSETS 1975 1974 LIABILITIES AND FUND BALANCES 1975 1974 CURRENT FUNDS-UNRESTRICTED CURRENT FUNDS-UNRESTRICTED CASH $ 930,505 $ 118,109 ACCOUNTS PAYABLE AND ACCRUED EXPENSES $ 772.814 $ 745.844 CERTIFICATES OF DEPOSIT AND U.S. TREASURY BILLS, at cost, ACCRUED RELOCATION COSTS (Note 3) 882.690 - which approximates market (Note 2) 13.502.628 13.591.866 UNEXPENDED BALANCE OF RESEARCH GRANTS IN AID, INVESTIGATORS, FELLOWSHIPS AND ACCRUED INVESTMENT INCOME 62,477 186.346 PROFESSIONAL EDUCATION AWARDS. payable within one year (Notes and 8) 8.073.496 6.840.212 DUE FROM AFFILIATES: NET UNEXPIRED SUBSCRIPTIONS TO PROFESSIONAL PUBLICATIONS 181,000 90,000 Campaign contributions (Notel) 12.145,466 11.569.365 9.910.000 7.676.056 Educational and campaign materials purchased 351.947 323.111 FUND BALANCE (Note 1): Notes receivable 206.435 89,500 Designated by the Board for - Programs and operations for the ensuing year (Note 6) 6.403.375 6,346,665 INVENTORY OF EDUCATIONAL AND CAMPAIGN MATERIALS, at first-in, first-out cost Research 9.302.317 8.562.338 or market, whichever is lower 1.131.422 945,053 Relocation (Note 3) - 1.000.000 National center (Note 3) 2.850.070 2.567.233 Program supplementation and contingencies 429.831 1.033.841 OTHER RECEIVABLES AND PREPAID EXPENSES 564,713 362.783 Total fund balance 18.985.593 19.510.077 $28,895,593 $27.186.133 $28,895,593 $27.186.133 CURRENT FUNDS-RESTRICTED CURRENT FUNDS RESTRICTED CASH $ 99,392 $ 67,573 FUND BALANCE: MARKETABLE SECURITIES, at cost, which approximates market (Note 2) 162,914 133.199 DUE FROM AFFILIATES: Designated by donors for - Campaign contributions 172.921 367,911 Research $ 462.291 $ 526.466 Cooperative research 233,001 116,735 Other 269,190 199,427 GRANTS RECEIVABLE 63.253 40,475 $ 731,481 $ 725,893 $ 731,481 $ 725.893 BUILDING AND EQUIPMENT FUND BUILDING AND EQUIPMENT FUND CASH $ - $ 18.304 CONSTRUCTIONNOTE PAYABLE (Note 3) $ 1,482,813 $ - CERTIFICATES OF DEPOSIT AND SHORT-TERM COMMERCIAL NOTES, at cost, which approximates market (Note 2) - 486,000 ACCRUED INVESTMENT INCOME - 8,280 FUND BALANCE: NATIONAL CENTER DEVELOPMENT COSTS (Notes 3 and 4) 2.300.875 110,773 Net investment in building and equipment 918,312 240.340 Unexpended-restricted - 512.584 EQUIPMENT at cost or appraised value, less accumulated depreciation of $418,157 in1975 and $323.424 in 1974 (Note 4) 100,250 129,567 Totalfund balance 918.312 752.924 $ 2,401,125 $ 752.924 $ 2,401,125 $ 752.924 ENDOWMENT FUND ENDOWMENT FUND ACCRUED INVESTMENT INCOME $ 4,785 $ 2,815 MARKETABLE SECURITIES, at cost. which approximates market (Note 2) 322,479 337,099 FUND BALANCE $ 327.264 $ 339.914 $ 327,264 $ 339,914 $ 327.264 $ 339.914 See accompanying notes to financial statements. 26 27 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 American Heart Association, Inc. (National Center) STATEMENT OF FUNCTIONAL EXPENSES YEAR ENDED JUNE 30, 1975 WITH COMPARATIVE TOTALS FOR 1974 Program Services Supporting Services Total Program and Supporting Services Public Professional Expenses Health Education Management Research Education and Training Community and Fund Services Total General Raising Total 1975 1974 Salaries $ 277.005 $ 515,137 $ 865.826 $ 424.613 $ 2.082.581 $ 698.175 $341.036 $1,039,211 $ 3.121.792 $ 2.915.012 Payroll taxes, etc. 16.999 31,020 47.283 23.186 118,488 35.984 19.699 55,683 174,171 168.782 Employee benefits (Note 5) 31.171 62.823 97.128 49.214 240.336 69,860 41.805 111.665 352.001 319.017 Occupancy 41,698 60,223 100.935 44.855 247.711 71.127 38.517 109.644 357.355 376.067 Telephone 14,644 31,040 41.362 24.303 111.349 35.962 20.608 56.570 167.919 156.686 Supplies 12,754 20.500 35.826 11,847 80.927 31,179 11.966 43,145 124.072 124.929 Rental and maintenance of equipment 15.595 21,426 39,439 13.335 89.795 30.951 12,531 43,482 133.277 101.195 Printing and publications (Notel) 20.977 120.726 283.838 65,473 491,014 41.352 124.600 165.952 656.966 490.356 Postage and shipping 10.773 19,167 29.963 12.254 72,157 19,195 11.641 30.836 102.993 121.637 Visual aids, films and media 1.202 90,573 25.233 178.886 295,894 7,210 64.706 71.916 367.810 314.125 Conferences, conventions and meetings: Travel 76.244 21.080 323,686 83.338 504.348 192,464 53.386 245.850 750.198 823.043 Other direct expenses - - 412.961 - 412.961 1,465 - 1,465 414.426 312.200 Other travel 12,177 29.356 55,008 49.810 146,351 80.269 37.344 117.613 263.964 266.990 Professional fees 892 33.224 18,071 22.385 74.572 65,139 45,602 110.741 185.313 135,422 Awards and grants (Note 8) 7,719,497 17.041 200,382 166.594 8.103.514 31,317 9.876 41.193 8.144.707 7.345.430 Other expenses 22,348 11,008 108.888 7.542 149.786 55.208 11.046 66.254 216.040 186.607 Total before depreciation and amortization 8.273.976 1.084.344 2.685.829 1.177.635 13.221.784 1,466,857 844.363 2.311.220 15.533.004 14.157.498 Depreciation and amortization (Notes 4 and 8) 7.997 14,873 27.983 10.250 61,103 25,425 8.205 33,630 94.733 92,541 Total functional expenses $8.281.973 $1,099,217 $2.713.812 $1,187,885 $13.282.887 $1,492,282 $852,568 $2,344,850 $15,627,737 $14,250.039 See accompanying notes to financial statements. 28 29 Source: :https://www.industrydocuments.ucsf.edu/docs/tInf0227 AUDITORS' REPORT AMERICAN HEART ASSOCIATION, INC. (NATIONAL CENTER) (2) INVESTMENTS All investments other than endowment securities. are on a short- To the Board of Directors of NOTES TO FINANCIAL STATEMENTS term basis. Income from investments carried in all funds is American Heart Association, Inc. credited directly to the Current Unrestricted Fund unless such (1) SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: income is restricted by the contributors We have examined the balance sheet of National Center- (3) NATIONAL CENTER: American Heart Association, Inc (National The accompanying financial statements reflect the accounts of In prior years the Board of Directors authorized the construction American Heart Association Inc. (National Center), and do not of a National Center in Dallas, Texas. and designated funds for Center a New York not-for-profi corporation) as include the accounts of affiliated associations which are construction and relocation of June 30, 1975. and the related statements of maintained individually by such associations Contribution are The Association initiated the move to Dallas during the year support, revenue and expenses and changes in received principally by the affiliated associations and are ended June 30. 1975. and all estimated relocation costs have shared with the National Center The National Center's share of fund balances and of functional expenses for the been accrued and charged to expense contributions and bequ jests reflected in these financial year then ended. We have also examined the statements for 1975 was $14,478 490 and $14.202 372 for 1974 The Association obtained a 3.000.000 line of credit and The related fund raising costs of affiliated associations were commitment for an additional $1,000.000 line with interest at the restated financial information for 1974 presented approximately $2.028.000 in 1975 and $1,869,000 in 1974. floating prime rate (7% at June 30 1975), from a Dallas bank to for comparative purposes. Our examinations finance construction and relocation costs. During 1975, an were made in accordance with generally Standards of Accounting and Reporting - average of $340.00 was outstanding under the line at an accepted auditing standards. and accordingly The Association follows the standards of accounting and average interest rate of 7.6%. The maximum balance outstanding was $1 1.482 813 Subsequent to year end additional included such tests of the accounting records financial reporting for voluntary health and welfare agencies prescribed by the National Health Council, the National draws were made on the line as construction on the building and such other auditing procedures as we Assembly of National Voluntary Health and Social Welfare progressed. The balance is due on July 1976 Alternative long considered necessary in the circumstances. Organizations and United Way of America. These standards are term financing methods are being considered As discussed in Notes and 8 to the financial in conformity with the recommendations of the American Asof June 30. 1975 the Association was committed for Institute of Certified Public Accountant which became approximately $1 600,000 of additional capital expenditures statements, the Association has changed its effective in fiscal 1975 (see Note 8) In accordance with these related to facilities of the National Center. methods of accounting for fringe benefits on standards expenditures for buildings and equipment and the research awards and for the costs of building and fair value of donated equipment are capitalized Depreciation (4) BUILDING AND EQUIPMENT: is recorded over the estimated useful lives of the assets. Depreciation of equipment is recorded on the straight line basis equipment additions and related depreciation. Investments are stated at cost All contributions are considered over the estimated useful lives of the assets. In our opinion, the accompanying financial available for the general programs of the Association unless No depreciation was recorded on the uncompleted National statements present fairly the financial position of specifically restricted by the donor. Interfund receivables and Center during 1975 will be depreciated on the straight line payables. arising from transactions which are to be completed basis over 40 years beginning December 1975 The building is American Heart Association, Inc (National after year end, have been eliminated situated or a donated leasehold The fair rental value of the Center) as of June 30, 1975, and its support, The amounts shown for 1974 in the accompanying financial leasehold will be recorded each year as a donation and revenue and expenses and changes in fund statements are presented in accordance with the corresponding expense when the building is put in service. balances for the year then ended, in conformity recommendation of the American Institute of Certified Public Accountants. This financial information is included to provide a (5) RETIREMENT PLAN: with generally accepted accounting principles. basis for comparison with 1975. and, other than for the balance The Association provides retirement benefits for substantially all In our opinion, except for the change (with which sheet. presents summarized totals only. Accordingly the 1974 employees and certain research awardees through individual amounts are not intended to present all information necessary annuities with Teachers Insurance and Annuity Association and we concur) in the method of accounting for fringe College Retirement iquities Fund Retirement benefits equal the benefits described in Note 8. the accounting for a fair presentation in accordance with generally accepted accounting principles In addition to the accounting changes amount accumulated to the imployees' individual credit at the principles were applied on a basis consistent with discussed in Note 8. certain amounts for 1974 have been date of retirement. All costs of the Plan are borne by the that of the preceding year, after giving reclassified to conform with the presentation used in the 1975 Association except that norder to increase benefits. a participant may at his election contribute a portion of his retroactive effect to the change (with which we financial statements. compensation The Plan costs to the Association for the years concur) in the method of accounting for building Awards and Grants- ended June 30. 1975 and 1974 were 4.000 and $266.000 for and equipment additions and related The Association's awards for research grants- in aid, employees and $325,000 and $316,000 for research awardees. depreciation discussed in Notes and 8. investigators. fellowships and professional education generally respectively cover a period of from one to five years, subject to annual The Pension Reform Act of 1974 requires the Association to Also, in our opinion, the financial information for renewal at oppion of the Association The liability for awards amend its Plan to conform with certain provisions of the Act. 1974, which has been restated for the change in is recorded on an annual basis upon notification to the recipient which will become effective in 1976. The Association estimates method of accounting for building and at the time of approval or renewal (see Note 8). that there will be no significant increase in the costs of the Plan equipment additions and related depreciation The aggregate contingent liability for payment of continuing as a result of the changes awards beyond the currently authorized year is estimated to be and is presented for comparative purposes (see S11 350 June 30. 1975. In addition, thirteen Career (6) OTHER COMMITMENTS: Notes and 8). presents fairly the information set Investigator Awards have been approved by the Board of The Association's lease agreements for office and warehouse forth therein. Directors providing salary and laboratory expenses for the space. which expire through 1979 provide for annual rental recipients, the aggregate contingent liability for such awards payments of $369 000 in 1976 (including $120,00 of unexpired Arthur Andersen & Co. (assuming payment to normal refirement date of each lease commitments on office space vacated in connection with Investigator) is estimated to be $6,000.000. Thus, the total the relocation. which has been expensed as discussed in Note Dallas, Texas, contingent liability for awards and grants at June 30. 1975 is 3). $14,500 in 1977 and $12,000 in 1978. December 5, 1975. estimated to be $17 .350.000. Continuing awards and awards granted in the future will be (7) TAX STATUS: The Association is exempt from income taxes under Section made from the Current Unrestricted Fund Balance designated for research of $9,302,317 from donor restricted funds 501(c)(3) of the U.S. Internal Revenue Code, has been determined to be an organization which not a private $462.29 and from contributions received in future years. foundation; and is qualified for the 50% charitable contributions Educational and Campaign Materials- deduction. Included in printing and publications expenses for 1975 and 1974 are net costs attributable to distribution of educational and (8) ACCOUNTING CHANGES AND PRIOR YEAR campaign materials and professiona pi oublications. The FINANCIAL STATEMENTS: Association absorbs costs for such items in excess of the Prior to July .1974. the costs of building and equipment amounts charged to affiliates and others. Amounts charged in additions were expensed in the Current Unrestricted Fund in the 1975 and 1974 were $2 919. 334, and $2,529,525; costs were year of acquisition. The cost and accumulated depreciation for $3.201.062 and $2 748 285. resulting in a net cost of $281,728 for major ecquisitions were recorded in the Building and 1975 and $218.760 for 1974, Equipment Fund. Straight line depreciation was reflected by charges to the Building and Equipment Fund balance. Designated for Program Supplementation Effective July 1974, the Association changed ifs accounting and Contingencies- policy to conform with the "Standards of Accounting and This portion of the Current Unrestricted Fund Balance. which may Financial Reporting for Voluntary Health and Welfare be utilized by specific action of the Board of Directors (see Note Organizations as revised during fiscal 1975 (see Note 1) 3). is reserved for the continuity of the Association' general Accordingly, the comparative financial information as of June activities, its scientific research program and to meet 30. 1974, has been retroactively restated to reflect this change in emergency demands. accounting procedure The effect of this change was to decrease expenditures and increase interfund transfers for the Available Funds- year ended June 30. 1974, by $23.508. The expenditures for each fiscal year are financed principally In years prior to fiscal 1975. fringe benefits related to research by funds received from the campaign of the previous year. awards were charged to expense as paid. Effective July 1974, Accordingly, the campaign income shown in the horder to reflect the total liability incurred as research awards accompanying statement of support, revenue and expenses are granted. the Association changed ifs policy to record and changes in fund balances will be available for research concurrently the estimated fringe benefits payable on research awards and for programs and operations budgeted for the awards with the basic award (see Note 1). The effect of this ensuing fiscal year. change was to increase expenses and unexpended awards payable for the year ended June 30. 1975. by $550,000. Had the Legacies in Process- Association consistently followed this policy in prior years. total The Association the beneficiary under various wills and trust program and supporting expenses for 1974 would have been agreements the total realizable amount of which not increased by approximately $64 000 and total fund balances presently determinable Such amounts will be recorded when would have been decreased by $549.278 31 clear title is established and the proceeds are measurable. 30 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 The American Heart Association The American Heart Association is comprised of 55 affiliates and ,996 local subdivisions of which 126 are chapters Each has its own volunteer leadership and operates within the policies of AHA. Eight Regional Heart Committees of the Board of Directors provide leadership and guidance through representative membership from the affiliates. GREAT PLAINS REGION Colorado Heart Association American Heart Association, Dakota Affiliate 4521 East Virginia Ave. Denver 1005 Twelfth Ave. S.E. Jamestown, N. Dakota Idaho Heart Association Iowa Heart Association 2309 Mountain View Drive, Suite TIO. Boise 3810 Ingersoll Ave. Des Moines Montana Heart Association Kansas Heart Association Professional Bldg. 510 1st Ave., North, Great Falls 5229 West 7th St. Topeka Oregon Heart Association Minnesota Heart Association 1500 S.W. 12th Ave Portland 4701 West 77th St. Minneapolis Utah Heart Association Missouri Heart Association 250 East 1st South, Salt Lake City 601 East Broadway, Columbia Washington State Heart Association Nebraska Heart Association 333 First Avenue West Seattle 3624 Farnam Omaha Wyoming Heart Association 217 West 18th St., Cheyenne MIDDLE ATLANTIC REGION Heart Association of Maryland SOUTHERN REGION 10 South St. Suite 100, Baltimore Alabama Heart Association North Carolina Heart Association 7061/2 South 29th St., Birmingham 1 Heart Circle, Chapel Hill Arkansas Heart Association South Carolina Heart Association 909 West 2nd St. Little Rock 2864 Devine St. Columbia Florida Heart Association Virginia Heart Association 2828 Central Ave. St Petersburg 316 East Clay St. Richmond Georgia Heart Association Washington (D.C.) Heart Association Broadview Plaza, Level C., 2581 Piedmont Rd. N.E., D. C. Medical Society Bldg. Atlanta 2007 Eye St. N.W. Washington, D.C. Louisiana Heart Association American Heart Association, West Virginia Affiliate 3303 Tulane Ave. New Orleans 211 35th St. S.E., Charleston Mississippi Heart Association 4830 East McWillie Circle, Jackson NEW ENGLAND REGION Oklahoma Heart Association Connecticut Heart Association 800 Northeast 15ths St., Oklahoma City 234 Murphy Road, Hartford Tennessee Heart Association Maine Heart Association Suite 308. 1720 West End Building. Nashville 20 Winter St., Augusta American Heart Association, SOUTHWEST REGION Massachusetts Affiliate American Heart Association, Arizona Affiliate 85 Devonshire St. Boston 1445 East Thomas. Phoenix New Hampshire Heart Association American Heart Association, California Affiliate 54 South State St., Concord 1370 Mission St. San Francisco Rhode Island Heart Association American Heart Association of Hawaii, Inc. 40 Broad St. Pawtucket 245 North Kukui St., Honolulu Vermont Heart Association American Heart Association, 56 Church St., Rutland Greater Los Angeles Affiliate 2405 West 8th St. Los Angeles NORTH CENTRAL REGION Nevada Heart Association Chicago Heart Association 455 West 5th St. Reno 22 West Madison St. Chicago New Mexico Heart Association Illinois Heart Association 142 Truman St., N.E. Suite D Albuquerque 1181 North Dirksen Parkway, Springfield American Heart Association, Texas Affiliate, Inc. American Heart Association, Indiana Affiliate, Inc. 860 North Highway 183. Austin 222 South Downey, Suite 222. Indianapolis Kentucky Heart Association UPPER ATLANTIC REGION 207 Speed Bldg. 333 Guthrie St., Louisville Delaware Heart Association Michigan Heart Association Independence Mall, Suite 46. 1601 Concord Pike. 16310 West Twelve Mile Rd. Southfield Wilmington American Heart Association, American Heart Association, New Jersey Affiliate Northeast Ohio Affiliate 1525 Morris Ave., Union 1689 East 115th St., Cleveland New York Heart Association American Heart Association, Ohio Affiliate 2 East 64th St. New York City 10 East Town St.: Room 506. Columbus American Heart Association, Wisconsin Heart Association New York State Affiliate 795 North Van Buren St., Milwaukee 3 West 29th St. New York City American Heart Association, Pennsylvania Affiliate NORTHWEST-ROCKY MOUNTAIN REGION 2743 North Front St. Harrisburg Alaska Heart Association Puerto Rico Heart Association 211 East 4th Ave., Anchorage Box 8215. Fernadez Juncos Station, Sanfurce 32 THE AMERICAN HEART ASSOCIATION 7320 Greenville Avenue Dallas, Texas 75231 This 1975 Annual Report was designed and written by the American Heart Association's Communications Division and, for the first time in Association history, was printed by the print production facility at the National Center. Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 American Heart Association Annual Report 1975 i This report to the public on the conduct of the American Heart Association program during 1975 is dedicated to the more than two million volunteers who are the lifeblood of the Association. They represent men and women from the grass roots of America who call on friends and neighbors in communities large and small to collect the dollars that finance the Association's work. And they include scientists, physicians, nurses and leaders of business, industry, law, the arts, and communications who sit on Boards, Councils, Committees and Task Forces to help set policies, develop programs and oversee their successful accomplishment. Without their freely-given time and skills we would not have been able to achieve the enormous strides of the past 25 years against cardiovascular disease. Indeed, without all of them, there would be no American Heart Association at all. Cover photo shows an echocardiogram of a patient's heart. Echocardiography is a relatively recent non-invasive technique, rapidly growing in use, which has made a major contribution to the diagnostic skills of the cardiologist. If aims ultra-high frequency sound waves through the chest wall to the target area of the heart. Returning echoes generate electrical impulses which are received and recorded by the echograph instrument. President's Message We know what the priorities and goals are: Research We still don't know the cause of coronary During the past year, the Association heart disease, even though heart attack death rates are declining; provided funds for the work of approximately We don't know the cause of 90 percent of 1,400 scientific investigators on all career all high blood pressure, though we have levels-to - assure that outstanding learned to control much of it; independent researchers may pursue We don't know the cause of primary original lines of thought to wherever they myocardial disease; and may lead, that the established investigator We still don't know why normal mothers has the means to complete his project and have babies with congenital heart disease. that younger scientists of promise have the Heart Association staff members and support they need to develop their skills. volunteers are rededicating themselves to unlocking more of these unknowns. We seek the support of all Americans so that the same sense of urgency that motivates us can have its expression in new and expanded programs. In the year covered by this report, the Our network of affiliates and chapters has American Heart Association allocated a steadily developed. Today it reaches into record amount of $18 million for heart thousands of communities involving citizen research, sending the total for such support volunteers, laymen, scientists, physicians, past the quarter billion dollar mark. During nurses and people from all walks of life in an the same period, there was confirmation that amalgam to cope with a complex of distinct the death rates from coronary disease had diseases generally referred to as turned downward. An analysis of these cardiovascular. closely watched statistics suggested that a Armies of distinguished scientists and combination of better prevention and more physicians, corps of non-medical personnel effective emergency treatment played an and more than two million volunteers form important role in this downtrend. the Heart Association. Much of the public There is reason to take satisfaction in funds donated to the Association support our contributions toward reaching these research scientists in their attempts to further milestones. But there is even more reason unlock the secrets of heart disease. Assisting to report that these achievements have in translating new medical knowledge from stimulated in us a new sense of urgency. We all sources into professional programs are have seen what dollars and dedication can about 10,000 scientists and physicians do. Yet, while heart and blood vessel forming 14 Scientific Councils, each diseases continue to impose an intolerable dedicated to a field of science or a medical health burden and economic cost on the specialty relating to heart disease. Through nation, we must do much more. their valuable guidance, the Association is in essence a micro-universify, developing and conducting hundreds of postgraduate medical courses across the country throughout the year to refine the skills of physicians and nurses and thus ensure better patient care. The Scientific Councils also are active in the development of programs for the general public, assuring that those programs are based on scientific fact and designed to educate Americans in the prevention of heart attack and stroke. In the pages that follow you will find highlights of our programs in the year covered by this report. Elliot Rapaport, M.D. President 2 If we are to make further inroads on the Professional Education enormous toll of death and disability caused by cardiovascular diseases, we must continue to help develop new scientific knowledge. This is at the foundation of all programs, professional and public, conducted by the Association. What increases our sense of urgency in this matter is that progress against cardiovascular disease, while rapid and progressive, must rely on one piece of new knowledge being gathered here atop another piece gathered elsewhere. We are forging a mosaic of hope and help. The results of research projects supported by AHA continue to find clinical expression in improvements in the diagnosis and treatment of heart disease. Two of the more significant advances reported during the past year are: The first significant decrease in mortality from coronary artery disease; There are hundreds of other bits and pieces A doubling of the number of patients with reported each year that may prove to be hypertension who have been recognized, put on therapy and had part of a new weapon in the war on heart their blood pressure controlled. disease. Biomedical investigators are facing Examples of research supported by the AHA up to the challenges. What we need are which promise to provide additional more of the means. Each of these new advances in overcoming heart disease approaches must be tried, tested and include: duplicated- in laboratories, on animals and Techniques for improved and earlier finally in humans- - before they can be recognition of heart attacks and the accepted as conclusive and beneficial and protection of injured heart muscle from added to the list of armaments. Knowledge gained through research is only progressive damage; as good as its application. With the Providing the means requires a new Recognition of the fundamental cellular acceleration in research in recent years has defect in a form of hereditary commitment from the public to support our come a steady increase in new information hypercholesterolemia, associated with a responsibility to do all in our power to help about cardiovascular diseases and new high incidence of heart attacks among gather and disseminate new knowledge. ways of treating and preventing such affected people in their 20's and 30's; The faster scientists can nail down disorders. This new knowledge often Development of sophisticated X-ray preliminary findings, the faster they can be techniques which will graphically becomes available at a pace swifter than applied to reducing suffering and death. demonstrate the intricate workings of the the busy cardiologist, coronary care nurse heart in the intact human; Simply put, the urgency is dollars to save or other health care specialists can be Proof that a prolonged regimen of diet lives. expected to seek it out and assimilate it. and exercise improve circulatory Aso result, a special sense of urgency derangements in the legs; stimulates us in development of our medical Application of new approaches to the recognition and treatment of education programs, to assure that they hypertension caused by decreased keep pace with advances in the field and blood flow to the kidneys; that they are geared to bringing new Improved diagnosis and therapy of research findings to the medical community thrombophlebitis in the legs, the source as quickly and as clearly as possible. of blood clots which cause 50,000 deaths each year in the U.S. Keystones for dissemination of valuable knowledge are the American Heart Association's 14 Scientific Councils, headed by many of the nation's foremost scientists and cardiovascular experts. Each of the Councils represents a special professional interest; together they reflect the broad scope of cardiovascular diseases and the concerns of the American Heart Association. They set the standards and conduct the professional activities of the Association. 4 5 The Councils conduct continuing education Public Education programs for their own members who total approximately 10,000. Reaching out to others A college professor in Baltimore, Maryland, in the medical community, the Councils are showed the AHA-produced film, active in the development of a wide range ``Hypertension: The Challenge of Diagnosis," of learning materials available to all to his biology class. One student was so 270 physicians and nurses. These include moved at learning hypertension or high pamphlets, newsletters, films, lecture series, blood pressure is a 'silent killer" that she 250 audio-visual aids and a group of scientific immediately urged her mother to undergo a journals which have a combined monthly long-delayed medical checkup. 230 circulation of more than 300,000. At the apex The examination revealed the woman of this activity is the annual Scientific indeed had high blood pressure, but thanks 210 Sessions, a meeting which attracts more than to a concerned daughter and a Heart 200 10,000 health professionals to exchange and Association message, her condition was 190 assess the year's new findings. brought to medical attention at an early 180 Affiliates and chapters of the Association time. 170 conduct hundreds of their own programs While that film was produced for 160 which bring together physicians and nurses professional education, it does show there on a community or state level, as contrasted are many ways of reaching the general 150 140 to Council-sponsored programs which are public with information vital to its welfare. conducted on a national basis. These 130 And the Association employs all means of 120 programs are not necessarily of interest just mass communication to alert Americans to / to the cardiologist, but are planned for the magnitude of the problem of heart 110 100 anyone concerned with better patient care disease; to what is known about factors that for prevention of heart disease and increase an individual's risk; and what one 90 80 management of patients. can do on his or her own and with a doctor's The Association constantly seeks to innovate help to change life styles moderately, 70 60 in its educational programs, as it has in control some easily identifiable health establishing research support programs conditions, and thus reduce that risk. 50 subsequently adopted elsewhere. Better The heart of this message includes these patient care is one of our goals and to get to major points: the crux of it, we conduct a unique Teaching If you have high blood pressure, follow Scholarship Program. This has a two-fold your doctor's orders and continue to take purpose: to raise standards of medication. undergraduate education for medical If you don't know whether you have high blood pressure, or suspect you might careers by creating a corps of unusually have it, visit your doctor. He can quickly, effective cardiology teachers, and thereby easily and painlessly find out. It usually on a day-to-day basis influence the has no set symptoms. So only a trained development of hundreds of students who person can tell. eventually will be in practice. This program If you smoke cigarettes, stop. has reached into medical schools across the If you eat foods rich in cholesterol and saturated fats, cut down on them. If you country and to date has supported 26 young don't know what they are, ask your Heart physicians, allowing them to devote virtually Association for booklets that tell you in all of their time to teaching and to plain, concise language. development of improved teaching If you that don't you exercise do become more regular active. basis, on a see If methods. you're middle-aged and/ have been leading a more than usual chair-borne existence, it would be wise to see your doctor before engaging in unaccustomed activity. 6 Community Programs Having just learned it in school, cardiopulmonary resuscitation was fresh in the mind of 13-year-old Lyn Kraft of Ventnor, N.J., the October night her father suffered a massive heart attack and lost consciousness. Lyn was able to maintain his breathing and heart beat for 10 minutes until medical help arrived. Usually, a victim of cardiac arrest who is denied oxygen for more than four to six minutes suffers brain damage. But today, Mr. Kraft is recovering, thanks to Lyn's prompt action, the CPR training she received from her school nurse, Marie Paludi, and to the South Jersey Shore Heart Chapter which certified Ms. Paludi in CPR which quickly proved its worth in that community. CPR is just one facet of a growing concept of area-wide comprehensive emergency pressure screening and control. This latter cardiac care systems being promoted by one has received particular emphasis the Association. But CPR's life-saving because there may be as many as 12 million potential has spurred us into teaching it to "hidden" cases of high blood pressure in this cadres of health professionals who, returning country; and among those known to be to their home areas or institutions, can afflicted, only one out of eight is receiving quickly train others-professionals and adequate medical care. public alike to provide basic emergency Other new efforts to improve and expand help wherever a life needs to be saved. community services include development of One example of this mushrooming effect: guidelines for medical management of last October, the Association conducted a teenagers with high levels of artery-clogging training course for 20 inspectors from the cholesterol in their blood; work on model Mining Enforcement and Safety programs applying principles of behavioral Minority Program Administration. Within two weeks, three of the science to risk reduction motivation; and a inspectors were conducting a course for 30 new film and stroke guide explaining the role Barrios, ghettos, isolated American Indian found heart disease, high blood pressure others- - other inspectors and of community hospitals in the optimum reservations. depressed rural villages. inner- and their devastating aftermaths, heart representatives from 24 industries covering a treatment of stroke victims, and then in city slums and other "out-of-the- attack and stroke, more so than in urban, seven-state area. They, in turn, are now returning them to as useful a life as modern mainstream" places- - all are synonymous higher income societies. prepared to train other groups. science makes possible. with minority groups, poverty and apathy. In recent years as more became known Where these elements exist, there also are In the past year, the Association distributed about the present concepts of programming more than 1.2 million copies of a booklet on for the total community and about the new standards in CPR, developed in concert relatively more serious impact of with the National Research Council-National cardiovascular diseases on isolated and Academy of Sciences. These went to health lower income groups, the Association professionals across the country and around began reaching out - to bring aid and the world. information to these groups and to encourage them to help design programs The same sense of urgency which underlies based on their urgent needs. our CPR activities, has prodded us into other community programming to motivate Starting in 1971, several national conferences Americans to reduce their risk of heart attack were sponsored by the Association to bring and stroke by making moderate changes in all interested organizations together. Today, life styles and controlling identifiable health Minority Involvement Working Group and a disorders. Poverty Planning and Development Fund These programs include smoking withdrawal Committee are working towards improving clinics, nutrition and diet instruction, the Association's program in the total community. rheumatic fever control, screening children for hidden heart disorders, stroke and heart Hand in hand with minority involvement in attack rehabilitation and high blood Association affairs has come a substantial 9 8 increase in programs of education and directors and in activities of state and local Major Awards Mrs. Alexander Ripley, Los Angeles. She prevention conducted jointly with those for Heart Associations. Thus, minority group Research Achievement Award, the "created an impressive record with the Heart whom the programs have been developed. leadership to further combat cardiovascular American Heart Association's highest award Cause in California and in the national The response has been impressive. Example: disease in these areas can be nurtured. for research accomplishment, to Arthur C. In South Dakota, at Standing Rock community," while encouraging other In 1975, AHA worked closely with the Guyton, M.D., in recognition of his brilliant, women's participation in that cause. Reservation alone, more than 5,000 Sioux Association of Black Cardiologists, the tireless research efforts spanning more than Moreover, she helped develop national are learning how to reduce their risk of heart National Medical Association composed of two decades, for his profound contributions attack and stroke. In Tulsa, Oklahoma, policies, and displayed organizational skills minority physicians, the National Congress of toward advancing knowledge of virtually Indians living in the urban area, are doing in planning annual meetings for the American Indians and the National every aspect of cardiovascular physiology, Association. likewise. Association of American Indian Physicians to and the influence his work had in stimulating Paul N. Yu, M.D., Professor of Medicine, Across the country, Heart Associations are encourage participation on regional, the efforts of other scientists. Dr. Guyton is University of Rochester (N.Y.) Medical Center. conducting high blood pressure screening affiliate and national boards and Professor and Chairman of the Department Dr. Yu, a former AHA president, "performed for blacks because this disease affects committees and on the Scientific Councils of of Physiology and Biophysics. University of brilliantly in the service of all elements of the blacks at double the rate of whites, and the Heart Association. Mississippi Medical Center. Association" for many years. Many of his usually with more devastating efforts have been directed toward consequences of heart attack and stroke. James B. Herrick Award, granted by the improving the quality of medical education When high blood pressure is detected, this Council on Clinical Cardiology to Lewis and the delivery of emergency cardiac program provides patients with follow-up Dexter, M.D., for outstanding achievement in care. resources for therapy and educational clinical cardiology. With almost 40 years programs. devoted to his field, he has "excelled in Howard W. Blakeslee Awards for Though critically important, educating advancing scientific knowledge, improving distinguished media communication minorities at the local level is only a part of the practice of cardiology. and in regarding cardiovascular diseases: the program's mission. Equally as important developing legions of medical students and JoAnn Ellison Rodgers of the "Baltimore News in reaching its objectives is achieving a scores of research fellows who today are American" for her four-part newspaper series higher degree of minority member making significant contributions of their own involvement in committees, boards of to cardiology.' Dr. Dexter is Professor of that comprehensively reported the rising incidence of heart disease in women. Medicine at Harvard University and Director of the Cardiovascular Laboratory at Peter Good Times, a CBS-TV weekly series Bent Brigham Hospital, Boston, featuring the episode "The Check Up.' This Massachusetts. particular telecast, aired May 8.1974, emphasized the importance of medical Gold Heart Awards honor those volunteers check ups for hypertension-prone black who have served with highest distinction in males. "Good Times" is produced by advancing the American Heart Association's Norman Lear and Tandem Productions. work. Recipients are: Andy Guthrie of WKYC-TVI News, Cleveland, Julius H. Comroe, Jr., M.D., Herzstein Professor Ohio, for his five-part report "The of Biology, University of California in San Ambulance Crisis: Who Will Come for You?" Francisco. As a scientist, he contributed If examined problems confronting importantly toward the enrichment of Cleveland's ambulance system, compared cardiovascular knowledge and improved it to those in other cities, and proposed clinical practice. Through his editorial solutions to these shortcomings. leadership, he brought "excellence" to AHA's scientific journal, "Circulation Research.' Elwood Ennis, Vice President, Griffenhagen- Kroeger, a management consultant firm in San Francisco. His knowledge of management procedures proved invaluable in establishing performance standards for AHA Affiliates and in developing personnel and training policies during his 20 years as a volunteer leader of the Association. 10 11 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 Joan Solomon, a science writer for Rose Pinneo, R.N., Associate Professor of Board Chairman's Message In 1975, we received 130 requests from young "Consumer Reports" magazine, for her Nursing, University of Rochester School of scientists for five-year Established article, "High Blood Pressure: What to Do Medicine and Dentistry, Rochester, New Investigatorships to support their heart When Your Numbers Are Up." Her story, York. research Monies were available to fund only according to competition judges, told the Richard H. C. Taylor, Richmond, Virginia. 32 of these qualified men and women. truth about the causes, diagnosis and Sam A. Threefoot, M.D., Assistant Dean and Moreover, we could support only 23 percent treatment of hypertension while dispelling Professor of Medicine, Medical College of of the over 400 Grants-in-Aid projects old myths about the disease. Georgia, Augusta. requested by investigators needing funding JoAnn Stichman and Jane Schoenberg for to perform vital heart research. Had the their book, "How to Survive Your Husband's Citation for Distinguished Service to dollars been available, more of these highly Heart Attack." The authors were cited for Research to: regarded people and projects would have "giving frank, full advice to women who David Bohr, M.D., Professor of Physiology, received funds from the Heart Association cope with a wide variety of new problems" University of Michigan, Ann Arbor. Inflation is also having undesirable effects on when facing heart attack crises. Jack Geer, M.D., Professor and Chairman, professional and public education Louis N. Katz Basic Science Research Department of Pathology, University of programs the Association conducts Alabama, Birmingham. nationwide. We are seeking both increased Prize for Young Investigators, to Kent Hermsmeyer, Ph.D., for demonstrating and Karlman Wasserman, M.D., Ph.D., Chief- fund-raising results and more cost-effective Respiratory Division, Harbor General programs to keep ahead of this specter of explaining an increased sensitivity of the Hospital, Torrance, California. shrinking dollars. blood vessels in high blood pressure to the hormone called norepinephrine. His Irwin Weiner, M.D., Professor and Chairman- Americans exhibited an increasing Additionally, we are working to cut research represents a significant advance Department of Pharmacology, State confidence in the American Heart operating costs and have done so. In this toward understanding how essential University, New York Upstate Medical Center, Association and its programs by contributing regard, the Executive Vice President's hypertension, a mysterious disease, gets Syracuse. record $59,951,245 in 1975. message on the following page explains some of the actions we have taken and started. Dr. Hermsmeyer is an Assistant However, the cost of "doing business" has Professor of Pharmacology at University of results already achieved. also reached all-time highs; the Association lowa College of Medicine in lowa City. has felt the impact of inflation as have other Through the years, past and present organizations. programs have proven their worth in Distinguished Achievement Award to contributing to reducing death and Irving S. Wright, M.D., Emeritus Clinical This new enemy in our war on heart disease is improving the quality of life. They have Professor of Medicine at Cornell University causing AHA dollars to shrink and is adding received increasing support from Medical College and Consulting Physician to our sense of urgency because it contributing individuals. to New York Hospital. Dr. Wright jeopardizes our ability to accelerate accomplished the "monumental task of progress through expanded programs. But they especially merit renewed consideration and more generous support bringing together, blending and presiding We feel inflation as a two-way stretch. Our from industry and business. over the work of the Inter-Society dollars don't buy as much research, education and community services. Yet Underlying this consideration should be the Commission for Heart Disease Resources. His fact that heart and blood vessel diseases leadership, knowledge, guidance and inflation makes increasing demands on us. Some of these demands grow out of cost the nation an estimated $22.7 billion understanding of human affairs resulted in the most effective collaboration among retrenchment in the federal government's annually. In addition to lost income and expenditures for medical care, 52,000,000 more than 200 experts representing the 29 research training program which affects the organizations and disciplines represented bright young scientist much more than it man-days of production are lost each year. Other 'hidden' costs such as losses in on the Commission." He is a foremost does the established researcher who has management skills, production know-how, authority on cardiovascular disease who other sources of support. These young personnel training and development, and pioneered in the study of thrombosis. scientists are turning to us for support in labor turn-over are difficult to determine, but greater numbers than before. are obviously significant. Awards of Merit for outstanding The Report on the Commission on Private contributions to development of the organization's national program to: Philanthropy and Public Needs has recommended that corporations set as a Donald S. Fredrickson, M.D., Director, minimum goal, to be reached no later than National Institutes of Health, Bethesda, 1980, the giving to charitable purposes of Maryland. two percent of pre-tax net income and that Robert J. Michtom, M.D., Rockville Centre, further studies of means to stimulate Long Island - -Associate Professor of corporate giving be pursued. Medicine, State University of New York, Stony Greater investment in our Heart program Brook. could turn out to be a long-term investment Robert H. Mitchell, M.D., Clinical Professor of in corporate health. Medicine, Texas Tech University School of Medicine, Lubbock, Texas. Richard D. Dotts Chairman 12 13 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 Executive Vice President's OFFICERS BOARD OF DIRECTORS Message Richard D. Dotts Walter H. Abelmann, M.D. Chairman of the Board Boston, Mass. As a meeting place and resource center for John T. Shepherd, M.D., D. Sc. William H. Ames, M.D. the dedicated workers of the American President St. Joseph, Mo. Heart Association, our new National Center now enables closer relationships and Harriet P. Dustan, M.D. John S. Andrews President-Elect Youngstown, Ohio communications with 55 Affiliates and 1,196 Philip P. Ardery Chapters and Units. It is also national Elliot Rapaport, M.D. Louisville, Ky. Immediate Past President headquarters of the Association. Adm. Philip F. Ashler Ross Reid Tallahassee, Fla. Planned and executed with long-term Immediate Past Chairman of the Board W. Gerald Austen, M.D. savings in mind, this relocation is but a part of the Association's strategy to refine VICE PRESIDENTS Boston. Mass. Philip P. Ardery Owen Beard, M.D. management practices and to implement Little Rock, Ark. economies and confront the challenge of Owen Beard, M.D. Rene Bine, Jr., M.D. fiscal restraint. John J. DeFeo, Ph.D. San Francisco, Calif. In this regard, am pleased to report that Mrs. Frank A. Dresslar, Jr. Miss Virginia Black, R.N. combined expenditures by the national Ham Jackson, M.D. Cheyenne, Wyo. office and all affiliates for fund raising and Kenneth W. Kihle, M.D. Reagan H. Bradford, Ph.D. Ira L. Lavin Oklahoma City, Okla. other overhead costs have been reduced John G. Martin Guy E. Bramon, Jr. dramatically from a high point of 30 percent Edward Meilman, M.D. Bloomfield, Conn. in the 1968 fiscal year to a low of 23 percent Nanette K. Wenger, M.D. Miss Grace Brown, R.N. in the fiscal year ending last June 30. Stanford Wessler, M.D. Riverdale, N.Y. To have curbed overhead while increasing James G. White, M.D. Jay D. Coffman, M.D. In 1975, the American Heart Association and expanding our program is a Boston, Mass. John S. Andrews William E. Conner, M.D. moved from New York to a newly- remarkable achievement, not only from a Treasurer Portland, Ore. constructed National Center in Dallas. management standpoint, but also for what it Mrs. M. Jeanne Pontious, R.N. B. Trent Cooper, M.D. Volunteer leaders of the Association contributed toward our public Secretary Roanoke, Ind. determined that a geographically central accountability. By practicing economies Robert J. Cruikshank location and modern facilities would bring and instituting other solid management Houston, Tx. about operating efficiency and economies. devices, the Heart Association has been Gordon Curren able to channel almost 80 cents of every Sisseton, S. Dak. This new building is the nerve center of our dollar spent into positive programs for the Vincent DeCristotaro voluntary mission to reduce premature death public's benefit. Providence, R.I. and disability from cardiovascular diseases. John J. DeFeo, Ph.D. If becomes the focal point of an By improving the processes of our planning Kingston, R.I. organization comprising 40,000 of America's and management systems, we are further Richard D. Dotts foremost scientists and physicians, 65,000 developing orderly mechanisms for doing Newport Beach, Calif. other key members and more than 2,000,000 an even better job and determining future Mrs. Frank A. Dresslar, Jr. citizen volunteers. priorities, objectives, and costs. Thus, we will Fresno, Calif. be increasingly able to approach the public Harriet P. Dustan, M.D. with targeted needs, rather than simply our Cleveland, Ohio overall program of research, education, and Robert R. Eddy community services. In this manner, am Concord, N.H. confident Americans will respond even more William H. Eells Columbus, Ohio positively. Blair D. Erb, M.D. Knoxville, Tenn. Allan L. Friedlich, M.D. William W. Moore Boston, Mass Emilio R. Giuliani, M.D. Executive Vice President Rochester, Minn. Samuel Goldfein, M.D. Tucson, Ariz. Judith Graham, M.D. Great Falls, Mont. Jared Grantham, M.D. Kansas City, Ks. 14 15 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 Robert Hay, M.D. C. Richard Newpher Gary Walkup, M.D. COUNCIL CHAIRMEN NATIONAL OFFICE STAFF Nampa, Idaho Cleveland, Ohio Fairbanks, Alaska Arteriosclerosis William W. Moore Robert N. Headley, M.D. Thomas R. Oglevie Nanette K. Wenger, M.D. William E. Conner, M.D. Executive Vice President Winston-Salem, N.C. Goodland, Ks. Atlanta, Ga. Portland, Ore. SPECIAL ASSISTANTS E. H. Heinrichs, M.D. Donald C. Overy, M.D. Stanford Wessler, M.D. Basic Science Dawn Bryan, Chief, Public Policy Watertown, S. Dak. Birmingham, Mich. New York, N.Y. Arnold Schwartz, Ph.D. and Government Affairs Jacob F. Hess, Jr. Raul Penagaricano James G. White, M.D. Carolina, P.R. Houston, Tex. James D. Lowe, Public Relations Canton, Ohio Minneapolis, Minn. Mrs. Haywood N. Hill J. Stephen Phalen, M.D. Robert W. Wissler, Ph.D., M.D. Cardiopulmonary Diseases Counsel Reno, Nev. Chicago, III. Gerard M. Turino, M.D. John T. Connolly Atlanta, Ga. Hon. Charles A. Pomeroy New York, N.Y. Deputy Vice President, Office of Operations Florencio A. Hipona, M.D. Richard A. Young, M.D. Portland, Me. Hagerstown, Md. Cardiovascular Disease in the Young Eugene J. Brennan Boston, Mass. Mrs. M. Jeanne Pontious, R.N. Paul N. Yu, M.D. Angelo V. Taranta, M.D. Director, Division of Fund Raising Edmund M. Hoffman Indianapolis, Ind. Rochester, N.Y. New York, N.Y. Leonard P. Cook Dallas, Tx. W. Gerald Rainer, M.D. Harry F. Zinsser, M.D. Cardiovascular Nursing Director, Division of Management Information Services Thomas B. Hogan Denver, Colo. Gladwyne. Pa Miss Grace E. Brown, R.N. Robert E. Killian New York, N.Y. Elliof Rapaport, M.D. Robert Levy, M.D. Riverdale, N.Y. Director, Division of Communications M. Harland Ison San Francisco, Calif. Bethesda, Md. Cardiovascular Radiology W. Timothy Mask Mobile, Ala. Ross Reid (Representing National Heart Florencio A. Hipona, M.D. Director, Division of Personnel and Training New York, N.Y. and Lung Institute) Ham Jackson, M.D. James Blozie Boston, Mass. Richard S. Ross, M.D. Richard E. Hurley, M.D. Ft. Morgan, Colo. Baltimore, Md. Hartford, Conn. Cardiovascular Surgery Deputy Vice President, Office of Medical Programs Harry I. Johnson, Jr., M.D. Mrs. Adria Rubin (Representing Society of Heart W. Gerald Austen, M.D. Joseph D. Goldstrich, M.D. Roanoke, Va. Association Professional Staff) Boston, Mass. Elmira, N.Y. Director, Division of Education and Community Programs James E. Kamas Circulation Clare J. Sanchez Curtis B. Nelson, Ph.D. Lincoln, Neb. Jay D. Coffman, M.D. Director, Division of Scientific Affairs William B. Kannel, M.D. Denver, Colo. Boston, Mass. Framingham, Mass. Donald E. Saunders, M.D. Norman M. Kaplan, M.D. Clinical Cardiology John W. Kendall Columbia, S.C. Deputy Vice President, Office of Research Programs Henry D. McIntosh, M.D. Portland, Ore. Samuel J. Castranova Elijah Saunders, M.D. Houston, Tex. Joseph H. Kern, Ph.D. Director, Division of Planning and Evaluation Baltimore, Md. Monroe, La. Epidemiology Arnold Schwartz, Ph.D. Howard Weisberg, Ph.D. Kenneth W. Kihle, M.D. William B. Kannel, M.D. Director, Division of Research Awards Bottineau, N. Dak. Houston, Tx. Framingham, Mass. Richard I. Schein Richard A. Koebler John T. Shepherd, M.D., D. Sc. High Blood Pressure Research Director, Division of Business Administration Springfield, III. Rochester, Minn. William H. Eells Ira L. Lavin Sam N. Sherman Columbus, Ohio Earl B. Beagle Phoenix, Ariz. Milwaukee, Wisc. President, Executive Board Southern Affiliate Services Coordinator Charles Levy, M.D. Sol Sherry, M.D. Louis Tobian, M.D. Jerry H. Bruner Wilmington, Del. Philadelphia, Pa. Minneapolis, Minn. Eastern Affiliate Services Coordinator W. Sexton Lewis, M.D. MartinD Shickman, M.D. Chairman, Executive Committee Warren L. Duntley Little Rock, Ark. Los Angeles, Calif. Medical Advisory Board Midwest Affiliate Services Coordinator W. Jefferson Lyon Robert G. Siekert, M.D. Kidney in Cardiovascular Disease Robert D. Moore Newark, N.J. Rochester, Minn. Jared Grantham, M.D. Western Affiliate Services Coordinator GermanE. Malaret, M.D. Ernest G. Spivey Kansas City, Ks. San Juan, P.R. Jackson, Miss. Stroke John G. Martin Robert A. Stewart Robert Siekert, M.D. Columbia, S.C. Seattle, Wash. Mrs. Ruby Massingale, R.N. Perry Sundust Rochester, Minn. Phoenix, Ariz. Thrombosis Seattle, Wash. Angelo V. Taranta, M.D. Stanford Wessler, M.D. John E. Mazuzan, Jr., M.D. Burlington, Vt. New York, N.Y. New York, N.Y. Paul N. McDaniel Thomas Tarnay, M.D. Honolulu, Hawaii Morgantown, W. Va. Henry D. McIntosh, M.D. B. W. (Jack) Taylor Houston, Tx. Mabank, Tx. William J. McManus Richard H. C. Taylor Washington, D.C. Richmond, Va. Edward Meilman, M.D. AlanF. Toronto, M.D. New Hyde Park, N.Y. Salt Lake City, Utah Franklin B. Moosnick, M.D. Gerard M. Turino, M.D. Lexington, Ky. New York, N.Y. Frank M. Mowry, M.D. Ray Uhlhorn Albuquerque, N.M. Council Bluffs, lowa 16 17 Source: https://www.industrydocuments.ucsf.edu/docs/tInf02 AMERICAN HEART ASSOCIATION, INC. and all affiliated Heart Associations Memorial Gifts Bequests and Planned Gifts COMBINED STATEMENT OF SUPPORT, REVENUE, AND EXPENSES AND CHANGES IN FUND BALANCES Many people find that the most fitting tribute Planned giving is an arrangement between YEAR ENDED JUNE 30, 1975 WITH COMPARATIVE TOTALS FOR 1974 to the memory of a victim of heart disease is a donor and the American Heart Association a memorial gift to the American Heart by which a gift of money or property is Land, Association. Memorials are an important irrevocably identified for use by the Building and Current Funds Equipment Endowment Total All Funds source of support in the fight against American Heart Association. Though the Unrestricted Restricted Fund Fund 1975 1974 premature heart deaths. All gifts are right to use the gift may be deferred, there PUBLIC SUPPORT AND REVENUE: promptly acknowledged both to the family can be immediate and future tax benefits to Public support- of the person honored and to the donor. To the donor. Received directly- make a memorial gift to the American Heart There are a variety of methods for planned Contributions $36,590,080 $1,112,214 $ 26,450 $ 52.605 $37,781,349 $37,793,548 Association, specify your name and address gifts including gifts of cash, appreciated Contributions to building fund - - 26,407 - 26.407 35.731 and the name and address of the family to Special events 2.852.307 82,443 6.175 - 2.940.925 2.285.195 property, such as securities or real estate, which acknowledgement should be sent. and of life insurance, outright or in trust. Your Legacies and bequests(Note D) 12.445.982 1.039.375 199.613 30.584 13.715.554 14.085.522 Send this information with your donation to attorney can advise you how to bring your Total received directly 51.888.369 2.234.032 258,645 83.189 54,464,235 54,199,996 your local American Heart Association estate plans up-to-date, and can assist you Received indirectly- affiliate or to the local chapter nearest you. to consider ways in which a planned gift to Allocated by federated fund the American Heart Association may not raising organizations 3.657.750 3.755 - - 3.661.505 2.996.352 only support its work, but may also help to Allocated by unassociated and improve your income, lessen taxes, and nonfederated fund-raising organizations (net of their fund-raising costs) 1.824.960 545 - - 1.825.505 1.724.621 reduce the costs of probate. Total received indirectly 5,482,710 4.300 - - 5,487,010 4.720.973 Legacies and bequests are among the most Total support from public 57.371.079 2.238.332 258,645 83.189 59.951.245 58.920.969 frequently used methods of perpetuating the work of the American Heart Association. The Fees and grants from governmental 2.720.683 1.968.633 following form can be used to name the agencies 782.950 1.936.133 1,600 - Association as beneficiary in your will: Other revenue- Membership dues individuals 314.194 - - - 314.194 285,483 "Igive to the American Heart Association, Inc. a corporation organized under the Not- Program service fees and net for-Profit Corporation Law of the State of New incidental revenue 935.930 81.704 - - 1.017.634 1,067,677 York and having its principal office at 7320 Investment income (Note F) 6.081.486 180.856 32,285 20.863 6.315.490 5.375.072 Greenville Avenue, Dallas, Texas 75231, the Gains (losses) on investment transactions (51.788) (32.585) (28.632) (12.650) (125.655) - sum of dollars, to be used for the general Miscellaneous revenue 101.359 206.168 (3.334) - 304.193 205.574 purpose of such corporation." Totalother revenue 7.381.181 436.143 319 8.213 7.825.856 6.933.806 Similar forms may be obtained from your Total public support and revenue 65,535,210 4.610.608 260.564 91,402 70.497.784 67.823.408 local Heart Association for your attorney's EXPENSES: convenience. Program services- For information regarding gifts or bequests Research 17,088,595 1,275,975 31.344 - 18.395.914 17.897.746 for specific program purposes contact the Public health education 8.999.125 369,020 156.127 - 9.524.272 8.377.183 American Heart Association or the Heart Professional education and training 8.334.006 554,203 165,401 1,000 9.054.610 8.361.679 Community services 10.143.520 1.519.202 217.264 1,000 11.880.986 10,079,542 Association in your community. Total program services 44.565.246 3.718.400 570.136 2.000 48.855.782 44.716.150 Supporting services- Management and general 7,040,155 26.946 137.137 - 7.204.238 6.907.590 Fund raising 8.790.353 34.992 122.674 - 8.948.019 8.303.264 Total supporting services 15,830,508 61.938 259.811 - 16.152.257 15.210.854 Total program and supporting services expenses 60.395.754 3.780.338 829.947 2,000 65.008.039 59.927.004 Excess (deficit) of public support and revenue over expenses, before relocation costs and cumulative effect of accounting changes 5,139,456 830.270 (569.383) 89.402 5,489,745 7.896.404 RELOCATION COSTS of National Center (Note C) (1.277.070) - (15,010) - (1.292.080) - CUMULATIVE EFFECT OF ACCOUNTING CHANGES (Note E) (1,210,740) 215.204 (116.471) (39.898) (1,151.905) 777,477 Excess (deficit) of public support and revenue over expenses 2.651.646 1.045.474 (700,864) 49.504 3.045.760 8.673.881 OTHER CHANGES IN FUND BALANCES Property and equipment acquisitions from unrestricted and other designated funds (1.425.839) (117.152) 1.566.351 (23.360) - - FUND BALANCES. beginning of year (Note E) 75.337.418 4.701.516 8.213.041 1.214.725 89.466.700 80.792.819 FUND BALANCES, end of year $76,563,225 $5,629,838 $9,078,528 $1,240,869 $92.512.460 $89,466.700 The accompanying notes to financial statements are an integral part of this statement. 18 19 Note: This statement has been prepared by the National Center from the individual certified audit report of each affiliated association and is not covered by the report of Arthur Andersen & Co. Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 American Heart Association, Inc. and all affiliated Heart Associations COMBINED BALANCE SHEET - JUNE 30, 1975 and 1974 ASSETS 1975 1974 LIABILITIES AND FUND BALANCES 1975 1974 CURRENT FUNDS-UNRESTRICTED CURRENT FUNDS UNRESTRICTED CASH: ACCOUNTS PAYABLE AND ACCRUED EXPENSES $ 1.706.284 $ 1.525.556 Checking accounts $ 6.381.182 $ 5.935.773 ACCRUED RELOCATION COSTS-NATIONAL CENTER (Note C) 882.690 - Savings accounts 17.682.249 18.692.730 UNEXPENDED BALANCE OF RESEARCH, PROFESSIONAL EDUCATION AND SHORT-TERM INVESTMENTS, at cost, which approximates market value (Note F) 60.778.388 55.235.818 COMMUNITY PROGRAM AWARDS (Note A) 9.748.704 7.553.522 SUPPORT AND REVENUE DESIGNATED FOR FUTURE PERIODS 1.555.263 938.084 ACCRUED INVESTMENT INCOME 490,477 552.221 13.892.941 10.017.162 ACCOUNTS RECEIVABLE: Federated and nonfederated fund-raising organizations 1.590.784 2.130.727 FUND BALANCES (Note A): Other 1.184.595 1.058.216 Designated by the governing Boards for - Budgetary expenditures for the year commencing Julyl 52.598.909 54.189.021 EDUCATIONAL AND CAMPAIGN MATERIALS HELD FOR USE, Research awards 13.199.697 11.929.597 at first-in, first-out cost or market, whichever is lower 1.652.612 1.327.873 National center construction and relocation 2.850.070 3.568.233 PREPAID EXPENSES 461,391 219.658 Undesignated, available for program supplementation and contingencies 7.914.549 5,650,567 OTHER ASSETS 234.488 201,564 Totalfund balances 76.563.225 75.337.418 $90,456,166 $85,354,580 $90,456,166 $85,354,580 CURRENT FUNDS RESTRICTED CURRENT FUNDS RESTRICTED ACCOUNTS PAYABLE AND ACCRUED EXPENSES $ 39.224 $ 105,502 CASH: UNEXPENDED BALANCE OF RESEARCH, PROFESSIONAL Checking accounts $ 318.394 $ 264,973 EDUCATION AND COMMUNITY PROGRAM AWARDS - 172.011 Savings accounts 2.013.132 2.539.891 SUPPORT AND REVENUE DESIGNATED FOR FUTURE PERIODS 145.118 293.320 184.342 570.833 SHORT-TERM INVESTMENTS, at cost, which approximates market value (Note F) 2.825.715 2.021.804 FUND BALANCES: ACCRUED INVESTMENT INCOME 6.818 3.250 Designated by donors for - Research 4.778.050 3.994.449 ACCOUNTS RECEIVABLE 483.216 210,620 Public health education 144.464 117.064 GRANTS RECEIVABLE 147,351 95,547 Professional education and training 107.746 88.968 Community services 599.578 501.035 OTHER ASSETS 19,554 136.264 Total fund balances 5.629.838 4.701.516 $ 5.814.180 $ 5.272.349 $ 5.814.180 $ 5.272.349 LAND, BUILDING AND EQUIPMENT FUND LAND, BUILDING AND EQUIPMENT FUND CASH $ 21.911 $ 18,304 ACCOUNTS PAYABLE $ 37.752 $ 68.856 CONSTRUCTIONLOAN PAYABLE (Note C) 1.482.813 - SHORT-TERM INVESTMENTS. at cost, which approximates market value (Note F) 20.812 488,500 MORTGAGES PAYABLE 1.540.184 1.096.228 ACCRUED INVESTMENT INCOME 1.579 8.280 3.060.749 1.165,084 FUND BALANCES: NATIONAL CENTER DEVELOPMENT COSTS (Note C) 2,300,875 110.773 Expended 9.034.226 7.697.957 LAND. BUILDINGS AND EQUIPMENT at cost or appraised value, Unexpended restricted 44.302 515.084 less accumulated depreciation 9,794,100 8.752.268 Total fund balances 9.078.528 8.213.041 $12.139.277 $ 9.378.125 $12.139.277 $ 9.378.125 ENDOWMENT FUND ENDOWMENT FUND CASH in savings accounts $ 385.505 $ 333.946 ACCOUNTS PAYABLE $ 44,661 $ - INVESTMENTS, at cost, which approximates market value (Note F) 900,025 880.779 FUND BALANCE 1.240.869 1.214.725 $ 1.285.530 $ 1.214.725 $ 1.285.530 $ 1.214.725 The accompanying notes to financial statements are an integral part of this balance sheet. Note: This statement has been prepared by the National Center from the individual certified audit report of each affiliated association and is not covered by the report of Arthur Andersen & Co. 20 21 Source: https:/lwww.industrydocuments.ucsf.edu/docs/tInf02 American Heart Association, Inc. and all affiliated Heart Associations COMBINED STATEMENT OF FUNCTIONAL EXPENSES YEAR ENDED JUNE 30, 1975 WITH COMPARATIVE TOTALS FOR 1974 Program Services Supporting Services Total Program and Supporting Services Public Professional Expenses Health Education Management Research Education and Training Community and Fund Services Total General Raising Total 1975 1974 Salaries $ 791,421 $4,833,323 $3,764,723 $ 5,725,938 $15,115,405 $3.765,345 $4,528,990 $ 8.294.335 $23,409,740 $20,917,005 Payroll taxes, etc. 53,500 334,117 254,143 384.260 1.026.020 253.746 310.182 563.928 1.589.948 1.432.357 Employee benefits 77.206 365.545 318.207 404.337 1,165,295 345,231 304.954 650.185 1.815.480 1.605.113 Occupancy 96.223 511.785 423.029 563.465 1,594,502 393.491 407.531 801.022 2.395.524 2.323.774 Telephone 40.996 304.919 214.760 323,898 884,573 221.510 345.597 567.107 1.451.680 1.286.031 Supplies 35.965 223.169 190.196 287,058 736.388 187.428 227.774 415.202 1.151.590 1.020.550 Rental and maintenance of equipment 23.967 106.289 109.257 183,007 422.520 99,581 95,136 194.717 617.237 871.647 Printing and publications 50,070 987.453 850.046 529.103 2.416.672 189,141 1.013.400 1.202.541 3.619.213 3.024.560 Postage and shipping 34.985 351.235 245.046 327.422 958.688 186.826 503.476 690.302 1.648.990 1.457.238 Visual aids, films and media 4,651 310,631 135,710 351,433 802.425 36.518 151,043 187,561 989.986 987.219 Conferences. conventions and meetings Travel 103.813 236.019 674,218 392.668 1.406.718 408.978 200.174 609,152 2.015.870 1.747.753 Other direct expenses 4,127 41.128 507,864 19,846 572.965 27.877 19.603 47,480 620,445 551.922 Other travel 42.417 373,461 331,209 491,350 1.238.437 284.371 342.287 626.658 1,865,095 1.744.814 Professional fees 10.346 140.320 83.182 503.975 737.823 453.700 208.965 662,665 1,400,488 1.073.466 Awards and grants to individuals and other organizations 16.947.136 94,491 580.932 946.035 18.568.594 3.902 4.628 8.530 18.577.124 17.733.614 Other expenses 47,747 154,260 206.687 229.927 638.621 209.456 161.605 371,061 1.009.682 1.282.876 Total before depreciation and amortization 18,364,570 9.368.145 8.889.209 11.663.722 48.285,646 7.067.101 8.825.345 15.892.446 64.178.092 59.059.939 Depreciation and amortization of buildings, equipment and improvements 31,344 156.127 165,401 217.264 570.136 137.137 122.674 259.811 829.947 867.065 Total functional expenses $18,395,914 $9,524,272 $9,054,610 $11,880,986 $48,855,782 $7.204.238 $8.948,019 $16,152,257 $65,008,039 $59,927,004 The accompanying notes to financial statements are an integral part of this statement Note: This statement has been prepared by the National Center from the individual certified audit report of each affiliated association and is not covered by the report of Arthur Andersen & Co. 22 23 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227 NOTES TO COMBINED FINANCIAL STATEMENTS American Heart Association, Inc. (National Center) (A) SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (B) TAX STATUS: Standards of Accounting and Reporting The Association is exempt from income taxes under Section STATEMENT OF SUPPORT, REVENUE AND EXPENSES AND CHANGES IN FUND BALANCES The Association follows the standards of accounting and 501(c)(3) of the U.S. Internal Revenue Code: has been determined to be an organization which is not a private YEAR ENDED JUNE 30, 1975 WITH COMPARATIVE TOTALS FOR 1974 financial reporting for voluntary health and welfare agencies prescribed by the National Health Council. the National foundation; and is qualified for the 50% charitable contributions Assembly of National Voluntary Health and Social Welfare deduction. Current Funds Organizations and United Way of America. These standards are Building and Total All Funds inconformity with the recommendations of the American (C) NATIONAL CENTER CONSTRUCTION AND RELOCATION: Equipment Endowment Institute of Certified Public Accountants which became In prior years. the Board of Directors authorized the construction Unrestricted Restricted Fund Fund of a National Center office building in Dallas, Texas. and 1975 1974 effective in fiscal 1975. In accordance with these standards, expenditures for buildings and equipment and the fair value of designated funds for construction and relocation PUBLIC SUPPORT AND REVENUE: donated equipment are capitalized Depreciation is recorded The National Center initiated the move to Dallas during the year Public support- over the estimated useful lives of the assets. Investments are ended June 30. 1975. and all estimated relocation costs have stated at cost. All contribu utions are considered available for the been accrued and charged to expense National Center share of campaign general programs of the Association, unless specifically The National Center obtained a $3,000,000 line of credit and a contributions and bequests (Note 1) $14,215,881 $262,609 $ $ - $14,478,490 $14,202,372 restricted by the donor. Interfund receivables and payables. commitment for an additional $1,000,000 line, with interest at the arising from transactions which are to be completed after year- Contributions to building fund - - 22.948 - 22.948 35.731 floating prime rate (7% at June 30. 1975), from a Dallas bank to end. have been eliminated finance construction and relocation costs Asof June 30. 1975, Contributed by affiliated organizations The amounts shown for 1974 in the accompanying financial the National Center was committed for approximately (net of their fund raising costs estimated statements are presented in accordance withthe $1,600.000 of additional construction costs. recommendations of the American Institute of Certified Public at $40,046 in 1975 and $27,134 in 1974) - 294.458 - - 294.458 195.209 Accountants, This financial information included to provide a (D) LEGACIES IN PROCESS basis for comparison with 1975. and, other than for the balance The Association is the beneficiary under various wills and trust Total support from public 14.215.881 557.067 22.948 - 14.795.896 14.433.312 sheet presents summarized totals only, Accordingly, the 1974 agreements, the total realizable amount of which not Fees and grants from governmental amounts are not intended to present all information necessary presently determinable Such amounts will be recorded when for a fair presentation in accordance with generally accepted clear title is established and the proceeds are measurable. agencies - 222.927 - - 222.927 227.157 accounting principles. Certain amounts for 1974 have been reclassified to conform with the presentation used in the 1975 (E) ACCOUNTING CHANGES AND PRIOR YEAR Other revenue- financial statements FINANCIAL STATEMENTS Membership dues council membership 91,060 - - - 91,060 72,615 Effective July 1974 the Association changed its accounting Awards and Grants- Program service fees 405.997 - - - policy to conform with the "Standards of Accounting and 405.997 355.969 The Association's awards for research grants- in aid, Financial Reporting for Voluntary Health and Welfare Investment income and miscellaneous investigators. fellowships and professional education generally Organizations' as revised during fiscal 1975 (see Note A) (Note 2) 1,575,186 7.224 26.978 - cover a period of from one to five years, subject to annua 1.609.388 1.575.147 Accordingly, in most instances the comparative financial renewal at the option of the Association The liability for awards information as of June 30. 1974 has been retroactively restated Gains (losses) on investment transactions - (9.681) - (12,650) (22.331) 21.208 is recorded on an annual basis upon notification to the recipient to reflect these changes in accounting procedure Where at the time of approval or renewal (see Note E). restatement was not practicable or appropriate the cumulative Total other revenue 2.072.243 (2,457) 26.978 (12.650) 2.084.114 2.024.939 Continuing awards and awards granted in the future will be effect of the change has been reflected in the current year's financial statements, Total public support and revenue 16.288.124 777.537 49.926 (12.650) 17.102.937 16.685.408 made from the Current Unrestricted Fund Balance designated for research of $13,199,697. from donor restricted funds of $4,778,050 and from contributions received in future years. (F) INVESTMENTS All investments, other than endowment securities, are on a short- EXPENSES: Available Funds- term basis. Income from investments carried in all funds is Program services - The expenditures for each fiscal year are financed principally credited directly to Current Unrestricted Funds unless such income is restricted by the contributors. Research 7.777.772 496.204 7,997 - by funds received from the campaign of the previous year. 8.281.973 7.507.009 Accordingly, the campaign income shown in the Public health education 1.075.312 9,032 14.873 - 1.099.217 1.062.137 accompanying statementof support revenue and expenses Professional education and training 2.481.862 203.967 27.983 - and changes in fund balances will be available for research 2.713.812 2.483.811 awards and for programs and operations budgeted for the Community services 1.166.194 11,441 10.250 - 1.187.885 1.055.192 ensuing fiscal year. Total program services 12.501.140 720,644 61.103 - 13.282.887 12.108.149 Designated for Program Supplementation and Contingencies Supporting services- This portion of the Current Unrestricted Fund Balance. which Management and general 1,435,908 30.949 25,425 - 1.492.282 1.409.984 may be utilized by specific action of the various governing Fund raising 824,007 20.356 8.205 - Boards, is reserved for the continuity of the Association's general 852.568 731.906 activities. its scientific research program and to meet Total supporting services 2.259.915 51,305 33.630 - 2.344.850 2.141.890 emergency demands Total program and supporting services expenses 14.761.055 771.949 94.733 - 15.627.737 14.250.039 Excess (deficit) of public support and revenue over expenses, before relocation costs and cumulative effect of accounting change 1,527.069 5,588 (44,807) (12.650) 1.475.200 2,435,369 RELOCATION COSTS (Note 3) (1,277,070) - (15.010) - (1.292.080) - CUMULATIVE EFFECT OF ACCOUNTING CHANGE Research Expenses (Note 8) (549.278) - - - (549.278) - Excess (deficit) of public support and revenue over expenses (299.279) 5,588 (59.817) (12.650) (366.158) 2.435.369 OTHER CHANGES IN FUND BALANCES: Property and equipment acquisitions from unrestricted funds (Notes and 8) (225.205) - 225.205 - - - FUND BALANCES, beginning of year 19.510.077 725,893 752.924 339.914 21.328.808 18.893.439 FUND BALANCES, end of year $18,985,593 $731,481 $918.312 $327,264 $20.962.650 $21,328.808 See accompanying notes to financial statements. 24 25 Source: https://www.industrydocuments.ucsf.edu/docs/tInf0227

what is the title?

lglg0227

lglg0227_p34, lglg0227_p35, lglg0227_p36, lglg0227_p37, lglg0227_p38, lglg0227_p39, lglg0227_p40, lglg0227_p41

freshmen examination may 1963

SLEEP REVERSAL I, JANUARY 1963 FIVE SUBJECTS 120 100 80 60 140 120 100 80 I 2 3 4 5 6 7 8 9 I 2 3 4 5 I II III BASELINE REVERSAL Source: https://www.industrydocuments.ucsf.edu/docs/Iglg0227 SLEEP REVERSAL II, MARCH 1963 FIVE SUBJECTS 70 69 68 86 84 82 80 78 76 74 72 70 68 66 1.2 1.1 1.0 0.9 0.8 0.7 0.6 1.90 1,80 . . 1.70 . T T T 1 T I 2 3 4 5 6 7 8 9 I 2 3 4 5. - - BASELINE I II III REVERSAL Source: https://www.industrydocuments.ucst.edu/docs//glg0227 SLEEP REVERSAL II, MARCH 1963 FIVE SUBJECTS 6.0 DAYTIME 5.0 NIGHT TIME 4.0 14 for 13 12 700 600 21 20 19 18 3.0 2.0 1.0 o -1.0 I 2 3 4 5 6 7 8 9 I 2 3 4 5 - - BASELINE I II III REVERSAL Source: https://www.industrydocuments.ucsf.edu/docs//glg0227 NITROGEN BALANCE POTASSIUM SODIUM g/24 hr (m Eq 24hr) (m Eq. 24 hr) O - 2 3 1 2 3 1 4 5 6 1 R 2 3 D 1 E 5 6 MAY 1861 FRESHMEN EXAMINATION MAY 1963 FIFTEEN SUBJECTS 73 72 . - 71 78 76 74 72 70 1.3 1.2 1.1 1.0 has 0.9 1.80 1.70 1.60 I T T I 2 3 4 5 6 7 I 2 3 4 5 6 7 * one value missing BL R E weighted mean used DAYS Source: https://www.industrydocuments.ucsf.edu/docs/lglg0227 FRESHMEN EXAMINATION MAY 1963 FIFTEEN SUBJECTS 6.0 DAY 5.0 NIGHT 4.0 10.0 . 9.0 8.0 14.0 13.0 . 12.0 700 600 500 .- 20 19 18 I 2 3 4 5 6 I 2 3 4 5 6 BL R E DAYS Source: https://www.industrydocuments.ucst.edu/docs/glg0227 SLEEP REVERSAL II, MARCH 1963 FIVE SUBJECTS 100 80 60 E 40 120 100 E 80 I 2 3 4 5 6 7 8 9 I 2 3 4 5 I II III Source: https://www.industrydocuments.ucsf.edu/docs/Iglg0227 FRESHMEN EXAMINATION MAY 1963 EIGHT SUBJECTS ONLY 70 69 68 80 79 78 - 77 - 76 - M 75 74 73 72 1.2 1.1 1.0 0.9 0.8 1.80 1.70 1.60 1.50 T' I 2 3 4 5 6 7 I 2 3 4 5 6 7 8 9 * one value missing BL R E PE weighted mean used DAYS Source: https://www.industrydocuments.ucsf.edu/docs/Iglg0227

the examination is of which year?

lglg0227

lglg0227_p34, lglg0227_p35, lglg0227_p36, lglg0227_p37, lglg0227_p38, lglg0227_p39, lglg0227_p40, lglg0227_p41

1963

SLEEP REVERSAL I, JANUARY 1963 FIVE SUBJECTS 120 100 80 60 140 120 100 80 I 2 3 4 5 6 7 8 9 I 2 3 4 5 I II III BASELINE REVERSAL Source: https://www.industrydocuments.ucsf.edu/docs/Iglg0227 SLEEP REVERSAL II, MARCH 1963 FIVE SUBJECTS 70 69 68 86 84 82 80 78 76 74 72 70 68 66 1.2 1.1 1.0 0.9 0.8 0.7 0.6 1.90 1,80 . . 1.70 . T T T 1 T I 2 3 4 5 6 7 8 9 I 2 3 4 5. - - BASELINE I II III REVERSAL Source: https://www.industrydocuments.ucst.edu/docs//glg0227 SLEEP REVERSAL II, MARCH 1963 FIVE SUBJECTS 6.0 DAYTIME 5.0 NIGHT TIME 4.0 14 for 13 12 700 600 21 20 19 18 3.0 2.0 1.0 o -1.0 I 2 3 4 5 6 7 8 9 I 2 3 4 5 - - BASELINE I II III REVERSAL Source: https://www.industrydocuments.ucsf.edu/docs//glg0227 NITROGEN BALANCE POTASSIUM SODIUM g/24 hr (m Eq 24hr) (m Eq. 24 hr) O - 2 3 1 2 3 1 4 5 6 1 R 2 3 D 1 E 5 6 MAY 1861 FRESHMEN EXAMINATION MAY 1963 FIFTEEN SUBJECTS 73 72 . - 71 78 76 74 72 70 1.3 1.2 1.1 1.0 has 0.9 1.80 1.70 1.60 I T T I 2 3 4 5 6 7 I 2 3 4 5 6 7 * one value missing BL R E weighted mean used DAYS Source: https://www.industrydocuments.ucsf.edu/docs/lglg0227 FRESHMEN EXAMINATION MAY 1963 FIFTEEN SUBJECTS 6.0 DAY 5.0 NIGHT 4.0 10.0 . 9.0 8.0 14.0 13.0 . 12.0 700 600 500 .- 20 19 18 I 2 3 4 5 6 I 2 3 4 5 6 BL R E DAYS Source: https://www.industrydocuments.ucst.edu/docs/glg0227 SLEEP REVERSAL II, MARCH 1963 FIVE SUBJECTS 100 80 60 E 40 120 100 E 80 I 2 3 4 5 6 7 8 9 I 2 3 4 5 I II III Source: https://www.industrydocuments.ucsf.edu/docs/Iglg0227 FRESHMEN EXAMINATION MAY 1963 EIGHT SUBJECTS ONLY 70 69 68 80 79 78 - 77 - 76 - M 75 74 73 72 1.2 1.1 1.0 0.9 0.8 1.80 1.70 1.60 1.50 T' I 2 3 4 5 6 7 I 2 3 4 5 6 7 8 9 * one value missing BL R E PE weighted mean used DAYS Source: https://www.industrydocuments.ucsf.edu/docs/Iglg0227

what does the y axis represent in the first chart from top?

lglg0227

lglg0227_p34, lglg0227_p35, lglg0227_p36, lglg0227_p37, lglg0227_p38, lglg0227_p39, lglg0227_p40, lglg0227_p41

body weight - kg, body weight - Kg, body weight

SLEEP REVERSAL I, JANUARY 1963 FIVE SUBJECTS 120 100 80 60 140 120 100 80 I 2 3 4 5 6 7 8 9 I 2 3 4 5 I II III BASELINE REVERSAL Source: https://www.industrydocuments.ucsf.edu/docs/Iglg0227 SLEEP REVERSAL II, MARCH 1963 FIVE SUBJECTS 70 69 68 86 84 82 80 78 76 74 72 70 68 66 1.2 1.1 1.0 0.9 0.8 0.7 0.6 1.90 1,80 . . 1.70 . T T T 1 T I 2 3 4 5 6 7 8 9 I 2 3 4 5. - - BASELINE I II III REVERSAL Source: https://www.industrydocuments.ucst.edu/docs//glg0227 SLEEP REVERSAL II, MARCH 1963 FIVE SUBJECTS 6.0 DAYTIME 5.0 NIGHT TIME 4.0 14 for 13 12 700 600 21 20 19 18 3.0 2.0 1.0 o -1.0 I 2 3 4 5 6 7 8 9 I 2 3 4 5 - - BASELINE I II III REVERSAL Source: https://www.industrydocuments.ucsf.edu/docs//glg0227 NITROGEN BALANCE POTASSIUM SODIUM g/24 hr (m Eq 24hr) (m Eq. 24 hr) O - 2 3 1 2 3 1 4 5 6 1 R 2 3 D 1 E 5 6 MAY 1861 FRESHMEN EXAMINATION MAY 1963 FIFTEEN SUBJECTS 73 72 . - 71 78 76 74 72 70 1.3 1.2 1.1 1.0 has 0.9 1.80 1.70 1.60 I T T I 2 3 4 5 6 7 I 2 3 4 5 6 7 * one value missing BL R E weighted mean used DAYS Source: https://www.industrydocuments.ucsf.edu/docs/lglg0227 FRESHMEN EXAMINATION MAY 1963 FIFTEEN SUBJECTS 6.0 DAY 5.0 NIGHT 4.0 10.0 . 9.0 8.0 14.0 13.0 . 12.0 700 600 500 .- 20 19 18 I 2 3 4 5 6 I 2 3 4 5 6 BL R E DAYS Source: https://www.industrydocuments.ucst.edu/docs/glg0227 SLEEP REVERSAL II, MARCH 1963 FIVE SUBJECTS 100 80 60 E 40 120 100 E 80 I 2 3 4 5 6 7 8 9 I 2 3 4 5 I II III Source: https://www.industrydocuments.ucsf.edu/docs/Iglg0227 FRESHMEN EXAMINATION MAY 1963 EIGHT SUBJECTS ONLY 70 69 68 80 79 78 - 77 - 76 - M 75 74 73 72 1.2 1.1 1.0 0.9 0.8 1.80 1.70 1.60 1.50 T' I 2 3 4 5 6 7 I 2 3 4 5 6 7 8 9 * one value missing BL R E PE weighted mean used DAYS Source: https://www.industrydocuments.ucsf.edu/docs/Iglg0227

which year is mentioned first on x-axis?

ktlw0227

ktlw0227_p5, ktlw0227_p6, ktlw0227_p7, ktlw0227_p8, ktlw0227_p9, ktlw0227_p10

1900

7.g. I age at menarche by year of birth - means of N 49 14.0 97 420 13.5 1387 50 221 13.0 56 43 241 braced point - only the 902 early menarches have 146 occurred at present 1890 1900 1910 1920 1930 1940 1950 1960 year of birth Source: https://www.industrydocuments.ucsf.edu/docs/ktlw0227 ty. age at minitche by year year memarch in the MH study ( trend is comfounded by sampling artifacts) 150 145 14.0 13.5 12.5 12.0 1900 1910 1920 1930 1940 1950 1960 1970 year mena the occurred Source: https:/lwww.industrydocuments.ucsf.edu/docs/ktlw0227 7.eg. The pecular trend he recorded age at menarche by year menaiche occurred H = 438 14 13.5 G is 13 12.5 th 12 1940 1950 1960 1970 year minarde occurred Source: https:/lwww.industrydocuments.ucsf.edu/docs/ktlw0227 (1) Tanner, J.M. (1962) Growth at Adolescence, 2nd ed., Blackwell Scientific Publications, Oxford. 326 p. & (2) Frisch, R., and R. Revelle (1967) "Variations in Body Weights Among Different Populations, " 3:1-41. In a Report of the: Panel on World Food Supply (1967) The World Food Problem, U.S. Government Printing Office, Washington : 3 vol. 3 Aznar, R., and A. E. Bennett (1961) "Pregnancy in the Adolescent - Girl, Amer. J. Obstet. Gynecol. 81:934-940. 4 Z Battaglia, F. C., T. M. Frazier, and A. E. Hellegers (1963) "Obstetric and Pediatric Complications of Juvenile Pregnancy, " Pediatrics, 39:902-910. 5 Bochner, K. (1962) "Pregnancies in Juveniles, Amer. J. Obstet. Gynecol , 83:269-271. 6 Briggs, R. M., R. R. Herren, and W. B. Thompson (1962) "Pregnancy in the Young Adolescent, " Amer. J. Obstet. Gynecol. 84:436-441. 7 13 Clamon, A. D., , and H. M. Bell (1964) "Pregnancy in the Very Young Teen-ager, " Amer. J. Obstet. Gynecol. , 90:350-354. 8 to Hassan, A. M., and F. H. Falls (1964) "The Young Primipara -- A Clinical Study, " Amer. J. Obstet. Gynecol. , 88:256-269. 9 7 Hulka, J. F., and J. T. Schaaf (1964) "Obstetrics in Adolescents: A Controlled Study of Deliveries by Mothers 15 Years of Age and Under, " Obstet. Gynecol. , 23:678-685. 10% Israel, S. L., , and T. B. Woutersz (1963) "Teenage Obstetrics: A Cooperative Study, Amer. J. Obstet. Gynecol. , 85:659-668. 11 h Lewis, B. V., and P. J. Nash (1967) "Pregnancy in Patients Under 16 Years, " Brit. Med. J., 2:733-734. 1256 Marchetti, A. A. and J. S. Menaker (1950) "Pregnancy and the Adolescent, Amer. J. Obstet. Gynecol. , 59:1013-1020. 13 H Metsälä, P. (1966) "Observations on Adolescent Parturients, " Ann. Chir. Gynecol. Fenn. 55:214-218. 14 12 Mussio, T. (1962) "Primigravidas under Age J. 14, " Amer. J. Obstet. Gynecol., 84:442-444. 15 11/1 Santow, G. S. (1965) "Obstetrics in the Adolescent: A Clinical Survey, " Med. J. Aust. 2:488-491. 16 Lt Stearn, R. H. (1963) "The Adolescent Primigravida, " Lancet, 2:1083-1085. 17 is Utian, W. H. (1967) "Obstetrical Implications of Pregnancy in Primigravidae Aged 16 Years or Less " Brit. Med. J. . 2:734-736 Source: https:/lwww.industrydocuments.ucsf.edu/docs/ktlw0227 18 Burke, B. S., R. B. Reed, A. S. vanden Berg, and H. C. Stuart (1959) "Caloric and Protein Intakes of Children between 1 and 18 Years of Age, " Pediatrics, 2:922-940. 19 1/ Eppright, E. S., V. D. Sidwell and P. P. Swanson (1954) "Nutritive Value of the Diets of Iowa School Children" J. Nutr. 54:371-387. 20 Z Wait, B, and L. J. Roberts (1932) "Studies in the Food Requirements of Adolescent Girls: I. The Energy Intake of Well-Nourished Girls 10-16 Years of Age, J. Amer. Diet. Asso. 8:209-237. 21 1 Food and Nutrition Board, National Academy of Sciences-National Research Council, Recommended Dietary Allowances, revised 1968, 7th ed. NAS-NRC Publication 1694, NAS-NRC Washington, D. C. (1968). 22 5 Weihl, D. G. and K. Berry (1945) "Medical Evaluation of Nutritional Status: Part XVI, " Milbank Mem. Fund Quart. , 23:353-385. 23 X Mitchell, H. S., R. B. Reed, I. Valadian, and M. Hoff (1966) "The Adolescent Growth Spurt and Nutrient Intake" Presented at the International Congress of Nutrition, Hamburg, Germany. 2 of A Burke, B. S., R. B. Reed, A. S. vanden Berg, and H. C. Stuart (1961) "Relationships between Animal Protein, Total Protein and Total Caloric Intakes in the Diets of Children from One to Eighteen Years of Age, Amer. J: Clin. Nutr. 9:729-734. 25$ Ohlson, M. A. and G. Stearns (1959) "Calcium Intake of Children and Adults, " Fed. Proc. 18: 1076-1085. 26. a Johnston, J. A. (1953) Nutritional Studies in Adolescent Girls and their Relation to Tuberculosis, C. C. Thomas, Springfield, Illinois 320 pp. 27 it Moore, C. (1955) "Studies on Iron Metabolism Using Radio Iron" In Modern Trends in Blood Disease, Wilkinson, J. F. (ed.) Butterworth: London 28 H Monsen, E. R., , I. N. Kuhn and C. A. Finch (1967) "Iron Status of Menstruating Women; " Amer. J. Clin. Nutr. , 20:842-849. to 29 Hodges, R. E. and W. A. Kuhl (1965) "Nutritional Status of Teenagers in Iowa; Amer. J. Clin. Nutr. , 17:200-209. Committee on Iron Deficiency (1968) "Iron Deficiency in the 30 United States, JAMA, 203:119-124. Source: https://www.industrydocuments.ucsf.edu/docs/ktlw022 31 M Morse, E. H., S. B. Merrow and R. F. Clarke "Some Biochemical Findings in Burlington (Vt.) Junior High School Children, " Amer. J. Clin. Nutr. , 17:211-217. 32 to Interdepartmental Committee on Nutrition for National Defense (1963) Manual for Nutrition Surveys (2nd ed.) Government Printing Office, Washington, D. C. Dibble, M. V., M. Brin, E. McMullen, A. Peel and N. Chen (1965) 33 "Some Preliminary Biochemical Findings in Junior High School Children in Syracuse and Onondaga County, New York, " Amer. J. Clin. Nutr 17:218-239. 34 / Huenemann, R. L., M. C. Hampton, L. P. Shapiro, and A. R. Behnke (1966) "Adolescent Food Practices Associated with Obesity, " Fed. Proc. , 25:1; 4-10. 35 Wakefield, L. M. and S. B. Merrow (1967) "Interrelationships between Selected Nutritional, Clinical, and Sociological Measurements of Preadolescent Children from Independent Low Income Families, " Amer. J. Clin. Nutr. , 20(4):291. 36 Wharton, M. A. (1963) "Nutritive Intake of Adolescents; " J. Amer. Diet. Ass., 42:306`. 37. Despectment inside citition al benestture Putistre vilue of duts correct coming 38. Rsans, K.D. and G.Reed (1964) Heath Stutus Personally Normal High School Students bmc J. Tis Clind 108;,472-600. Source: https:/lwww.industrydocuments.ucsf.edu/docs/ktlw0227

What is written on right top corner of the page?

qtpg0227

qtpg0227_p0

1st Working Draft

lst Working Draft Food and Nutrition Board, National Academy of Sciences-National Research Council Recommended Daily Dietary Allowances¹, , Revised 1963 Designed for the maintenance of good nutrition of practically all healthy persons in the U.S.A. (Allowances are intended for persons normally active in a temperate climate) Pro- Cal- Vita- Equiv 3 2 Thia- Ribo= Ascores Vita- Age Weight He ght Calo tein cium Iron min A mine flavin Niacin bic Acid min D years kg. (lbs.) cm. (in. ries gm. gm. mg. I.U. mg. mg. mg. me. I.U. Men 25 70 (154) 175 (69) 3000 70 0.8 5000 1.2 1.8 20 70 45 70 (154) 175 (69) 2700 70 0.8 5000 1.1 1.6 18 70 65 70 (154) 175 (69) 2400 70 0.8 5000 1.0 1.4 16 70 Women 25 58 (128) 163 (64) 2200 58 0.8 5000 0.9 1.3 15 70 45 58 (128) 163 (64) 2000 58 0.8 5000 0.8 1.2 13 70 65 58 (128) 163 (64) 1800 58 0.8 5000 0.8 1.1 12 70 Pregnant (last Trimester) +200 +20 +0.5 + 1000 +0.2 +0.3 + 3 + 30 400 Lactating + 1000 +40 +0.5 +3000 + 0.4 +0.6 +' 7 +30 400 Infants O-1 Kgx115 Kgx2.5 0.7 30 1144 -0.5 4 Children 1-3 12 (27) 87 (34) 1400 35 0.8 2000 0.6 0.8 9 40 400 3-6 18 (40) 107 (42) 1600 40 0.8 2500 0.6 1.0 11 50 400 6.9 24 (53) 124 (49) 2100 52 0.8 3500 0.8 1.3 14 60 400 Boys 9-12 33 (72) 140 (55) 2400 60 1.1 4500 1.0 1.4 16 70 400 12-15 45 (98) 156 (61.) 3000 75 1.4 5000 1.2 1.8 20 8o 400 15-18 61 (134) 172 (68) 3400 85 1.4 5000 1.4 2.0 22 80 400 Girls 9-12 33 (72) 140 (55) 2200 55 1.1 4500 0.9 1.3 15 80 400 12-15 47 (103) 158 (62) 2500 62 1.3 5000 1.0 1.5 17 8o 400 15-18 53 (117) 163 (64) 2200 55 1.3 5000 0.9 1.3 15 70 400 the allowance levels are intended to cover individual is from beginning of lst year to end of 2nd year; variations among most normal persons as they live in the 3-6 (representing 43 years) is from beginning of United States under usual environmental stresses. The 3rd to end of 5th year, etc. recommended allowances can be attained with a variety of common foods, providing other nutrients for which human 3Niacin equivalents include dietary sources of the requirements have been less well defined. See text for preformed vitamin and the precursor, tryptophan. 60 more detailed discussion of allowances and of nutrients milligrams tryptophan equals 1 milligram niacin. not tabulated. The calorie and protein allowances per kilogram for 2adult age entry 25 is for period 18-35, 45 is for infants are considered to decrease progressively from 35-55, 65 for 55=75. The age entries for infants and birth; i.e., at birth calorie allowance is 125 per kg. children mark the beginning of each age, e.ge: 0.1 is protein allowance is 3.0 gm. kg. Protein allowance from birth to end of lst year; 1-3 (representing 2 years) for infants and children approximate 10% of total calories from protein. Source: https://www.industrydocuments.ucst.edu/docs/qtpg022

what is option 'A'?

jqxf0227

jqxf0227_p1, jqxf0227_p2, jqxf0227_p3, jqxf0227_p4, jqxf0227_p5, jqxf0227_p6, jqxf0227_p7, jqxf0227_p8, jqxf0227_p9, jqxf0227_p10, jqxf0227_p11, jqxf0227_p12, jqxf0227_p13, jqxf0227_p14, jqxf0227_p15, jqxf0227_p16, jqxf0227_p17, jqxf0227_p18, jqxf0227_p19, jqxf0227_p20, jqxf0227_p21, jqxf0227_p22, jqxf0227_p23, jqxf0227_p24, jqxf0227_p25, jqxf0227_p26

annually

Preventive Medicine and CONFIDENTIAL Public Health Subjeci NATIONAL BOARD OF MEDICAL EXAMINERS Total number of Itoms CORRECT CATEGORY ANSWER No. A 3 6 (b) Most common cause of maternal mortality today. 0 E 3 7 (b) Has shown greatest decline as cause of maternal mortality. 0 8 (b) / 3 Most frequently associated with spontaneous abortions. - B alrotrick - 2 - regists D 3 9 (b) Associated maternal deaths almost completely preventable. produce ? A 3 10 (b) May be related to renal impairment -1 A 3 11 (e) Prematurity is currently the most important cause of infant mortality che roles for Because )other causes have been more markedly reduced. / D 3 12 (e) Infant mortality has been most markedly reduced in infants under one month of age Because infections causing infant mortality have been effectively controlled and controlled 1 markedly reduced. C 3 13 (e) Maternal mortality is higher in southern states than in the rest of the United States Because the larger non white population accounts O for all the excess mortality. B 3 14 (e) Infant mortality after the first month of life has declined markedly Because death rates from prematurity have been reduced. O A 3 15 (e) Infant death rates on the first day of life have been only moderately reduced Because such deaths are largely due to asphyxia, birth injury, and congenital malformations. O (A) Schizophrenia (B) Paresis (c) Senile and arteriossclerotic psychoins (D) Manic ar depressive psychosis (E) Korsakoff's psychosis A 4 16 (b) The most common psychosis under 50. C 4 17 (b) Increasing because of population trends. D 4 18 (b) Greatest tendency to remission. CONFIDENTIAL Preventive Medicine and Subject Public Health NATIONAL SOARD OF MADICAL EXAMINERS Total number of itoms cornect CATEGORY ANSWER No. B 4 infection inate 1 19 (b) Can be caused by maternal infection. which Bertswn E 4 20 (b) May be favorably affected by vitamin B. 1 C 5 21 (e) association Beriberi occurs in connection with alcoholism Because alcohol inter- feres with absorption of thiamin. O B 5 22 (e) Magenta-colored glossitis occurs in riboflavin deficiency Because ? vitamin deficiencies are frequently multiple. A 6 23 (k) which may be water bome Human infections caused by water include (1) Typhoid fever 2 (2) Anfectious hepatitis a (3) Fularemia - has been repented (4) Typhus D 6 24 (a) With accidental contamination of a public water supply today, the most common infection is likely to be (A) Typhoid fever (B) /Bacillary dysentery (c) Amebic dysentery (D) Acute diarrhea review term (E) Sicerative colitis C 6 25 (e) An Imhoff tank is a valuable sanitation procedure Because it is 2 an essential step in the purification of public water supplies. E 6 26 (e) Thoroughly cooked food does not cause food poisoning Because the staphylococcus toxin is heat labile. -1 ROM C 7 27 (a) Select for the five possible interpretations the one which best fits the data presented in the following Retailed table: friends foint 2 quick lot 1000-4/57 CONFIDENTIAS Preventive Medicine and Subjoct Public Health NATIONAL BOARD OF MHDICAL EXAMINERS Total comber of liems - CORRECS CATEGORY ITEM ANSWER No. Results of Tuberculosis Surveys among Selected Population Groups in Minneapolis das 1953. New Cases per Thousand Persons Screened Groups Total Cases Active Cases Salvation Army Hostel 34.6 22.2 Hennepin County 2.8 0.4 Mobile TB Unit (Minneapolis school students and personnel) 0.5 0.2 New Case Rates among General U. S. Population 0.8 0.3 (A) One of the permanent employees of the Salvation Army Hostel must have active tuberculosis. (B) The BCG vaccination program has been successful in Minneapolis. (c) Undernourished transients living in dormitories provide ideal hosts for tubercle bacilli. (D) Environmental conditions in the Hostel must predispose to tuberculosis, (E) The Hennepin County Health Department is doing a better job in con- trolling Luberculosis than the Minneapolis Health Department, but both are below the standard for the country as a whole. (A) Group medical Practice (B) Social medicine (c) Comprehensive medicine (D) Compulsory health Insurance (E) None of the above B 7 28 (b) A point of view in medicine which regards many diseases as forms of maladaptation to cultural and societal vectors. 1800-4/57 Source. https:/iwww.industrydocuments.ucsi.edu/docsijqxi0227 Preventive Medicine and CONFIDENTIAL Subject Public Health NATIONAL BOARD OF MRDICAL EXAMINERS Total nomber of Nems CORRECT ITEM CATEGORY ANSWAP No E 7 29 (b) That part of a county medical society's activities pertaining to re- creation and the development of physicians social interests. O D 7 30 (b) A pattern of medical organization in which direct fee-for-service remuneration is replaced by various universal insurance and salary provisions. (1) C 7 31 (b) An approach to medical practice in which physicians attempt to under- stand all aspects of their patients health problems including the physio-pathologica, anatomic, emotional, and social elements. 0 A 7 32 (b) A form of medical organization in which several physicians (usually including various specialists) share overhead, responsibilities, con- sultation and combine their earnings, dividing the net income on a pre "arranged basis. 0 Recently B 7 33 (a) Increa'sed hospital charges are chiefly attributable to increased the of or to (A) Inoreased cost of drugs and supplies. sive : (B) Increased personnel costs. sevilor the name (c) Increased-use of expensive drugs (D) Inereased equipment overhead. average ent of single homputelization (1) A 7 34 (e) The increase in total hospital bills has not kept pace with increased hospital charges Because the period of hospitalization for most illnesses has been greatly reduced. .) e E 8 35 (e) Rehabilitation of paraplegies has bean routinized Because disability - to alvers from all spinal cord injuries is sufficiently similar. D 36 (e) It is not possible to train a hemiplegic to become ambulatory more than six months after the vascular accident Because virtually all return of function of nervous tissue will have occurred within six months; 0 1800-4/57 Preventive Medicine and Public Health CONFIDENTIAL Subjoch NATIONAL BOARD OF MEDICAL EXAMINIRS Total sumber of itoms - CORRECT ITEA ITEM CATEGORY ANSWER No. A 8 37 (e) Removal of slight or even potential prostatic obstruction is important in a paraplegic Because bladder emptying by gravity is important in preventing urinary infections. 0 C 9 38 (e) Control of industrial accidents and toxicity is emphasized by occupa- tional health today Because such control will significantly reduce absenteeism. 0 C 9 39 (e) Pre-employment examinations are important in industry Because in- dividuals with health problems must be excluded. U C 10 40 (e) Tetanus spores are commonly present in the soil of barnyards Because the presence of manure is necessary for their survival. A. Anthrax B. Tuberculosis C. Syphilis D. Typhoid E. Diphtheria The etiologic agent don't how about system I ?x C 11 41 (b) Dies quickly outside the body. -0 A 11 Is very resistant outside the body. how about T B- - ?x 42 (b) - B 11 43 (b) Has waxy structure. (1) I C 11 44 (b) Is best recognized while still alive. 0 E 11 45 (b) Produces an antigenic toxin. - also typhad A 11 46 (e) The pneumococcus is the most important etiologics agent in lobar pneumonia Because it is the causative agent in approximately 95 pero cent of such cases. technique 1800-4/57 CONFIDENTIAL Preventive Medicine Subjock and Public Health NATIONAL BOARD OF MEDICAL EXAMENERS Total sumber of Homs CORRECT ITEM CATEGORY ANSWER No. C 11 47 (e) The death rate from tuberculosis in the American negro is at least sel four times that in the white population Because the attack rate of the disease is four times greater in the negro than in the white U population. D 11 48 (e) The tuberculosis death rate is much higher in rural than in urban areas Because proper health facilities are less adequate in rural reality available 0 areas. E 11 49 (e) Economic circumstances do not affect the tuberculosis rate in a population Because susceptibility to tuberculosis is uniform throughout the population. too remigh C 11 50 (e) BCG vaccination against tuberculosis has proven to be safe Because the antigen is composed of heat-killed bacilli. 0 Overall C 12 51 (e) (Mortality from heart disease has increased Because of the increased mortality rate in the fifth and sixth decades. D which C 12 52 (a) The númber of cases of ene of the following disease entities has increased ? (A) Thyrotoxicosis (B) Gastric ulcer : (c) Duodenal ulcer too strour done how B R (D) Tuberculosis (E) Syphilis 1800-4/57 urce. htps.llwww.industrydocuments.ucsi.edu/docsijuxi0227 CONFIDENTIAL Preventive Medicine Subjock and Public Health NATIONAL BOARD OF MEDICAL EXAMINERS Totel of items CORRECT CATEGORY TEEM STEM ANSWER No. which D 12 53 (a) One of the following diseases is more common in females ? (A) Coronary artery disease (c) mently wals 7907 (B) Duodenal ulcer Marie-Strumpell disease (D) Rheumatoid arthritis (E) Bronchial asthma anithor - bosh up - A 12 54 (e) Increased mortality from cancer is due to the aging of the population (1) Because overall age specific cancer mortality rates have not increased. A 12 55 (e) a Over-all mortality from coronary heart disease has increased Because the mortality rate in white males has increased. 2X ales female B 12 56 (e) Heart disease now ranks in first place in causes of death Because heart disease deaths account for more than a third of deaths from all- causes. 0 - 2x 7 A C 13 57 (e) Prevention of industrial accidents should be a major activity of an accident prevention program Because the fatality ratio exceeds even that in motor vehicle accidents. 0 D 13 58 (e) Accidents are in first place as a cause of death in the 65 and over age Because they deaths 100,000 any sifture group cause more per than in other age group. 0 Public Hea th CONFIDENTIAL Biometrics NATIONAL BOARIO OF MEDICAL EXAMINERS VI Total Subjech 79 of items 4 7-19-57 CORRECT ITEMA CATEGORY IXEM ANSWER No. E 1 1 In evaluating the relationship of smoking to lung cancer, it would be most practicable to use as a basic population segment A) lung cancer cases with tissue proor B) lung cancer cases as listed on death certificates C) heavy smokers 0 D) a random sample of the general population E) a random sample of men over age 45 D 3 2 All solitary nodules of the lung should be removed because thoracic surgeons report that a high percentage of resected nodules are malignanto 1800-4/57 Source.hups/lwww.industrydocuments.ucsi.edu/docsijuxi0227 CONFIDENTIAL Subject Public Health Administration NATIONAL BOARD OF MIDICAL EXAMINERS Total number of items 2 CORRECT CATEGORY ITEM ANSWER No. A 2 Steps toward the successful establishment of a local 3 health department in an area without one include 1. a survey of local health needs. 0 20 obtaining cooperation of the County Medical Society 30 a referendun of the voters. - (is this always necessary) 4. obtaining a grant from a voluntary health organization. C 2 The minimal recommendad population warranting establishment 4 of a local health unit is A) 15,000 2 B) 25,000 C) 50,000 D) 75,000 E) 100,000 1800-4/57 CONFIDENTIAL Subject Maternal and Child Health NATIONAL BOARD OF MEDICAL EXAMENERS Total number of itoms 8 in item type @ guestions - both the assertion and veasen should be complete CORRECT CATEGORY ITEM ANSWER No. statements ITEM - the be can A 3 An adequate child health program should provide annual 5 tuberculin tests because of the special importance of is is important that be afforded close clinical supervision of Fecent tuberculin converters. O ? x C 3 An infant attending a well-child conference usually has 6 1) scarlet fever immunization X 6 2) tetanus-pertussis-diphtheria vaccine before months of age. 3) a booster injection of triple vaccine about two years after the first injection. 4) smallpox vaccination during the first year. O B 3 Prematurity is the ma jor cause of paranatal deaths becaus se 7 infectious diseases of infants have been so much better controlled since the antibiotic 0 A 3 The major causes of maternal mortality are 1) hemorrhage 2) infection xemids 3) tonomies of pregnancy 4) heart disease 1000-4/57 CONFIDENTIAL Maternal and Child Health Subject NATIONAL BOARD OF MEDICAL EXAMINERS Total number of items 8 CORRECT CATEGORY ITEM ITEM ANSWER No. B 3 It does not matter much what parents do or say to young 9 childron so long as they really love them because security in affection is adequate for good mental health. 2 n D 3 Mentally deficient children never have normal developmental 10 histories because they tend to be slow in sitting, teething, c standing. walking and talking. - E 3 The child brought to the physician because of scholastic 11 difficulties may have 1) hearing difficulties all are principle convert 2) visual difficulties 2 3) too high intelligence quotient 4) too low an I.S. intelligence quotient D 3 The earlier toilet training is accomplished the better 12 because discipline is important in child training what are ibefore 1000--4/57 CONFIDENTIAL Subject Mental Hygiene NATIONAL BOARD OF MEDICAL EXAMINERS Total number of items 5 CORRECT CATEGORY ITEM ITEM ANSWER No. C 4 A) Prenatal conferences for prospective fathers and mothers D B B) Group conferences for mothers at Well-Child Conferences C B C) Both D) Neither 13. 1. Breast feeding 0 14. 2. Post~partum hemorrhage 15. 3. Thumb sucking 16. 4. Sibling rivalry 0 C 17. 5. Enuresis 5 B 4 Alcoholics Anonymous have been most successful because 18. the members, themselves, know the problems of alcoholism from personal experience. abustion ix WITB understand C IX 4 A) Suiciãe 190 The solution involves consideration A IX of the norm. B IX B) Frigidity E IX 20. The epidemiologic approach may be officer D 1 x C) Homosexuality helpful. D) Irritable colon 21. Childhood experiences often underlie it. E) Impotence 220 Interpersonal relationships are of utmost importance. things 23. Stressful situations to be avoided. 1300-4/57 CONFIDENTIAL Subject Mental Hygiene NATIONAL BOARD OF MEDICAL EXAMINERS Total number of Items 5 CORRECT CATEGORY ITEM ANSWER No. ITEMA A & 24 Patients who suffer from excessive self-criticism should be urged to be as kind to themselves as they are to others because mental health requires being comfortable about one-solf. A 25 In evaluating the psychiatric status of a patient, important include the fol lewing points in the history ane impontant- 1) adoption 2) frequent job changes 2 3) domineering parent 4) income 1800-4/57 Source.hups://www.industrydocuments.ucsi.edu/docsijuxi0227 CONFIDENTIAL Subject Nutrition NATIONAL BOARD OF MEDICAL EXAMINERS Total number of items 4 CORRECT ITEAA CATEGORY ANSWER No. ITEM B 5 A) Prevention 1. Urinalysis 3 26. B) Early detection 2. Blood sugar determination the C) Early therapy 3. Avoidance of obesity 2 4. Glucose tolerance test 5. Medical history A 5 A weight reduction program should 27. 1. always include a lowered caloric intake. 20 avoid a high salt intake. 0 3. not be inaugurated for depressed patients 4. always include small amounts of thyroid. C 5 A) Pyridoxine B B) Vitamin A C) Ascorbic acid other listings D) Therapeutic vitamins E) Nicotinic acid 28. IX The amount excreted in the urine reflects the state of tissue saturation. abstrumance < N- 6-pyridme a 29. Deficiency may affect the mucosa of the entire gastro- intestinal tract. E has 30. 0 A-number of cases of hypervitaminosi S have been reported in children. B item AB 31. 2X It is a valuable adjunct to most geriatric diets Because of the danger of INH-induced peripheral 32. 0 neuritis, it is given in combination with that drug in the troatment of tuberculosiso 1300-4/57 Source.htps://www.industrydocumentsucsi.edu/docsijuxi0227 CONFIDENTIAL Subject Nutrition NATIONAL BOARD OF MEDICAL EXAMINERS Total sumber of items 4 CORRECT ITEM CATEGORY ITEM ANSWER No. C 5 A. Agannaglobulinemd.a 1. Liver disease B.C. 3 33 l B. Hyperglobulinenda 2. Hookworm disease Co Hypoproteinemia 30 Sarcoidosis 40 Chronic malnutzition 5. Renal disease e.htps:liwww.industrydocuments.ucsi.edu/docsijyxi0227 CONFIDENTIAL Env iornmental Sanitation Subjech NATIONAL BOARD OF MEDICAL EXAMINERS 2 Total number of Hems CORRECT CATEGORY ITEM No. Su item # 5 ITEM ANSWER A 6 Air pollution is an unsolved public health problem 34. there is because of lack of basic scientific information on 0 the relationship of specific pollutants and snog to health. E 6 Annual medical examinations of foodhandlers effectively 35. protect the public because they rule out the presence of 0 infectious disease. Source.https://www.industrydocuments.ucsi.edu/docsijuxi0227 ONFIDENTIAL Subject Socio=economic aspects of Medical Care NATIONAL BOARD OF MEDICAL EXAMINERS Total number of Itoms 2 CORRECT CATEGORY ITEM ITEM ANSWER No. E 7 A successful home care program requires 36. 1. the provision of adequate medical care. I 2. the availability of hospital beds for emergenciese 3. family interest in having the patient at home. In the preference of the patient for home care. A 7 Older people develop psychologic problems because of 3% 1. insecurity IX 20 mutritional deficiencies. ? 3. loss of contemporaries. 40 nocturia. CONFIDENTIAL Rehabilitation, Physical Subject Medicine NATIONAL BOARD OF MEDICAL EXAMINERS 8 Total number of items CORRECT ITEM CATEGORY ITEM ANSWER No. * 8 On 7-5=57, a 40myear-old white man, applies for D 38. the job of clerk. Physical examination reveals no abnormality but there is a history of hospitalization for for active tuberculosis over a six-month period in 1952. Which of the following will be most helpful in deciding employability? A. to Lack of abnormal findings on physical examination. roentgenogram B 20 A chest revealing fibrocalcific strands. C 3. The light nature of the job for which the man is applying. the roentgenogram D &. Comparison of your chest with the series available since 1952. E S. The long interval since the hospitalization. B 8 A) Talipes planus 1. Daily exercises A 5 39. 2 B) Low back strain 2. Weight reduction C) Scoliosis 3. Brace C 4. Postural elimination of lordosis 5. Orthopedic surgery C 8 A patient with advanced omphysema should 40. 1. increase his physical activities. X 2. limit his activities to those which do not produce dyspnea. 3. move to a dry climate. 4. avoid contact with respiratory infection. 1800-4/57 Source.htps:llwww.industrydocuments.ucsi.edu/docsijqxi0227 CONFIDENTIAL Rehabilitation, Physical Sobject Medic ine NATIONAL BOARD OF MEDICAL EXAMINERS Total number of items 8 CORRECT CATEGORY ITEM ITEM ANSWER No. B 8 4/ A. Absenteeism among handicapped workers. B. Absenteeism among woman workers. & 8 The blind are more dextrous than the sighted because B 42. they are not distracted by lights and colors. - A 8 Congenital dislocations of the hip should be sought 43. early because resultant deformity depends upon the age at which therapy is inaugurated. C 8 A) Social Security 1 4H. B) National Foundation for Infantile Paralysis c) Federal Vocational Rehabilitation Program 1. Grant=in-aid BC - (c-doe provide grants in and - u Teacher Srawl w.ll.) 2. Testing C 3. Medical Care BC 4. Tuition B 5. Living expense A,C C 8 In the management of a fractured lega the most inexcusable 45. complication is A) fat embolismo B) deformityo C) crutch paralysiso D) failure to detect the presence of tuberculosis. E) dermatitis under the cast. 1800-4/57 e.htps:liwww.industrydocuments.ucsi.edu/docsijuxi0227 CONFIDENTIAL Subject Occupational Health NATIONAL BOARD OF MEDICAL EXAMINERS Total number of itoms 3 CORRECT ITEM CATEGORY ITSM ANSWER No. E 9 Tuberculosis is a major problem in industry because 46 one tuberculous worker infects many fellow=workers. C 9 Responsible management is increasingly concerned with the C D health of its employeese The major problem in this area is 47 e Sick benefits should be provided, beginning 48 By this means 49 o is will be reduced and the plan will be on a former actuarial basis. 47. a A) accidents on the job you A) the day of onset 0 0 B) pneumoconioses B) one day after onset c) non-occupational illness C) one week after onset D) dermatoses D) one month after onset E) low back strain E) two days after onset 4% A) serious illness 1x B) malingering = - clne to D. - c) strikes D) misuse of sick leave E) employee unrest 9 Disability in silicosis is proportional to the 50. 0 A) the extent of nodulation. B) the extent of conglomerations c) the associated emphysema. D) the length of exposure to St Oz silicon oxygen E) the age of the patients Epidomiologa 1 B 10 51 The provalence of a disease is the number of cases r. 0 in a : ivon area occuring A) annually B) at a given instanto C) endemically in the population D) at the time of an epidemico E) per unit time CONFIDENTIAL Subject Communicable Disease Control NATIONAL BOARD OF MEDICAL EXAMINERS Total number of items 7 CORRECT CATEGORY ITEM ITEMA ANSWER No. B 11 A) Detection of diabetes 10 Radiologic study BC 5 52. B) Detection of tuberculosis 2. Skin test B c) Detection of ling cancer 30 Tissue diagnosi a 40 Bacteriologic study B 2 50 Blood test A A 11 Tuberculosis control programs should be based on newly reported 53. active cases rather than on death rates because the antituberculosis O drugs have reduced the tuberculosis death rate so markedly that it no longer reflects the magnitude of the tuberculosis problemo obvious driver A 11 "Booster" inoculations are indicated against 54. 1. typhoid fever 1 2. tetanus 3. diphtheria 40 smallpox A 11 A) Gemma-globulin 1. Woman in early pregnancy exposed A 5 55. to rubella. B) Antitoxin 20 Parents of a child with A 2 infectious hepatitiso c) Prophylactic penicillin 30 Adult male with mumps parotitis 40 Infant exposed to measles. A 5. Contact to scarlet fevero B 11 A) The mortality from pertussis in childreno st. B) The mortality from accidents in childreno 0 1300-4/57 CONFIDENTIAL Communicable Disease Control Subjeci NATIONAL DOARD OF MEDICAL EXAMINERS Total nember of items 7 CORRECT CATEGORY ITEM ITIM ANSWER No. 11 Influenza is characteristically a 57. disease caused by 58. against which vaccination is effective 59. 0 57 A) sporadic A) rickettsia TIF. B) endemic B) cocous O kingle C) epidemic C) virus D) household D) spirochate E) childhood E) mycobacterium 59. A) without qualification B) only 11 the causative type has been included in the vaccine C) in older persons D) because protection against one type protects against other types E) provided it has been administered (probably (envel) within two years of exposure 11 A) Diphtheria E-D B) Typhoid fever C) Salmonellosis D) Amebic dysentery E) Cholera 60. A carrier register is most effective when based on follow B up of clinical cases rather than on routine stool arro examinations of foodhandlers. 61. The probloms of "food poisoning" have increased C markedly with increase in consumption of processed foods. 62. Isolation and quarantine will not materially reduce A the spread but routine active immunization programs will practically eradicate it from a community. 63. This disease is particularly amenable to quarantine E measures because of its short incubation period. While fecal examinations are the most satisfactory 64. diagnostic procedures, even experienced technicians D may find it difficult to make the diagnosis 1300-4/57 Source.htps:/lwww.industrydocuments.ucsi.edu/docsijuxi0227 CONFIDENTIAL Subject Chronic illness Degenerative Diseases NATIONAL BOARO OF MEDICAL EXAMINERS Totres nomber of items 6 CORRECT ITEM CATEGORY ITEM ANSWER No. IS 12 Nutritional factors are of great importance in the 65. management of 1. achalasia 2. hypartrophic arthritis 3. hypothyroidism 40 gout e C Modorn life is gwared too rapidly. By 66. 12 C D the effects of constant tension become manifest through 67. diseases. When these become manifest, the wise physician, after a thorough evaluations advises 68. as well as appropriate medical therapy 66 A) the late twenties 67 A) arteriosclerotic B) arthritic 2 B) the late ?teens 2 C) spastic what head of develop C) middle age mether D) old age D) neurologic E) age terr 10 E) infectious 68 A) a long vacation B) changing jobs 2 C) taking up a hobby D) avoiding stressful situations E) psychiatric consultation 1800-4/57 CONFIDENTIAL Subject Chronic illness Degenerative Diseases NATIONAL BOARD OF MEDICAL EXAMINERS Total number of items 6 CORRECT CATEGORY ITEAA ITEM ANSWER No. B 12 A) Ostecarthritis 69. Always systemi c A 70. Onset usually gradual A 0 A B) Rheuratoid arthritis B D c) Both 11. Overweight a frequent factor D) Nei ther 72. Rest important D 73. Vaccine therapy 0 B 12 A) Peptic ulcer 1. Crampy abdominal pain BC 4 74. B) Irritable colon 2. Stress AB . C) Diverticulosis 30 Good nutrition C / 40 Occult blood in stool ABC 5. Laxative habit 6 D 12 Normal tonometric findings constitute adequate study of an 15. individual suspected of having glaucoma because all glaucoma patients have increased intraocular tension. of C 12 Blood sugar determinations as well as urine sugar studies should 96 be used in diabetic detection campaigns because most obese diabetics have a high renal threshold for glucose o 1800-4/57 Source.https://www.industrydocuments.ucsi.edu/docsijuxi0227 CONFIDENTIAL Subject Accident Prevention NATIONAL BOARD OF MEDICAL EXAMINERS Total nomber of items 2 CORRECT CATEGORY ITEM tram ANSWER No. E 13 Accidents are more frequent in 17. 1. the home than at work. ? 2. employees learning to use new machinery 3. young drivers. 4. certain personality types. A 13 The responsibilities of practising physicians in the 18. prevention of automobile accidents are limited because mass media are more effective. 1000-4/57 Source.htps://www.industrydocuments.ucsi.edu/docs/juxi0227

what is the subject name mentioned at the top right corner?

jqxf0227

jqxf0227_p1, jqxf0227_p2, jqxf0227_p3, jqxf0227_p4, jqxf0227_p5, jqxf0227_p6, jqxf0227_p7, jqxf0227_p8, jqxf0227_p9, jqxf0227_p10, jqxf0227_p11, jqxf0227_p12, jqxf0227_p13, jqxf0227_p14, jqxf0227_p15, jqxf0227_p16, jqxf0227_p17, jqxf0227_p18, jqxf0227_p19, jqxf0227_p20, jqxf0227_p21, jqxf0227_p22, jqxf0227_p23, jqxf0227_p24, jqxf0227_p25, jqxf0227_p26

Epidemiology, epidemiology

Preventive Medicine and CONFIDENTIAL Public Health Subjeci NATIONAL BOARD OF MEDICAL EXAMINERS Total number of Itoms CORRECT CATEGORY ANSWER No. A 3 6 (b) Most common cause of maternal mortality today. 0 E 3 7 (b) Has shown greatest decline as cause of maternal mortality. 0 8 (b) / 3 Most frequently associated with spontaneous abortions. - B alrotrick - 2 - regists D 3 9 (b) Associated maternal deaths almost completely preventable. produce ? A 3 10 (b) May be related to renal impairment -1 A 3 11 (e) Prematurity is currently the most important cause of infant mortality che roles for Because )other causes have been more markedly reduced. / D 3 12 (e) Infant mortality has been most markedly reduced in infants under one month of age Because infections causing infant mortality have been effectively controlled and controlled 1 markedly reduced. C 3 13 (e) Maternal mortality is higher in southern states than in the rest of the United States Because the larger non white population accounts O for all the excess mortality. B 3 14 (e) Infant mortality after the first month of life has declined markedly Because death rates from prematurity have been reduced. O A 3 15 (e) Infant death rates on the first day of life have been only moderately reduced Because such deaths are largely due to asphyxia, birth injury, and congenital malformations. O (A) Schizophrenia (B) Paresis (c) Senile and arteriossclerotic psychoins (D) Manic ar depressive psychosis (E) Korsakoff's psychosis A 4 16 (b) The most common psychosis under 50. C 4 17 (b) Increasing because of population trends. D 4 18 (b) Greatest tendency to remission. CONFIDENTIAL Preventive Medicine and Subject Public Health NATIONAL SOARD OF MADICAL EXAMINERS Total number of itoms cornect CATEGORY ANSWER No. B 4 infection inate 1 19 (b) Can be caused by maternal infection. which Bertswn E 4 20 (b) May be favorably affected by vitamin B. 1 C 5 21 (e) association Beriberi occurs in connection with alcoholism Because alcohol inter- feres with absorption of thiamin. O B 5 22 (e) Magenta-colored glossitis occurs in riboflavin deficiency Because ? vitamin deficiencies are frequently multiple. A 6 23 (k) which may be water bome Human infections caused by water include (1) Typhoid fever 2 (2) Anfectious hepatitis a (3) Fularemia - has been repented (4) Typhus D 6 24 (a) With accidental contamination of a public water supply today, the most common infection is likely to be (A) Typhoid fever (B) /Bacillary dysentery (c) Amebic dysentery (D) Acute diarrhea review term (E) Sicerative colitis C 6 25 (e) An Imhoff tank is a valuable sanitation procedure Because it is 2 an essential step in the purification of public water supplies. E 6 26 (e) Thoroughly cooked food does not cause food poisoning Because the staphylococcus toxin is heat labile. -1 ROM C 7 27 (a) Select for the five possible interpretations the one which best fits the data presented in the following Retailed table: friends foint 2 quick lot 1000-4/57 CONFIDENTIAS Preventive Medicine and Subjoct Public Health NATIONAL BOARD OF MHDICAL EXAMINERS Total comber of liems - CORRECS CATEGORY ITEM ANSWER No. Results of Tuberculosis Surveys among Selected Population Groups in Minneapolis das 1953. New Cases per Thousand Persons Screened Groups Total Cases Active Cases Salvation Army Hostel 34.6 22.2 Hennepin County 2.8 0.4 Mobile TB Unit (Minneapolis school students and personnel) 0.5 0.2 New Case Rates among General U. S. Population 0.8 0.3 (A) One of the permanent employees of the Salvation Army Hostel must have active tuberculosis. (B) The BCG vaccination program has been successful in Minneapolis. (c) Undernourished transients living in dormitories provide ideal hosts for tubercle bacilli. (D) Environmental conditions in the Hostel must predispose to tuberculosis, (E) The Hennepin County Health Department is doing a better job in con- trolling Luberculosis than the Minneapolis Health Department, but both are below the standard for the country as a whole. (A) Group medical Practice (B) Social medicine (c) Comprehensive medicine (D) Compulsory health Insurance (E) None of the above B 7 28 (b) A point of view in medicine which regards many diseases as forms of maladaptation to cultural and societal vectors. 1800-4/57 Source. https:/iwww.industrydocuments.ucsi.edu/docsijqxi0227 Preventive Medicine and CONFIDENTIAL Subject Public Health NATIONAL BOARD OF MRDICAL EXAMINERS Total nomber of Nems CORRECT ITEM CATEGORY ANSWAP No E 7 29 (b) That part of a county medical society's activities pertaining to re- creation and the development of physicians social interests. O D 7 30 (b) A pattern of medical organization in which direct fee-for-service remuneration is replaced by various universal insurance and salary provisions. (1) C 7 31 (b) An approach to medical practice in which physicians attempt to under- stand all aspects of their patients health problems including the physio-pathologica, anatomic, emotional, and social elements. 0 A 7 32 (b) A form of medical organization in which several physicians (usually including various specialists) share overhead, responsibilities, con- sultation and combine their earnings, dividing the net income on a pre "arranged basis. 0 Recently B 7 33 (a) Increa'sed hospital charges are chiefly attributable to increased the of or to (A) Inoreased cost of drugs and supplies. sive : (B) Increased personnel costs. sevilor the name (c) Increased-use of expensive drugs (D) Inereased equipment overhead. average ent of single homputelization (1) A 7 34 (e) The increase in total hospital bills has not kept pace with increased hospital charges Because the period of hospitalization for most illnesses has been greatly reduced. .) e E 8 35 (e) Rehabilitation of paraplegies has bean routinized Because disability - to alvers from all spinal cord injuries is sufficiently similar. D 36 (e) It is not possible to train a hemiplegic to become ambulatory more than six months after the vascular accident Because virtually all return of function of nervous tissue will have occurred within six months; 0 1800-4/57 Preventive Medicine and Public Health CONFIDENTIAL Subjoch NATIONAL BOARD OF MEDICAL EXAMINIRS Total sumber of itoms - CORRECT ITEA ITEM CATEGORY ANSWER No. A 8 37 (e) Removal of slight or even potential prostatic obstruction is important in a paraplegic Because bladder emptying by gravity is important in preventing urinary infections. 0 C 9 38 (e) Control of industrial accidents and toxicity is emphasized by occupa- tional health today Because such control will significantly reduce absenteeism. 0 C 9 39 (e) Pre-employment examinations are important in industry Because in- dividuals with health problems must be excluded. U C 10 40 (e) Tetanus spores are commonly present in the soil of barnyards Because the presence of manure is necessary for their survival. A. Anthrax B. Tuberculosis C. Syphilis D. Typhoid E. Diphtheria The etiologic agent don't how about system I ?x C 11 41 (b) Dies quickly outside the body. -0 A 11 Is very resistant outside the body. how about T B- - ?x 42 (b) - B 11 43 (b) Has waxy structure. (1) I C 11 44 (b) Is best recognized while still alive. 0 E 11 45 (b) Produces an antigenic toxin. - also typhad A 11 46 (e) The pneumococcus is the most important etiologics agent in lobar pneumonia Because it is the causative agent in approximately 95 pero cent of such cases. technique 1800-4/57 CONFIDENTIAL Preventive Medicine Subjock and Public Health NATIONAL BOARD OF MEDICAL EXAMENERS Total sumber of Homs CORRECT ITEM CATEGORY ANSWER No. C 11 47 (e) The death rate from tuberculosis in the American negro is at least sel four times that in the white population Because the attack rate of the disease is four times greater in the negro than in the white U population. D 11 48 (e) The tuberculosis death rate is much higher in rural than in urban areas Because proper health facilities are less adequate in rural reality available 0 areas. E 11 49 (e) Economic circumstances do not affect the tuberculosis rate in a population Because susceptibility to tuberculosis is uniform throughout the population. too remigh C 11 50 (e) BCG vaccination against tuberculosis has proven to be safe Because the antigen is composed of heat-killed bacilli. 0 Overall C 12 51 (e) (Mortality from heart disease has increased Because of the increased mortality rate in the fifth and sixth decades. D which C 12 52 (a) The númber of cases of ene of the following disease entities has increased ? (A) Thyrotoxicosis (B) Gastric ulcer : (c) Duodenal ulcer too strour done how B R (D) Tuberculosis (E) Syphilis 1800-4/57 urce. htps.llwww.industrydocuments.ucsi.edu/docsijuxi0227 CONFIDENTIAL Preventive Medicine Subjock and Public Health NATIONAL BOARD OF MEDICAL EXAMINERS Totel of items CORRECT CATEGORY TEEM STEM ANSWER No. which D 12 53 (a) One of the following diseases is more common in females ? (A) Coronary artery disease (c) mently wals 7907 (B) Duodenal ulcer Marie-Strumpell disease (D) Rheumatoid arthritis (E) Bronchial asthma anithor - bosh up - A 12 54 (e) Increased mortality from cancer is due to the aging of the population (1) Because overall age specific cancer mortality rates have not increased. A 12 55 (e) a Over-all mortality from coronary heart disease has increased Because the mortality rate in white males has increased. 2X ales female B 12 56 (e) Heart disease now ranks in first place in causes of death Because heart disease deaths account for more than a third of deaths from all- causes. 0 - 2x 7 A C 13 57 (e) Prevention of industrial accidents should be a major activity of an accident prevention program Because the fatality ratio exceeds even that in motor vehicle accidents. 0 D 13 58 (e) Accidents are in first place as a cause of death in the 65 and over age Because they deaths 100,000 any sifture group cause more per than in other age group. 0 Public Hea th CONFIDENTIAL Biometrics NATIONAL BOARIO OF MEDICAL EXAMINERS VI Total Subjech 79 of items 4 7-19-57 CORRECT ITEMA CATEGORY IXEM ANSWER No. E 1 1 In evaluating the relationship of smoking to lung cancer, it would be most practicable to use as a basic population segment A) lung cancer cases with tissue proor B) lung cancer cases as listed on death certificates C) heavy smokers 0 D) a random sample of the general population E) a random sample of men over age 45 D 3 2 All solitary nodules of the lung should be removed because thoracic surgeons report that a high percentage of resected nodules are malignanto 1800-4/57 Source.hups/lwww.industrydocuments.ucsi.edu/docsijuxi0227 CONFIDENTIAL Subject Public Health Administration NATIONAL BOARD OF MIDICAL EXAMINERS Total number of items 2 CORRECT CATEGORY ITEM ANSWER No. A 2 Steps toward the successful establishment of a local 3 health department in an area without one include 1. a survey of local health needs. 0 20 obtaining cooperation of the County Medical Society 30 a referendun of the voters. - (is this always necessary) 4. obtaining a grant from a voluntary health organization. C 2 The minimal recommendad population warranting establishment 4 of a local health unit is A) 15,000 2 B) 25,000 C) 50,000 D) 75,000 E) 100,000 1800-4/57 CONFIDENTIAL Subject Maternal and Child Health NATIONAL BOARD OF MEDICAL EXAMENERS Total number of itoms 8 in item type @ guestions - both the assertion and veasen should be complete CORRECT CATEGORY ITEM ANSWER No. statements ITEM - the be can A 3 An adequate child health program should provide annual 5 tuberculin tests because of the special importance of is is important that be afforded close clinical supervision of Fecent tuberculin converters. O ? x C 3 An infant attending a well-child conference usually has 6 1) scarlet fever immunization X 6 2) tetanus-pertussis-diphtheria vaccine before months of age. 3) a booster injection of triple vaccine about two years after the first injection. 4) smallpox vaccination during the first year. O B 3 Prematurity is the ma jor cause of paranatal deaths becaus se 7 infectious diseases of infants have been so much better controlled since the antibiotic 0 A 3 The major causes of maternal mortality are 1) hemorrhage 2) infection xemids 3) tonomies of pregnancy 4) heart disease 1000-4/57 CONFIDENTIAL Maternal and Child Health Subject NATIONAL BOARD OF MEDICAL EXAMINERS Total number of items 8 CORRECT CATEGORY ITEM ITEM ANSWER No. B 3 It does not matter much what parents do or say to young 9 childron so long as they really love them because security in affection is adequate for good mental health. 2 n D 3 Mentally deficient children never have normal developmental 10 histories because they tend to be slow in sitting, teething, c standing. walking and talking. - E 3 The child brought to the physician because of scholastic 11 difficulties may have 1) hearing difficulties all are principle convert 2) visual difficulties 2 3) too high intelligence quotient 4) too low an I.S. intelligence quotient D 3 The earlier toilet training is accomplished the better 12 because discipline is important in child training what are ibefore 1000--4/57 CONFIDENTIAL Subject Mental Hygiene NATIONAL BOARD OF MEDICAL EXAMINERS Total number of items 5 CORRECT CATEGORY ITEM ITEM ANSWER No. C 4 A) Prenatal conferences for prospective fathers and mothers D B B) Group conferences for mothers at Well-Child Conferences C B C) Both D) Neither 13. 1. Breast feeding 0 14. 2. Post~partum hemorrhage 15. 3. Thumb sucking 16. 4. Sibling rivalry 0 C 17. 5. Enuresis 5 B 4 Alcoholics Anonymous have been most successful because 18. the members, themselves, know the problems of alcoholism from personal experience. abustion ix WITB understand C IX 4 A) Suiciãe 190 The solution involves consideration A IX of the norm. B IX B) Frigidity E IX 20. The epidemiologic approach may be officer D 1 x C) Homosexuality helpful. D) Irritable colon 21. Childhood experiences often underlie it. E) Impotence 220 Interpersonal relationships are of utmost importance. things 23. Stressful situations to be avoided. 1300-4/57 CONFIDENTIAL Subject Mental Hygiene NATIONAL BOARD OF MEDICAL EXAMINERS Total number of Items 5 CORRECT CATEGORY ITEM ANSWER No. ITEMA A & 24 Patients who suffer from excessive self-criticism should be urged to be as kind to themselves as they are to others because mental health requires being comfortable about one-solf. A 25 In evaluating the psychiatric status of a patient, important include the fol lewing points in the history ane impontant- 1) adoption 2) frequent job changes 2 3) domineering parent 4) income 1800-4/57 Source.hups://www.industrydocuments.ucsi.edu/docsijuxi0227 CONFIDENTIAL Subject Nutrition NATIONAL BOARD OF MEDICAL EXAMINERS Total number of items 4 CORRECT ITEAA CATEGORY ANSWER No. ITEM B 5 A) Prevention 1. Urinalysis 3 26. B) Early detection 2. Blood sugar determination the C) Early therapy 3. Avoidance of obesity 2 4. Glucose tolerance test 5. Medical history A 5 A weight reduction program should 27. 1. always include a lowered caloric intake. 20 avoid a high salt intake. 0 3. not be inaugurated for depressed patients 4. always include small amounts of thyroid. C 5 A) Pyridoxine B B) Vitamin A C) Ascorbic acid other listings D) Therapeutic vitamins E) Nicotinic acid 28. IX The amount excreted in the urine reflects the state of tissue saturation. abstrumance < N- 6-pyridme a 29. Deficiency may affect the mucosa of the entire gastro- intestinal tract. E has 30. 0 A-number of cases of hypervitaminosi S have been reported in children. B item AB 31. 2X It is a valuable adjunct to most geriatric diets Because of the danger of INH-induced peripheral 32. 0 neuritis, it is given in combination with that drug in the troatment of tuberculosiso 1300-4/57 Source.htps://www.industrydocumentsucsi.edu/docsijuxi0227 CONFIDENTIAL Subject Nutrition NATIONAL BOARD OF MEDICAL EXAMINERS Total sumber of items 4 CORRECT ITEM CATEGORY ITEM ANSWER No. C 5 A. Agannaglobulinemd.a 1. Liver disease B.C. 3 33 l B. Hyperglobulinenda 2. Hookworm disease Co Hypoproteinemia 30 Sarcoidosis 40 Chronic malnutzition 5. Renal disease e.htps:liwww.industrydocuments.ucsi.edu/docsijyxi0227 CONFIDENTIAL Env iornmental Sanitation Subjech NATIONAL BOARD OF MEDICAL EXAMINERS 2 Total number of Hems CORRECT CATEGORY ITEM No. Su item # 5 ITEM ANSWER A 6 Air pollution is an unsolved public health problem 34. there is because of lack of basic scientific information on 0 the relationship of specific pollutants and snog to health. E 6 Annual medical examinations of foodhandlers effectively 35. protect the public because they rule out the presence of 0 infectious disease. Source.https://www.industrydocuments.ucsi.edu/docsijuxi0227 ONFIDENTIAL Subject Socio=economic aspects of Medical Care NATIONAL BOARD OF MEDICAL EXAMINERS Total number of Itoms 2 CORRECT CATEGORY ITEM ITEM ANSWER No. E 7 A successful home care program requires 36. 1. the provision of adequate medical care. I 2. the availability of hospital beds for emergenciese 3. family interest in having the patient at home. In the preference of the patient for home care. A 7 Older people develop psychologic problems because of 3% 1. insecurity IX 20 mutritional deficiencies. ? 3. loss of contemporaries. 40 nocturia. CONFIDENTIAL Rehabilitation, Physical Subject Medicine NATIONAL BOARD OF MEDICAL EXAMINERS 8 Total number of items CORRECT ITEM CATEGORY ITEM ANSWER No. * 8 On 7-5=57, a 40myear-old white man, applies for D 38. the job of clerk. Physical examination reveals no abnormality but there is a history of hospitalization for for active tuberculosis over a six-month period in 1952. Which of the following will be most helpful in deciding employability? A. to Lack of abnormal findings on physical examination. roentgenogram B 20 A chest revealing fibrocalcific strands. C 3. The light nature of the job for which the man is applying. the roentgenogram D &. Comparison of your chest with the series available since 1952. E S. The long interval since the hospitalization. B 8 A) Talipes planus 1. Daily exercises A 5 39. 2 B) Low back strain 2. Weight reduction C) Scoliosis 3. Brace C 4. Postural elimination of lordosis 5. Orthopedic surgery C 8 A patient with advanced omphysema should 40. 1. increase his physical activities. X 2. limit his activities to those which do not produce dyspnea. 3. move to a dry climate. 4. avoid contact with respiratory infection. 1800-4/57 Source.htps:llwww.industrydocuments.ucsi.edu/docsijqxi0227 CONFIDENTIAL Rehabilitation, Physical Sobject Medic ine NATIONAL BOARD OF MEDICAL EXAMINERS Total number of items 8 CORRECT CATEGORY ITEM ITEM ANSWER No. B 8 4/ A. Absenteeism among handicapped workers. B. Absenteeism among woman workers. & 8 The blind are more dextrous than the sighted because B 42. they are not distracted by lights and colors. - A 8 Congenital dislocations of the hip should be sought 43. early because resultant deformity depends upon the age at which therapy is inaugurated. C 8 A) Social Security 1 4H. B) National Foundation for Infantile Paralysis c) Federal Vocational Rehabilitation Program 1. Grant=in-aid BC - (c-doe provide grants in and - u Teacher Srawl w.ll.) 2. Testing C 3. Medical Care BC 4. Tuition B 5. Living expense A,C C 8 In the management of a fractured lega the most inexcusable 45. complication is A) fat embolismo B) deformityo C) crutch paralysiso D) failure to detect the presence of tuberculosis. E) dermatitis under the cast. 1800-4/57 e.htps:liwww.industrydocuments.ucsi.edu/docsijuxi0227 CONFIDENTIAL Subject Occupational Health NATIONAL BOARD OF MEDICAL EXAMINERS Total number of itoms 3 CORRECT ITEM CATEGORY ITSM ANSWER No. E 9 Tuberculosis is a major problem in industry because 46 one tuberculous worker infects many fellow=workers. C 9 Responsible management is increasingly concerned with the C D health of its employeese The major problem in this area is 47 e Sick benefits should be provided, beginning 48 By this means 49 o is will be reduced and the plan will be on a former actuarial basis. 47. a A) accidents on the job you A) the day of onset 0 0 B) pneumoconioses B) one day after onset c) non-occupational illness C) one week after onset D) dermatoses D) one month after onset E) low back strain E) two days after onset 4% A) serious illness 1x B) malingering = - clne to D. - c) strikes D) misuse of sick leave E) employee unrest 9 Disability in silicosis is proportional to the 50. 0 A) the extent of nodulation. B) the extent of conglomerations c) the associated emphysema. D) the length of exposure to St Oz silicon oxygen E) the age of the patients Epidomiologa 1 B 10 51 The provalence of a disease is the number of cases r. 0 in a : ivon area occuring A) annually B) at a given instanto C) endemically in the population D) at the time of an epidemico E) per unit time CONFIDENTIAL Subject Communicable Disease Control NATIONAL BOARD OF MEDICAL EXAMINERS Total number of items 7 CORRECT CATEGORY ITEM ITEMA ANSWER No. B 11 A) Detection of diabetes 10 Radiologic study BC 5 52. B) Detection of tuberculosis 2. Skin test B c) Detection of ling cancer 30 Tissue diagnosi a 40 Bacteriologic study B 2 50 Blood test A A 11 Tuberculosis control programs should be based on newly reported 53. active cases rather than on death rates because the antituberculosis O drugs have reduced the tuberculosis death rate so markedly that it no longer reflects the magnitude of the tuberculosis problemo obvious driver A 11 "Booster" inoculations are indicated against 54. 1. typhoid fever 1 2. tetanus 3. diphtheria 40 smallpox A 11 A) Gemma-globulin 1. Woman in early pregnancy exposed A 5 55. to rubella. B) Antitoxin 20 Parents of a child with A 2 infectious hepatitiso c) Prophylactic penicillin 30 Adult male with mumps parotitis 40 Infant exposed to measles. A 5. Contact to scarlet fevero B 11 A) The mortality from pertussis in childreno st. B) The mortality from accidents in childreno 0 1300-4/57 CONFIDENTIAL Communicable Disease Control Subjeci NATIONAL DOARD OF MEDICAL EXAMINERS Total nember of items 7 CORRECT CATEGORY ITEM ITIM ANSWER No. 11 Influenza is characteristically a 57. disease caused by 58. against which vaccination is effective 59. 0 57 A) sporadic A) rickettsia TIF. B) endemic B) cocous O kingle C) epidemic C) virus D) household D) spirochate E) childhood E) mycobacterium 59. A) without qualification B) only 11 the causative type has been included in the vaccine C) in older persons D) because protection against one type protects against other types E) provided it has been administered (probably (envel) within two years of exposure 11 A) Diphtheria E-D B) Typhoid fever C) Salmonellosis D) Amebic dysentery E) Cholera 60. A carrier register is most effective when based on follow B up of clinical cases rather than on routine stool arro examinations of foodhandlers. 61. The probloms of "food poisoning" have increased C markedly with increase in consumption of processed foods. 62. Isolation and quarantine will not materially reduce A the spread but routine active immunization programs will practically eradicate it from a community. 63. This disease is particularly amenable to quarantine E measures because of its short incubation period. While fecal examinations are the most satisfactory 64. diagnostic procedures, even experienced technicians D may find it difficult to make the diagnosis 1300-4/57 Source.htps:/lwww.industrydocuments.ucsi.edu/docsijuxi0227 CONFIDENTIAL Subject Chronic illness Degenerative Diseases NATIONAL BOARO OF MEDICAL EXAMINERS Totres nomber of items 6 CORRECT ITEM CATEGORY ITEM ANSWER No. IS 12 Nutritional factors are of great importance in the 65. management of 1. achalasia 2. hypartrophic arthritis 3. hypothyroidism 40 gout e C Modorn life is gwared too rapidly. By 66. 12 C D the effects of constant tension become manifest through 67. diseases. When these become manifest, the wise physician, after a thorough evaluations advises 68. as well as appropriate medical therapy 66 A) the late twenties 67 A) arteriosclerotic B) arthritic 2 B) the late ?teens 2 C) spastic what head of develop C) middle age mether D) old age D) neurologic E) age terr 10 E) infectious 68 A) a long vacation B) changing jobs 2 C) taking up a hobby D) avoiding stressful situations E) psychiatric consultation 1800-4/57 CONFIDENTIAL Subject Chronic illness Degenerative Diseases NATIONAL BOARD OF MEDICAL EXAMINERS Total number of items 6 CORRECT CATEGORY ITEAA ITEM ANSWER No. B 12 A) Ostecarthritis 69. Always systemi c A 70. Onset usually gradual A 0 A B) Rheuratoid arthritis B D c) Both 11. Overweight a frequent factor D) Nei ther 72. Rest important D 73. Vaccine therapy 0 B 12 A) Peptic ulcer 1. Crampy abdominal pain BC 4 74. B) Irritable colon 2. Stress AB . C) Diverticulosis 30 Good nutrition C / 40 Occult blood in stool ABC 5. Laxative habit 6 D 12 Normal tonometric findings constitute adequate study of an 15. individual suspected of having glaucoma because all glaucoma patients have increased intraocular tension. of C 12 Blood sugar determinations as well as urine sugar studies should 96 be used in diabetic detection campaigns because most obese diabetics have a high renal threshold for glucose o 1800-4/57 Source.https://www.industrydocuments.ucsi.edu/docsijuxi0227 CONFIDENTIAL Subject Accident Prevention NATIONAL BOARD OF MEDICAL EXAMINERS Total nomber of items 2 CORRECT CATEGORY ITEM tram ANSWER No. E 13 Accidents are more frequent in 17. 1. the home than at work. ? 2. employees learning to use new machinery 3. young drivers. 4. certain personality types. A 13 The responsibilities of practising physicians in the 18. prevention of automobile accidents are limited because mass media are more effective. 1000-4/57 Source.htps://www.industrydocuments.ucsi.edu/docs/juxi0227

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Preventive Medicine and CONFIDENTIAL Public Health Subjeci NATIONAL BOARD OF MEDICAL EXAMINERS Total number of Itoms CORRECT CATEGORY ANSWER No. A 3 6 (b) Most common cause of maternal mortality today. 0 E 3 7 (b) Has shown greatest decline as cause of maternal mortality. 0 8 (b) / 3 Most frequently associated with spontaneous abortions. - B alrotrick - 2 - regists D 3 9 (b) Associated maternal deaths almost completely preventable. produce ? A 3 10 (b) May be related to renal impairment -1 A 3 11 (e) Prematurity is currently the most important cause of infant mortality che roles for Because )other causes have been more markedly reduced. / D 3 12 (e) Infant mortality has been most markedly reduced in infants under one month of age Because infections causing infant mortality have been effectively controlled and controlled 1 markedly reduced. C 3 13 (e) Maternal mortality is higher in southern states than in the rest of the United States Because the larger non white population accounts O for all the excess mortality. B 3 14 (e) Infant mortality after the first month of life has declined markedly Because death rates from prematurity have been reduced. O A 3 15 (e) Infant death rates on the first day of life have been only moderately reduced Because such deaths are largely due to asphyxia, birth injury, and congenital malformations. O (A) Schizophrenia (B) Paresis (c) Senile and arteriossclerotic psychoins (D) Manic ar depressive psychosis (E) Korsakoff's psychosis A 4 16 (b) The most common psychosis under 50. C 4 17 (b) Increasing because of population trends. D 4 18 (b) Greatest tendency to remission. CONFIDENTIAL Preventive Medicine and Subject Public Health NATIONAL SOARD OF MADICAL EXAMINERS Total number of itoms cornect CATEGORY ANSWER No. B 4 infection inate 1 19 (b) Can be caused by maternal infection. which Bertswn E 4 20 (b) May be favorably affected by vitamin B. 1 C 5 21 (e) association Beriberi occurs in connection with alcoholism Because alcohol inter- feres with absorption of thiamin. O B 5 22 (e) Magenta-colored glossitis occurs in riboflavin deficiency Because ? vitamin deficiencies are frequently multiple. A 6 23 (k) which may be water bome Human infections caused by water include (1) Typhoid fever 2 (2) Anfectious hepatitis a (3) Fularemia - has been repented (4) Typhus D 6 24 (a) With accidental contamination of a public water supply today, the most common infection is likely to be (A) Typhoid fever (B) /Bacillary dysentery (c) Amebic dysentery (D) Acute diarrhea review term (E) Sicerative colitis C 6 25 (e) An Imhoff tank is a valuable sanitation procedure Because it is 2 an essential step in the purification of public water supplies. E 6 26 (e) Thoroughly cooked food does not cause food poisoning Because the staphylococcus toxin is heat labile. -1 ROM C 7 27 (a) Select for the five possible interpretations the one which best fits the data presented in the following Retailed table: friends foint 2 quick lot 1000-4/57 CONFIDENTIAS Preventive Medicine and Subjoct Public Health NATIONAL BOARD OF MHDICAL EXAMINERS Total comber of liems - CORRECS CATEGORY ITEM ANSWER No. Results of Tuberculosis Surveys among Selected Population Groups in Minneapolis das 1953. New Cases per Thousand Persons Screened Groups Total Cases Active Cases Salvation Army Hostel 34.6 22.2 Hennepin County 2.8 0.4 Mobile TB Unit (Minneapolis school students and personnel) 0.5 0.2 New Case Rates among General U. S. Population 0.8 0.3 (A) One of the permanent employees of the Salvation Army Hostel must have active tuberculosis. (B) The BCG vaccination program has been successful in Minneapolis. (c) Undernourished transients living in dormitories provide ideal hosts for tubercle bacilli. (D) Environmental conditions in the Hostel must predispose to tuberculosis, (E) The Hennepin County Health Department is doing a better job in con- trolling Luberculosis than the Minneapolis Health Department, but both are below the standard for the country as a whole. (A) Group medical Practice (B) Social medicine (c) Comprehensive medicine (D) Compulsory health Insurance (E) None of the above B 7 28 (b) A point of view in medicine which regards many diseases as forms of maladaptation to cultural and societal vectors. 1800-4/57 Source. https:/iwww.industrydocuments.ucsi.edu/docsijqxi0227 Preventive Medicine and CONFIDENTIAL Subject Public Health NATIONAL BOARD OF MRDICAL EXAMINERS Total nomber of Nems CORRECT ITEM CATEGORY ANSWAP No E 7 29 (b) That part of a county medical society's activities pertaining to re- creation and the development of physicians social interests. O D 7 30 (b) A pattern of medical organization in which direct fee-for-service remuneration is replaced by various universal insurance and salary provisions. (1) C 7 31 (b) An approach to medical practice in which physicians attempt to under- stand all aspects of their patients health problems including the physio-pathologica, anatomic, emotional, and social elements. 0 A 7 32 (b) A form of medical organization in which several physicians (usually including various specialists) share overhead, responsibilities, con- sultation and combine their earnings, dividing the net income on a pre "arranged basis. 0 Recently B 7 33 (a) Increa'sed hospital charges are chiefly attributable to increased the of or to (A) Inoreased cost of drugs and supplies. sive : (B) Increased personnel costs. sevilor the name (c) Increased-use of expensive drugs (D) Inereased equipment overhead. average ent of single homputelization (1) A 7 34 (e) The increase in total hospital bills has not kept pace with increased hospital charges Because the period of hospitalization for most illnesses has been greatly reduced. .) e E 8 35 (e) Rehabilitation of paraplegies has bean routinized Because disability - to alvers from all spinal cord injuries is sufficiently similar. D 36 (e) It is not possible to train a hemiplegic to become ambulatory more than six months after the vascular accident Because virtually all return of function of nervous tissue will have occurred within six months; 0 1800-4/57 Preventive Medicine and Public Health CONFIDENTIAL Subjoch NATIONAL BOARD OF MEDICAL EXAMINIRS Total sumber of itoms - CORRECT ITEA ITEM CATEGORY ANSWER No. A 8 37 (e) Removal of slight or even potential prostatic obstruction is important in a paraplegic Because bladder emptying by gravity is important in preventing urinary infections. 0 C 9 38 (e) Control of industrial accidents and toxicity is emphasized by occupa- tional health today Because such control will significantly reduce absenteeism. 0 C 9 39 (e) Pre-employment examinations are important in industry Because in- dividuals with health problems must be excluded. U C 10 40 (e) Tetanus spores are commonly present in the soil of barnyards Because the presence of manure is necessary for their survival. A. Anthrax B. Tuberculosis C. Syphilis D. Typhoid E. Diphtheria The etiologic agent don't how about system I ?x C 11 41 (b) Dies quickly outside the body. -0 A 11 Is very resistant outside the body. how about T B- - ?x 42 (b) - B 11 43 (b) Has waxy structure. (1) I C 11 44 (b) Is best recognized while still alive. 0 E 11 45 (b) Produces an antigenic toxin. - also typhad A 11 46 (e) The pneumococcus is the most important etiologics agent in lobar pneumonia Because it is the causative agent in approximately 95 pero cent of such cases. technique 1800-4/57 CONFIDENTIAL Preventive Medicine Subjock and Public Health NATIONAL BOARD OF MEDICAL EXAMENERS Total sumber of Homs CORRECT ITEM CATEGORY ANSWER No. C 11 47 (e) The death rate from tuberculosis in the American negro is at least sel four times that in the white population Because the attack rate of the disease is four times greater in the negro than in the white U population. D 11 48 (e) The tuberculosis death rate is much higher in rural than in urban areas Because proper health facilities are less adequate in rural reality available 0 areas. E 11 49 (e) Economic circumstances do not affect the tuberculosis rate in a population Because susceptibility to tuberculosis is uniform throughout the population. too remigh C 11 50 (e) BCG vaccination against tuberculosis has proven to be safe Because the antigen is composed of heat-killed bacilli. 0 Overall C 12 51 (e) (Mortality from heart disease has increased Because of the increased mortality rate in the fifth and sixth decades. D which C 12 52 (a) The númber of cases of ene of the following disease entities has increased ? (A) Thyrotoxicosis (B) Gastric ulcer : (c) Duodenal ulcer too strour done how B R (D) Tuberculosis (E) Syphilis 1800-4/57 urce. htps.llwww.industrydocuments.ucsi.edu/docsijuxi0227 CONFIDENTIAL Preventive Medicine Subjock and Public Health NATIONAL BOARD OF MEDICAL EXAMINERS Totel of items CORRECT CATEGORY TEEM STEM ANSWER No. which D 12 53 (a) One of the following diseases is more common in females ? (A) Coronary artery disease (c) mently wals 7907 (B) Duodenal ulcer Marie-Strumpell disease (D) Rheumatoid arthritis (E) Bronchial asthma anithor - bosh up - A 12 54 (e) Increased mortality from cancer is due to the aging of the population (1) Because overall age specific cancer mortality rates have not increased. A 12 55 (e) a Over-all mortality from coronary heart disease has increased Because the mortality rate in white males has increased. 2X ales female B 12 56 (e) Heart disease now ranks in first place in causes of death Because heart disease deaths account for more than a third of deaths from all- causes. 0 - 2x 7 A C 13 57 (e) Prevention of industrial accidents should be a major activity of an accident prevention program Because the fatality ratio exceeds even that in motor vehicle accidents. 0 D 13 58 (e) Accidents are in first place as a cause of death in the 65 and over age Because they deaths 100,000 any sifture group cause more per than in other age group. 0 Public Hea th CONFIDENTIAL Biometrics NATIONAL BOARIO OF MEDICAL EXAMINERS VI Total Subjech 79 of items 4 7-19-57 CORRECT ITEMA CATEGORY IXEM ANSWER No. E 1 1 In evaluating the relationship of smoking to lung cancer, it would be most practicable to use as a basic population segment A) lung cancer cases with tissue proor B) lung cancer cases as listed on death certificates C) heavy smokers 0 D) a random sample of the general population E) a random sample of men over age 45 D 3 2 All solitary nodules of the lung should be removed because thoracic surgeons report that a high percentage of resected nodules are malignanto 1800-4/57 Source.hups/lwww.industrydocuments.ucsi.edu/docsijuxi0227 CONFIDENTIAL Subject Public Health Administration NATIONAL BOARD OF MIDICAL EXAMINERS Total number of items 2 CORRECT CATEGORY ITEM ANSWER No. A 2 Steps toward the successful establishment of a local 3 health department in an area without one include 1. a survey of local health needs. 0 20 obtaining cooperation of the County Medical Society 30 a referendun of the voters. - (is this always necessary) 4. obtaining a grant from a voluntary health organization. C 2 The minimal recommendad population warranting establishment 4 of a local health unit is A) 15,000 2 B) 25,000 C) 50,000 D) 75,000 E) 100,000 1800-4/57 CONFIDENTIAL Subject Maternal and Child Health NATIONAL BOARD OF MEDICAL EXAMENERS Total number of itoms 8 in item type @ guestions - both the assertion and veasen should be complete CORRECT CATEGORY ITEM ANSWER No. statements ITEM - the be can A 3 An adequate child health program should provide annual 5 tuberculin tests because of the special importance of is is important that be afforded close clinical supervision of Fecent tuberculin converters. O ? x C 3 An infant attending a well-child conference usually has 6 1) scarlet fever immunization X 6 2) tetanus-pertussis-diphtheria vaccine before months of age. 3) a booster injection of triple vaccine about two years after the first injection. 4) smallpox vaccination during the first year. O B 3 Prematurity is the ma jor cause of paranatal deaths becaus se 7 infectious diseases of infants have been so much better controlled since the antibiotic 0 A 3 The major causes of maternal mortality are 1) hemorrhage 2) infection xemids 3) tonomies of pregnancy 4) heart disease 1000-4/57 CONFIDENTIAL Maternal and Child Health Subject NATIONAL BOARD OF MEDICAL EXAMINERS Total number of items 8 CORRECT CATEGORY ITEM ITEM ANSWER No. B 3 It does not matter much what parents do or say to young 9 childron so long as they really love them because security in affection is adequate for good mental health. 2 n D 3 Mentally deficient children never have normal developmental 10 histories because they tend to be slow in sitting, teething, c standing. walking and talking. - E 3 The child brought to the physician because of scholastic 11 difficulties may have 1) hearing difficulties all are principle convert 2) visual difficulties 2 3) too high intelligence quotient 4) too low an I.S. intelligence quotient D 3 The earlier toilet training is accomplished the better 12 because discipline is important in child training what are ibefore 1000--4/57 CONFIDENTIAL Subject Mental Hygiene NATIONAL BOARD OF MEDICAL EXAMINERS Total number of items 5 CORRECT CATEGORY ITEM ITEM ANSWER No. C 4 A) Prenatal conferences for prospective fathers and mothers D B B) Group conferences for mothers at Well-Child Conferences C B C) Both D) Neither 13. 1. Breast feeding 0 14. 2. Post~partum hemorrhage 15. 3. Thumb sucking 16. 4. Sibling rivalry 0 C 17. 5. Enuresis 5 B 4 Alcoholics Anonymous have been most successful because 18. the members, themselves, know the problems of alcoholism from personal experience. abustion ix WITB understand C IX 4 A) Suiciãe 190 The solution involves consideration A IX of the norm. B IX B) Frigidity E IX 20. The epidemiologic approach may be officer D 1 x C) Homosexuality helpful. D) Irritable colon 21. Childhood experiences often underlie it. E) Impotence 220 Interpersonal relationships are of utmost importance. things 23. Stressful situations to be avoided. 1300-4/57 CONFIDENTIAL Subject Mental Hygiene NATIONAL BOARD OF MEDICAL EXAMINERS Total number of Items 5 CORRECT CATEGORY ITEM ANSWER No. ITEMA A & 24 Patients who suffer from excessive self-criticism should be urged to be as kind to themselves as they are to others because mental health requires being comfortable about one-solf. A 25 In evaluating the psychiatric status of a patient, important include the fol lewing points in the history ane impontant- 1) adoption 2) frequent job changes 2 3) domineering parent 4) income 1800-4/57 Source.hups://www.industrydocuments.ucsi.edu/docsijuxi0227 CONFIDENTIAL Subject Nutrition NATIONAL BOARD OF MEDICAL EXAMINERS Total number of items 4 CORRECT ITEAA CATEGORY ANSWER No. ITEM B 5 A) Prevention 1. Urinalysis 3 26. B) Early detection 2. Blood sugar determination the C) Early therapy 3. Avoidance of obesity 2 4. Glucose tolerance test 5. Medical history A 5 A weight reduction program should 27. 1. always include a lowered caloric intake. 20 avoid a high salt intake. 0 3. not be inaugurated for depressed patients 4. always include small amounts of thyroid. C 5 A) Pyridoxine B B) Vitamin A C) Ascorbic acid other listings D) Therapeutic vitamins E) Nicotinic acid 28. IX The amount excreted in the urine reflects the state of tissue saturation. abstrumance < N- 6-pyridme a 29. Deficiency may affect the mucosa of the entire gastro- intestinal tract. E has 30. 0 A-number of cases of hypervitaminosi S have been reported in children. B item AB 31. 2X It is a valuable adjunct to most geriatric diets Because of the danger of INH-induced peripheral 32. 0 neuritis, it is given in combination with that drug in the troatment of tuberculosiso 1300-4/57 Source.htps://www.industrydocumentsucsi.edu/docsijuxi0227 CONFIDENTIAL Subject Nutrition NATIONAL BOARD OF MEDICAL EXAMINERS Total sumber of items 4 CORRECT ITEM CATEGORY ITEM ANSWER No. C 5 A. Agannaglobulinemd.a 1. Liver disease B.C. 3 33 l B. Hyperglobulinenda 2. Hookworm disease Co Hypoproteinemia 30 Sarcoidosis 40 Chronic malnutzition 5. Renal disease e.htps:liwww.industrydocuments.ucsi.edu/docsijyxi0227 CONFIDENTIAL Env iornmental Sanitation Subjech NATIONAL BOARD OF MEDICAL EXAMINERS 2 Total number of Hems CORRECT CATEGORY ITEM No. Su item # 5 ITEM ANSWER A 6 Air pollution is an unsolved public health problem 34. there is because of lack of basic scientific information on 0 the relationship of specific pollutants and snog to health. E 6 Annual medical examinations of foodhandlers effectively 35. protect the public because they rule out the presence of 0 infectious disease. Source.https://www.industrydocuments.ucsi.edu/docsijuxi0227 ONFIDENTIAL Subject Socio=economic aspects of Medical Care NATIONAL BOARD OF MEDICAL EXAMINERS Total number of Itoms 2 CORRECT CATEGORY ITEM ITEM ANSWER No. E 7 A successful home care program requires 36. 1. the provision of adequate medical care. I 2. the availability of hospital beds for emergenciese 3. family interest in having the patient at home. In the preference of the patient for home care. A 7 Older people develop psychologic problems because of 3% 1. insecurity IX 20 mutritional deficiencies. ? 3. loss of contemporaries. 40 nocturia. CONFIDENTIAL Rehabilitation, Physical Subject Medicine NATIONAL BOARD OF MEDICAL EXAMINERS 8 Total number of items CORRECT ITEM CATEGORY ITEM ANSWER No. * 8 On 7-5=57, a 40myear-old white man, applies for D 38. the job of clerk. Physical examination reveals no abnormality but there is a history of hospitalization for for active tuberculosis over a six-month period in 1952. Which of the following will be most helpful in deciding employability? A. to Lack of abnormal findings on physical examination. roentgenogram B 20 A chest revealing fibrocalcific strands. C 3. The light nature of the job for which the man is applying. the roentgenogram D &. Comparison of your chest with the series available since 1952. E S. The long interval since the hospitalization. B 8 A) Talipes planus 1. Daily exercises A 5 39. 2 B) Low back strain 2. Weight reduction C) Scoliosis 3. Brace C 4. Postural elimination of lordosis 5. Orthopedic surgery C 8 A patient with advanced omphysema should 40. 1. increase his physical activities. X 2. limit his activities to those which do not produce dyspnea. 3. move to a dry climate. 4. avoid contact with respiratory infection. 1800-4/57 Source.htps:llwww.industrydocuments.ucsi.edu/docsijqxi0227 CONFIDENTIAL Rehabilitation, Physical Sobject Medic ine NATIONAL BOARD OF MEDICAL EXAMINERS Total number of items 8 CORRECT CATEGORY ITEM ITEM ANSWER No. B 8 4/ A. Absenteeism among handicapped workers. B. Absenteeism among woman workers. & 8 The blind are more dextrous than the sighted because B 42. they are not distracted by lights and colors. - A 8 Congenital dislocations of the hip should be sought 43. early because resultant deformity depends upon the age at which therapy is inaugurated. C 8 A) Social Security 1 4H. B) National Foundation for Infantile Paralysis c) Federal Vocational Rehabilitation Program 1. Grant=in-aid BC - (c-doe provide grants in and - u Teacher Srawl w.ll.) 2. Testing C 3. Medical Care BC 4. Tuition B 5. Living expense A,C C 8 In the management of a fractured lega the most inexcusable 45. complication is A) fat embolismo B) deformityo C) crutch paralysiso D) failure to detect the presence of tuberculosis. E) dermatitis under the cast. 1800-4/57 e.htps:liwww.industrydocuments.ucsi.edu/docsijuxi0227 CONFIDENTIAL Subject Occupational Health NATIONAL BOARD OF MEDICAL EXAMINERS Total number of itoms 3 CORRECT ITEM CATEGORY ITSM ANSWER No. E 9 Tuberculosis is a major problem in industry because 46 one tuberculous worker infects many fellow=workers. C 9 Responsible management is increasingly concerned with the C D health of its employeese The major problem in this area is 47 e Sick benefits should be provided, beginning 48 By this means 49 o is will be reduced and the plan will be on a former actuarial basis. 47. a A) accidents on the job you A) the day of onset 0 0 B) pneumoconioses B) one day after onset c) non-occupational illness C) one week after onset D) dermatoses D) one month after onset E) low back strain E) two days after onset 4% A) serious illness 1x B) malingering = - clne to D. - c) strikes D) misuse of sick leave E) employee unrest 9 Disability in silicosis is proportional to the 50. 0 A) the extent of nodulation. B) the extent of conglomerations c) the associated emphysema. D) the length of exposure to St Oz silicon oxygen E) the age of the patients Epidomiologa 1 B 10 51 The provalence of a disease is the number of cases r. 0 in a : ivon area occuring A) annually B) at a given instanto C) endemically in the population D) at the time of an epidemico E) per unit time CONFIDENTIAL Subject Communicable Disease Control NATIONAL BOARD OF MEDICAL EXAMINERS Total number of items 7 CORRECT CATEGORY ITEM ITEMA ANSWER No. B 11 A) Detection of diabetes 10 Radiologic study BC 5 52. B) Detection of tuberculosis 2. Skin test B c) Detection of ling cancer 30 Tissue diagnosi a 40 Bacteriologic study B 2 50 Blood test A A 11 Tuberculosis control programs should be based on newly reported 53. active cases rather than on death rates because the antituberculosis O drugs have reduced the tuberculosis death rate so markedly that it no longer reflects the magnitude of the tuberculosis problemo obvious driver A 11 "Booster" inoculations are indicated against 54. 1. typhoid fever 1 2. tetanus 3. diphtheria 40 smallpox A 11 A) Gemma-globulin 1. Woman in early pregnancy exposed A 5 55. to rubella. B) Antitoxin 20 Parents of a child with A 2 infectious hepatitiso c) Prophylactic penicillin 30 Adult male with mumps parotitis 40 Infant exposed to measles. A 5. Contact to scarlet fevero B 11 A) The mortality from pertussis in childreno st. B) The mortality from accidents in childreno 0 1300-4/57 CONFIDENTIAL Communicable Disease Control Subjeci NATIONAL DOARD OF MEDICAL EXAMINERS Total nember of items 7 CORRECT CATEGORY ITEM ITIM ANSWER No. 11 Influenza is characteristically a 57. disease caused by 58. against which vaccination is effective 59. 0 57 A) sporadic A) rickettsia TIF. B) endemic B) cocous O kingle C) epidemic C) virus D) household D) spirochate E) childhood E) mycobacterium 59. A) without qualification B) only 11 the causative type has been included in the vaccine C) in older persons D) because protection against one type protects against other types E) provided it has been administered (probably (envel) within two years of exposure 11 A) Diphtheria E-D B) Typhoid fever C) Salmonellosis D) Amebic dysentery E) Cholera 60. A carrier register is most effective when based on follow B up of clinical cases rather than on routine stool arro examinations of foodhandlers. 61. The probloms of "food poisoning" have increased C markedly with increase in consumption of processed foods. 62. Isolation and quarantine will not materially reduce A the spread but routine active immunization programs will practically eradicate it from a community. 63. This disease is particularly amenable to quarantine E measures because of its short incubation period. While fecal examinations are the most satisfactory 64. diagnostic procedures, even experienced technicians D may find it difficult to make the diagnosis 1300-4/57 Source.htps:/lwww.industrydocuments.ucsi.edu/docsijuxi0227 CONFIDENTIAL Subject Chronic illness Degenerative Diseases NATIONAL BOARO OF MEDICAL EXAMINERS Totres nomber of items 6 CORRECT ITEM CATEGORY ITEM ANSWER No. IS 12 Nutritional factors are of great importance in the 65. management of 1. achalasia 2. hypartrophic arthritis 3. hypothyroidism 40 gout e C Modorn life is gwared too rapidly. By 66. 12 C D the effects of constant tension become manifest through 67. diseases. When these become manifest, the wise physician, after a thorough evaluations advises 68. as well as appropriate medical therapy 66 A) the late twenties 67 A) arteriosclerotic B) arthritic 2 B) the late ?teens 2 C) spastic what head of develop C) middle age mether D) old age D) neurologic E) age terr 10 E) infectious 68 A) a long vacation B) changing jobs 2 C) taking up a hobby D) avoiding stressful situations E) psychiatric consultation 1800-4/57 CONFIDENTIAL Subject Chronic illness Degenerative Diseases NATIONAL BOARD OF MEDICAL EXAMINERS Total number of items 6 CORRECT CATEGORY ITEAA ITEM ANSWER No. B 12 A) Ostecarthritis 69. Always systemi c A 70. Onset usually gradual A 0 A B) Rheuratoid arthritis B D c) Both 11. Overweight a frequent factor D) Nei ther 72. Rest important D 73. Vaccine therapy 0 B 12 A) Peptic ulcer 1. Crampy abdominal pain BC 4 74. B) Irritable colon 2. Stress AB . C) Diverticulosis 30 Good nutrition C / 40 Occult blood in stool ABC 5. Laxative habit 6 D 12 Normal tonometric findings constitute adequate study of an 15. individual suspected of having glaucoma because all glaucoma patients have increased intraocular tension. of C 12 Blood sugar determinations as well as urine sugar studies should 96 be used in diabetic detection campaigns because most obese diabetics have a high renal threshold for glucose o 1800-4/57 Source.https://www.industrydocuments.ucsi.edu/docsijuxi0227 CONFIDENTIAL Subject Accident Prevention NATIONAL BOARD OF MEDICAL EXAMINERS Total nomber of items 2 CORRECT CATEGORY ITEM tram ANSWER No. E 13 Accidents are more frequent in 17. 1. the home than at work. ? 2. employees learning to use new machinery 3. young drivers. 4. certain personality types. A 13 The responsibilities of practising physicians in the 18. prevention of automobile accidents are limited because mass media are more effective. 1000-4/57 Source.htps://www.industrydocuments.ucsi.edu/docs/juxi0227

what is the chart number?

tkyg0227

tkyg0227_p5, tkyg0227_p6, tkyg0227_p7, tkyg0227_p8, tkyg0227_p9, tkyg0227_p10

27, Chart 27.

The dosage levels investigated should range from an absence of the additive in controls through a series of intermediate levels and through at least one producing significant effects. The material should be fed at a sufficient number of levels to determine the maxinum level of no response and to indicate the nature of the response at the higher levels. These observations will allow an estimate of safety in the species under study and will serve as a basis for extrapolation to other species. In growth studies, differences may not be interpretable unless caloric intakes are equalized or othervise taken into account. No single program can be laid down which will apply to every new additive in all its applications. As an investigation progresses, data obtained may indicate the advisability of altering the program of study as originally designed. With the above considerations in mind, the following tests may be suggested as a program which could be reasonably expected to yield the toxicologic data needed to assess hazard. 1. Acute oral toxicity: The approximate lethal single oral dose should be determined in at least tbree species, at least one of which is a non-rodent such as the dog. This information is of value in planning studies of subacute or chronic toxicity and in the recognition of symptcms. Extension of these acute tests may occasionally be desirable. The signs, clinical course, gross and microscopic tissue changes, and, if poss- ible, the mode of death should be described. Surviving animals should be observed until completely recovered. 2. Subacute oral toxicity: Results from a 90-day feeding test with ten animals of each sex at each of several feeding levels may permit one to decide whether the proposed use is too hazardous to warrant further toxicologic study. The informa- tion obtained may also serve as a guide in selecting feeding levels for the chronic toxicity study. The dose-response relationship should be exemined. is Source: https://www.industrydocuments.ucst.edu/docs/tkygo227 The data sought may include, at each of the several feeding levels, the effects on food consumption, growth, mortality rate, blood and urine composition, and organs as measured by weight and bistopathologic findings. Any alterations in functions and behavior should be noted. Effects on digestibility and utilization of the ration may be important. The subacute feeding tests with rats may be so designed that enough rata are used at each dietary level to provide animals to be continued to tests for cbronic toxicity, in the event it becomes advisable to conduct Buch tests. 3. Chronic oral toxicity: Long-term tests are conducted on the premise that the possible effects of the lifetime ingestion of an additive in food by man camot be predicted from results of tests less stringent than lifetime (approximately two years) feeding in a short-lived animal such as the rat, and one year or longer feed- ing in the dog or monkey. Obviously these tests may be either inadequate to the pur pose or more stringent than necessary, but past experience has not supplied a more rational alternative. In the tests with rats the material is fed at selected levels in the diet to groups of ten or more weanling animals of each sex. The levels to be red should be chosen on the basis of the data obtained in the subacute feeding tests. The two-year tests may include observations on food consumption, growth, ab- sorption, excretion and-tissue storage of the additive; mortality, organ weights, histopathologic and hematologic findings, blood and urine chemistry, such changes in behavior and function as may be determined by gross observation, and such other ob- servations as may be indicated in special circumstances, Effects on ration digest- ibility and utilization and on reproduction and lactation may be especially significant. For dogs or monkeys, groups of three or more animals are usually fed the mater- ial under test at three or more intake levels for one year or longer. Observations are similar to those made in the chronic feeding test with rats. The dog or monkey tests are generally started after the rat studies have been in progress long enough to provide data to aid in selecting the feeding levels likely to be most informative. 5 Source: https://www.industrydocuments.ucst.edu/docs/tkyg0227 BIOCHEMICAL, METABOLIC, AND NUTRITIONAL ASPECTS: It is desirable to study in animals the biochemistry and the metabolic fate of additives. When animal tests have IN MAN indicated reasonable safety, appropriate studies on volunteers (under medical supervision) may yield valuable information. Biochemical evidence can be of value in determining the safety of a compound by showing whether the additive is a product formed during the normal intermediary metabolism of foodstuff in the human body and whether it is metabolized by way of the well-known pathways of dietary components. This evidence can seldom entirely replace that from chronic toxicity tests. Special consideration must be given the possibility that the metabolism of the additive will overload the normal pathways for metabolism of foodstuffs. The influence of an intentional additive upon-the nutritional contribution of the foods in which it may appear mast be considered. It is important to ascertain the effect of the additive on the stability of mutrients in the foods, as well as on the digestibility and utilization of the ration. In addition to the foregoing, two special considerations should be reemphasized: (a) The possibility of alteration of the additive after its addition to foodstuffs should be explored. The altered additive or its reaction product with an entity of the food may be more or less toxic than the original chemical. (b) The extent to which chemically or pharmacologically similar substances are present in the usual diet should be known. C. ANTICIPATED LEVELS AND PATTERNS OF CONSUMPTION In order to estimate the probable intake level of the additive, information on its proposed use is essential. This information includes (a) the amount of the additive technically desirable in foods, (b) the proportion of the usual diet composed of foods in which this additive may appear, and (c) the extremes of probable intakes of these foods. From this information the maximum potential consumption by individuals or special groups as well as the average potential consumption for the general population can be estimated. 6 Source: https://www.industrydocuments.ucsf.edu/docs/tkyg0227 V. EVALUATION One of the most difficult problems in the interpretation of toxicologic data is the translation of such data into terms of human use levels and margins of safety. Each substance presents problems peculiar to itself and requires individual considera- tion by experts competent to exercise objective judgment of all the available evidence. The decision as to a safe level for an intentional food additive should be based upon such factors as the maximum dietary level that produced no unfavorable re- sponse in test animals; the severity of response in test animals at dietary levels above the no-response level; and the estimated potential for human consumption of the food or foods for which the additive is proposed. 7 Source: https://www.industrydocuments.ucsf.edu/docs/tkyg0227 CHART 23. - PER CAPITA CONSUMPTION OF GRAIN PRODUCTS, * ALL OTHER FOODS, AND TOTAL FOODS, FROM 1879 (Calories per day) 4,000 4,000 3,500 3,500 All foods 3,000 3,000 2,500 2,500 All other foods 2,000 2,000 1,500 1,500 Grain products 1,000 1,000 500 500 o o 1875 1885 1895 1905 1915 1925 1935 1945 1955 # Data from Part E, Tables VIII, IX. Source: https://www.industrydocuments.ucsf.edu/docs/tkyg0227 CHART 27. - PER CAPITA FLOW OF GOODS TO CONSUMERS, AND GRAIN PRODUCTS * CALORIES AS PERCENT OF TOTAL CALORIE CONSUMPTION, FROM 1879 (1929 dollars and percent) 1,100 1,100 1,000 1,000 900 900 800 800 700 700 Flow of goods leisure 600 600 Flow of goods 500 50 500 400 40 300 -30 Grain-products calories as percent of total INSET SCALE 200 20 100 10 o 1875 1885 1895 1905 1915 1925 1935 1945 1955 * Per capita flow of goods from Simon Kuznets, "Long-Term Changes since 1870," in Income and Wealth of the United States: Trends and Structure , ed. by Simon Kuz- nets (Cambridge, 1952), pp. 59, 68. Flow of goods including leisure according to Kuznets' Assumption I. Grain products as percent of total calories from Part E, Tables X, XI. Source: https:/lwww.industrydocuments.ucsf.edu/docs/tkyg0227

what is the chart title?

tkyg0227

tkyg0227_p5, tkyg0227_p6, tkyg0227_p7, tkyg0227_p8, tkyg0227_p9, tkyg0227_p10

per capita flow of goods to consumers, and grain products calories as percent of total calorie consumption, from 1879, Per capita flow of goods to consumers, and grain products calories as percent of total calorie consumption, from 1879*, Per capita flow of goods to consumers, and grain products calories as percent of total calorie consumption, from 1879

The dosage levels investigated should range from an absence of the additive in controls through a series of intermediate levels and through at least one producing significant effects. The material should be fed at a sufficient number of levels to determine the maxinum level of no response and to indicate the nature of the response at the higher levels. These observations will allow an estimate of safety in the species under study and will serve as a basis for extrapolation to other species. In growth studies, differences may not be interpretable unless caloric intakes are equalized or othervise taken into account. No single program can be laid down which will apply to every new additive in all its applications. As an investigation progresses, data obtained may indicate the advisability of altering the program of study as originally designed. With the above considerations in mind, the following tests may be suggested as a program which could be reasonably expected to yield the toxicologic data needed to assess hazard. 1. Acute oral toxicity: The approximate lethal single oral dose should be determined in at least tbree species, at least one of which is a non-rodent such as the dog. This information is of value in planning studies of subacute or chronic toxicity and in the recognition of symptcms. Extension of these acute tests may occasionally be desirable. The signs, clinical course, gross and microscopic tissue changes, and, if poss- ible, the mode of death should be described. Surviving animals should be observed until completely recovered. 2. Subacute oral toxicity: Results from a 90-day feeding test with ten animals of each sex at each of several feeding levels may permit one to decide whether the proposed use is too hazardous to warrant further toxicologic study. The informa- tion obtained may also serve as a guide in selecting feeding levels for the chronic toxicity study. The dose-response relationship should be exemined. is Source: https://www.industrydocuments.ucst.edu/docs/tkygo227 The data sought may include, at each of the several feeding levels, the effects on food consumption, growth, mortality rate, blood and urine composition, and organs as measured by weight and bistopathologic findings. Any alterations in functions and behavior should be noted. Effects on digestibility and utilization of the ration may be important. The subacute feeding tests with rats may be so designed that enough rata are used at each dietary level to provide animals to be continued to tests for cbronic toxicity, in the event it becomes advisable to conduct Buch tests. 3. Chronic oral toxicity: Long-term tests are conducted on the premise that the possible effects of the lifetime ingestion of an additive in food by man camot be predicted from results of tests less stringent than lifetime (approximately two years) feeding in a short-lived animal such as the rat, and one year or longer feed- ing in the dog or monkey. Obviously these tests may be either inadequate to the pur pose or more stringent than necessary, but past experience has not supplied a more rational alternative. In the tests with rats the material is fed at selected levels in the diet to groups of ten or more weanling animals of each sex. The levels to be red should be chosen on the basis of the data obtained in the subacute feeding tests. The two-year tests may include observations on food consumption, growth, ab- sorption, excretion and-tissue storage of the additive; mortality, organ weights, histopathologic and hematologic findings, blood and urine chemistry, such changes in behavior and function as may be determined by gross observation, and such other ob- servations as may be indicated in special circumstances, Effects on ration digest- ibility and utilization and on reproduction and lactation may be especially significant. For dogs or monkeys, groups of three or more animals are usually fed the mater- ial under test at three or more intake levels for one year or longer. Observations are similar to those made in the chronic feeding test with rats. The dog or monkey tests are generally started after the rat studies have been in progress long enough to provide data to aid in selecting the feeding levels likely to be most informative. 5 Source: https://www.industrydocuments.ucst.edu/docs/tkyg0227 BIOCHEMICAL, METABOLIC, AND NUTRITIONAL ASPECTS: It is desirable to study in animals the biochemistry and the metabolic fate of additives. When animal tests have IN MAN indicated reasonable safety, appropriate studies on volunteers (under medical supervision) may yield valuable information. Biochemical evidence can be of value in determining the safety of a compound by showing whether the additive is a product formed during the normal intermediary metabolism of foodstuff in the human body and whether it is metabolized by way of the well-known pathways of dietary components. This evidence can seldom entirely replace that from chronic toxicity tests. Special consideration must be given the possibility that the metabolism of the additive will overload the normal pathways for metabolism of foodstuffs. The influence of an intentional additive upon-the nutritional contribution of the foods in which it may appear mast be considered. It is important to ascertain the effect of the additive on the stability of mutrients in the foods, as well as on the digestibility and utilization of the ration. In addition to the foregoing, two special considerations should be reemphasized: (a) The possibility of alteration of the additive after its addition to foodstuffs should be explored. The altered additive or its reaction product with an entity of the food may be more or less toxic than the original chemical. (b) The extent to which chemically or pharmacologically similar substances are present in the usual diet should be known. C. ANTICIPATED LEVELS AND PATTERNS OF CONSUMPTION In order to estimate the probable intake level of the additive, information on its proposed use is essential. This information includes (a) the amount of the additive technically desirable in foods, (b) the proportion of the usual diet composed of foods in which this additive may appear, and (c) the extremes of probable intakes of these foods. From this information the maximum potential consumption by individuals or special groups as well as the average potential consumption for the general population can be estimated. 6 Source: https://www.industrydocuments.ucsf.edu/docs/tkyg0227 V. EVALUATION One of the most difficult problems in the interpretation of toxicologic data is the translation of such data into terms of human use levels and margins of safety. Each substance presents problems peculiar to itself and requires individual considera- tion by experts competent to exercise objective judgment of all the available evidence. The decision as to a safe level for an intentional food additive should be based upon such factors as the maximum dietary level that produced no unfavorable re- sponse in test animals; the severity of response in test animals at dietary levels above the no-response level; and the estimated potential for human consumption of the food or foods for which the additive is proposed. 7 Source: https://www.industrydocuments.ucsf.edu/docs/tkyg0227 CHART 23. - PER CAPITA CONSUMPTION OF GRAIN PRODUCTS, * ALL OTHER FOODS, AND TOTAL FOODS, FROM 1879 (Calories per day) 4,000 4,000 3,500 3,500 All foods 3,000 3,000 2,500 2,500 All other foods 2,000 2,000 1,500 1,500 Grain products 1,000 1,000 500 500 o o 1875 1885 1895 1905 1915 1925 1935 1945 1955 # Data from Part E, Tables VIII, IX. Source: https://www.industrydocuments.ucsf.edu/docs/tkyg0227 CHART 27. - PER CAPITA FLOW OF GOODS TO CONSUMERS, AND GRAIN PRODUCTS * CALORIES AS PERCENT OF TOTAL CALORIE CONSUMPTION, FROM 1879 (1929 dollars and percent) 1,100 1,100 1,000 1,000 900 900 800 800 700 700 Flow of goods leisure 600 600 Flow of goods 500 50 500 400 40 300 -30 Grain-products calories as percent of total INSET SCALE 200 20 100 10 o 1875 1885 1895 1905 1915 1925 1935 1945 1955 * Per capita flow of goods from Simon Kuznets, "Long-Term Changes since 1870," in Income and Wealth of the United States: Trends and Structure , ed. by Simon Kuz- nets (Cambridge, 1952), pp. 59, 68. Flow of goods including leisure according to Kuznets' Assumption I. Grain products as percent of total calories from Part E, Tables X, XI. Source: https:/lwww.industrydocuments.ucsf.edu/docs/tkyg0227

What is the heading of the document?

qtpg0227

qtpg0227_p0

Food and Nutrition Board, National Academy of Sciences-National Research Council

lst Working Draft Food and Nutrition Board, National Academy of Sciences-National Research Council Recommended Daily Dietary Allowances¹, , Revised 1963 Designed for the maintenance of good nutrition of practically all healthy persons in the U.S.A. (Allowances are intended for persons normally active in a temperate climate) Pro- Cal- Vita- Equiv 3 2 Thia- Ribo= Ascores Vita- Age Weight He ght Calo tein cium Iron min A mine flavin Niacin bic Acid min D years kg. (lbs.) cm. (in. ries gm. gm. mg. I.U. mg. mg. mg. me. I.U. Men 25 70 (154) 175 (69) 3000 70 0.8 5000 1.2 1.8 20 70 45 70 (154) 175 (69) 2700 70 0.8 5000 1.1 1.6 18 70 65 70 (154) 175 (69) 2400 70 0.8 5000 1.0 1.4 16 70 Women 25 58 (128) 163 (64) 2200 58 0.8 5000 0.9 1.3 15 70 45 58 (128) 163 (64) 2000 58 0.8 5000 0.8 1.2 13 70 65 58 (128) 163 (64) 1800 58 0.8 5000 0.8 1.1 12 70 Pregnant (last Trimester) +200 +20 +0.5 + 1000 +0.2 +0.3 + 3 + 30 400 Lactating + 1000 +40 +0.5 +3000 + 0.4 +0.6 +' 7 +30 400 Infants O-1 Kgx115 Kgx2.5 0.7 30 1144 -0.5 4 Children 1-3 12 (27) 87 (34) 1400 35 0.8 2000 0.6 0.8 9 40 400 3-6 18 (40) 107 (42) 1600 40 0.8 2500 0.6 1.0 11 50 400 6.9 24 (53) 124 (49) 2100 52 0.8 3500 0.8 1.3 14 60 400 Boys 9-12 33 (72) 140 (55) 2400 60 1.1 4500 1.0 1.4 16 70 400 12-15 45 (98) 156 (61.) 3000 75 1.4 5000 1.2 1.8 20 8o 400 15-18 61 (134) 172 (68) 3400 85 1.4 5000 1.4 2.0 22 80 400 Girls 9-12 33 (72) 140 (55) 2200 55 1.1 4500 0.9 1.3 15 80 400 12-15 47 (103) 158 (62) 2500 62 1.3 5000 1.0 1.5 17 8o 400 15-18 53 (117) 163 (64) 2200 55 1.3 5000 0.9 1.3 15 70 400 the allowance levels are intended to cover individual is from beginning of lst year to end of 2nd year; variations among most normal persons as they live in the 3-6 (representing 43 years) is from beginning of United States under usual environmental stresses. The 3rd to end of 5th year, etc. recommended allowances can be attained with a variety of common foods, providing other nutrients for which human 3Niacin equivalents include dietary sources of the requirements have been less well defined. See text for preformed vitamin and the precursor, tryptophan. 60 more detailed discussion of allowances and of nutrients milligrams tryptophan equals 1 milligram niacin. not tabulated. The calorie and protein allowances per kilogram for 2adult age entry 25 is for period 18-35, 45 is for infants are considered to decrease progressively from 35-55, 65 for 55=75. The age entries for infants and birth; i.e., at birth calorie allowance is 125 per kg. children mark the beginning of each age, e.ge: 0.1 is protein allowance is 3.0 gm. kg. Protein allowance from birth to end of lst year; 1-3 (representing 2 years) for infants and children approximate 10% of total calories from protein. Source: https://www.industrydocuments.ucst.edu/docs/qtpg022

which year is mentioned first on x-axis?

tkyg0227

tkyg0227_p5, tkyg0227_p6, tkyg0227_p7, tkyg0227_p8, tkyg0227_p9, tkyg0227_p10

1875

The dosage levels investigated should range from an absence of the additive in controls through a series of intermediate levels and through at least one producing significant effects. The material should be fed at a sufficient number of levels to determine the maxinum level of no response and to indicate the nature of the response at the higher levels. These observations will allow an estimate of safety in the species under study and will serve as a basis for extrapolation to other species. In growth studies, differences may not be interpretable unless caloric intakes are equalized or othervise taken into account. No single program can be laid down which will apply to every new additive in all its applications. As an investigation progresses, data obtained may indicate the advisability of altering the program of study as originally designed. With the above considerations in mind, the following tests may be suggested as a program which could be reasonably expected to yield the toxicologic data needed to assess hazard. 1. Acute oral toxicity: The approximate lethal single oral dose should be determined in at least tbree species, at least one of which is a non-rodent such as the dog. This information is of value in planning studies of subacute or chronic toxicity and in the recognition of symptcms. Extension of these acute tests may occasionally be desirable. The signs, clinical course, gross and microscopic tissue changes, and, if poss- ible, the mode of death should be described. Surviving animals should be observed until completely recovered. 2. Subacute oral toxicity: Results from a 90-day feeding test with ten animals of each sex at each of several feeding levels may permit one to decide whether the proposed use is too hazardous to warrant further toxicologic study. The informa- tion obtained may also serve as a guide in selecting feeding levels for the chronic toxicity study. The dose-response relationship should be exemined. is Source: https://www.industrydocuments.ucst.edu/docs/tkygo227 The data sought may include, at each of the several feeding levels, the effects on food consumption, growth, mortality rate, blood and urine composition, and organs as measured by weight and bistopathologic findings. Any alterations in functions and behavior should be noted. Effects on digestibility and utilization of the ration may be important. The subacute feeding tests with rats may be so designed that enough rata are used at each dietary level to provide animals to be continued to tests for cbronic toxicity, in the event it becomes advisable to conduct Buch tests. 3. Chronic oral toxicity: Long-term tests are conducted on the premise that the possible effects of the lifetime ingestion of an additive in food by man camot be predicted from results of tests less stringent than lifetime (approximately two years) feeding in a short-lived animal such as the rat, and one year or longer feed- ing in the dog or monkey. Obviously these tests may be either inadequate to the pur pose or more stringent than necessary, but past experience has not supplied a more rational alternative. In the tests with rats the material is fed at selected levels in the diet to groups of ten or more weanling animals of each sex. The levels to be red should be chosen on the basis of the data obtained in the subacute feeding tests. The two-year tests may include observations on food consumption, growth, ab- sorption, excretion and-tissue storage of the additive; mortality, organ weights, histopathologic and hematologic findings, blood and urine chemistry, such changes in behavior and function as may be determined by gross observation, and such other ob- servations as may be indicated in special circumstances, Effects on ration digest- ibility and utilization and on reproduction and lactation may be especially significant. For dogs or monkeys, groups of three or more animals are usually fed the mater- ial under test at three or more intake levels for one year or longer. Observations are similar to those made in the chronic feeding test with rats. The dog or monkey tests are generally started after the rat studies have been in progress long enough to provide data to aid in selecting the feeding levels likely to be most informative. 5 Source: https://www.industrydocuments.ucst.edu/docs/tkyg0227 BIOCHEMICAL, METABOLIC, AND NUTRITIONAL ASPECTS: It is desirable to study in animals the biochemistry and the metabolic fate of additives. When animal tests have IN MAN indicated reasonable safety, appropriate studies on volunteers (under medical supervision) may yield valuable information. Biochemical evidence can be of value in determining the safety of a compound by showing whether the additive is a product formed during the normal intermediary metabolism of foodstuff in the human body and whether it is metabolized by way of the well-known pathways of dietary components. This evidence can seldom entirely replace that from chronic toxicity tests. Special consideration must be given the possibility that the metabolism of the additive will overload the normal pathways for metabolism of foodstuffs. The influence of an intentional additive upon-the nutritional contribution of the foods in which it may appear mast be considered. It is important to ascertain the effect of the additive on the stability of mutrients in the foods, as well as on the digestibility and utilization of the ration. In addition to the foregoing, two special considerations should be reemphasized: (a) The possibility of alteration of the additive after its addition to foodstuffs should be explored. The altered additive or its reaction product with an entity of the food may be more or less toxic than the original chemical. (b) The extent to which chemically or pharmacologically similar substances are present in the usual diet should be known. C. ANTICIPATED LEVELS AND PATTERNS OF CONSUMPTION In order to estimate the probable intake level of the additive, information on its proposed use is essential. This information includes (a) the amount of the additive technically desirable in foods, (b) the proportion of the usual diet composed of foods in which this additive may appear, and (c) the extremes of probable intakes of these foods. From this information the maximum potential consumption by individuals or special groups as well as the average potential consumption for the general population can be estimated. 6 Source: https://www.industrydocuments.ucsf.edu/docs/tkyg0227 V. EVALUATION One of the most difficult problems in the interpretation of toxicologic data is the translation of such data into terms of human use levels and margins of safety. Each substance presents problems peculiar to itself and requires individual considera- tion by experts competent to exercise objective judgment of all the available evidence. The decision as to a safe level for an intentional food additive should be based upon such factors as the maximum dietary level that produced no unfavorable re- sponse in test animals; the severity of response in test animals at dietary levels above the no-response level; and the estimated potential for human consumption of the food or foods for which the additive is proposed. 7 Source: https://www.industrydocuments.ucsf.edu/docs/tkyg0227 CHART 23. - PER CAPITA CONSUMPTION OF GRAIN PRODUCTS, * ALL OTHER FOODS, AND TOTAL FOODS, FROM 1879 (Calories per day) 4,000 4,000 3,500 3,500 All foods 3,000 3,000 2,500 2,500 All other foods 2,000 2,000 1,500 1,500 Grain products 1,000 1,000 500 500 o o 1875 1885 1895 1905 1915 1925 1935 1945 1955 # Data from Part E, Tables VIII, IX. Source: https://www.industrydocuments.ucsf.edu/docs/tkyg0227 CHART 27. - PER CAPITA FLOW OF GOODS TO CONSUMERS, AND GRAIN PRODUCTS * CALORIES AS PERCENT OF TOTAL CALORIE CONSUMPTION, FROM 1879 (1929 dollars and percent) 1,100 1,100 1,000 1,000 900 900 800 800 700 700 Flow of goods leisure 600 600 Flow of goods 500 50 500 400 40 300 -30 Grain-products calories as percent of total INSET SCALE 200 20 100 10 o 1875 1885 1895 1905 1915 1925 1935 1945 1955 * Per capita flow of goods from Simon Kuznets, "Long-Term Changes since 1870," in Income and Wealth of the United States: Trends and Structure , ed. by Simon Kuz- nets (Cambridge, 1952), pp. 59, 68. Flow of goods including leisure according to Kuznets' Assumption I. Grain products as percent of total calories from Part E, Tables X, XI. Source: https:/lwww.industrydocuments.ucsf.edu/docs/tkyg0227

Revised "Recommended Daily Dietary Allowances" of which year is given?

qtpg0227

qtpg0227_p0

1963

lst Working Draft Food and Nutrition Board, National Academy of Sciences-National Research Council Recommended Daily Dietary Allowances¹, , Revised 1963 Designed for the maintenance of good nutrition of practically all healthy persons in the U.S.A. (Allowances are intended for persons normally active in a temperate climate) Pro- Cal- Vita- Equiv 3 2 Thia- Ribo= Ascores Vita- Age Weight He ght Calo tein cium Iron min A mine flavin Niacin bic Acid min D years kg. (lbs.) cm. (in. ries gm. gm. mg. I.U. mg. mg. mg. me. I.U. Men 25 70 (154) 175 (69) 3000 70 0.8 5000 1.2 1.8 20 70 45 70 (154) 175 (69) 2700 70 0.8 5000 1.1 1.6 18 70 65 70 (154) 175 (69) 2400 70 0.8 5000 1.0 1.4 16 70 Women 25 58 (128) 163 (64) 2200 58 0.8 5000 0.9 1.3 15 70 45 58 (128) 163 (64) 2000 58 0.8 5000 0.8 1.2 13 70 65 58 (128) 163 (64) 1800 58 0.8 5000 0.8 1.1 12 70 Pregnant (last Trimester) +200 +20 +0.5 + 1000 +0.2 +0.3 + 3 + 30 400 Lactating + 1000 +40 +0.5 +3000 + 0.4 +0.6 +' 7 +30 400 Infants O-1 Kgx115 Kgx2.5 0.7 30 1144 -0.5 4 Children 1-3 12 (27) 87 (34) 1400 35 0.8 2000 0.6 0.8 9 40 400 3-6 18 (40) 107 (42) 1600 40 0.8 2500 0.6 1.0 11 50 400 6.9 24 (53) 124 (49) 2100 52 0.8 3500 0.8 1.3 14 60 400 Boys 9-12 33 (72) 140 (55) 2400 60 1.1 4500 1.0 1.4 16 70 400 12-15 45 (98) 156 (61.) 3000 75 1.4 5000 1.2 1.8 20 8o 400 15-18 61 (134) 172 (68) 3400 85 1.4 5000 1.4 2.0 22 80 400 Girls 9-12 33 (72) 140 (55) 2200 55 1.1 4500 0.9 1.3 15 80 400 12-15 47 (103) 158 (62) 2500 62 1.3 5000 1.0 1.5 17 8o 400 15-18 53 (117) 163 (64) 2200 55 1.3 5000 0.9 1.3 15 70 400 the allowance levels are intended to cover individual is from beginning of lst year to end of 2nd year; variations among most normal persons as they live in the 3-6 (representing 43 years) is from beginning of United States under usual environmental stresses. The 3rd to end of 5th year, etc. recommended allowances can be attained with a variety of common foods, providing other nutrients for which human 3Niacin equivalents include dietary sources of the requirements have been less well defined. See text for preformed vitamin and the precursor, tryptophan. 60 more detailed discussion of allowances and of nutrients milligrams tryptophan equals 1 milligram niacin. not tabulated. The calorie and protein allowances per kilogram for 2adult age entry 25 is for period 18-35, 45 is for infants are considered to decrease progressively from 35-55, 65 for 55=75. The age entries for infants and birth; i.e., at birth calorie allowance is 125 per kg. children mark the beginning of each age, e.ge: 0.1 is protein allowance is 3.0 gm. kg. Protein allowance from birth to end of lst year; 1-3 (representing 2 years) for infants and children approximate 10% of total calories from protein. Source: https://www.industrydocuments.ucst.edu/docs/qtpg022

to how manay boards of education does the cuyhoga county general health provides service?

xhfg0227

xhfg0227_p25, xhfg0227_p26, xhfg0227_p27, xhfg0227_p28, xhfg0227_p29, xhfg0227_p30, xhfg0227_p31, xhfg0227_p32, xhfg0227_p33, xhfg0227_p34, xhfg0227_p35, xhfg0227_p36, xhfg0227_p37, xhfg0227_p38

25

of these kinds of services, though hard to measure, will decrease in 1963 because of cut-backs in funds for State personnel in all administrative agencies and at all pro- fessional levels. 3) Federal grants-in-aid Table V-13 shows the proportion of local public health funds received in 1962 from federal grant sources to be about 15%. Those funds administered by the State Health Depart- ment, and disbursed to local health districts by a distribution formula which considers both financial needs and population size, have applied to : Cancer, general health and community health services, heart, maternal and child health, and water pollution. Crippled children's program funds are administered by the State Department of Welfare. Portions of salaries of persönnel in state regional and central offices, and drugs distributed free to local health districts, are financed by federal formula grancs. Federal money has been used to finance special projects in local health districts, or aid general health services. The proportion of Cuyahoga County (and Cleveland) public health ser- vices financed through state administered federal grants is reflected in Table V-14 in the Appendix. This table also shows the federal assistance -22- Source: https://www.industrydocuments.ucsf.edu/docsixhfg022 portions of other health programs in Cuyahoga County, not administered by the Health Departments. It is possible that Ohio's 1963 austerity program will also result in a diminution of some of the federal grant funds accruing to local health districts. There were programs in the planning stages for which some federal funds had been received that cannot be carried out because of the cut-back in personnel, or the "freeze" order prohibiting the addition of new employees or the replacement of personnel retired, re- signed, or lost by death. Sources of Income to Local Health Districts, Other Than State Aid There are five sources from which local health districts may re- ceive funds other than state subsidies or federal grants-in-aid. They are: Deductions from property taxes distributed to town- ships and villages; licenses, permits and inspection fees; contractual agreements with cities and Boards of Education; agency grants; voted public health levies limited in County Districts to .5 mill Property Taxes - This is the traditional and major source of public health financing. Monies for health districts are deducted by the County Auditor from taxes levied within a 10 mill limitation. Figure V-3 shows that, in 1962, the Cuyahoga County General Health District derived 6% of its income from village and township taxation, and another 63% from contracts - 23 - Source: https://www.industrydocuments.ucsf.edu/docsxhfg0227 with cities and school boards. The contract funds are, in turn, derived from the tax funds of these jurisdictions, plus state subsidies, (which are re- flected separately in Figure V-3). The City of Cleveland's public health program received 76% of its financial support from taxation. Cuyahoga County voters have not had a health levy before them. Fees - Income is derived in some Ohio cities and counties from as many as forty different kinds of fees. In the Cuyahoga County General Health District fees are collected, for example, for licensing milk and meat handling establishments, food handling and processing, trailer parks. Fees are collected for issuing birth and death certificates. Fee collection is not specifically authorized by law, and in some counties, court decisions have prohibited or restricted the collection of such fees. Contracts - Only four General Health Districts in Ohio have contractual arrangements with one or more cities. Cuyahoga is one of these, providing services to 30 contracting cities. The law requires that it must be determined by the Ohio Department of Health that the General Health District is organized and equipped to provide adequate health services by this -24- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 Figure V-3 1962 INCOME BY SOURCE OF FUNDS City of Cleveland, Division of Health Cuyahoga County General Health District City of Cleveland Total: $1,964,801 MEDICAL CARE-INDIGENT - 1 % MISCELLANEOUS (including I A X E S cash balance) - 3% STATE SUBSIDY - 0.1 % from City; County and State 76% FEES AND LICENSES 20% Cuyahoga County Total: $531,331 MISCELLANEOUS (including cash balance) - 11% STATE SUBSIDY - 109 c/o I A X E S from cities; county FEES AND LICENSES - 5% Boards or Education 639 % FEDERAL - 5 % from villages and townships - 6 % -25- Source: https:I/www.industrydocuments.ucsf.edu/docs/xhfgo227 method. The Cuyahoga County General Health District also provides services by contract to 25 Boards of Education. There are four municipalities in Cuyahoga County, plus the city of Cleveland, maintaining independent municipal health departments - Shaker Heights, Cleveland Heights, East Cleveland and Lakewood. * Table V-15 CUYAHOGA COUNTY HEALTH DISTRICTS 19/ TOTAL LOCAL BUDGETS - 1963 Per Increase or Funds for Capita Decrease City Public Health Approp. From 1962 (less Fed. GIA) City of Cleveland 2,204,443 2.56 +10.5 Cuyahoga County General Health District and contracting cities 525,414 .81 + 4.0 Cleveland Heights 60,805 .97 + 1.5 East Cleveland 38,450 1.03 + 2.6 Shaker Heights 21,987 .57 + 3.0 Lakewood 52,525 .80 -14.7 The current recommendations of the American Public Health Assoc- iation are that per capita appropriations should exceed $2.50. *In its "Financial Report of Local Health Departments-1963", - the Ohio Department of Health has given these independent health departments of the smaller municipalities the following designations: Qualified (full-time) - Cleveland Heights and East Cleveland Unqualified (part-time) - Shaker Heights and Lakewood - 26 - Source: https://www.industrydocuments.ucsf.edu/docs/xhfg0227 PUBLIC HEALTH EXPENDITURE AND ABILITY TO PAY The per capita tax valuation can be used as a measure of a district's ability to appropriate funds for public health. The Ohio State Department of Health has ranked Health Districts in order of per capita assessed val- uation (1962) as compared with a rank order for per capita local appro- 20/ priation. There are 281 statutory Health Districts. In Table V-16 the rank order by assessed valuation and by local health appropriation of Cuyahoga County's General Health District and each separate municipal Health Department within the county, is compared with similar data for Summit County and the City of Akron. Cuyahoga County's General Health District is a contracting system; that is a number of city health districts within the geographic boundaries of the county contract with the General Health District for services. All municipalities eligible by statute for the designation "Health District" contract with the county except those four previously mentioned and the City of Cleveland as stated; twenty-five Boards of Education also contract for School Health Services. (This represents all Boards of Education with- in its jurisdiction, but two). The County General Health District Board of Health also serves all primary parochial schools in its jurisdiction. While the administrative structure of the Summit County General Health District follows the pattern known as combined, * it was chosen as the most appropriate for comparison with Cuyahoga County because its public health expenditures cover a similar array of services including comprehensive school health programs. (The Summit County General Health District serves all Boards of Education in its jurisdiction). The City of Cleveland provides comprehensive school health programs in primary parochial schools, and the Cleveland Board of Education in the public schools, but there is also good cooperation between the two juris- dictions. The City of Akron Health Department serves all public, private and parochial schools within the city limits. There is a combined Board of Health as provided in the Ohio Revised Code. Three municipalities within Summit County also contract with the General Health District for services, and each is entitled to one representative on the 7-man Board of Health. The cities of Akron and Barberton have independent Health Departments. - 27 - Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 TABLE V-16 HEALTH APPROPRIATIONS IN CUYAHOGA AND SUMMIT COUNTIES 1963 Rank By Per Capita Rank By Per Capita Assessed Health Health Local Health Valuation (1962) District Appropriation Appropriation CUYAHOGA COUNTY 41 General Health District .81 170 (with contracting municipalities ranging from 10th to 244th) 17 Shaker Heights .57 210 83 Cleveland Heights .97 143 118 East Cleveland 1.03 127 151 Lakewood .80 171 37 City of Cleveland 2.56 8 SUMMIT COUNTY 116 General Health District 1.82 29 109 City of Akron 2.08 15 - 28 - Source: https://www.industrydocuments.ucsf.edu/docs/xhfg0227 EXPENDITURES OF MAJOR CUYAHOGA COUNTY HEALTH DEPARTMENTS BY PROGRAM Figure V=4 analyzes the expenditures of the Cuyahoga County General Health District, including contracting cities, and of the City of Cleveland Division of Health, by program. It will be noted that both major Health Departments allocate a large proportion of budget to Public Healch nursing, and that, in the County, services by nurses to the public school health programs are included. In the city the public school health program is separate, staffed and financed by the Board of Education. The City of Cleveland is able to maintain a professionally staffed laboratory. The County uses state laboratory facilities. The city has a staff of full and part-time physicians` to cover both home care of the medically indigent population, and some preventive and control programs in communicable disease and venereal disease. The County uses state regional office services for V.D. control, and must rely even more heavily than the City of Cleveland on nursing services in, for example, infectious disease work. The vital statistics services which receive 6% of the Cleveland city budget, represent a geographic area for reporting greater than the city's confines, since registration districts fixed by separate state statutes are designated as this department's responsibility. The city's registrar is not, however, responsible for the entire county. Food and sanitation inspection services consume about 1/3 of each Health District budget. In the county this program includes: sampling and testing of water; inspection of sewage disposal facilities; inspection of garbage and refuse disposal arrangements; some housing inspection; -29- Source: https://www.industrydocuments.ucst.edu/docsixhfg0227 Figure V-4 1962 EXPENDITURES BY PROGRAM City of Cleveland, Division of Health Cuyahoga County General Health District City of Cleveland Total: $1,955,751 FOOD AND SANITATION CONTROL LABORATORY - 6 % SCHOOL MEDICAL 2 8 % SERVICES - 9 % (Est) VITAL STATISTICS - 6% MEDICAL SCHOOL HEALTH SERVICES NURSING - 9 % (Est) PUBLIC 16; % HEALTH NURSING 26% Cuyahoga County Total: $476,856 FOOD AND SANITATION CONTROL 30% MEDICAL SERVICES - 3 % PUBLIC SCHOOL MEDICAL SERVICES - 5 % HEALTH SCHOOL HEALTH NURSING NURSING 45% 17% -30- Source: https://www.industrydocuments.ucsf.edu/docs/xhfg0227 some vector control programs; and food and milk service and handling consultation and inspection programs. In the city food handler programs, milk, meat and poultry processing inspection; rat control; and some public building inspection (barber shops, laundries, hotels, trailer camps) are under the supervision of the Sanitary Unit of the City Division of Health. Collection and dis- posal of garbage and refuse is the responsibility of the Department of Public Service. The Division of Sewage Disposal is a section of the Public Utilities Department. The City Department of Urban Renewal and Housing is responsible for most programs of hygiene of housing, and for inspection of all nursing homes, hospitals and maternity wards as provided for in the Ohio codes. This Department also operates the Division of Air and Stream Pollution. No expenditures for such programs are reflected, then, in the food and sanitation budget of the Cleveland City Division of Health. -31- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 TRENDS IN EXPENDITURES FOR ALL HEALTH SERVICES IN CUYAHOGA COUNTY The Cleveland Welfare Federation has prepared an analysis of income and expenditures of all Health, Welfare and Recreation programs, according to United Community Funds and Councils of America classifications. Trends in health financing are demonstrated by comparing 1955 and 1960. Table V-17 summarizes these trends, and full details are recapi- tulated in Tables V-14 a & b in the Appendix. In the five year span, expenditures for health and medical care have increased in Cuyahoga County, by 72%, but the private philanthropic and agency self-support share of this has had to increase, while the tax dollar portion has actually de- creased. This trend holds for individual areas of health expenditure such as hospitals, including state and county=operated facilities. The medical vendor payments of family and child welfare programs did receive greater federal assistance in 1960 than in 1955, while the local tax share also increased and the state support decreased. Criteria for eligibility for payment of medical care costs, par- ticularly hospitalization, for the "medically indigent", were reduced in 1961, by a resolution of the County Commissioners to cover only those families whose income and resources did not exceed 80% of the State Wel- fare Department standards, and all persons over 65 were declared 21/ ineligible. As of 1963, state matching funds to General Relief were cut from 50% to 40%, putting medical vendor payments for both relief families and the undefined "medically indigent" into further jeopardy. Yet, from 1952 to 1962 medical and health care costs to public assistance 22/ programs in Cuyahoga County had risen 387%. -32- Source: https:/lwww.industrydocuments.ucsf.edu/docsixhfg0227 The question of defining medical indigency plus assessment of fiscal responsibility for payment is the current subject of litigation brought by certain hospitals. The only major public health program in which both local and private financial support showed a decrease, while total expenditures increased, was that of local health departments, but their total expenditures for public health services rose only 31% in the 5 years, while hospital expenditures rose 73.5% and those of public assistance programs - 167.5% (see figures V-5 to V-8). Table V-17 EXPENDITURES FOR HEALTH AND MEDICAL CARE UNDER ALL AUSPICES IN CUYAHOGA COUNTY, BY SOURCE OF FUNDS * 1955 - 1960 (In Thousands of Dollars) 1 9 6 0 % 1955 % of % of Increase Amount Total Amount Total 1955-1960 All Sources $ 72,728 100.0% $125,082 100.0% 72.0 Public (tax support) 22,337 30.7 29,130 23.3 30.4 Private (philanthropic 50,391 69.3 95,954 76.7 90.4 contributions, fees to hospitals, etc. SOURCES: 1. Expenditure Studies for Health, Welfare and Recreation Services, 1955 and 1960: Research Department, Welfare Federation of Cleveland 2. Financial Reports of Department of Public Welfare, State of Ohio 3. Ohio Citizens' Council 4. Fiscal Officers of Veterans Administration Does not include private out of pocket payments for direct medical and dental care, or for health insurance. -33- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 Figure V - 5 EXPENDITURES FOR HEALTH CARE SERVICES UNDER ALL AUSPICES IN CUYAHOGA COUNTY, BY SOURCE OF FUNDS 1955 - 1960 DOLLARS (Millions) $125,082,000 120 110 23 100 4 90 80 $72,728,000 70 60 31 50 5 40 30 20 64 72 10 1955 1960 KEY: Self Public Support (Gov't) Contri- 9 Percent bution of Total -34- Source: https://www.industrydocuments.ucst.edu/docsixhfg227 Figure V-6 EXPENDITURES FOR HEALTH CARE SERVICES BY HOSPITALS IN CUYAHOGA COUNTY, BY SOURCE OF FUNDS 1955 - 1960 DOLLARS (Millions) $116,666,000 110 20 100 90 3 80 70 $67,238,000 60 29 50 3 40 77 30 68 20 10 1955 1960 KEY: Self Public Support (Gov't) Contri- 5 Percent bution of Total -35- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227

What is the "Adult age entry" for period 18-35?

qtpg0227

qtpg0227_p0

25

lst Working Draft Food and Nutrition Board, National Academy of Sciences-National Research Council Recommended Daily Dietary Allowances¹, , Revised 1963 Designed for the maintenance of good nutrition of practically all healthy persons in the U.S.A. (Allowances are intended for persons normally active in a temperate climate) Pro- Cal- Vita- Equiv 3 2 Thia- Ribo= Ascores Vita- Age Weight He ght Calo tein cium Iron min A mine flavin Niacin bic Acid min D years kg. (lbs.) cm. (in. ries gm. gm. mg. I.U. mg. mg. mg. me. I.U. Men 25 70 (154) 175 (69) 3000 70 0.8 5000 1.2 1.8 20 70 45 70 (154) 175 (69) 2700 70 0.8 5000 1.1 1.6 18 70 65 70 (154) 175 (69) 2400 70 0.8 5000 1.0 1.4 16 70 Women 25 58 (128) 163 (64) 2200 58 0.8 5000 0.9 1.3 15 70 45 58 (128) 163 (64) 2000 58 0.8 5000 0.8 1.2 13 70 65 58 (128) 163 (64) 1800 58 0.8 5000 0.8 1.1 12 70 Pregnant (last Trimester) +200 +20 +0.5 + 1000 +0.2 +0.3 + 3 + 30 400 Lactating + 1000 +40 +0.5 +3000 + 0.4 +0.6 +' 7 +30 400 Infants O-1 Kgx115 Kgx2.5 0.7 30 1144 -0.5 4 Children 1-3 12 (27) 87 (34) 1400 35 0.8 2000 0.6 0.8 9 40 400 3-6 18 (40) 107 (42) 1600 40 0.8 2500 0.6 1.0 11 50 400 6.9 24 (53) 124 (49) 2100 52 0.8 3500 0.8 1.3 14 60 400 Boys 9-12 33 (72) 140 (55) 2400 60 1.1 4500 1.0 1.4 16 70 400 12-15 45 (98) 156 (61.) 3000 75 1.4 5000 1.2 1.8 20 8o 400 15-18 61 (134) 172 (68) 3400 85 1.4 5000 1.4 2.0 22 80 400 Girls 9-12 33 (72) 140 (55) 2200 55 1.1 4500 0.9 1.3 15 80 400 12-15 47 (103) 158 (62) 2500 62 1.3 5000 1.0 1.5 17 8o 400 15-18 53 (117) 163 (64) 2200 55 1.3 5000 0.9 1.3 15 70 400 the allowance levels are intended to cover individual is from beginning of lst year to end of 2nd year; variations among most normal persons as they live in the 3-6 (representing 43 years) is from beginning of United States under usual environmental stresses. The 3rd to end of 5th year, etc. recommended allowances can be attained with a variety of common foods, providing other nutrients for which human 3Niacin equivalents include dietary sources of the requirements have been less well defined. See text for preformed vitamin and the precursor, tryptophan. 60 more detailed discussion of allowances and of nutrients milligrams tryptophan equals 1 milligram niacin. not tabulated. The calorie and protein allowances per kilogram for 2adult age entry 25 is for period 18-35, 45 is for infants are considered to decrease progressively from 35-55, 65 for 55=75. The age entries for infants and birth; i.e., at birth calorie allowance is 125 per kg. children mark the beginning of each age, e.ge: 0.1 is protein allowance is 3.0 gm. kg. Protein allowance from birth to end of lst year; 1-3 (representing 2 years) for infants and children approximate 10% of total calories from protein. Source: https://www.industrydocuments.ucst.edu/docs/qtpg022

how many municipalities are there in Cuyahoga county?

xhfg0227

xhfg0227_p25, xhfg0227_p26, xhfg0227_p27, xhfg0227_p28, xhfg0227_p29, xhfg0227_p30, xhfg0227_p31, xhfg0227_p32, xhfg0227_p33, xhfg0227_p34, xhfg0227_p35, xhfg0227_p36, xhfg0227_p37, xhfg0227_p38

four

of these kinds of services, though hard to measure, will decrease in 1963 because of cut-backs in funds for State personnel in all administrative agencies and at all pro- fessional levels. 3) Federal grants-in-aid Table V-13 shows the proportion of local public health funds received in 1962 from federal grant sources to be about 15%. Those funds administered by the State Health Depart- ment, and disbursed to local health districts by a distribution formula which considers both financial needs and population size, have applied to : Cancer, general health and community health services, heart, maternal and child health, and water pollution. Crippled children's program funds are administered by the State Department of Welfare. Portions of salaries of persönnel in state regional and central offices, and drugs distributed free to local health districts, are financed by federal formula grancs. Federal money has been used to finance special projects in local health districts, or aid general health services. The proportion of Cuyahoga County (and Cleveland) public health ser- vices financed through state administered federal grants is reflected in Table V-14 in the Appendix. This table also shows the federal assistance -22- Source: https://www.industrydocuments.ucsf.edu/docsixhfg022 portions of other health programs in Cuyahoga County, not administered by the Health Departments. It is possible that Ohio's 1963 austerity program will also result in a diminution of some of the federal grant funds accruing to local health districts. There were programs in the planning stages for which some federal funds had been received that cannot be carried out because of the cut-back in personnel, or the "freeze" order prohibiting the addition of new employees or the replacement of personnel retired, re- signed, or lost by death. Sources of Income to Local Health Districts, Other Than State Aid There are five sources from which local health districts may re- ceive funds other than state subsidies or federal grants-in-aid. They are: Deductions from property taxes distributed to town- ships and villages; licenses, permits and inspection fees; contractual agreements with cities and Boards of Education; agency grants; voted public health levies limited in County Districts to .5 mill Property Taxes - This is the traditional and major source of public health financing. Monies for health districts are deducted by the County Auditor from taxes levied within a 10 mill limitation. Figure V-3 shows that, in 1962, the Cuyahoga County General Health District derived 6% of its income from village and township taxation, and another 63% from contracts - 23 - Source: https://www.industrydocuments.ucsf.edu/docsxhfg0227 with cities and school boards. The contract funds are, in turn, derived from the tax funds of these jurisdictions, plus state subsidies, (which are re- flected separately in Figure V-3). The City of Cleveland's public health program received 76% of its financial support from taxation. Cuyahoga County voters have not had a health levy before them. Fees - Income is derived in some Ohio cities and counties from as many as forty different kinds of fees. In the Cuyahoga County General Health District fees are collected, for example, for licensing milk and meat handling establishments, food handling and processing, trailer parks. Fees are collected for issuing birth and death certificates. Fee collection is not specifically authorized by law, and in some counties, court decisions have prohibited or restricted the collection of such fees. Contracts - Only four General Health Districts in Ohio have contractual arrangements with one or more cities. Cuyahoga is one of these, providing services to 30 contracting cities. The law requires that it must be determined by the Ohio Department of Health that the General Health District is organized and equipped to provide adequate health services by this -24- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 Figure V-3 1962 INCOME BY SOURCE OF FUNDS City of Cleveland, Division of Health Cuyahoga County General Health District City of Cleveland Total: $1,964,801 MEDICAL CARE-INDIGENT - 1 % MISCELLANEOUS (including I A X E S cash balance) - 3% STATE SUBSIDY - 0.1 % from City; County and State 76% FEES AND LICENSES 20% Cuyahoga County Total: $531,331 MISCELLANEOUS (including cash balance) - 11% STATE SUBSIDY - 109 c/o I A X E S from cities; county FEES AND LICENSES - 5% Boards or Education 639 % FEDERAL - 5 % from villages and townships - 6 % -25- Source: https:I/www.industrydocuments.ucsf.edu/docs/xhfgo227 method. The Cuyahoga County General Health District also provides services by contract to 25 Boards of Education. There are four municipalities in Cuyahoga County, plus the city of Cleveland, maintaining independent municipal health departments - Shaker Heights, Cleveland Heights, East Cleveland and Lakewood. * Table V-15 CUYAHOGA COUNTY HEALTH DISTRICTS 19/ TOTAL LOCAL BUDGETS - 1963 Per Increase or Funds for Capita Decrease City Public Health Approp. From 1962 (less Fed. GIA) City of Cleveland 2,204,443 2.56 +10.5 Cuyahoga County General Health District and contracting cities 525,414 .81 + 4.0 Cleveland Heights 60,805 .97 + 1.5 East Cleveland 38,450 1.03 + 2.6 Shaker Heights 21,987 .57 + 3.0 Lakewood 52,525 .80 -14.7 The current recommendations of the American Public Health Assoc- iation are that per capita appropriations should exceed $2.50. *In its "Financial Report of Local Health Departments-1963", - the Ohio Department of Health has given these independent health departments of the smaller municipalities the following designations: Qualified (full-time) - Cleveland Heights and East Cleveland Unqualified (part-time) - Shaker Heights and Lakewood - 26 - Source: https://www.industrydocuments.ucsf.edu/docs/xhfg0227 PUBLIC HEALTH EXPENDITURE AND ABILITY TO PAY The per capita tax valuation can be used as a measure of a district's ability to appropriate funds for public health. The Ohio State Department of Health has ranked Health Districts in order of per capita assessed val- uation (1962) as compared with a rank order for per capita local appro- 20/ priation. There are 281 statutory Health Districts. In Table V-16 the rank order by assessed valuation and by local health appropriation of Cuyahoga County's General Health District and each separate municipal Health Department within the county, is compared with similar data for Summit County and the City of Akron. Cuyahoga County's General Health District is a contracting system; that is a number of city health districts within the geographic boundaries of the county contract with the General Health District for services. All municipalities eligible by statute for the designation "Health District" contract with the county except those four previously mentioned and the City of Cleveland as stated; twenty-five Boards of Education also contract for School Health Services. (This represents all Boards of Education with- in its jurisdiction, but two). The County General Health District Board of Health also serves all primary parochial schools in its jurisdiction. While the administrative structure of the Summit County General Health District follows the pattern known as combined, * it was chosen as the most appropriate for comparison with Cuyahoga County because its public health expenditures cover a similar array of services including comprehensive school health programs. (The Summit County General Health District serves all Boards of Education in its jurisdiction). The City of Cleveland provides comprehensive school health programs in primary parochial schools, and the Cleveland Board of Education in the public schools, but there is also good cooperation between the two juris- dictions. The City of Akron Health Department serves all public, private and parochial schools within the city limits. There is a combined Board of Health as provided in the Ohio Revised Code. Three municipalities within Summit County also contract with the General Health District for services, and each is entitled to one representative on the 7-man Board of Health. The cities of Akron and Barberton have independent Health Departments. - 27 - Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 TABLE V-16 HEALTH APPROPRIATIONS IN CUYAHOGA AND SUMMIT COUNTIES 1963 Rank By Per Capita Rank By Per Capita Assessed Health Health Local Health Valuation (1962) District Appropriation Appropriation CUYAHOGA COUNTY 41 General Health District .81 170 (with contracting municipalities ranging from 10th to 244th) 17 Shaker Heights .57 210 83 Cleveland Heights .97 143 118 East Cleveland 1.03 127 151 Lakewood .80 171 37 City of Cleveland 2.56 8 SUMMIT COUNTY 116 General Health District 1.82 29 109 City of Akron 2.08 15 - 28 - Source: https://www.industrydocuments.ucsf.edu/docs/xhfg0227 EXPENDITURES OF MAJOR CUYAHOGA COUNTY HEALTH DEPARTMENTS BY PROGRAM Figure V=4 analyzes the expenditures of the Cuyahoga County General Health District, including contracting cities, and of the City of Cleveland Division of Health, by program. It will be noted that both major Health Departments allocate a large proportion of budget to Public Healch nursing, and that, in the County, services by nurses to the public school health programs are included. In the city the public school health program is separate, staffed and financed by the Board of Education. The City of Cleveland is able to maintain a professionally staffed laboratory. The County uses state laboratory facilities. The city has a staff of full and part-time physicians` to cover both home care of the medically indigent population, and some preventive and control programs in communicable disease and venereal disease. The County uses state regional office services for V.D. control, and must rely even more heavily than the City of Cleveland on nursing services in, for example, infectious disease work. The vital statistics services which receive 6% of the Cleveland city budget, represent a geographic area for reporting greater than the city's confines, since registration districts fixed by separate state statutes are designated as this department's responsibility. The city's registrar is not, however, responsible for the entire county. Food and sanitation inspection services consume about 1/3 of each Health District budget. In the county this program includes: sampling and testing of water; inspection of sewage disposal facilities; inspection of garbage and refuse disposal arrangements; some housing inspection; -29- Source: https://www.industrydocuments.ucst.edu/docsixhfg0227 Figure V-4 1962 EXPENDITURES BY PROGRAM City of Cleveland, Division of Health Cuyahoga County General Health District City of Cleveland Total: $1,955,751 FOOD AND SANITATION CONTROL LABORATORY - 6 % SCHOOL MEDICAL 2 8 % SERVICES - 9 % (Est) VITAL STATISTICS - 6% MEDICAL SCHOOL HEALTH SERVICES NURSING - 9 % (Est) PUBLIC 16; % HEALTH NURSING 26% Cuyahoga County Total: $476,856 FOOD AND SANITATION CONTROL 30% MEDICAL SERVICES - 3 % PUBLIC SCHOOL MEDICAL SERVICES - 5 % HEALTH SCHOOL HEALTH NURSING NURSING 45% 17% -30- Source: https://www.industrydocuments.ucsf.edu/docs/xhfg0227 some vector control programs; and food and milk service and handling consultation and inspection programs. In the city food handler programs, milk, meat and poultry processing inspection; rat control; and some public building inspection (barber shops, laundries, hotels, trailer camps) are under the supervision of the Sanitary Unit of the City Division of Health. Collection and dis- posal of garbage and refuse is the responsibility of the Department of Public Service. The Division of Sewage Disposal is a section of the Public Utilities Department. The City Department of Urban Renewal and Housing is responsible for most programs of hygiene of housing, and for inspection of all nursing homes, hospitals and maternity wards as provided for in the Ohio codes. This Department also operates the Division of Air and Stream Pollution. No expenditures for such programs are reflected, then, in the food and sanitation budget of the Cleveland City Division of Health. -31- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 TRENDS IN EXPENDITURES FOR ALL HEALTH SERVICES IN CUYAHOGA COUNTY The Cleveland Welfare Federation has prepared an analysis of income and expenditures of all Health, Welfare and Recreation programs, according to United Community Funds and Councils of America classifications. Trends in health financing are demonstrated by comparing 1955 and 1960. Table V-17 summarizes these trends, and full details are recapi- tulated in Tables V-14 a & b in the Appendix. In the five year span, expenditures for health and medical care have increased in Cuyahoga County, by 72%, but the private philanthropic and agency self-support share of this has had to increase, while the tax dollar portion has actually de- creased. This trend holds for individual areas of health expenditure such as hospitals, including state and county=operated facilities. The medical vendor payments of family and child welfare programs did receive greater federal assistance in 1960 than in 1955, while the local tax share also increased and the state support decreased. Criteria for eligibility for payment of medical care costs, par- ticularly hospitalization, for the "medically indigent", were reduced in 1961, by a resolution of the County Commissioners to cover only those families whose income and resources did not exceed 80% of the State Wel- fare Department standards, and all persons over 65 were declared 21/ ineligible. As of 1963, state matching funds to General Relief were cut from 50% to 40%, putting medical vendor payments for both relief families and the undefined "medically indigent" into further jeopardy. Yet, from 1952 to 1962 medical and health care costs to public assistance 22/ programs in Cuyahoga County had risen 387%. -32- Source: https:/lwww.industrydocuments.ucsf.edu/docsixhfg0227 The question of defining medical indigency plus assessment of fiscal responsibility for payment is the current subject of litigation brought by certain hospitals. The only major public health program in which both local and private financial support showed a decrease, while total expenditures increased, was that of local health departments, but their total expenditures for public health services rose only 31% in the 5 years, while hospital expenditures rose 73.5% and those of public assistance programs - 167.5% (see figures V-5 to V-8). Table V-17 EXPENDITURES FOR HEALTH AND MEDICAL CARE UNDER ALL AUSPICES IN CUYAHOGA COUNTY, BY SOURCE OF FUNDS * 1955 - 1960 (In Thousands of Dollars) 1 9 6 0 % 1955 % of % of Increase Amount Total Amount Total 1955-1960 All Sources $ 72,728 100.0% $125,082 100.0% 72.0 Public (tax support) 22,337 30.7 29,130 23.3 30.4 Private (philanthropic 50,391 69.3 95,954 76.7 90.4 contributions, fees to hospitals, etc. SOURCES: 1. Expenditure Studies for Health, Welfare and Recreation Services, 1955 and 1960: Research Department, Welfare Federation of Cleveland 2. Financial Reports of Department of Public Welfare, State of Ohio 3. Ohio Citizens' Council 4. Fiscal Officers of Veterans Administration Does not include private out of pocket payments for direct medical and dental care, or for health insurance. -33- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 Figure V - 5 EXPENDITURES FOR HEALTH CARE SERVICES UNDER ALL AUSPICES IN CUYAHOGA COUNTY, BY SOURCE OF FUNDS 1955 - 1960 DOLLARS (Millions) $125,082,000 120 110 23 100 4 90 80 $72,728,000 70 60 31 50 5 40 30 20 64 72 10 1955 1960 KEY: Self Public Support (Gov't) Contri- 9 Percent bution of Total -34- Source: https://www.industrydocuments.ucst.edu/docsixhfg227 Figure V-6 EXPENDITURES FOR HEALTH CARE SERVICES BY HOSPITALS IN CUYAHOGA COUNTY, BY SOURCE OF FUNDS 1955 - 1960 DOLLARS (Millions) $116,666,000 110 20 100 90 3 80 70 $67,238,000 60 29 50 3 40 77 30 68 20 10 1955 1960 KEY: Self Public Support (Gov't) Contri- 5 Percent bution of Total -35- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227

What is the "Adult age entry" for period 35-55?

qtpg0227

qtpg0227_p0

45

lst Working Draft Food and Nutrition Board, National Academy of Sciences-National Research Council Recommended Daily Dietary Allowances¹, , Revised 1963 Designed for the maintenance of good nutrition of practically all healthy persons in the U.S.A. (Allowances are intended for persons normally active in a temperate climate) Pro- Cal- Vita- Equiv 3 2 Thia- Ribo= Ascores Vita- Age Weight He ght Calo tein cium Iron min A mine flavin Niacin bic Acid min D years kg. (lbs.) cm. (in. ries gm. gm. mg. I.U. mg. mg. mg. me. I.U. Men 25 70 (154) 175 (69) 3000 70 0.8 5000 1.2 1.8 20 70 45 70 (154) 175 (69) 2700 70 0.8 5000 1.1 1.6 18 70 65 70 (154) 175 (69) 2400 70 0.8 5000 1.0 1.4 16 70 Women 25 58 (128) 163 (64) 2200 58 0.8 5000 0.9 1.3 15 70 45 58 (128) 163 (64) 2000 58 0.8 5000 0.8 1.2 13 70 65 58 (128) 163 (64) 1800 58 0.8 5000 0.8 1.1 12 70 Pregnant (last Trimester) +200 +20 +0.5 + 1000 +0.2 +0.3 + 3 + 30 400 Lactating + 1000 +40 +0.5 +3000 + 0.4 +0.6 +' 7 +30 400 Infants O-1 Kgx115 Kgx2.5 0.7 30 1144 -0.5 4 Children 1-3 12 (27) 87 (34) 1400 35 0.8 2000 0.6 0.8 9 40 400 3-6 18 (40) 107 (42) 1600 40 0.8 2500 0.6 1.0 11 50 400 6.9 24 (53) 124 (49) 2100 52 0.8 3500 0.8 1.3 14 60 400 Boys 9-12 33 (72) 140 (55) 2400 60 1.1 4500 1.0 1.4 16 70 400 12-15 45 (98) 156 (61.) 3000 75 1.4 5000 1.2 1.8 20 8o 400 15-18 61 (134) 172 (68) 3400 85 1.4 5000 1.4 2.0 22 80 400 Girls 9-12 33 (72) 140 (55) 2200 55 1.1 4500 0.9 1.3 15 80 400 12-15 47 (103) 158 (62) 2500 62 1.3 5000 1.0 1.5 17 8o 400 15-18 53 (117) 163 (64) 2200 55 1.3 5000 0.9 1.3 15 70 400 the allowance levels are intended to cover individual is from beginning of lst year to end of 2nd year; variations among most normal persons as they live in the 3-6 (representing 43 years) is from beginning of United States under usual environmental stresses. The 3rd to end of 5th year, etc. recommended allowances can be attained with a variety of common foods, providing other nutrients for which human 3Niacin equivalents include dietary sources of the requirements have been less well defined. See text for preformed vitamin and the precursor, tryptophan. 60 more detailed discussion of allowances and of nutrients milligrams tryptophan equals 1 milligram niacin. not tabulated. The calorie and protein allowances per kilogram for 2adult age entry 25 is for period 18-35, 45 is for infants are considered to decrease progressively from 35-55, 65 for 55=75. The age entries for infants and birth; i.e., at birth calorie allowance is 125 per kg. children mark the beginning of each age, e.ge: 0.1 is protein allowance is 3.0 gm. kg. Protein allowance from birth to end of lst year; 1-3 (representing 2 years) for infants and children approximate 10% of total calories from protein. Source: https://www.industrydocuments.ucst.edu/docs/qtpg022

total local budgets is for which year?

xhfg0227

xhfg0227_p25, xhfg0227_p26, xhfg0227_p27, xhfg0227_p28, xhfg0227_p29, xhfg0227_p30, xhfg0227_p31, xhfg0227_p32, xhfg0227_p33, xhfg0227_p34, xhfg0227_p35, xhfg0227_p36, xhfg0227_p37, xhfg0227_p38

1963

of these kinds of services, though hard to measure, will decrease in 1963 because of cut-backs in funds for State personnel in all administrative agencies and at all pro- fessional levels. 3) Federal grants-in-aid Table V-13 shows the proportion of local public health funds received in 1962 from federal grant sources to be about 15%. Those funds administered by the State Health Depart- ment, and disbursed to local health districts by a distribution formula which considers both financial needs and population size, have applied to : Cancer, general health and community health services, heart, maternal and child health, and water pollution. Crippled children's program funds are administered by the State Department of Welfare. Portions of salaries of persönnel in state regional and central offices, and drugs distributed free to local health districts, are financed by federal formula grancs. Federal money has been used to finance special projects in local health districts, or aid general health services. The proportion of Cuyahoga County (and Cleveland) public health ser- vices financed through state administered federal grants is reflected in Table V-14 in the Appendix. This table also shows the federal assistance -22- Source: https://www.industrydocuments.ucsf.edu/docsixhfg022 portions of other health programs in Cuyahoga County, not administered by the Health Departments. It is possible that Ohio's 1963 austerity program will also result in a diminution of some of the federal grant funds accruing to local health districts. There were programs in the planning stages for which some federal funds had been received that cannot be carried out because of the cut-back in personnel, or the "freeze" order prohibiting the addition of new employees or the replacement of personnel retired, re- signed, or lost by death. Sources of Income to Local Health Districts, Other Than State Aid There are five sources from which local health districts may re- ceive funds other than state subsidies or federal grants-in-aid. They are: Deductions from property taxes distributed to town- ships and villages; licenses, permits and inspection fees; contractual agreements with cities and Boards of Education; agency grants; voted public health levies limited in County Districts to .5 mill Property Taxes - This is the traditional and major source of public health financing. Monies for health districts are deducted by the County Auditor from taxes levied within a 10 mill limitation. Figure V-3 shows that, in 1962, the Cuyahoga County General Health District derived 6% of its income from village and township taxation, and another 63% from contracts - 23 - Source: https://www.industrydocuments.ucsf.edu/docsxhfg0227 with cities and school boards. The contract funds are, in turn, derived from the tax funds of these jurisdictions, plus state subsidies, (which are re- flected separately in Figure V-3). The City of Cleveland's public health program received 76% of its financial support from taxation. Cuyahoga County voters have not had a health levy before them. Fees - Income is derived in some Ohio cities and counties from as many as forty different kinds of fees. In the Cuyahoga County General Health District fees are collected, for example, for licensing milk and meat handling establishments, food handling and processing, trailer parks. Fees are collected for issuing birth and death certificates. Fee collection is not specifically authorized by law, and in some counties, court decisions have prohibited or restricted the collection of such fees. Contracts - Only four General Health Districts in Ohio have contractual arrangements with one or more cities. Cuyahoga is one of these, providing services to 30 contracting cities. The law requires that it must be determined by the Ohio Department of Health that the General Health District is organized and equipped to provide adequate health services by this -24- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 Figure V-3 1962 INCOME BY SOURCE OF FUNDS City of Cleveland, Division of Health Cuyahoga County General Health District City of Cleveland Total: $1,964,801 MEDICAL CARE-INDIGENT - 1 % MISCELLANEOUS (including I A X E S cash balance) - 3% STATE SUBSIDY - 0.1 % from City; County and State 76% FEES AND LICENSES 20% Cuyahoga County Total: $531,331 MISCELLANEOUS (including cash balance) - 11% STATE SUBSIDY - 109 c/o I A X E S from cities; county FEES AND LICENSES - 5% Boards or Education 639 % FEDERAL - 5 % from villages and townships - 6 % -25- Source: https:I/www.industrydocuments.ucsf.edu/docs/xhfgo227 method. The Cuyahoga County General Health District also provides services by contract to 25 Boards of Education. There are four municipalities in Cuyahoga County, plus the city of Cleveland, maintaining independent municipal health departments - Shaker Heights, Cleveland Heights, East Cleveland and Lakewood. * Table V-15 CUYAHOGA COUNTY HEALTH DISTRICTS 19/ TOTAL LOCAL BUDGETS - 1963 Per Increase or Funds for Capita Decrease City Public Health Approp. From 1962 (less Fed. GIA) City of Cleveland 2,204,443 2.56 +10.5 Cuyahoga County General Health District and contracting cities 525,414 .81 + 4.0 Cleveland Heights 60,805 .97 + 1.5 East Cleveland 38,450 1.03 + 2.6 Shaker Heights 21,987 .57 + 3.0 Lakewood 52,525 .80 -14.7 The current recommendations of the American Public Health Assoc- iation are that per capita appropriations should exceed $2.50. *In its "Financial Report of Local Health Departments-1963", - the Ohio Department of Health has given these independent health departments of the smaller municipalities the following designations: Qualified (full-time) - Cleveland Heights and East Cleveland Unqualified (part-time) - Shaker Heights and Lakewood - 26 - Source: https://www.industrydocuments.ucsf.edu/docs/xhfg0227 PUBLIC HEALTH EXPENDITURE AND ABILITY TO PAY The per capita tax valuation can be used as a measure of a district's ability to appropriate funds for public health. The Ohio State Department of Health has ranked Health Districts in order of per capita assessed val- uation (1962) as compared with a rank order for per capita local appro- 20/ priation. There are 281 statutory Health Districts. In Table V-16 the rank order by assessed valuation and by local health appropriation of Cuyahoga County's General Health District and each separate municipal Health Department within the county, is compared with similar data for Summit County and the City of Akron. Cuyahoga County's General Health District is a contracting system; that is a number of city health districts within the geographic boundaries of the county contract with the General Health District for services. All municipalities eligible by statute for the designation "Health District" contract with the county except those four previously mentioned and the City of Cleveland as stated; twenty-five Boards of Education also contract for School Health Services. (This represents all Boards of Education with- in its jurisdiction, but two). The County General Health District Board of Health also serves all primary parochial schools in its jurisdiction. While the administrative structure of the Summit County General Health District follows the pattern known as combined, * it was chosen as the most appropriate for comparison with Cuyahoga County because its public health expenditures cover a similar array of services including comprehensive school health programs. (The Summit County General Health District serves all Boards of Education in its jurisdiction). The City of Cleveland provides comprehensive school health programs in primary parochial schools, and the Cleveland Board of Education in the public schools, but there is also good cooperation between the two juris- dictions. The City of Akron Health Department serves all public, private and parochial schools within the city limits. There is a combined Board of Health as provided in the Ohio Revised Code. Three municipalities within Summit County also contract with the General Health District for services, and each is entitled to one representative on the 7-man Board of Health. The cities of Akron and Barberton have independent Health Departments. - 27 - Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 TABLE V-16 HEALTH APPROPRIATIONS IN CUYAHOGA AND SUMMIT COUNTIES 1963 Rank By Per Capita Rank By Per Capita Assessed Health Health Local Health Valuation (1962) District Appropriation Appropriation CUYAHOGA COUNTY 41 General Health District .81 170 (with contracting municipalities ranging from 10th to 244th) 17 Shaker Heights .57 210 83 Cleveland Heights .97 143 118 East Cleveland 1.03 127 151 Lakewood .80 171 37 City of Cleveland 2.56 8 SUMMIT COUNTY 116 General Health District 1.82 29 109 City of Akron 2.08 15 - 28 - Source: https://www.industrydocuments.ucsf.edu/docs/xhfg0227 EXPENDITURES OF MAJOR CUYAHOGA COUNTY HEALTH DEPARTMENTS BY PROGRAM Figure V=4 analyzes the expenditures of the Cuyahoga County General Health District, including contracting cities, and of the City of Cleveland Division of Health, by program. It will be noted that both major Health Departments allocate a large proportion of budget to Public Healch nursing, and that, in the County, services by nurses to the public school health programs are included. In the city the public school health program is separate, staffed and financed by the Board of Education. The City of Cleveland is able to maintain a professionally staffed laboratory. The County uses state laboratory facilities. The city has a staff of full and part-time physicians` to cover both home care of the medically indigent population, and some preventive and control programs in communicable disease and venereal disease. The County uses state regional office services for V.D. control, and must rely even more heavily than the City of Cleveland on nursing services in, for example, infectious disease work. The vital statistics services which receive 6% of the Cleveland city budget, represent a geographic area for reporting greater than the city's confines, since registration districts fixed by separate state statutes are designated as this department's responsibility. The city's registrar is not, however, responsible for the entire county. Food and sanitation inspection services consume about 1/3 of each Health District budget. In the county this program includes: sampling and testing of water; inspection of sewage disposal facilities; inspection of garbage and refuse disposal arrangements; some housing inspection; -29- Source: https://www.industrydocuments.ucst.edu/docsixhfg0227 Figure V-4 1962 EXPENDITURES BY PROGRAM City of Cleveland, Division of Health Cuyahoga County General Health District City of Cleveland Total: $1,955,751 FOOD AND SANITATION CONTROL LABORATORY - 6 % SCHOOL MEDICAL 2 8 % SERVICES - 9 % (Est) VITAL STATISTICS - 6% MEDICAL SCHOOL HEALTH SERVICES NURSING - 9 % (Est) PUBLIC 16; % HEALTH NURSING 26% Cuyahoga County Total: $476,856 FOOD AND SANITATION CONTROL 30% MEDICAL SERVICES - 3 % PUBLIC SCHOOL MEDICAL SERVICES - 5 % HEALTH SCHOOL HEALTH NURSING NURSING 45% 17% -30- Source: https://www.industrydocuments.ucsf.edu/docs/xhfg0227 some vector control programs; and food and milk service and handling consultation and inspection programs. In the city food handler programs, milk, meat and poultry processing inspection; rat control; and some public building inspection (barber shops, laundries, hotels, trailer camps) are under the supervision of the Sanitary Unit of the City Division of Health. Collection and dis- posal of garbage and refuse is the responsibility of the Department of Public Service. The Division of Sewage Disposal is a section of the Public Utilities Department. The City Department of Urban Renewal and Housing is responsible for most programs of hygiene of housing, and for inspection of all nursing homes, hospitals and maternity wards as provided for in the Ohio codes. This Department also operates the Division of Air and Stream Pollution. No expenditures for such programs are reflected, then, in the food and sanitation budget of the Cleveland City Division of Health. -31- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 TRENDS IN EXPENDITURES FOR ALL HEALTH SERVICES IN CUYAHOGA COUNTY The Cleveland Welfare Federation has prepared an analysis of income and expenditures of all Health, Welfare and Recreation programs, according to United Community Funds and Councils of America classifications. Trends in health financing are demonstrated by comparing 1955 and 1960. Table V-17 summarizes these trends, and full details are recapi- tulated in Tables V-14 a & b in the Appendix. In the five year span, expenditures for health and medical care have increased in Cuyahoga County, by 72%, but the private philanthropic and agency self-support share of this has had to increase, while the tax dollar portion has actually de- creased. This trend holds for individual areas of health expenditure such as hospitals, including state and county=operated facilities. The medical vendor payments of family and child welfare programs did receive greater federal assistance in 1960 than in 1955, while the local tax share also increased and the state support decreased. Criteria for eligibility for payment of medical care costs, par- ticularly hospitalization, for the "medically indigent", were reduced in 1961, by a resolution of the County Commissioners to cover only those families whose income and resources did not exceed 80% of the State Wel- fare Department standards, and all persons over 65 were declared 21/ ineligible. As of 1963, state matching funds to General Relief were cut from 50% to 40%, putting medical vendor payments for both relief families and the undefined "medically indigent" into further jeopardy. Yet, from 1952 to 1962 medical and health care costs to public assistance 22/ programs in Cuyahoga County had risen 387%. -32- Source: https:/lwww.industrydocuments.ucsf.edu/docsixhfg0227 The question of defining medical indigency plus assessment of fiscal responsibility for payment is the current subject of litigation brought by certain hospitals. The only major public health program in which both local and private financial support showed a decrease, while total expenditures increased, was that of local health departments, but their total expenditures for public health services rose only 31% in the 5 years, while hospital expenditures rose 73.5% and those of public assistance programs - 167.5% (see figures V-5 to V-8). Table V-17 EXPENDITURES FOR HEALTH AND MEDICAL CARE UNDER ALL AUSPICES IN CUYAHOGA COUNTY, BY SOURCE OF FUNDS * 1955 - 1960 (In Thousands of Dollars) 1 9 6 0 % 1955 % of % of Increase Amount Total Amount Total 1955-1960 All Sources $ 72,728 100.0% $125,082 100.0% 72.0 Public (tax support) 22,337 30.7 29,130 23.3 30.4 Private (philanthropic 50,391 69.3 95,954 76.7 90.4 contributions, fees to hospitals, etc. SOURCES: 1. Expenditure Studies for Health, Welfare and Recreation Services, 1955 and 1960: Research Department, Welfare Federation of Cleveland 2. Financial Reports of Department of Public Welfare, State of Ohio 3. Ohio Citizens' Council 4. Fiscal Officers of Veterans Administration Does not include private out of pocket payments for direct medical and dental care, or for health insurance. -33- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 Figure V - 5 EXPENDITURES FOR HEALTH CARE SERVICES UNDER ALL AUSPICES IN CUYAHOGA COUNTY, BY SOURCE OF FUNDS 1955 - 1960 DOLLARS (Millions) $125,082,000 120 110 23 100 4 90 80 $72,728,000 70 60 31 50 5 40 30 20 64 72 10 1955 1960 KEY: Self Public Support (Gov't) Contri- 9 Percent bution of Total -34- Source: https://www.industrydocuments.ucst.edu/docsixhfg227 Figure V-6 EXPENDITURES FOR HEALTH CARE SERVICES BY HOSPITALS IN CUYAHOGA COUNTY, BY SOURCE OF FUNDS 1955 - 1960 DOLLARS (Millions) $116,666,000 110 20 100 90 3 80 70 $67,238,000 60 29 50 3 40 77 30 68 20 10 1955 1960 KEY: Self Public Support (Gov't) Contri- 5 Percent bution of Total -35- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227

What is the "Adult age entry" for period 55-75?

qtpg0227

qtpg0227_p0

65

lst Working Draft Food and Nutrition Board, National Academy of Sciences-National Research Council Recommended Daily Dietary Allowances¹, , Revised 1963 Designed for the maintenance of good nutrition of practically all healthy persons in the U.S.A. (Allowances are intended for persons normally active in a temperate climate) Pro- Cal- Vita- Equiv 3 2 Thia- Ribo= Ascores Vita- Age Weight He ght Calo tein cium Iron min A mine flavin Niacin bic Acid min D years kg. (lbs.) cm. (in. ries gm. gm. mg. I.U. mg. mg. mg. me. I.U. Men 25 70 (154) 175 (69) 3000 70 0.8 5000 1.2 1.8 20 70 45 70 (154) 175 (69) 2700 70 0.8 5000 1.1 1.6 18 70 65 70 (154) 175 (69) 2400 70 0.8 5000 1.0 1.4 16 70 Women 25 58 (128) 163 (64) 2200 58 0.8 5000 0.9 1.3 15 70 45 58 (128) 163 (64) 2000 58 0.8 5000 0.8 1.2 13 70 65 58 (128) 163 (64) 1800 58 0.8 5000 0.8 1.1 12 70 Pregnant (last Trimester) +200 +20 +0.5 + 1000 +0.2 +0.3 + 3 + 30 400 Lactating + 1000 +40 +0.5 +3000 + 0.4 +0.6 +' 7 +30 400 Infants O-1 Kgx115 Kgx2.5 0.7 30 1144 -0.5 4 Children 1-3 12 (27) 87 (34) 1400 35 0.8 2000 0.6 0.8 9 40 400 3-6 18 (40) 107 (42) 1600 40 0.8 2500 0.6 1.0 11 50 400 6.9 24 (53) 124 (49) 2100 52 0.8 3500 0.8 1.3 14 60 400 Boys 9-12 33 (72) 140 (55) 2400 60 1.1 4500 1.0 1.4 16 70 400 12-15 45 (98) 156 (61.) 3000 75 1.4 5000 1.2 1.8 20 8o 400 15-18 61 (134) 172 (68) 3400 85 1.4 5000 1.4 2.0 22 80 400 Girls 9-12 33 (72) 140 (55) 2200 55 1.1 4500 0.9 1.3 15 80 400 12-15 47 (103) 158 (62) 2500 62 1.3 5000 1.0 1.5 17 8o 400 15-18 53 (117) 163 (64) 2200 55 1.3 5000 0.9 1.3 15 70 400 the allowance levels are intended to cover individual is from beginning of lst year to end of 2nd year; variations among most normal persons as they live in the 3-6 (representing 43 years) is from beginning of United States under usual environmental stresses. The 3rd to end of 5th year, etc. recommended allowances can be attained with a variety of common foods, providing other nutrients for which human 3Niacin equivalents include dietary sources of the requirements have been less well defined. See text for preformed vitamin and the precursor, tryptophan. 60 more detailed discussion of allowances and of nutrients milligrams tryptophan equals 1 milligram niacin. not tabulated. The calorie and protein allowances per kilogram for 2adult age entry 25 is for period 18-35, 45 is for infants are considered to decrease progressively from 35-55, 65 for 55=75. The age entries for infants and birth; i.e., at birth calorie allowance is 125 per kg. children mark the beginning of each age, e.ge: 0.1 is protein allowance is 3.0 gm. kg. Protein allowance from birth to end of lst year; 1-3 (representing 2 years) for infants and children approximate 10% of total calories from protein. Source: https://www.industrydocuments.ucst.edu/docs/qtpg022

how much is the per capita approp. for city of cleveland?

xhfg0227

xhfg0227_p25, xhfg0227_p26, xhfg0227_p27, xhfg0227_p28, xhfg0227_p29, xhfg0227_p30, xhfg0227_p31, xhfg0227_p32, xhfg0227_p33, xhfg0227_p34, xhfg0227_p35, xhfg0227_p36, xhfg0227_p37, xhfg0227_p38

2.56

of these kinds of services, though hard to measure, will decrease in 1963 because of cut-backs in funds for State personnel in all administrative agencies and at all pro- fessional levels. 3) Federal grants-in-aid Table V-13 shows the proportion of local public health funds received in 1962 from federal grant sources to be about 15%. Those funds administered by the State Health Depart- ment, and disbursed to local health districts by a distribution formula which considers both financial needs and population size, have applied to : Cancer, general health and community health services, heart, maternal and child health, and water pollution. Crippled children's program funds are administered by the State Department of Welfare. Portions of salaries of persönnel in state regional and central offices, and drugs distributed free to local health districts, are financed by federal formula grancs. Federal money has been used to finance special projects in local health districts, or aid general health services. The proportion of Cuyahoga County (and Cleveland) public health ser- vices financed through state administered federal grants is reflected in Table V-14 in the Appendix. This table also shows the federal assistance -22- Source: https://www.industrydocuments.ucsf.edu/docsixhfg022 portions of other health programs in Cuyahoga County, not administered by the Health Departments. It is possible that Ohio's 1963 austerity program will also result in a diminution of some of the federal grant funds accruing to local health districts. There were programs in the planning stages for which some federal funds had been received that cannot be carried out because of the cut-back in personnel, or the "freeze" order prohibiting the addition of new employees or the replacement of personnel retired, re- signed, or lost by death. Sources of Income to Local Health Districts, Other Than State Aid There are five sources from which local health districts may re- ceive funds other than state subsidies or federal grants-in-aid. They are: Deductions from property taxes distributed to town- ships and villages; licenses, permits and inspection fees; contractual agreements with cities and Boards of Education; agency grants; voted public health levies limited in County Districts to .5 mill Property Taxes - This is the traditional and major source of public health financing. Monies for health districts are deducted by the County Auditor from taxes levied within a 10 mill limitation. Figure V-3 shows that, in 1962, the Cuyahoga County General Health District derived 6% of its income from village and township taxation, and another 63% from contracts - 23 - Source: https://www.industrydocuments.ucsf.edu/docsxhfg0227 with cities and school boards. The contract funds are, in turn, derived from the tax funds of these jurisdictions, plus state subsidies, (which are re- flected separately in Figure V-3). The City of Cleveland's public health program received 76% of its financial support from taxation. Cuyahoga County voters have not had a health levy before them. Fees - Income is derived in some Ohio cities and counties from as many as forty different kinds of fees. In the Cuyahoga County General Health District fees are collected, for example, for licensing milk and meat handling establishments, food handling and processing, trailer parks. Fees are collected for issuing birth and death certificates. Fee collection is not specifically authorized by law, and in some counties, court decisions have prohibited or restricted the collection of such fees. Contracts - Only four General Health Districts in Ohio have contractual arrangements with one or more cities. Cuyahoga is one of these, providing services to 30 contracting cities. The law requires that it must be determined by the Ohio Department of Health that the General Health District is organized and equipped to provide adequate health services by this -24- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 Figure V-3 1962 INCOME BY SOURCE OF FUNDS City of Cleveland, Division of Health Cuyahoga County General Health District City of Cleveland Total: $1,964,801 MEDICAL CARE-INDIGENT - 1 % MISCELLANEOUS (including I A X E S cash balance) - 3% STATE SUBSIDY - 0.1 % from City; County and State 76% FEES AND LICENSES 20% Cuyahoga County Total: $531,331 MISCELLANEOUS (including cash balance) - 11% STATE SUBSIDY - 109 c/o I A X E S from cities; county FEES AND LICENSES - 5% Boards or Education 639 % FEDERAL - 5 % from villages and townships - 6 % -25- Source: https:I/www.industrydocuments.ucsf.edu/docs/xhfgo227 method. The Cuyahoga County General Health District also provides services by contract to 25 Boards of Education. There are four municipalities in Cuyahoga County, plus the city of Cleveland, maintaining independent municipal health departments - Shaker Heights, Cleveland Heights, East Cleveland and Lakewood. * Table V-15 CUYAHOGA COUNTY HEALTH DISTRICTS 19/ TOTAL LOCAL BUDGETS - 1963 Per Increase or Funds for Capita Decrease City Public Health Approp. From 1962 (less Fed. GIA) City of Cleveland 2,204,443 2.56 +10.5 Cuyahoga County General Health District and contracting cities 525,414 .81 + 4.0 Cleveland Heights 60,805 .97 + 1.5 East Cleveland 38,450 1.03 + 2.6 Shaker Heights 21,987 .57 + 3.0 Lakewood 52,525 .80 -14.7 The current recommendations of the American Public Health Assoc- iation are that per capita appropriations should exceed $2.50. *In its "Financial Report of Local Health Departments-1963", - the Ohio Department of Health has given these independent health departments of the smaller municipalities the following designations: Qualified (full-time) - Cleveland Heights and East Cleveland Unqualified (part-time) - Shaker Heights and Lakewood - 26 - Source: https://www.industrydocuments.ucsf.edu/docs/xhfg0227 PUBLIC HEALTH EXPENDITURE AND ABILITY TO PAY The per capita tax valuation can be used as a measure of a district's ability to appropriate funds for public health. The Ohio State Department of Health has ranked Health Districts in order of per capita assessed val- uation (1962) as compared with a rank order for per capita local appro- 20/ priation. There are 281 statutory Health Districts. In Table V-16 the rank order by assessed valuation and by local health appropriation of Cuyahoga County's General Health District and each separate municipal Health Department within the county, is compared with similar data for Summit County and the City of Akron. Cuyahoga County's General Health District is a contracting system; that is a number of city health districts within the geographic boundaries of the county contract with the General Health District for services. All municipalities eligible by statute for the designation "Health District" contract with the county except those four previously mentioned and the City of Cleveland as stated; twenty-five Boards of Education also contract for School Health Services. (This represents all Boards of Education with- in its jurisdiction, but two). The County General Health District Board of Health also serves all primary parochial schools in its jurisdiction. While the administrative structure of the Summit County General Health District follows the pattern known as combined, * it was chosen as the most appropriate for comparison with Cuyahoga County because its public health expenditures cover a similar array of services including comprehensive school health programs. (The Summit County General Health District serves all Boards of Education in its jurisdiction). The City of Cleveland provides comprehensive school health programs in primary parochial schools, and the Cleveland Board of Education in the public schools, but there is also good cooperation between the two juris- dictions. The City of Akron Health Department serves all public, private and parochial schools within the city limits. There is a combined Board of Health as provided in the Ohio Revised Code. Three municipalities within Summit County also contract with the General Health District for services, and each is entitled to one representative on the 7-man Board of Health. The cities of Akron and Barberton have independent Health Departments. - 27 - Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 TABLE V-16 HEALTH APPROPRIATIONS IN CUYAHOGA AND SUMMIT COUNTIES 1963 Rank By Per Capita Rank By Per Capita Assessed Health Health Local Health Valuation (1962) District Appropriation Appropriation CUYAHOGA COUNTY 41 General Health District .81 170 (with contracting municipalities ranging from 10th to 244th) 17 Shaker Heights .57 210 83 Cleveland Heights .97 143 118 East Cleveland 1.03 127 151 Lakewood .80 171 37 City of Cleveland 2.56 8 SUMMIT COUNTY 116 General Health District 1.82 29 109 City of Akron 2.08 15 - 28 - Source: https://www.industrydocuments.ucsf.edu/docs/xhfg0227 EXPENDITURES OF MAJOR CUYAHOGA COUNTY HEALTH DEPARTMENTS BY PROGRAM Figure V=4 analyzes the expenditures of the Cuyahoga County General Health District, including contracting cities, and of the City of Cleveland Division of Health, by program. It will be noted that both major Health Departments allocate a large proportion of budget to Public Healch nursing, and that, in the County, services by nurses to the public school health programs are included. In the city the public school health program is separate, staffed and financed by the Board of Education. The City of Cleveland is able to maintain a professionally staffed laboratory. The County uses state laboratory facilities. The city has a staff of full and part-time physicians` to cover both home care of the medically indigent population, and some preventive and control programs in communicable disease and venereal disease. The County uses state regional office services for V.D. control, and must rely even more heavily than the City of Cleveland on nursing services in, for example, infectious disease work. The vital statistics services which receive 6% of the Cleveland city budget, represent a geographic area for reporting greater than the city's confines, since registration districts fixed by separate state statutes are designated as this department's responsibility. The city's registrar is not, however, responsible for the entire county. Food and sanitation inspection services consume about 1/3 of each Health District budget. In the county this program includes: sampling and testing of water; inspection of sewage disposal facilities; inspection of garbage and refuse disposal arrangements; some housing inspection; -29- Source: https://www.industrydocuments.ucst.edu/docsixhfg0227 Figure V-4 1962 EXPENDITURES BY PROGRAM City of Cleveland, Division of Health Cuyahoga County General Health District City of Cleveland Total: $1,955,751 FOOD AND SANITATION CONTROL LABORATORY - 6 % SCHOOL MEDICAL 2 8 % SERVICES - 9 % (Est) VITAL STATISTICS - 6% MEDICAL SCHOOL HEALTH SERVICES NURSING - 9 % (Est) PUBLIC 16; % HEALTH NURSING 26% Cuyahoga County Total: $476,856 FOOD AND SANITATION CONTROL 30% MEDICAL SERVICES - 3 % PUBLIC SCHOOL MEDICAL SERVICES - 5 % HEALTH SCHOOL HEALTH NURSING NURSING 45% 17% -30- Source: https://www.industrydocuments.ucsf.edu/docs/xhfg0227 some vector control programs; and food and milk service and handling consultation and inspection programs. In the city food handler programs, milk, meat and poultry processing inspection; rat control; and some public building inspection (barber shops, laundries, hotels, trailer camps) are under the supervision of the Sanitary Unit of the City Division of Health. Collection and dis- posal of garbage and refuse is the responsibility of the Department of Public Service. The Division of Sewage Disposal is a section of the Public Utilities Department. The City Department of Urban Renewal and Housing is responsible for most programs of hygiene of housing, and for inspection of all nursing homes, hospitals and maternity wards as provided for in the Ohio codes. This Department also operates the Division of Air and Stream Pollution. No expenditures for such programs are reflected, then, in the food and sanitation budget of the Cleveland City Division of Health. -31- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 TRENDS IN EXPENDITURES FOR ALL HEALTH SERVICES IN CUYAHOGA COUNTY The Cleveland Welfare Federation has prepared an analysis of income and expenditures of all Health, Welfare and Recreation programs, according to United Community Funds and Councils of America classifications. Trends in health financing are demonstrated by comparing 1955 and 1960. Table V-17 summarizes these trends, and full details are recapi- tulated in Tables V-14 a & b in the Appendix. In the five year span, expenditures for health and medical care have increased in Cuyahoga County, by 72%, but the private philanthropic and agency self-support share of this has had to increase, while the tax dollar portion has actually de- creased. This trend holds for individual areas of health expenditure such as hospitals, including state and county=operated facilities. The medical vendor payments of family and child welfare programs did receive greater federal assistance in 1960 than in 1955, while the local tax share also increased and the state support decreased. Criteria for eligibility for payment of medical care costs, par- ticularly hospitalization, for the "medically indigent", were reduced in 1961, by a resolution of the County Commissioners to cover only those families whose income and resources did not exceed 80% of the State Wel- fare Department standards, and all persons over 65 were declared 21/ ineligible. As of 1963, state matching funds to General Relief were cut from 50% to 40%, putting medical vendor payments for both relief families and the undefined "medically indigent" into further jeopardy. Yet, from 1952 to 1962 medical and health care costs to public assistance 22/ programs in Cuyahoga County had risen 387%. -32- Source: https:/lwww.industrydocuments.ucsf.edu/docsixhfg0227 The question of defining medical indigency plus assessment of fiscal responsibility for payment is the current subject of litigation brought by certain hospitals. The only major public health program in which both local and private financial support showed a decrease, while total expenditures increased, was that of local health departments, but their total expenditures for public health services rose only 31% in the 5 years, while hospital expenditures rose 73.5% and those of public assistance programs - 167.5% (see figures V-5 to V-8). Table V-17 EXPENDITURES FOR HEALTH AND MEDICAL CARE UNDER ALL AUSPICES IN CUYAHOGA COUNTY, BY SOURCE OF FUNDS * 1955 - 1960 (In Thousands of Dollars) 1 9 6 0 % 1955 % of % of Increase Amount Total Amount Total 1955-1960 All Sources $ 72,728 100.0% $125,082 100.0% 72.0 Public (tax support) 22,337 30.7 29,130 23.3 30.4 Private (philanthropic 50,391 69.3 95,954 76.7 90.4 contributions, fees to hospitals, etc. SOURCES: 1. Expenditure Studies for Health, Welfare and Recreation Services, 1955 and 1960: Research Department, Welfare Federation of Cleveland 2. Financial Reports of Department of Public Welfare, State of Ohio 3. Ohio Citizens' Council 4. Fiscal Officers of Veterans Administration Does not include private out of pocket payments for direct medical and dental care, or for health insurance. -33- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 Figure V - 5 EXPENDITURES FOR HEALTH CARE SERVICES UNDER ALL AUSPICES IN CUYAHOGA COUNTY, BY SOURCE OF FUNDS 1955 - 1960 DOLLARS (Millions) $125,082,000 120 110 23 100 4 90 80 $72,728,000 70 60 31 50 5 40 30 20 64 72 10 1955 1960 KEY: Self Public Support (Gov't) Contri- 9 Percent bution of Total -34- Source: https://www.industrydocuments.ucst.edu/docsixhfg227 Figure V-6 EXPENDITURES FOR HEALTH CARE SERVICES BY HOSPITALS IN CUYAHOGA COUNTY, BY SOURCE OF FUNDS 1955 - 1960 DOLLARS (Millions) $116,666,000 110 20 100 90 3 80 70 $67,238,000 60 29 50 3 40 77 30 68 20 10 1955 1960 KEY: Self Public Support (Gov't) Contri- 5 Percent bution of Total -35- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227

What is the heading of the table ?

snyc0227

snyc0227_p288, snyc0227_p289, snyc0227_p290, snyc0227_p291, snyc0227_p292, snyc0227_p293, snyc0227_p294, snyc0227_p295, snyc0227_p296, snyc0227_p297, snyc0227_p298, snyc0227_p299, snyc0227_p300, snyc0227_p301, snyc0227_p302, snyc0227_p303, snyc0227_p304, snyc0227_p305, snyc0227_p306, snyc0227_p307, snyc0227_p308

suggested values by sex and age groups for hemoglobin and hematocrit, SUGGESTED VALUES BY SEX AND AGE GROUPS FOR HEMOGLOBIN AND HEMATOCRIT, appendix table viii-7. suggested values by sex and age groups for hemoglobin and hematocrit

APPENDIX VII-1.GLOSSARY OF COMMONLY SERVED MALAY DISHES Sambal belachan Aged fish paste mixed with chillies, onions, etc. Sambal telor A fried dish of egg, belachan and sambal. Ikan goreng Fried fresh or salt fish. Tumis togei A common Malay dish made from bean sprouts, to which are added fried condiments and water. Quai kodok A breakfast food made from water, wheat flour and salt. The batter is dropped into coconut oil and deep=fried. Apam balek A common Malay breakfast food similar to a pancake. The batter is made of wheat flour, water and sliced bananas. The kuali is lightly oiled and then rubbed with a piece of fresh coconut. Enough batter for one apam balek is spread thinly over the surface. When cooked, a spoonful of a mixture of shredded fresh coconut and brown sugar is placed in the center and the cake is rolled up. Tumis Vegetables fried in coconut oil to which condiments and spices have been added. Pisang goreng Special varieties of bananas (green) sliced in half length wise and dipped in a batter of wheat flour and water, and deep=fried in coconut oil. Roti chanai A favorite breakfast item resembling a pancake, made from a soft dough of wheat flour, water and coconut oil. The oil is added by kneading and working the dough by hand. The dough is worked in individual amounts, pulled and stretched over a flat surface until paper thin and then rolled in a long thin strip and wound together in a spiral to give a circular flat cake about six inches in diameter which is fried in the kuali. Children eat them with sugar. Adar=adar A pancake batter of wheat flour and water. After frying, the pancake is spread with a previously fried mixture of shredded fresh coconut and brown and white sugar. Goreng keledeh Keledeh is similar to sweet potato. In Malaya it is often sliced raw, dipped in rice flour and water and deep fried in coconut oil for breakfast. Achar timun Raw cucumber mixed with raw onion and fresh chilli, re- sembling a pickle. Gulai ikan (fish Fish cooked in water or santan to which condiments and curry) spices are added. Goreng kajong Long green beans fried in coconut oil with ikan bilis. Sayor lemak paku Young fern shoots boiled in santan to which condiments are added. 292 Source: https://wwww.industrydocuments.ucsf.edu/docsisnyc0227 APPENDIX TABLE VII-2. RECOMMENDED DAILY DIETARY , Age Body Vita- Thia- Ribo- Ascorbic Vita- (years) Weight Calories Protein Calcium Iron min A mine flavin Niacin³/ Acid min D kg gm gm mg IU mg mg mg mg IU equiv- alent Men 25 55 2,570 55 0.5 10 5,000 1.3 1.4 17 75 45 55 2,430 55 0.5 10 5,000 1.2 1.4 16 75 65 55 2,050 55 0.5 10 5,000 1.0 1.4 14 75 Women 25 50 1,900 50 0.5 12 5,000 1.0 1.3 17 70 45 50 1,860 50 0.5 12 5,000 1.0 1.3 16 70 65 50 1,520 50 0.5 12 5,000 1.0 1.3 13 70 Pregnant (2d half) +285 +20 1.0-1.2 15 6,000 1.1 1.8 +3 100 400 Lactating +950 +40 1.0-1.2 15 8,000 1.4 2.3 +2 150 400 Infants 0-1 (6)4/ (Age in 2-6 (9)kg X 115 See Foot- 0.5-0.6 5 1,500 0.3 0.4 5 30 400 months) 7-12 kg X 95 note 5/ 0.5-0.6 7 1,500 0.4 0.5 6 30 400 Children 1-3 1,240 40 1.0 7 2,000 0.6 1.0 8 35 400 4-6 1,620 50 1.0 8 2,500 0.8 1.3 11 50 400 7-9 2,000 60 1.0 10 3,500 1.0 1.5 13 60 400 10-12 2,380 70 1.2 12 4,500 1.2 1.8 16 75 400 Boys 13-15 2,950 85 1.4 15 5,000 1.5 2.1 19 90 400 16-19 3,420 100 1.4 15 5,000 1.7 2.5 23 100 400 Girls 13-15 2,470 80 1.3 15 5,000 1.2 2.0 16 80 400 16-19 2,280 75 1.3 15 5,000 1.1 1.9 15 80 400 1/ Estimated requirements of essential nutrients for individuals in Malaya, based on the recommendations of the Food and Nutrition Board, National Research Council, U.S.A. (1958; 3), and modified for local climatic conditions. 2/ IMR Report No. 64 (2). 3/ Niacin equivalents include dietary sources of the preformed vitamin and the precursor tryptophan (60 mg tryptophan = 1 mg niacin). 41 These figures represent ideal weights (in kg) for babies. 5 Needs can be met by 3.5 gm/kg in first 6 months and 3 gm/kg for remainder of first year. Source: https:/lwww.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5. BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and females Age (years) 5-14 Location Total BLOOD Total Plasma Protein gm/100 ml No. 45 18 29 43 58 42 32 267 Mean 7.0 8.1 7.3 7.3 7.3 7.3 7.1 7.3 Percent Distribution 6.00-6.39 6.7 -- - 1.7 -- 3.1 1.9 6.40-6.99 48.9 -- 24.1 27.9 20.7 28.6 37.5 28.8 >7.00 44.4 100.0 75.9 72.1 77.6 71.4 59.4 69.3 Albumin/Globulin Ratio No. 45 18 29 43 58 41 32 266 Mean 1.3 0.9 1.2 0.9 1.2 1.3 1.0 1.1 Percent Distribution <0.5 - - -- 2.3 -- -- -- 0.4 0.5-0.9 6.7 72.2 24.1 69.8 6.9 17.1 37.5 28.6 1.0-1.4 75.6 27.8 65.5 20.9 69.0 56.1 62.5 56.4 1.5-1.9 11.1 -- 10.3 7.0 24.1 24.4 -- 13.2 >2.0 6.7 -- -- -- -- 2.4 -- 1.5 Plasma Albumin gm/100 ml No. 45 18 29 43 58 41 32 266 Mean 3.9 3.8 3.9 3.3 4.0 4.0 3.5 3.8 Percent Distribution <2.5 - - -- 4.6 -- -- -- 0.8 2.5-3.4 15.6 22.2 17.2 60.5 1.7 9.8 43.8 22.9 3.5-5.0 84.4 77.8 82.8 34.9 98.3 90.2 56.2 76.3 >5.0 -- -- -- -- -- -- Plasma Globulin gm/100 ml No. 45 18 29 43 58 41 32 266 Mean 3.1 4.3 3.4 4.0 3.3 3.3 3.6 3.5 Percent Distribution 1.0-1.9 2.2 - -- -- -- -- - 0.4 2.0-2.9 31.1 - 13.8 7.0 29.3 36.6 12.5 21.4 3.0-3.5 55.6 5.6 55.2 14.0 39.6 39.0 40.6 37.6 >3.5 11.1 94.4 31.0 79.1 31.0 24.4 46.9 40.6 294 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and nonpregnant, nonlactating females 15+ Total BLOOD 52 40 50 22 34 24 2 14 238 7.2 7.8 7.4 7.6 7.4 7.4 7.8 7.7 7.5 Percent Distribution 11.5 -- -- 2.9 4.2 - -- 3.4 17.3 7.5 24.0 4.5 20.6 16.7 -- 7.1 15.5 71.2 92.5 76.0 95.4 76.5 79.2 100.0 92.8 81.1 52 40 50 22 34 24 2 13 237 1.2 1.2 1.1 1.1 1.1 1.2 1.0 0.8 1.1 Percent Distribution - - - 4.5 -- - -- - 0.4 13.5 25.0 22.0 27.3 35.3 29.2 50.0 61.5 26.2 67.3 52.5 66.0 54.5 61.8 54.2 50.0 38.5 59.5 17.3 22.5 12.0 9.1 2.9 12.5 -- 12.6 1.9 - -- 4.5 -- 4.2 -- -- 1.3 52 40 50 22 34 24 2 13 237 3.8 4.2 3.9 3.8 3.8 3.9 3.9 3.4 3.9 Percent Distribution -- -- 4.5 -- -- -- 0.4 11.5 2.5 12.0 22.7 20.6 4.2 -- 53.8 13.9 88.5 97.5 88.0 68.2 79.4 95.8 100.0 46.2 85.2 -- 4.5 -- -- -- -- 0.4 52 40 50 22 34 24 2 13 237 3.3 3.6 3.5 3.8 3.6 3.5 3.8 4.2 3.6 Percent Distribution - - - -- - - 30.8 17.5 16.0 13.6 5.9 16.7 - - 16.9 48.1 40.0 42.0 40.9 41.2 41.7 - 7.7 40.5 21.2 42.5 42.0 45.4 52.9 41.7 100.0 92.3 42.6 295 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and females Age (years) 5-14 Location Total BLOOD Hemoglobin gm/100 ml No. 45 18 30 40 58 43 32 266 Mean 13.5 13.5 12.6 13.6 12.8 13.8 12.8 13.2 Percent Distribution <12.0 6.7 11.1 20.0 10.0 24.1 7.0 6.3 12.8 12.0-13.9 71.1 55.6 63.3 42.5 50.0 48.8 78.1 57.5 14.0-14.9 13.3 11.1 16.7 30.0 22.4 37.2 15.6 22.2 >15.0 8.9 22.2 17.5 3.4 7.0 - 7.5 Hematocrit percent No. 45 18 29 34 58 42 32 258 Mean 39.8 41.5 38.4 37.5 39.3 40.3 38.0 39.2 Percent Distribution <36 6.7 5.6 10.3 20.6 10.3 2.4 18.8 10.5 36-41 73.3 38.9 75.9 67.6 60.3 73.8 68.8 67.0 42-44 8.9 38.9 10.3 11.8 27.6 14.3 9.4 16.7 >45 11.1 16.7 3.4 -- 1.7 9.5 3.1 5.8 Mean Corpuscular Hemoglobin Concentration, percent No. 45 18 29 34 58 42 32 258 Mean 34.0 32.7 32.7 36.0 32.5 34.2 33.6 33.7 Percent Distribution <28.0 13.8 5.9 5.2 4.8 3.1 4.6 28.0-29.9 2.2 5.6 3.4 2.9 8.6 -- -- 3.5 30.0-31.9 15.6 38.9 10.3 2.9 17.2 7.1 21.9 14.7 >32.0 82.2 55.6 72.4 88.2 69.0 88.1 75.0 77.1 Plasma Vitamin C mg/100 ml No. 45 18 28 25 58 42 32 248 Mean 0.65 0.60 0.79 0.30 0.79 1.11 0.59 0.73 Percent Distribution <0.10 - -- -- -- -- -- -- - 0.10-0.19 - -- -- 12.0 3.4 -- -- 2.0 0.20-0.39 28.9 22.2 17.8 72.0 6.9 4.8 37.5 23.4 >0.40 71.1 77.8 82.1 16.0 89.6 95.2 62.5 74.6 296 Source. https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and nonpregnant, nonlactating females 15+ Total BLOOD 50 40 46 21 35 24 6 14 236 14.5 14.2 12.4 14.6 12.7 13.9 12.8 14.0 13.6 Percent Distribution 4.0 5.0 41.3 9.5 22.8 12.5 33.3 14.3 16.9 32.0 40.0 37.0 9.5 48.6 37.5 50.0 21.4 35.2 24.0 30.0 13.0 47.6 20.0 25.0 -- 35.7 24.6 40.0 25.0 8.7 33.3 8.6 25.0 16.7 28.6 23.3 52 38 47 18 35 22 5 14 231 42.5 43.6 38.2 42.6 39.8 40.6 39.4 40.3 41.0 Percent Distribution 7.7 - 21.3 5.6 11.4 18.2 40.0 14.3 11.7 38.5 34.2 57.4 33.3 48.6 36.4 20.0 42.8 42.4 15.4 26.3 12.8 33.3 20.0 22.7 20.0 21.4 19.9 38.5 39.5 8.5 27.8 20.0 22.7 20.0 21.4 26.0 50 38 44 18 35 22 5 14 226 34.2 32.6 32.5 34.7 27.7 34.0 34.6 34.8 33.3 Percent Distribution 2.0 - 15.9 -- 8.6 4.5 40.0 .... 6.2 4.0 18.4 11.4 -- 11.4 -- -- -- 8.0 10.0 26.3 15.9 11.1 20.0 4.5 -- 14.3 15.0 84.0 55.3 56.8 88.9 60.0 90.9 60.0 85.7 70.8 52 40 50 16 35 24 -- 14 231 0.48 0.52 0.68 0.24 0.43 0.71 -- 0.48 0.53 Percent Distribution -- -- - -- 5.7 -- -- - 0.9 13.5 10.0 -- 50.0 5.7 -- -- 21.4 10.4 32.7 30.0 16.0 43.8 42.8 16.7 - 21.4 28.6 53.8 60.0 84.0 6.2 45.7 83.3 -- 57.1 60.2 297 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and females Age (years) 5-14 Location Total BLOOD Plasma Vitamin A g/100 ml No. 45 18 29 41 58 42 32 265 Mean 26.6 28.2 25.5 25. 8 41. 1 19.2 26.9 28.5 Percent Distribution <10 -- -- 3.4 - 23.8 -- 4.2 10-19 15.6 27.8 20.7 24.4 13.8 38.1 12.5 21.1 20-49 82.2 61.1 75.9 73.2 46.6 38.1 87.5 64.5 >50 2.2 11.1 -- 2.4 39.6 - -- 10.2 Plasma Carotene g/100 ml No. 45 18 29 41 58 42 32 265 Mean 80 64 64 90 71 74 78 76 Percent Distribution <20 -- -- -- -- - 3.1 0.4 20-39 6.7 27.8 20.7 4.9 12.1 11.9 9.4 11.7 40-99 68.9 55.6 75.9 61.0 72.4 76.2 62.5 68.7 >100 24.4 16.7 3.4 34.1 15.5 11.9 25.0 19.2 Cholesterol mg/100 ml No. 43 18 29 42 58 41 32 263 Mean 171 177 179 169 174 180 150 171 Percent Distribution 70-99 -- -- -- - -- 3.1 0.4 100-149 30.2 22.2 10.3 33.3 25.9 17.1 50.0 27.4 150-199 55.8 61.1 72.4 50.0 53.4 65.8 40.6 56.3 >200 14.0 16.7 17.2 16.7 20.7 17.1 6.2 16.0 P-Lipoprotein mm No. 44 - 30 42 4 42 32 194 Mean 2.5 - 2.7 2.7 2.3 2.4 2.5 2.6 Lipid Phosphorus mg/100 ml No. 43 18 28 42 58 42 32 263 Mean 9.8 8.0 9.4 8.6 10.2 10.5 10.4 9.7 298 Source: https://www.industrydocuments.ucsf.edu/docssnyco227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and nonpregnant, nonlactating females 1,5+ Total BLOOD 52 39 48 22 33 24 -- 14 232 39.9 38.2 30.6 43.7 51.8 26.3 -- 43.2 38.5 Percent Distribution -- -- 2.1 -- -- 12.5 -- 1.7 1.9 -- 10.4 4.5 -- 29.2 -- -- 6.0 86.5 87.2 83.3 63.6 48.5 45.8 -- 71.4 73.3 11.5 12.8 4.2 31.8 51.5 12.5 -- 28.6 19.0 52 39 48 22 33 24 -- 14 232 103 82 69 107 74 99 -- 126 90 Percent Distribution - -- 4.2 -- -- -- -- -- 0.9 1.9 7.7 8.3 - 18.2 4.2 -- -- 6.5 50.0 66.7 72.9 45.4 66.7 50.0 -- 28.6 58.2 48.1 25.6 14.6 54.5 15.2 45.8 -- 71.4 34.5 52 40 50 22 35 24 2 14 239 192 190 188 197 194 203 130 203 193 Percent Distribution 1.9 - - -- 50.0 - 0.8 17.3 15.0 12.0 9.1 17.1 8.3 - 13.0 36.5 50.0 56.0 45.4 45.7 45.8 50.0 57.1 47.3 44.2 35.0 32.0 45.4 37.1 45.8 -- 42.8 38.9 51 -- 50 22 3 23 2 14 165 2.7 2.9 3.4 2.9 2.8 2.8 2.6 2.8 52 40 48 22 35 24 2 13 236 11.5 9.0 9.4 7.2 10.7 10.8 8.8 11.7 10.0 299 Source: https:/lwww.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and females Age (years) 5-14 Location Total URINE Thiamine g/gm creatinine No. 38 12 26 37 41 27 22 203 Median 106 72 150 118 86 147 111 113 Percent Distribution <27 - -- -- -- 2.4 -- -- 0.5 27-65 18.4 50.0 3.8 18.9 36.6 3.7 27.3 21.2 66-129 50.0 33.3 34.6 37.8 34.1 40.7 31.8 38.4 >130 31.6 16.7 61.5 43.2 26.8 55.6 40.9 39.9 Riboflavin g/gm creatinine No. 41 16 27 35 49 29 28 225 Median 33 30 48 48 28 52 35 38 Percent Distribution <27 39.0 43.8 22.2 22.8 49.0 27.6 32.1 34.7 27-79 46.3 50.0 51.8 51.4 40.8 37.9 60.7 47.6 80-269 14.6 6.2 25.9 22.8 8.2 24.1 3.6 15.1 >270 -- - - 2.1 2.0 10.3 3.6 2.7 N' -Methylnicotinamide mg/gm creatinine No. 42 17 25 40 54 37 30 245 Median 6.4 8.3 9.0 6.2 8.6 6.2 7.0 7.3 Percent Distribution <0.50 -- -- -- - - 2.7 -- 0.4 0.50-1.59 -- -- - 10.0 -- - -- 1.6 1.60-4.29 14.3 -- 8.0 25.0 9.2 35.1 20.0 17.1 >4.30 85.7 100.0 92.0 65.0 90.7 62.2 80.0 80.8 300 Source: https://www.industrydocuments.ucst.edu/docsisnyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and nonpregnant, nonlactating females 15+ Total URINE 38 30 40 22 27 19 3 8 187 72 52 72 44 55 107 56 108 63 Percent Distribution 7.9 30.0 22.5 31.8 25.9 10.5 -- -- 19.8 42.1 30.0 27.5 40.9 33.3 15.8 66.7 25.0 32.6 26.3 33.3 27.5 4.5 11.1 36.8 -- 37.5 24.1 23.7 6.7 22.5 22.7 29.6 36.8 33.3 37.5 23.5 48 38 43 18 30 20 3 12 212 40 28 37 44 33 30 16 36 34 Percent Distribution 33.3 50.0 37.2 33.3 40.0 50.0 100.0 33.3 40.6 43.7 42.1 48.8 38.9 36.7 35.0 -- 58.3 42.4 20.8 5.3 7.0 27.8 10.0 10.0 -- 8.3 12.3 2.1 2.6 7.0 -- 13.3 5.0 -- -- 4.7 46 38 34 22 31 23 3 10 207 5.3 5.1 5.4 1.7 6.5 6.4 4.0 3.4 5.2 Percent Distribution -- -- -- -- - -- -- 2.2 -- 5.9 50.0 - -- -- 6.8 34.8 36.8 26.5 31.8 22.6 21.7 66.7 70.0 32.4 63.0 63.2 67.6 18.2 77.4 78.3 33.3 30.0 60.9 301 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-6. BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and Females Age (years) 6-16 Percent 70- 80- 90- 100- "Standard Weight" 79 89 99 109 110+ Unknown Total BLOOD Total Plasma Protein gm/100 ml No. 11 79 110 56 18 9 283 Mean 7.2 7.3 7.3 7.4 7.6 7.2 7.3 S.E.1/ 0.11 0.06 0.04 0.08 0.15 0.12 0.03 Percent Distribution 6.00-6.39 - 2.5 1.8 1.8 5.6 -- 2.1 6.40-6.99 36.4 26.6 29.1 28.6 5.6 22.2 26.8 >7.00 63.6 70.9 69.1 69.6 88.9 77.8 71.0 Albumin/Globulin Ratio No. 11 79 109 56 18 9 282 Mean 0.9 1.2 1.2 1.1 1.2 1.1 1.1 S.E. 0.13 0.04 0.03 0.03 0.06 0.06 0.02 Percent Distribution <0.5 - - 0.9 -- -- - 0.4 0.5-0.9 54.5 26.6 28.4 26.8 16.7 22.2 27.6 1.0-1.4 36.4 54.4 55.0 64.3 66.7 77.8 57.4 1.5-1.9 9.1 15.2 14.7 8.9 16.7 -- 13.1 >2.0 -- 3.8 0.9 - -- ... 1.4 Plasma Albumin gm/100 ml No. 11 79 109 56 18 9 282 Mean 3.4 3.8 3.8 3.8 4.0 3.8 3.8 S.E. 0.20 0.06 0.04 0.05 0.09 0.12 0.03 Percent Distribution <2.5 ... -- 1.8 -- -- -- 0.7 2.5=3.4 54.5 20.2 21.1 23.2 5.6 22.2 21.6 3.5-5.0 45.4 79.7 77.1 76.8 94.4 77.8 77.6 >5.0 - -- -- -- -- -- Plasma Globulin gm/100 ml No. 11 79 109 56 18 9 282 Mean 3.8 3.4 3.4 3.6 3.6 3.4 3.5 Percent Distribution 1.0-1.9 -- 1.3 -- -- -- -- 0.4 2.0-2.9 18.2 22.8 22.9 16.1 22.2 -- 20.6 3.0-3.5 18.2 38.0 41.3 37.5 22.2 77.8 38.6 >3.5 63.6 38.0 35.8 46.4 55.6 22.2 40.4 1/ S.E. = standard error. 302 Source: https://www.industrydocuments.ucst.edu/docs/snyc0227 APPENDIX TABLE VIII-6(Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and Nonpregnant, Nonlactating Females 17+ 80= 90- 100- <80 89 99 109 110+ Unknown Total BLOOD 30 68 58 28 28 3 215 7.4 7.4 7.4 7.6 7.4 8.3 7.4 0.08 0.07 0.08 0.09 0.11 -- 0.04 Percent Distribution -- 5.9 3.4 -- 3.6 3.2 16.7 11.8 20.7 7.1 21.4 -- 15.3 83.3 82.4 75.9 92.8 75.0 100.0 81.4 30 67 58 28 28 3 214 1.1 1.1 1.1 1.1 1.2 0.9 1.1 0.06 0.03 0.04 0.05 0.06 0.10 0.02 Percent Distribution - 1.5 - -- -- -- 0.5 20.0 31.3 29.3 21.4 21.4 66.7 27.1 63.3 59.7 58.6 71.4 50.0 33.3 59.8 13.3 7.5 12.1 3.6 25.0 - 11.2 3.3 --- -- 3.6 3.6 - 1.4 30 67 58 28 28 3 214 3.9 3.8 3.8 3.9 4.0 3.8 3.8 0.10 0.06 0.06 0.07 0.07 - 0.03 Percent Distribution -- 1.5 -- -- -- -- 0.5 13.3 19.4 17.2 7.1 7.1 -- 14.5 83.3 79.1 82.8 92.8 92.8 100.0 84.6 3.3 -- -- -- - - -- 0.5 30 67 58 28 28 3 214 3.5 3.6 3.6 3.7 3.4 4.4 3.6 Percent Distribution - -- -- -- -- - - - 16.7 13.4 19.0 3.6 32.1 -- 16.4 46.7 41.8 32.8 53.6 32.1 33.3 40.2 36.7 44.8 48.3 42.8 35.7 66.7 43.4 303 Source: https://www.industrydocuments.ucsf.edu/docsisnyc0227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and Females Age (years) 6-16 Percent 70- 80- 90- 100= "Standard Weight" 79 89 99 109 110+ Unknown Total Hemoglobin gm/100 ml No. 9 79 109 55 18 10 280 Mean 13.3 13.3 13.4 13.0 14.1 13.1 13.3 S.E. 1.15 0.19 0.14 0.22 0.27 0.43 0.10 Percent Distribution <12.0 22.2 12.6 11.9 12.7 - 20.0 12.1 12.0-13.9 44.4 51.9 55.0 60.0 44.4 70.0 54.6 14.0-14.9 27.8 24.8 23.6 33.3 - 24.3 >15.0 33.3 7.6 8.2 3.6 22.2 10.0 8.9 Hematocrit percent No. 10 74 106 54 18 10 272 Mean 35.3 40.0 40.0 39.0 40.7 41.3 39.4 S.E. 2.20 0.45 0.32 0.49 0.78 1.12 0.23 Percent Distribution <36 40.0 13.5 7.5 9.2 5.6 - 10.3 36-41 50.0 54.0 70.8 72.2 55.6 60.0 64.3 42-44 -- 24.3 15.1 14.8 27.8 20.0 18.0 >45 10.0 8.1 6.6 3.7 11.1 20.0 7.4 Mean Corpuscular Hemoglobin Concentration, percent No. 9 74 106 54 18 10 271 Mean 38.3 33.4 33.7 33.4 35.0 32.0 33.7 Percent Distribution <28.0 11.1 5.4 2.8 3.7 -- 10.0 4.0 28.0=29.9 -- 2.7 1.9 7.4 - 10.0 3.3 30.0-31.9 - 16.2 16.0 18.5 -- 20.0 15.1 >32.0 88.9 75.7 79.2 70.4 100.0 60.0 77.5 Plasma Vitamin C mg/100 ml No. 5 71 104 56 18 9 263 Mean 0.80 0.76 0.70 0.71 0.70 0.82 0.72 Percent Distribution <0.10 -- ... - -- -- -- -- 0.10~0.19 - 2.8 2.9 1.8 -- -- 2.3 0.20-0.39 -- 18.3 26.0 23.2 16.7 22.2 22.0 >0.40 100.0 78.9 71.2 75.0 83.3 77.8 75.7 304 Source: https:/lwww.industrydocuments.ucsf.edu/docsisnyc0227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and Nonpregnant, Nonlactating Females 17+ 80- 90- 100- <80 89 99 109 110+ Unknown Total 32 70 58 24 28 2 214 13.6 13.4 13.6 14.0 13.9 12.7 13.6 0.40 0.30 0.24 0.34 0.35 -- 0.14 Percent Distribution 25.0 22.8 13.8 16.7 10.7 -- 18.2 28.1 31.4 48.3 29.2 28.6 100.0 35.5 15.6 27.1 15.5 29.2 32.1 -- 22.9 31.2 18.6 22.4 25.0 28.6 (- 23.4 31 67 56 24 28 3 209 41.3 40.5 40.8 42.1 41.2 37.3 41.0 0.99 0.76 0.53 1.06 0.77 0.68 0.35 Percent Distribution 16.1 16.4 8.9 12.5 7.1 -- 12.4 35.5 34.3 51.8 29.2 53.6 100.0 42.1 16.1 19.4 19.6 16.7 25.0 19.1 32.2 29.8 19.6 41.7 14.3 -- 26.3 31 67 55 22 28 2 205 33.1 33.0 33.3 33.0 33.8 33.4 33.2 Percent Distribution 9.7 10.4 3.6 4.5 3.6 -- 6.8 12.9 9.0 5.4 4.5 14.3 - 8.8 16,1 11.9 14.5 18.2 14.3 50.0 14.6 61.3 68.6 76.4 72.7 67.8 50.0 69.8 29 67 56 26 28 3 209 0.58 0.53 0.46 0.52 0.53 0.51 0.52 Percent Distribution - 1.5 1.8 - -- -- 1.0 6.9 7.5 14.3 19.2 7.1 33.3 11.0 20.7 32.8 37.5 19.2 35.7 - 30.6 72.4 58.2 46.4 61.5 57.1 66.7 57.4 305 Source: https://www.industrydocuments.ucsi.edu/docsisnyco227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and Females Age (years) 6-16 Percent 70- 80- 90- 100- "Standard Weight" 79 89 99 109 110+ Unknown Total Plasma Vitamin A g/100 ml No. 10 79 108 56 17 9 279 Mean 28.9 29.6 28.5 30.7 36.5 27.3 29.7 Percent Distribution <10 -- -- 3.7 3.6 11.8 22.2 3.6 10-19 10.0 20.2 23.1 21.4 5.9 -- 19.7 20-49 80.0 72.2 64.8 58.9 58.8 66.7 65.9 >50 10.0 7.6 8.3 16.1 23.5 11.1 10.8 Plasma Carotene g/100 ml No. 10 79 108 56 17 9 279 Mean 86 82 74 76 78 59 77 Percent Distribution <20 -- -- 0.9 -- -- -- 0.4 20-39 7.6 11.1 12.5 17.6 22.2 10.8 40-99 90.0 65.8 71.3 66.1 58.8 77.8 68.8 >100 10.0 26.6 16.7 21.4 23.5 -- 20.1 Cholesterol mg/100 ml No. 11 78 107 56 18 9 279 Mean 165 176 170 172 182 173 173 Percent Distribution 70-99 -- -- -- -- -- -- - 100-149 45.4 21.8 29.9 25.0 27.8 22.2 26.9 150-199 36.4 56.4 54.2 58.9 44.4 77.8 55.2 >200 18.2 21.8 15.9 16.1 27.8 -- 17.9 B=Lipoprotein mm No. 10 59 70 31 8 8 196 Mean 2.5 2.5 2.9 2.5 2.5 2.4 2.6 Lipid Phosphorus mg/100 ml No. 11 78 107 56 18 9 279 Mean 9.4 9.6 9.6 9.8 9.4 9.7 9.6 306 Source: https:/lwww.industrydocuments.ucsf.edu/docsisnyc022/ APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and Nonpregnant, Nonlactating Females 17+ 80- 90- 100- <80 89 99 109 110+ Unknown Total 27 67 57 28 28 3 210 33.4 37.1 40.3 38.9 41.2 33.3 38.2 Percent Distribution -- 3.0 1.8 -- 3.6 -- 1.9 11.1 9.0 1.8 3.6 10.7 -- 6.7 74.1 71.6 70.2 82.1 60.7 100.0 71.9 14.8 16.4 26.3 14.3 25.0 -- 19.5 27 67 57 28 28 3 210 74 88 91 95 102 72 89 Percent Distribution 7.4 -- - -- -- 1.0 3.7 6.0 8.8 7.1 7.1 -- 6.7 59.2 61.2 56.1 50.0 53.6 100.0 57.6 29.6 32.8 35.1 42.8 39.3 -- 34.8 31 68 58 28 28 3 216 184 184 196 202 217 158 194 Percent Distribution -- 1.5 1.7 -- -- 0.9 12.9 16.2 6.9 10.7 7.1 66.7 12.0 58.0 51.5 48.3 50.0 28.6 -- 47.7 29.0 30.9 43.1 39.3 64.3 33.3 39.4 24 49 37 20 23 2 155 2.9 2.6 2.9 3.3 3.1 2.8 2.9 30 66 58 28 28 3 213 8.9 10.1 10.8 9.6 11.4 7.6 10.2 307 Source: https:/lwww.industrydocuments.ucsf.edu/docsisnyc0227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and Females Age (years) 6-16 Percent 70- 80- 90- 100- "Standard Weight" 79 89 99 109 110+ Unknown Total URINE Thiamine g/gm creatinine No. 9 60 84 46 12 6 217 Median 164 115 118 82 91 147 110 Percent Distribution <27 -- 1.7 1.2 -- -- -- 0.9 27=65 33.3 13.3 16.7 41.3 33.3 16.7 22.6 66-129 -- 45.0 39.3 34.8 41.7 16.7 37.8 >130 66.7 40.0 42.8 23.9 25.0 66.7 38.7 Riboflavin g/gm creatinine No. 10 63 95 48 16 7 239 Median 64 48 36 36 24 46 39 Percent Distribution <27 20.0 23.8 36.8. 33.3 62.5 14.3 33.0 27-79 40.0 55.6 45.3 58.3 37.5 42.8 49.8 80-269 40.0 20.6 13.7 6.2 - 42.8 15.1 >270 -- -- 4.2 2.1 -- -- 2.1 N'-Methylnicotinamide mg/gm creatinine No. 10 72 102 52 17 6 259 Median 7.3 8.3 7.0 6.4 7.0 5.4 7.2 Percent Distribution <0.50 -- 1.4 -- - - - 0.4 0.50-1.59 -- 4.2 1.0 3.8 -- -- 2.3 1.60-4.29 20.0 9.7 19.6 19.2 23.5 16.7 17.0 >4.30 80.0 84.7 79.4 76.9 76.5 83.3 80.3 308 Source: https:/lwww.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and Nonpregnant, Nonlactating Females 17+ 80- 90- 100- <80 89 99 109 110+ Unknown Total URINE 29 56 40 22 19 2 168 64 70 54 54 62 46 60 Percent Distribution 13.8 21.4 20.0 27.3 26.3 50.0 21.4 37.9 26.8 42.5 31.8 26.3 -- 32.7 31.0 23.2 12.5 27.3 31.6 50.0 23.8 17.2 28.6 25.0 13.6 15.8 -- 22.0 28 59 51 23 27 3 191 36 31 26 38 33 32 32 Percent Distribution 35.7 45.8 52.9 26.1 40.7 33.3 42.9 50.0 35.6 31.4 47.8 48.1 66.7 40.3 10.7 15.2 9.8 13.0 7.4 -- 11.5 3.6 3.4 5.9 13.0 3.7 -- 5.2 27 57 51 25 25 1 186 5.0 5.1 5.6 3.8 6.2 5.0 Percent Distribution -- -- -- - -- -- -- 3.7 7.0 3.9 16.0 4.0 -- 6.4 33.3 33.3 35.3 44.0 28.0 100.0 34.9 63.0 59.6 60.8 40.0 68.0 -- 58.6 309 Source: https://www.industrydocuments.ucst.edu/docsisnyc0227 APPENDIX TABLE VIII-7. SUGGESTED VALUES BY SEX AND AGE GROUPS FOR HEMOGLOBIN AND HEMATOCRIT Deficient Low Acceptable High Hemoglobin Males >13 years <12 12.0-13.9 14.0-14.9 >15.0 Females nonpregnant, nonlactating >13 years <10.0 10.0-10.9 11.0-14.4 >14.5 Children 3-12 years <10.0 10.0-10.9 11.0-12.4 >12.5 Hematocrit Males >13 years <36 36-41 42-44 >45 Females nonpregnant, nonlactating >13 years <30 30-37 38-42 >43 Children 3-12 years <30.0 30.0-33.9 34.0-36.9 >37.0 310 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-9. IODINE EXCRETION VS. PRESENCE OF GOITER, CIVILIANS AND MILITARY DEPENDENTS, MALAYA <15 Years 15+ Years Urinary Iodine Excretion Total Enlarged Thyroid Total Enlarged Thyroid g/gm creatinine Group No. Percent Group No. Percent 0-9 -- -- 10-19 5 1 20-29 20 1 7 1 30-39 19 1 12 3 40-49 11 1 9 50-99 20 2 16 2 100+ 7 8 Total 82 5 6.1 53 6 11.3 Mean 53 50 135 43 Total Enlarged Thyroid Urinary Iodine Group No. Percent <20 8 -- -- 20-29 37 2 5.4 30-39 44 4 9.1 40-49 30 1 3.3 50+ 72 4 5.6 Total 191 11 5.8 Source: https://wwww.industrydocuments.ucsf.edu/docs/snyc0227 1/ APPENDIX TABLE VIII-10. SUGGESTED GUIDE TO INTERPRETATION OF BIOCHEMICAL DATA Deficient Low Acceptable High Blood Total Plasma Protein, gm/100 ml < 6.00 6.00-6.39 6.40-6.99 >7.00 Plasma Albumin, gm/100 ml < 2.5 2.5-3.4 3.5-5.0 >5.0 Globulin, gm/100 ml < 2.0 2.0-2.9 3.0-3.5 >3.5 Albumin/Globulin Ratio < 1.0 1.0-1.4 1.5-1.9 >2.0 Hemoglobin, gm/100 ml <12.0 12.0-13.9 14.0-14.9 >15.0 Hematocrit, percent <36 36-41 42-44 >45 Mean Corpuscular Hemoglobin Concentration, percent <28.0 28.0-29.9 30.0-31.9 >32.0 Plasma Vitamin A, g/100 ml <10 10-19 20-49 >50 Plasma Carotene, g/100 ml <20 20-39 40-99 >100 Plasma Vitamin C, mg/100 ml < 0.10 0.10-0.19 0.20-0.39 >0.40 Urine Thiamine, g/gm creatinine <27 27-65 66-129 >130 Riboflavin, g/gm creatinine <27 27-79 80-269 >270 N'-Methylnicotinamide, mg/gm creatinine < 0.50 0.50-1.59 1.60-4.29 >4.30 1/ Based on ICNND suggested reference values. Source: https://www.industrydocuments.ucst.edu/docsisnyc0227

How many males are deficient in hemoglobin ?

snyc0227

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APPENDIX VII-1.GLOSSARY OF COMMONLY SERVED MALAY DISHES Sambal belachan Aged fish paste mixed with chillies, onions, etc. Sambal telor A fried dish of egg, belachan and sambal. Ikan goreng Fried fresh or salt fish. Tumis togei A common Malay dish made from bean sprouts, to which are added fried condiments and water. Quai kodok A breakfast food made from water, wheat flour and salt. The batter is dropped into coconut oil and deep=fried. Apam balek A common Malay breakfast food similar to a pancake. The batter is made of wheat flour, water and sliced bananas. The kuali is lightly oiled and then rubbed with a piece of fresh coconut. Enough batter for one apam balek is spread thinly over the surface. When cooked, a spoonful of a mixture of shredded fresh coconut and brown sugar is placed in the center and the cake is rolled up. Tumis Vegetables fried in coconut oil to which condiments and spices have been added. Pisang goreng Special varieties of bananas (green) sliced in half length wise and dipped in a batter of wheat flour and water, and deep=fried in coconut oil. Roti chanai A favorite breakfast item resembling a pancake, made from a soft dough of wheat flour, water and coconut oil. The oil is added by kneading and working the dough by hand. The dough is worked in individual amounts, pulled and stretched over a flat surface until paper thin and then rolled in a long thin strip and wound together in a spiral to give a circular flat cake about six inches in diameter which is fried in the kuali. Children eat them with sugar. Adar=adar A pancake batter of wheat flour and water. After frying, the pancake is spread with a previously fried mixture of shredded fresh coconut and brown and white sugar. Goreng keledeh Keledeh is similar to sweet potato. In Malaya it is often sliced raw, dipped in rice flour and water and deep fried in coconut oil for breakfast. Achar timun Raw cucumber mixed with raw onion and fresh chilli, re- sembling a pickle. Gulai ikan (fish Fish cooked in water or santan to which condiments and curry) spices are added. Goreng kajong Long green beans fried in coconut oil with ikan bilis. Sayor lemak paku Young fern shoots boiled in santan to which condiments are added. 292 Source: https://wwww.industrydocuments.ucsf.edu/docsisnyc0227 APPENDIX TABLE VII-2. RECOMMENDED DAILY DIETARY , Age Body Vita- Thia- Ribo- Ascorbic Vita- (years) Weight Calories Protein Calcium Iron min A mine flavin Niacin³/ Acid min D kg gm gm mg IU mg mg mg mg IU equiv- alent Men 25 55 2,570 55 0.5 10 5,000 1.3 1.4 17 75 45 55 2,430 55 0.5 10 5,000 1.2 1.4 16 75 65 55 2,050 55 0.5 10 5,000 1.0 1.4 14 75 Women 25 50 1,900 50 0.5 12 5,000 1.0 1.3 17 70 45 50 1,860 50 0.5 12 5,000 1.0 1.3 16 70 65 50 1,520 50 0.5 12 5,000 1.0 1.3 13 70 Pregnant (2d half) +285 +20 1.0-1.2 15 6,000 1.1 1.8 +3 100 400 Lactating +950 +40 1.0-1.2 15 8,000 1.4 2.3 +2 150 400 Infants 0-1 (6)4/ (Age in 2-6 (9)kg X 115 See Foot- 0.5-0.6 5 1,500 0.3 0.4 5 30 400 months) 7-12 kg X 95 note 5/ 0.5-0.6 7 1,500 0.4 0.5 6 30 400 Children 1-3 1,240 40 1.0 7 2,000 0.6 1.0 8 35 400 4-6 1,620 50 1.0 8 2,500 0.8 1.3 11 50 400 7-9 2,000 60 1.0 10 3,500 1.0 1.5 13 60 400 10-12 2,380 70 1.2 12 4,500 1.2 1.8 16 75 400 Boys 13-15 2,950 85 1.4 15 5,000 1.5 2.1 19 90 400 16-19 3,420 100 1.4 15 5,000 1.7 2.5 23 100 400 Girls 13-15 2,470 80 1.3 15 5,000 1.2 2.0 16 80 400 16-19 2,280 75 1.3 15 5,000 1.1 1.9 15 80 400 1/ Estimated requirements of essential nutrients for individuals in Malaya, based on the recommendations of the Food and Nutrition Board, National Research Council, U.S.A. (1958; 3), and modified for local climatic conditions. 2/ IMR Report No. 64 (2). 3/ Niacin equivalents include dietary sources of the preformed vitamin and the precursor tryptophan (60 mg tryptophan = 1 mg niacin). 41 These figures represent ideal weights (in kg) for babies. 5 Needs can be met by 3.5 gm/kg in first 6 months and 3 gm/kg for remainder of first year. Source: https:/lwww.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5. BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and females Age (years) 5-14 Location Total BLOOD Total Plasma Protein gm/100 ml No. 45 18 29 43 58 42 32 267 Mean 7.0 8.1 7.3 7.3 7.3 7.3 7.1 7.3 Percent Distribution 6.00-6.39 6.7 -- - 1.7 -- 3.1 1.9 6.40-6.99 48.9 -- 24.1 27.9 20.7 28.6 37.5 28.8 >7.00 44.4 100.0 75.9 72.1 77.6 71.4 59.4 69.3 Albumin/Globulin Ratio No. 45 18 29 43 58 41 32 266 Mean 1.3 0.9 1.2 0.9 1.2 1.3 1.0 1.1 Percent Distribution <0.5 - - -- 2.3 -- -- -- 0.4 0.5-0.9 6.7 72.2 24.1 69.8 6.9 17.1 37.5 28.6 1.0-1.4 75.6 27.8 65.5 20.9 69.0 56.1 62.5 56.4 1.5-1.9 11.1 -- 10.3 7.0 24.1 24.4 -- 13.2 >2.0 6.7 -- -- -- -- 2.4 -- 1.5 Plasma Albumin gm/100 ml No. 45 18 29 43 58 41 32 266 Mean 3.9 3.8 3.9 3.3 4.0 4.0 3.5 3.8 Percent Distribution <2.5 - - -- 4.6 -- -- -- 0.8 2.5-3.4 15.6 22.2 17.2 60.5 1.7 9.8 43.8 22.9 3.5-5.0 84.4 77.8 82.8 34.9 98.3 90.2 56.2 76.3 >5.0 -- -- -- -- -- -- Plasma Globulin gm/100 ml No. 45 18 29 43 58 41 32 266 Mean 3.1 4.3 3.4 4.0 3.3 3.3 3.6 3.5 Percent Distribution 1.0-1.9 2.2 - -- -- -- -- - 0.4 2.0-2.9 31.1 - 13.8 7.0 29.3 36.6 12.5 21.4 3.0-3.5 55.6 5.6 55.2 14.0 39.6 39.0 40.6 37.6 >3.5 11.1 94.4 31.0 79.1 31.0 24.4 46.9 40.6 294 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and nonpregnant, nonlactating females 15+ Total BLOOD 52 40 50 22 34 24 2 14 238 7.2 7.8 7.4 7.6 7.4 7.4 7.8 7.7 7.5 Percent Distribution 11.5 -- -- 2.9 4.2 - -- 3.4 17.3 7.5 24.0 4.5 20.6 16.7 -- 7.1 15.5 71.2 92.5 76.0 95.4 76.5 79.2 100.0 92.8 81.1 52 40 50 22 34 24 2 13 237 1.2 1.2 1.1 1.1 1.1 1.2 1.0 0.8 1.1 Percent Distribution - - - 4.5 -- - -- - 0.4 13.5 25.0 22.0 27.3 35.3 29.2 50.0 61.5 26.2 67.3 52.5 66.0 54.5 61.8 54.2 50.0 38.5 59.5 17.3 22.5 12.0 9.1 2.9 12.5 -- 12.6 1.9 - -- 4.5 -- 4.2 -- -- 1.3 52 40 50 22 34 24 2 13 237 3.8 4.2 3.9 3.8 3.8 3.9 3.9 3.4 3.9 Percent Distribution -- -- 4.5 -- -- -- 0.4 11.5 2.5 12.0 22.7 20.6 4.2 -- 53.8 13.9 88.5 97.5 88.0 68.2 79.4 95.8 100.0 46.2 85.2 -- 4.5 -- -- -- -- 0.4 52 40 50 22 34 24 2 13 237 3.3 3.6 3.5 3.8 3.6 3.5 3.8 4.2 3.6 Percent Distribution - - - -- - - 30.8 17.5 16.0 13.6 5.9 16.7 - - 16.9 48.1 40.0 42.0 40.9 41.2 41.7 - 7.7 40.5 21.2 42.5 42.0 45.4 52.9 41.7 100.0 92.3 42.6 295 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and females Age (years) 5-14 Location Total BLOOD Hemoglobin gm/100 ml No. 45 18 30 40 58 43 32 266 Mean 13.5 13.5 12.6 13.6 12.8 13.8 12.8 13.2 Percent Distribution <12.0 6.7 11.1 20.0 10.0 24.1 7.0 6.3 12.8 12.0-13.9 71.1 55.6 63.3 42.5 50.0 48.8 78.1 57.5 14.0-14.9 13.3 11.1 16.7 30.0 22.4 37.2 15.6 22.2 >15.0 8.9 22.2 17.5 3.4 7.0 - 7.5 Hematocrit percent No. 45 18 29 34 58 42 32 258 Mean 39.8 41.5 38.4 37.5 39.3 40.3 38.0 39.2 Percent Distribution <36 6.7 5.6 10.3 20.6 10.3 2.4 18.8 10.5 36-41 73.3 38.9 75.9 67.6 60.3 73.8 68.8 67.0 42-44 8.9 38.9 10.3 11.8 27.6 14.3 9.4 16.7 >45 11.1 16.7 3.4 -- 1.7 9.5 3.1 5.8 Mean Corpuscular Hemoglobin Concentration, percent No. 45 18 29 34 58 42 32 258 Mean 34.0 32.7 32.7 36.0 32.5 34.2 33.6 33.7 Percent Distribution <28.0 13.8 5.9 5.2 4.8 3.1 4.6 28.0-29.9 2.2 5.6 3.4 2.9 8.6 -- -- 3.5 30.0-31.9 15.6 38.9 10.3 2.9 17.2 7.1 21.9 14.7 >32.0 82.2 55.6 72.4 88.2 69.0 88.1 75.0 77.1 Plasma Vitamin C mg/100 ml No. 45 18 28 25 58 42 32 248 Mean 0.65 0.60 0.79 0.30 0.79 1.11 0.59 0.73 Percent Distribution <0.10 - -- -- -- -- -- -- - 0.10-0.19 - -- -- 12.0 3.4 -- -- 2.0 0.20-0.39 28.9 22.2 17.8 72.0 6.9 4.8 37.5 23.4 >0.40 71.1 77.8 82.1 16.0 89.6 95.2 62.5 74.6 296 Source. https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and nonpregnant, nonlactating females 15+ Total BLOOD 50 40 46 21 35 24 6 14 236 14.5 14.2 12.4 14.6 12.7 13.9 12.8 14.0 13.6 Percent Distribution 4.0 5.0 41.3 9.5 22.8 12.5 33.3 14.3 16.9 32.0 40.0 37.0 9.5 48.6 37.5 50.0 21.4 35.2 24.0 30.0 13.0 47.6 20.0 25.0 -- 35.7 24.6 40.0 25.0 8.7 33.3 8.6 25.0 16.7 28.6 23.3 52 38 47 18 35 22 5 14 231 42.5 43.6 38.2 42.6 39.8 40.6 39.4 40.3 41.0 Percent Distribution 7.7 - 21.3 5.6 11.4 18.2 40.0 14.3 11.7 38.5 34.2 57.4 33.3 48.6 36.4 20.0 42.8 42.4 15.4 26.3 12.8 33.3 20.0 22.7 20.0 21.4 19.9 38.5 39.5 8.5 27.8 20.0 22.7 20.0 21.4 26.0 50 38 44 18 35 22 5 14 226 34.2 32.6 32.5 34.7 27.7 34.0 34.6 34.8 33.3 Percent Distribution 2.0 - 15.9 -- 8.6 4.5 40.0 .... 6.2 4.0 18.4 11.4 -- 11.4 -- -- -- 8.0 10.0 26.3 15.9 11.1 20.0 4.5 -- 14.3 15.0 84.0 55.3 56.8 88.9 60.0 90.9 60.0 85.7 70.8 52 40 50 16 35 24 -- 14 231 0.48 0.52 0.68 0.24 0.43 0.71 -- 0.48 0.53 Percent Distribution -- -- - -- 5.7 -- -- - 0.9 13.5 10.0 -- 50.0 5.7 -- -- 21.4 10.4 32.7 30.0 16.0 43.8 42.8 16.7 - 21.4 28.6 53.8 60.0 84.0 6.2 45.7 83.3 -- 57.1 60.2 297 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and females Age (years) 5-14 Location Total BLOOD Plasma Vitamin A g/100 ml No. 45 18 29 41 58 42 32 265 Mean 26.6 28.2 25.5 25. 8 41. 1 19.2 26.9 28.5 Percent Distribution <10 -- -- 3.4 - 23.8 -- 4.2 10-19 15.6 27.8 20.7 24.4 13.8 38.1 12.5 21.1 20-49 82.2 61.1 75.9 73.2 46.6 38.1 87.5 64.5 >50 2.2 11.1 -- 2.4 39.6 - -- 10.2 Plasma Carotene g/100 ml No. 45 18 29 41 58 42 32 265 Mean 80 64 64 90 71 74 78 76 Percent Distribution <20 -- -- -- -- - 3.1 0.4 20-39 6.7 27.8 20.7 4.9 12.1 11.9 9.4 11.7 40-99 68.9 55.6 75.9 61.0 72.4 76.2 62.5 68.7 >100 24.4 16.7 3.4 34.1 15.5 11.9 25.0 19.2 Cholesterol mg/100 ml No. 43 18 29 42 58 41 32 263 Mean 171 177 179 169 174 180 150 171 Percent Distribution 70-99 -- -- -- - -- 3.1 0.4 100-149 30.2 22.2 10.3 33.3 25.9 17.1 50.0 27.4 150-199 55.8 61.1 72.4 50.0 53.4 65.8 40.6 56.3 >200 14.0 16.7 17.2 16.7 20.7 17.1 6.2 16.0 P-Lipoprotein mm No. 44 - 30 42 4 42 32 194 Mean 2.5 - 2.7 2.7 2.3 2.4 2.5 2.6 Lipid Phosphorus mg/100 ml No. 43 18 28 42 58 42 32 263 Mean 9.8 8.0 9.4 8.6 10.2 10.5 10.4 9.7 298 Source: https://www.industrydocuments.ucsf.edu/docssnyco227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and nonpregnant, nonlactating females 1,5+ Total BLOOD 52 39 48 22 33 24 -- 14 232 39.9 38.2 30.6 43.7 51.8 26.3 -- 43.2 38.5 Percent Distribution -- -- 2.1 -- -- 12.5 -- 1.7 1.9 -- 10.4 4.5 -- 29.2 -- -- 6.0 86.5 87.2 83.3 63.6 48.5 45.8 -- 71.4 73.3 11.5 12.8 4.2 31.8 51.5 12.5 -- 28.6 19.0 52 39 48 22 33 24 -- 14 232 103 82 69 107 74 99 -- 126 90 Percent Distribution - -- 4.2 -- -- -- -- -- 0.9 1.9 7.7 8.3 - 18.2 4.2 -- -- 6.5 50.0 66.7 72.9 45.4 66.7 50.0 -- 28.6 58.2 48.1 25.6 14.6 54.5 15.2 45.8 -- 71.4 34.5 52 40 50 22 35 24 2 14 239 192 190 188 197 194 203 130 203 193 Percent Distribution 1.9 - - -- 50.0 - 0.8 17.3 15.0 12.0 9.1 17.1 8.3 - 13.0 36.5 50.0 56.0 45.4 45.7 45.8 50.0 57.1 47.3 44.2 35.0 32.0 45.4 37.1 45.8 -- 42.8 38.9 51 -- 50 22 3 23 2 14 165 2.7 2.9 3.4 2.9 2.8 2.8 2.6 2.8 52 40 48 22 35 24 2 13 236 11.5 9.0 9.4 7.2 10.7 10.8 8.8 11.7 10.0 299 Source: https:/lwww.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and females Age (years) 5-14 Location Total URINE Thiamine g/gm creatinine No. 38 12 26 37 41 27 22 203 Median 106 72 150 118 86 147 111 113 Percent Distribution <27 - -- -- -- 2.4 -- -- 0.5 27-65 18.4 50.0 3.8 18.9 36.6 3.7 27.3 21.2 66-129 50.0 33.3 34.6 37.8 34.1 40.7 31.8 38.4 >130 31.6 16.7 61.5 43.2 26.8 55.6 40.9 39.9 Riboflavin g/gm creatinine No. 41 16 27 35 49 29 28 225 Median 33 30 48 48 28 52 35 38 Percent Distribution <27 39.0 43.8 22.2 22.8 49.0 27.6 32.1 34.7 27-79 46.3 50.0 51.8 51.4 40.8 37.9 60.7 47.6 80-269 14.6 6.2 25.9 22.8 8.2 24.1 3.6 15.1 >270 -- - - 2.1 2.0 10.3 3.6 2.7 N' -Methylnicotinamide mg/gm creatinine No. 42 17 25 40 54 37 30 245 Median 6.4 8.3 9.0 6.2 8.6 6.2 7.0 7.3 Percent Distribution <0.50 -- -- -- - - 2.7 -- 0.4 0.50-1.59 -- -- - 10.0 -- - -- 1.6 1.60-4.29 14.3 -- 8.0 25.0 9.2 35.1 20.0 17.1 >4.30 85.7 100.0 92.0 65.0 90.7 62.2 80.0 80.8 300 Source: https://www.industrydocuments.ucst.edu/docsisnyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and nonpregnant, nonlactating females 15+ Total URINE 38 30 40 22 27 19 3 8 187 72 52 72 44 55 107 56 108 63 Percent Distribution 7.9 30.0 22.5 31.8 25.9 10.5 -- -- 19.8 42.1 30.0 27.5 40.9 33.3 15.8 66.7 25.0 32.6 26.3 33.3 27.5 4.5 11.1 36.8 -- 37.5 24.1 23.7 6.7 22.5 22.7 29.6 36.8 33.3 37.5 23.5 48 38 43 18 30 20 3 12 212 40 28 37 44 33 30 16 36 34 Percent Distribution 33.3 50.0 37.2 33.3 40.0 50.0 100.0 33.3 40.6 43.7 42.1 48.8 38.9 36.7 35.0 -- 58.3 42.4 20.8 5.3 7.0 27.8 10.0 10.0 -- 8.3 12.3 2.1 2.6 7.0 -- 13.3 5.0 -- -- 4.7 46 38 34 22 31 23 3 10 207 5.3 5.1 5.4 1.7 6.5 6.4 4.0 3.4 5.2 Percent Distribution -- -- -- -- - -- -- 2.2 -- 5.9 50.0 - -- -- 6.8 34.8 36.8 26.5 31.8 22.6 21.7 66.7 70.0 32.4 63.0 63.2 67.6 18.2 77.4 78.3 33.3 30.0 60.9 301 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-6. BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and Females Age (years) 6-16 Percent 70- 80- 90- 100- "Standard Weight" 79 89 99 109 110+ Unknown Total BLOOD Total Plasma Protein gm/100 ml No. 11 79 110 56 18 9 283 Mean 7.2 7.3 7.3 7.4 7.6 7.2 7.3 S.E.1/ 0.11 0.06 0.04 0.08 0.15 0.12 0.03 Percent Distribution 6.00-6.39 - 2.5 1.8 1.8 5.6 -- 2.1 6.40-6.99 36.4 26.6 29.1 28.6 5.6 22.2 26.8 >7.00 63.6 70.9 69.1 69.6 88.9 77.8 71.0 Albumin/Globulin Ratio No. 11 79 109 56 18 9 282 Mean 0.9 1.2 1.2 1.1 1.2 1.1 1.1 S.E. 0.13 0.04 0.03 0.03 0.06 0.06 0.02 Percent Distribution <0.5 - - 0.9 -- -- - 0.4 0.5-0.9 54.5 26.6 28.4 26.8 16.7 22.2 27.6 1.0-1.4 36.4 54.4 55.0 64.3 66.7 77.8 57.4 1.5-1.9 9.1 15.2 14.7 8.9 16.7 -- 13.1 >2.0 -- 3.8 0.9 - -- ... 1.4 Plasma Albumin gm/100 ml No. 11 79 109 56 18 9 282 Mean 3.4 3.8 3.8 3.8 4.0 3.8 3.8 S.E. 0.20 0.06 0.04 0.05 0.09 0.12 0.03 Percent Distribution <2.5 ... -- 1.8 -- -- -- 0.7 2.5=3.4 54.5 20.2 21.1 23.2 5.6 22.2 21.6 3.5-5.0 45.4 79.7 77.1 76.8 94.4 77.8 77.6 >5.0 - -- -- -- -- -- Plasma Globulin gm/100 ml No. 11 79 109 56 18 9 282 Mean 3.8 3.4 3.4 3.6 3.6 3.4 3.5 Percent Distribution 1.0-1.9 -- 1.3 -- -- -- -- 0.4 2.0-2.9 18.2 22.8 22.9 16.1 22.2 -- 20.6 3.0-3.5 18.2 38.0 41.3 37.5 22.2 77.8 38.6 >3.5 63.6 38.0 35.8 46.4 55.6 22.2 40.4 1/ S.E. = standard error. 302 Source: https://www.industrydocuments.ucst.edu/docs/snyc0227 APPENDIX TABLE VIII-6(Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and Nonpregnant, Nonlactating Females 17+ 80= 90- 100- <80 89 99 109 110+ Unknown Total BLOOD 30 68 58 28 28 3 215 7.4 7.4 7.4 7.6 7.4 8.3 7.4 0.08 0.07 0.08 0.09 0.11 -- 0.04 Percent Distribution -- 5.9 3.4 -- 3.6 3.2 16.7 11.8 20.7 7.1 21.4 -- 15.3 83.3 82.4 75.9 92.8 75.0 100.0 81.4 30 67 58 28 28 3 214 1.1 1.1 1.1 1.1 1.2 0.9 1.1 0.06 0.03 0.04 0.05 0.06 0.10 0.02 Percent Distribution - 1.5 - -- -- -- 0.5 20.0 31.3 29.3 21.4 21.4 66.7 27.1 63.3 59.7 58.6 71.4 50.0 33.3 59.8 13.3 7.5 12.1 3.6 25.0 - 11.2 3.3 --- -- 3.6 3.6 - 1.4 30 67 58 28 28 3 214 3.9 3.8 3.8 3.9 4.0 3.8 3.8 0.10 0.06 0.06 0.07 0.07 - 0.03 Percent Distribution -- 1.5 -- -- -- -- 0.5 13.3 19.4 17.2 7.1 7.1 -- 14.5 83.3 79.1 82.8 92.8 92.8 100.0 84.6 3.3 -- -- -- - - -- 0.5 30 67 58 28 28 3 214 3.5 3.6 3.6 3.7 3.4 4.4 3.6 Percent Distribution - -- -- -- -- - - - 16.7 13.4 19.0 3.6 32.1 -- 16.4 46.7 41.8 32.8 53.6 32.1 33.3 40.2 36.7 44.8 48.3 42.8 35.7 66.7 43.4 303 Source: https://www.industrydocuments.ucsf.edu/docsisnyc0227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and Females Age (years) 6-16 Percent 70- 80- 90- 100= "Standard Weight" 79 89 99 109 110+ Unknown Total Hemoglobin gm/100 ml No. 9 79 109 55 18 10 280 Mean 13.3 13.3 13.4 13.0 14.1 13.1 13.3 S.E. 1.15 0.19 0.14 0.22 0.27 0.43 0.10 Percent Distribution <12.0 22.2 12.6 11.9 12.7 - 20.0 12.1 12.0-13.9 44.4 51.9 55.0 60.0 44.4 70.0 54.6 14.0-14.9 27.8 24.8 23.6 33.3 - 24.3 >15.0 33.3 7.6 8.2 3.6 22.2 10.0 8.9 Hematocrit percent No. 10 74 106 54 18 10 272 Mean 35.3 40.0 40.0 39.0 40.7 41.3 39.4 S.E. 2.20 0.45 0.32 0.49 0.78 1.12 0.23 Percent Distribution <36 40.0 13.5 7.5 9.2 5.6 - 10.3 36-41 50.0 54.0 70.8 72.2 55.6 60.0 64.3 42-44 -- 24.3 15.1 14.8 27.8 20.0 18.0 >45 10.0 8.1 6.6 3.7 11.1 20.0 7.4 Mean Corpuscular Hemoglobin Concentration, percent No. 9 74 106 54 18 10 271 Mean 38.3 33.4 33.7 33.4 35.0 32.0 33.7 Percent Distribution <28.0 11.1 5.4 2.8 3.7 -- 10.0 4.0 28.0=29.9 -- 2.7 1.9 7.4 - 10.0 3.3 30.0-31.9 - 16.2 16.0 18.5 -- 20.0 15.1 >32.0 88.9 75.7 79.2 70.4 100.0 60.0 77.5 Plasma Vitamin C mg/100 ml No. 5 71 104 56 18 9 263 Mean 0.80 0.76 0.70 0.71 0.70 0.82 0.72 Percent Distribution <0.10 -- ... - -- -- -- -- 0.10~0.19 - 2.8 2.9 1.8 -- -- 2.3 0.20-0.39 -- 18.3 26.0 23.2 16.7 22.2 22.0 >0.40 100.0 78.9 71.2 75.0 83.3 77.8 75.7 304 Source: https:/lwww.industrydocuments.ucsf.edu/docsisnyc0227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and Nonpregnant, Nonlactating Females 17+ 80- 90- 100- <80 89 99 109 110+ Unknown Total 32 70 58 24 28 2 214 13.6 13.4 13.6 14.0 13.9 12.7 13.6 0.40 0.30 0.24 0.34 0.35 -- 0.14 Percent Distribution 25.0 22.8 13.8 16.7 10.7 -- 18.2 28.1 31.4 48.3 29.2 28.6 100.0 35.5 15.6 27.1 15.5 29.2 32.1 -- 22.9 31.2 18.6 22.4 25.0 28.6 (- 23.4 31 67 56 24 28 3 209 41.3 40.5 40.8 42.1 41.2 37.3 41.0 0.99 0.76 0.53 1.06 0.77 0.68 0.35 Percent Distribution 16.1 16.4 8.9 12.5 7.1 -- 12.4 35.5 34.3 51.8 29.2 53.6 100.0 42.1 16.1 19.4 19.6 16.7 25.0 19.1 32.2 29.8 19.6 41.7 14.3 -- 26.3 31 67 55 22 28 2 205 33.1 33.0 33.3 33.0 33.8 33.4 33.2 Percent Distribution 9.7 10.4 3.6 4.5 3.6 -- 6.8 12.9 9.0 5.4 4.5 14.3 - 8.8 16,1 11.9 14.5 18.2 14.3 50.0 14.6 61.3 68.6 76.4 72.7 67.8 50.0 69.8 29 67 56 26 28 3 209 0.58 0.53 0.46 0.52 0.53 0.51 0.52 Percent Distribution - 1.5 1.8 - -- -- 1.0 6.9 7.5 14.3 19.2 7.1 33.3 11.0 20.7 32.8 37.5 19.2 35.7 - 30.6 72.4 58.2 46.4 61.5 57.1 66.7 57.4 305 Source: https://www.industrydocuments.ucsi.edu/docsisnyco227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and Females Age (years) 6-16 Percent 70- 80- 90- 100- "Standard Weight" 79 89 99 109 110+ Unknown Total Plasma Vitamin A g/100 ml No. 10 79 108 56 17 9 279 Mean 28.9 29.6 28.5 30.7 36.5 27.3 29.7 Percent Distribution <10 -- -- 3.7 3.6 11.8 22.2 3.6 10-19 10.0 20.2 23.1 21.4 5.9 -- 19.7 20-49 80.0 72.2 64.8 58.9 58.8 66.7 65.9 >50 10.0 7.6 8.3 16.1 23.5 11.1 10.8 Plasma Carotene g/100 ml No. 10 79 108 56 17 9 279 Mean 86 82 74 76 78 59 77 Percent Distribution <20 -- -- 0.9 -- -- -- 0.4 20-39 7.6 11.1 12.5 17.6 22.2 10.8 40-99 90.0 65.8 71.3 66.1 58.8 77.8 68.8 >100 10.0 26.6 16.7 21.4 23.5 -- 20.1 Cholesterol mg/100 ml No. 11 78 107 56 18 9 279 Mean 165 176 170 172 182 173 173 Percent Distribution 70-99 -- -- -- -- -- -- - 100-149 45.4 21.8 29.9 25.0 27.8 22.2 26.9 150-199 36.4 56.4 54.2 58.9 44.4 77.8 55.2 >200 18.2 21.8 15.9 16.1 27.8 -- 17.9 B=Lipoprotein mm No. 10 59 70 31 8 8 196 Mean 2.5 2.5 2.9 2.5 2.5 2.4 2.6 Lipid Phosphorus mg/100 ml No. 11 78 107 56 18 9 279 Mean 9.4 9.6 9.6 9.8 9.4 9.7 9.6 306 Source: https:/lwww.industrydocuments.ucsf.edu/docsisnyc022/ APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and Nonpregnant, Nonlactating Females 17+ 80- 90- 100- <80 89 99 109 110+ Unknown Total 27 67 57 28 28 3 210 33.4 37.1 40.3 38.9 41.2 33.3 38.2 Percent Distribution -- 3.0 1.8 -- 3.6 -- 1.9 11.1 9.0 1.8 3.6 10.7 -- 6.7 74.1 71.6 70.2 82.1 60.7 100.0 71.9 14.8 16.4 26.3 14.3 25.0 -- 19.5 27 67 57 28 28 3 210 74 88 91 95 102 72 89 Percent Distribution 7.4 -- - -- -- 1.0 3.7 6.0 8.8 7.1 7.1 -- 6.7 59.2 61.2 56.1 50.0 53.6 100.0 57.6 29.6 32.8 35.1 42.8 39.3 -- 34.8 31 68 58 28 28 3 216 184 184 196 202 217 158 194 Percent Distribution -- 1.5 1.7 -- -- 0.9 12.9 16.2 6.9 10.7 7.1 66.7 12.0 58.0 51.5 48.3 50.0 28.6 -- 47.7 29.0 30.9 43.1 39.3 64.3 33.3 39.4 24 49 37 20 23 2 155 2.9 2.6 2.9 3.3 3.1 2.8 2.9 30 66 58 28 28 3 213 8.9 10.1 10.8 9.6 11.4 7.6 10.2 307 Source: https:/lwww.industrydocuments.ucsf.edu/docsisnyc0227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and Females Age (years) 6-16 Percent 70- 80- 90- 100- "Standard Weight" 79 89 99 109 110+ Unknown Total URINE Thiamine g/gm creatinine No. 9 60 84 46 12 6 217 Median 164 115 118 82 91 147 110 Percent Distribution <27 -- 1.7 1.2 -- -- -- 0.9 27=65 33.3 13.3 16.7 41.3 33.3 16.7 22.6 66-129 -- 45.0 39.3 34.8 41.7 16.7 37.8 >130 66.7 40.0 42.8 23.9 25.0 66.7 38.7 Riboflavin g/gm creatinine No. 10 63 95 48 16 7 239 Median 64 48 36 36 24 46 39 Percent Distribution <27 20.0 23.8 36.8. 33.3 62.5 14.3 33.0 27-79 40.0 55.6 45.3 58.3 37.5 42.8 49.8 80-269 40.0 20.6 13.7 6.2 - 42.8 15.1 >270 -- -- 4.2 2.1 -- -- 2.1 N'-Methylnicotinamide mg/gm creatinine No. 10 72 102 52 17 6 259 Median 7.3 8.3 7.0 6.4 7.0 5.4 7.2 Percent Distribution <0.50 -- 1.4 -- - - - 0.4 0.50-1.59 -- 4.2 1.0 3.8 -- -- 2.3 1.60-4.29 20.0 9.7 19.6 19.2 23.5 16.7 17.0 >4.30 80.0 84.7 79.4 76.9 76.5 83.3 80.3 308 Source: https:/lwww.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and Nonpregnant, Nonlactating Females 17+ 80- 90- 100- <80 89 99 109 110+ Unknown Total URINE 29 56 40 22 19 2 168 64 70 54 54 62 46 60 Percent Distribution 13.8 21.4 20.0 27.3 26.3 50.0 21.4 37.9 26.8 42.5 31.8 26.3 -- 32.7 31.0 23.2 12.5 27.3 31.6 50.0 23.8 17.2 28.6 25.0 13.6 15.8 -- 22.0 28 59 51 23 27 3 191 36 31 26 38 33 32 32 Percent Distribution 35.7 45.8 52.9 26.1 40.7 33.3 42.9 50.0 35.6 31.4 47.8 48.1 66.7 40.3 10.7 15.2 9.8 13.0 7.4 -- 11.5 3.6 3.4 5.9 13.0 3.7 -- 5.2 27 57 51 25 25 1 186 5.0 5.1 5.6 3.8 6.2 5.0 Percent Distribution -- -- -- - -- -- -- 3.7 7.0 3.9 16.0 4.0 -- 6.4 33.3 33.3 35.3 44.0 28.0 100.0 34.9 63.0 59.6 60.8 40.0 68.0 -- 58.6 309 Source: https://www.industrydocuments.ucst.edu/docsisnyc0227 APPENDIX TABLE VIII-7. SUGGESTED VALUES BY SEX AND AGE GROUPS FOR HEMOGLOBIN AND HEMATOCRIT Deficient Low Acceptable High Hemoglobin Males >13 years <12 12.0-13.9 14.0-14.9 >15.0 Females nonpregnant, nonlactating >13 years <10.0 10.0-10.9 11.0-14.4 >14.5 Children 3-12 years <10.0 10.0-10.9 11.0-12.4 >12.5 Hematocrit Males >13 years <36 36-41 42-44 >45 Females nonpregnant, nonlactating >13 years <30 30-37 38-42 >43 Children 3-12 years <30.0 30.0-33.9 34.0-36.9 >37.0 310 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-9. IODINE EXCRETION VS. PRESENCE OF GOITER, CIVILIANS AND MILITARY DEPENDENTS, MALAYA <15 Years 15+ Years Urinary Iodine Excretion Total Enlarged Thyroid Total Enlarged Thyroid g/gm creatinine Group No. Percent Group No. Percent 0-9 -- -- 10-19 5 1 20-29 20 1 7 1 30-39 19 1 12 3 40-49 11 1 9 50-99 20 2 16 2 100+ 7 8 Total 82 5 6.1 53 6 11.3 Mean 53 50 135 43 Total Enlarged Thyroid Urinary Iodine Group No. Percent <20 8 -- -- 20-29 37 2 5.4 30-39 44 4 9.1 40-49 30 1 3.3 50+ 72 4 5.6 Total 191 11 5.8 Source: https://wwww.industrydocuments.ucsf.edu/docs/snyc0227 1/ APPENDIX TABLE VIII-10. SUGGESTED GUIDE TO INTERPRETATION OF BIOCHEMICAL DATA Deficient Low Acceptable High Blood Total Plasma Protein, gm/100 ml < 6.00 6.00-6.39 6.40-6.99 >7.00 Plasma Albumin, gm/100 ml < 2.5 2.5-3.4 3.5-5.0 >5.0 Globulin, gm/100 ml < 2.0 2.0-2.9 3.0-3.5 >3.5 Albumin/Globulin Ratio < 1.0 1.0-1.4 1.5-1.9 >2.0 Hemoglobin, gm/100 ml <12.0 12.0-13.9 14.0-14.9 >15.0 Hematocrit, percent <36 36-41 42-44 >45 Mean Corpuscular Hemoglobin Concentration, percent <28.0 28.0-29.9 30.0-31.9 >32.0 Plasma Vitamin A, g/100 ml <10 10-19 20-49 >50 Plasma Carotene, g/100 ml <20 20-39 40-99 >100 Plasma Vitamin C, mg/100 ml < 0.10 0.10-0.19 0.20-0.39 >0.40 Urine Thiamine, g/gm creatinine <27 27-65 66-129 >130 Riboflavin, g/gm creatinine <27 27-79 80-269 >270 N'-Methylnicotinamide, mg/gm creatinine < 0.50 0.50-1.59 1.60-4.29 >4.30 1/ Based on ICNND suggested reference values. Source: https://www.industrydocuments.ucst.edu/docsisnyc0227

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xhfg0227_p25, xhfg0227_p26, xhfg0227_p27, xhfg0227_p28, xhfg0227_p29, xhfg0227_p30, xhfg0227_p31, xhfg0227_p32, xhfg0227_p33, xhfg0227_p34, xhfg0227_p35, xhfg0227_p36, xhfg0227_p37, xhfg0227_p38

52,525

of these kinds of services, though hard to measure, will decrease in 1963 because of cut-backs in funds for State personnel in all administrative agencies and at all pro- fessional levels. 3) Federal grants-in-aid Table V-13 shows the proportion of local public health funds received in 1962 from federal grant sources to be about 15%. Those funds administered by the State Health Depart- ment, and disbursed to local health districts by a distribution formula which considers both financial needs and population size, have applied to : Cancer, general health and community health services, heart, maternal and child health, and water pollution. Crippled children's program funds are administered by the State Department of Welfare. Portions of salaries of persönnel in state regional and central offices, and drugs distributed free to local health districts, are financed by federal formula grancs. Federal money has been used to finance special projects in local health districts, or aid general health services. The proportion of Cuyahoga County (and Cleveland) public health ser- vices financed through state administered federal grants is reflected in Table V-14 in the Appendix. This table also shows the federal assistance -22- Source: https://www.industrydocuments.ucsf.edu/docsixhfg022 portions of other health programs in Cuyahoga County, not administered by the Health Departments. It is possible that Ohio's 1963 austerity program will also result in a diminution of some of the federal grant funds accruing to local health districts. There were programs in the planning stages for which some federal funds had been received that cannot be carried out because of the cut-back in personnel, or the "freeze" order prohibiting the addition of new employees or the replacement of personnel retired, re- signed, or lost by death. Sources of Income to Local Health Districts, Other Than State Aid There are five sources from which local health districts may re- ceive funds other than state subsidies or federal grants-in-aid. They are: Deductions from property taxes distributed to town- ships and villages; licenses, permits and inspection fees; contractual agreements with cities and Boards of Education; agency grants; voted public health levies limited in County Districts to .5 mill Property Taxes - This is the traditional and major source of public health financing. Monies for health districts are deducted by the County Auditor from taxes levied within a 10 mill limitation. Figure V-3 shows that, in 1962, the Cuyahoga County General Health District derived 6% of its income from village and township taxation, and another 63% from contracts - 23 - Source: https://www.industrydocuments.ucsf.edu/docsxhfg0227 with cities and school boards. The contract funds are, in turn, derived from the tax funds of these jurisdictions, plus state subsidies, (which are re- flected separately in Figure V-3). The City of Cleveland's public health program received 76% of its financial support from taxation. Cuyahoga County voters have not had a health levy before them. Fees - Income is derived in some Ohio cities and counties from as many as forty different kinds of fees. In the Cuyahoga County General Health District fees are collected, for example, for licensing milk and meat handling establishments, food handling and processing, trailer parks. Fees are collected for issuing birth and death certificates. Fee collection is not specifically authorized by law, and in some counties, court decisions have prohibited or restricted the collection of such fees. Contracts - Only four General Health Districts in Ohio have contractual arrangements with one or more cities. Cuyahoga is one of these, providing services to 30 contracting cities. The law requires that it must be determined by the Ohio Department of Health that the General Health District is organized and equipped to provide adequate health services by this -24- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 Figure V-3 1962 INCOME BY SOURCE OF FUNDS City of Cleveland, Division of Health Cuyahoga County General Health District City of Cleveland Total: $1,964,801 MEDICAL CARE-INDIGENT - 1 % MISCELLANEOUS (including I A X E S cash balance) - 3% STATE SUBSIDY - 0.1 % from City; County and State 76% FEES AND LICENSES 20% Cuyahoga County Total: $531,331 MISCELLANEOUS (including cash balance) - 11% STATE SUBSIDY - 109 c/o I A X E S from cities; county FEES AND LICENSES - 5% Boards or Education 639 % FEDERAL - 5 % from villages and townships - 6 % -25- Source: https:I/www.industrydocuments.ucsf.edu/docs/xhfgo227 method. The Cuyahoga County General Health District also provides services by contract to 25 Boards of Education. There are four municipalities in Cuyahoga County, plus the city of Cleveland, maintaining independent municipal health departments - Shaker Heights, Cleveland Heights, East Cleveland and Lakewood. * Table V-15 CUYAHOGA COUNTY HEALTH DISTRICTS 19/ TOTAL LOCAL BUDGETS - 1963 Per Increase or Funds for Capita Decrease City Public Health Approp. From 1962 (less Fed. GIA) City of Cleveland 2,204,443 2.56 +10.5 Cuyahoga County General Health District and contracting cities 525,414 .81 + 4.0 Cleveland Heights 60,805 .97 + 1.5 East Cleveland 38,450 1.03 + 2.6 Shaker Heights 21,987 .57 + 3.0 Lakewood 52,525 .80 -14.7 The current recommendations of the American Public Health Assoc- iation are that per capita appropriations should exceed $2.50. *In its "Financial Report of Local Health Departments-1963", - the Ohio Department of Health has given these independent health departments of the smaller municipalities the following designations: Qualified (full-time) - Cleveland Heights and East Cleveland Unqualified (part-time) - Shaker Heights and Lakewood - 26 - Source: https://www.industrydocuments.ucsf.edu/docs/xhfg0227 PUBLIC HEALTH EXPENDITURE AND ABILITY TO PAY The per capita tax valuation can be used as a measure of a district's ability to appropriate funds for public health. The Ohio State Department of Health has ranked Health Districts in order of per capita assessed val- uation (1962) as compared with a rank order for per capita local appro- 20/ priation. There are 281 statutory Health Districts. In Table V-16 the rank order by assessed valuation and by local health appropriation of Cuyahoga County's General Health District and each separate municipal Health Department within the county, is compared with similar data for Summit County and the City of Akron. Cuyahoga County's General Health District is a contracting system; that is a number of city health districts within the geographic boundaries of the county contract with the General Health District for services. All municipalities eligible by statute for the designation "Health District" contract with the county except those four previously mentioned and the City of Cleveland as stated; twenty-five Boards of Education also contract for School Health Services. (This represents all Boards of Education with- in its jurisdiction, but two). The County General Health District Board of Health also serves all primary parochial schools in its jurisdiction. While the administrative structure of the Summit County General Health District follows the pattern known as combined, * it was chosen as the most appropriate for comparison with Cuyahoga County because its public health expenditures cover a similar array of services including comprehensive school health programs. (The Summit County General Health District serves all Boards of Education in its jurisdiction). The City of Cleveland provides comprehensive school health programs in primary parochial schools, and the Cleveland Board of Education in the public schools, but there is also good cooperation between the two juris- dictions. The City of Akron Health Department serves all public, private and parochial schools within the city limits. There is a combined Board of Health as provided in the Ohio Revised Code. Three municipalities within Summit County also contract with the General Health District for services, and each is entitled to one representative on the 7-man Board of Health. The cities of Akron and Barberton have independent Health Departments. - 27 - Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 TABLE V-16 HEALTH APPROPRIATIONS IN CUYAHOGA AND SUMMIT COUNTIES 1963 Rank By Per Capita Rank By Per Capita Assessed Health Health Local Health Valuation (1962) District Appropriation Appropriation CUYAHOGA COUNTY 41 General Health District .81 170 (with contracting municipalities ranging from 10th to 244th) 17 Shaker Heights .57 210 83 Cleveland Heights .97 143 118 East Cleveland 1.03 127 151 Lakewood .80 171 37 City of Cleveland 2.56 8 SUMMIT COUNTY 116 General Health District 1.82 29 109 City of Akron 2.08 15 - 28 - Source: https://www.industrydocuments.ucsf.edu/docs/xhfg0227 EXPENDITURES OF MAJOR CUYAHOGA COUNTY HEALTH DEPARTMENTS BY PROGRAM Figure V=4 analyzes the expenditures of the Cuyahoga County General Health District, including contracting cities, and of the City of Cleveland Division of Health, by program. It will be noted that both major Health Departments allocate a large proportion of budget to Public Healch nursing, and that, in the County, services by nurses to the public school health programs are included. In the city the public school health program is separate, staffed and financed by the Board of Education. The City of Cleveland is able to maintain a professionally staffed laboratory. The County uses state laboratory facilities. The city has a staff of full and part-time physicians` to cover both home care of the medically indigent population, and some preventive and control programs in communicable disease and venereal disease. The County uses state regional office services for V.D. control, and must rely even more heavily than the City of Cleveland on nursing services in, for example, infectious disease work. The vital statistics services which receive 6% of the Cleveland city budget, represent a geographic area for reporting greater than the city's confines, since registration districts fixed by separate state statutes are designated as this department's responsibility. The city's registrar is not, however, responsible for the entire county. Food and sanitation inspection services consume about 1/3 of each Health District budget. In the county this program includes: sampling and testing of water; inspection of sewage disposal facilities; inspection of garbage and refuse disposal arrangements; some housing inspection; -29- Source: https://www.industrydocuments.ucst.edu/docsixhfg0227 Figure V-4 1962 EXPENDITURES BY PROGRAM City of Cleveland, Division of Health Cuyahoga County General Health District City of Cleveland Total: $1,955,751 FOOD AND SANITATION CONTROL LABORATORY - 6 % SCHOOL MEDICAL 2 8 % SERVICES - 9 % (Est) VITAL STATISTICS - 6% MEDICAL SCHOOL HEALTH SERVICES NURSING - 9 % (Est) PUBLIC 16; % HEALTH NURSING 26% Cuyahoga County Total: $476,856 FOOD AND SANITATION CONTROL 30% MEDICAL SERVICES - 3 % PUBLIC SCHOOL MEDICAL SERVICES - 5 % HEALTH SCHOOL HEALTH NURSING NURSING 45% 17% -30- Source: https://www.industrydocuments.ucsf.edu/docs/xhfg0227 some vector control programs; and food and milk service and handling consultation and inspection programs. In the city food handler programs, milk, meat and poultry processing inspection; rat control; and some public building inspection (barber shops, laundries, hotels, trailer camps) are under the supervision of the Sanitary Unit of the City Division of Health. Collection and dis- posal of garbage and refuse is the responsibility of the Department of Public Service. The Division of Sewage Disposal is a section of the Public Utilities Department. The City Department of Urban Renewal and Housing is responsible for most programs of hygiene of housing, and for inspection of all nursing homes, hospitals and maternity wards as provided for in the Ohio codes. This Department also operates the Division of Air and Stream Pollution. No expenditures for such programs are reflected, then, in the food and sanitation budget of the Cleveland City Division of Health. -31- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 TRENDS IN EXPENDITURES FOR ALL HEALTH SERVICES IN CUYAHOGA COUNTY The Cleveland Welfare Federation has prepared an analysis of income and expenditures of all Health, Welfare and Recreation programs, according to United Community Funds and Councils of America classifications. Trends in health financing are demonstrated by comparing 1955 and 1960. Table V-17 summarizes these trends, and full details are recapi- tulated in Tables V-14 a & b in the Appendix. In the five year span, expenditures for health and medical care have increased in Cuyahoga County, by 72%, but the private philanthropic and agency self-support share of this has had to increase, while the tax dollar portion has actually de- creased. This trend holds for individual areas of health expenditure such as hospitals, including state and county=operated facilities. The medical vendor payments of family and child welfare programs did receive greater federal assistance in 1960 than in 1955, while the local tax share also increased and the state support decreased. Criteria for eligibility for payment of medical care costs, par- ticularly hospitalization, for the "medically indigent", were reduced in 1961, by a resolution of the County Commissioners to cover only those families whose income and resources did not exceed 80% of the State Wel- fare Department standards, and all persons over 65 were declared 21/ ineligible. As of 1963, state matching funds to General Relief were cut from 50% to 40%, putting medical vendor payments for both relief families and the undefined "medically indigent" into further jeopardy. Yet, from 1952 to 1962 medical and health care costs to public assistance 22/ programs in Cuyahoga County had risen 387%. -32- Source: https:/lwww.industrydocuments.ucsf.edu/docsixhfg0227 The question of defining medical indigency plus assessment of fiscal responsibility for payment is the current subject of litigation brought by certain hospitals. The only major public health program in which both local and private financial support showed a decrease, while total expenditures increased, was that of local health departments, but their total expenditures for public health services rose only 31% in the 5 years, while hospital expenditures rose 73.5% and those of public assistance programs - 167.5% (see figures V-5 to V-8). Table V-17 EXPENDITURES FOR HEALTH AND MEDICAL CARE UNDER ALL AUSPICES IN CUYAHOGA COUNTY, BY SOURCE OF FUNDS * 1955 - 1960 (In Thousands of Dollars) 1 9 6 0 % 1955 % of % of Increase Amount Total Amount Total 1955-1960 All Sources $ 72,728 100.0% $125,082 100.0% 72.0 Public (tax support) 22,337 30.7 29,130 23.3 30.4 Private (philanthropic 50,391 69.3 95,954 76.7 90.4 contributions, fees to hospitals, etc. SOURCES: 1. Expenditure Studies for Health, Welfare and Recreation Services, 1955 and 1960: Research Department, Welfare Federation of Cleveland 2. Financial Reports of Department of Public Welfare, State of Ohio 3. Ohio Citizens' Council 4. Fiscal Officers of Veterans Administration Does not include private out of pocket payments for direct medical and dental care, or for health insurance. -33- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 Figure V - 5 EXPENDITURES FOR HEALTH CARE SERVICES UNDER ALL AUSPICES IN CUYAHOGA COUNTY, BY SOURCE OF FUNDS 1955 - 1960 DOLLARS (Millions) $125,082,000 120 110 23 100 4 90 80 $72,728,000 70 60 31 50 5 40 30 20 64 72 10 1955 1960 KEY: Self Public Support (Gov't) Contri- 9 Percent bution of Total -34- Source: https://www.industrydocuments.ucst.edu/docsixhfg227 Figure V-6 EXPENDITURES FOR HEALTH CARE SERVICES BY HOSPITALS IN CUYAHOGA COUNTY, BY SOURCE OF FUNDS 1955 - 1960 DOLLARS (Millions) $116,666,000 110 20 100 90 3 80 70 $67,238,000 60 29 50 3 40 77 30 68 20 10 1955 1960 KEY: Self Public Support (Gov't) Contri- 5 Percent bution of Total -35- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227

What quantity of "tryptophan equals 1 milligram niacin?

qtpg0227

qtpg0227_p0

60 milligrams

lst Working Draft Food and Nutrition Board, National Academy of Sciences-National Research Council Recommended Daily Dietary Allowances¹, , Revised 1963 Designed for the maintenance of good nutrition of practically all healthy persons in the U.S.A. (Allowances are intended for persons normally active in a temperate climate) Pro- Cal- Vita- Equiv 3 2 Thia- Ribo= Ascores Vita- Age Weight He ght Calo tein cium Iron min A mine flavin Niacin bic Acid min D years kg. (lbs.) cm. (in. ries gm. gm. mg. I.U. mg. mg. mg. me. I.U. Men 25 70 (154) 175 (69) 3000 70 0.8 5000 1.2 1.8 20 70 45 70 (154) 175 (69) 2700 70 0.8 5000 1.1 1.6 18 70 65 70 (154) 175 (69) 2400 70 0.8 5000 1.0 1.4 16 70 Women 25 58 (128) 163 (64) 2200 58 0.8 5000 0.9 1.3 15 70 45 58 (128) 163 (64) 2000 58 0.8 5000 0.8 1.2 13 70 65 58 (128) 163 (64) 1800 58 0.8 5000 0.8 1.1 12 70 Pregnant (last Trimester) +200 +20 +0.5 + 1000 +0.2 +0.3 + 3 + 30 400 Lactating + 1000 +40 +0.5 +3000 + 0.4 +0.6 +' 7 +30 400 Infants O-1 Kgx115 Kgx2.5 0.7 30 1144 -0.5 4 Children 1-3 12 (27) 87 (34) 1400 35 0.8 2000 0.6 0.8 9 40 400 3-6 18 (40) 107 (42) 1600 40 0.8 2500 0.6 1.0 11 50 400 6.9 24 (53) 124 (49) 2100 52 0.8 3500 0.8 1.3 14 60 400 Boys 9-12 33 (72) 140 (55) 2400 60 1.1 4500 1.0 1.4 16 70 400 12-15 45 (98) 156 (61.) 3000 75 1.4 5000 1.2 1.8 20 8o 400 15-18 61 (134) 172 (68) 3400 85 1.4 5000 1.4 2.0 22 80 400 Girls 9-12 33 (72) 140 (55) 2200 55 1.1 4500 0.9 1.3 15 80 400 12-15 47 (103) 158 (62) 2500 62 1.3 5000 1.0 1.5 17 8o 400 15-18 53 (117) 163 (64) 2200 55 1.3 5000 0.9 1.3 15 70 400 the allowance levels are intended to cover individual is from beginning of lst year to end of 2nd year; variations among most normal persons as they live in the 3-6 (representing 43 years) is from beginning of United States under usual environmental stresses. The 3rd to end of 5th year, etc. recommended allowances can be attained with a variety of common foods, providing other nutrients for which human 3Niacin equivalents include dietary sources of the requirements have been less well defined. See text for preformed vitamin and the precursor, tryptophan. 60 more detailed discussion of allowances and of nutrients milligrams tryptophan equals 1 milligram niacin. not tabulated. The calorie and protein allowances per kilogram for 2adult age entry 25 is for period 18-35, 45 is for infants are considered to decrease progressively from 35-55, 65 for 55=75. The age entries for infants and birth; i.e., at birth calorie allowance is 125 per kg. children mark the beginning of each age, e.ge: 0.1 is protein allowance is 3.0 gm. kg. Protein allowance from birth to end of lst year; 1-3 (representing 2 years) for infants and children approximate 10% of total calories from protein. Source: https://www.industrydocuments.ucst.edu/docs/qtpg022

How many females are deficient in hemoglobin ?

snyc0227

snyc0227_p288, snyc0227_p289, snyc0227_p290, snyc0227_p291, snyc0227_p292, snyc0227_p293, snyc0227_p294, snyc0227_p295, snyc0227_p296, snyc0227_p297, snyc0227_p298, snyc0227_p299, snyc0227_p300, snyc0227_p301, snyc0227_p302, snyc0227_p303, snyc0227_p304, snyc0227_p305, snyc0227_p306, snyc0227_p307, snyc0227_p308

<10.0, <10

APPENDIX VII-1.GLOSSARY OF COMMONLY SERVED MALAY DISHES Sambal belachan Aged fish paste mixed with chillies, onions, etc. Sambal telor A fried dish of egg, belachan and sambal. Ikan goreng Fried fresh or salt fish. Tumis togei A common Malay dish made from bean sprouts, to which are added fried condiments and water. Quai kodok A breakfast food made from water, wheat flour and salt. The batter is dropped into coconut oil and deep=fried. Apam balek A common Malay breakfast food similar to a pancake. The batter is made of wheat flour, water and sliced bananas. The kuali is lightly oiled and then rubbed with a piece of fresh coconut. Enough batter for one apam balek is spread thinly over the surface. When cooked, a spoonful of a mixture of shredded fresh coconut and brown sugar is placed in the center and the cake is rolled up. Tumis Vegetables fried in coconut oil to which condiments and spices have been added. Pisang goreng Special varieties of bananas (green) sliced in half length wise and dipped in a batter of wheat flour and water, and deep=fried in coconut oil. Roti chanai A favorite breakfast item resembling a pancake, made from a soft dough of wheat flour, water and coconut oil. The oil is added by kneading and working the dough by hand. The dough is worked in individual amounts, pulled and stretched over a flat surface until paper thin and then rolled in a long thin strip and wound together in a spiral to give a circular flat cake about six inches in diameter which is fried in the kuali. Children eat them with sugar. Adar=adar A pancake batter of wheat flour and water. After frying, the pancake is spread with a previously fried mixture of shredded fresh coconut and brown and white sugar. Goreng keledeh Keledeh is similar to sweet potato. In Malaya it is often sliced raw, dipped in rice flour and water and deep fried in coconut oil for breakfast. Achar timun Raw cucumber mixed with raw onion and fresh chilli, re- sembling a pickle. Gulai ikan (fish Fish cooked in water or santan to which condiments and curry) spices are added. Goreng kajong Long green beans fried in coconut oil with ikan bilis. Sayor lemak paku Young fern shoots boiled in santan to which condiments are added. 292 Source: https://wwww.industrydocuments.ucsf.edu/docsisnyc0227 APPENDIX TABLE VII-2. RECOMMENDED DAILY DIETARY , Age Body Vita- Thia- Ribo- Ascorbic Vita- (years) Weight Calories Protein Calcium Iron min A mine flavin Niacin³/ Acid min D kg gm gm mg IU mg mg mg mg IU equiv- alent Men 25 55 2,570 55 0.5 10 5,000 1.3 1.4 17 75 45 55 2,430 55 0.5 10 5,000 1.2 1.4 16 75 65 55 2,050 55 0.5 10 5,000 1.0 1.4 14 75 Women 25 50 1,900 50 0.5 12 5,000 1.0 1.3 17 70 45 50 1,860 50 0.5 12 5,000 1.0 1.3 16 70 65 50 1,520 50 0.5 12 5,000 1.0 1.3 13 70 Pregnant (2d half) +285 +20 1.0-1.2 15 6,000 1.1 1.8 +3 100 400 Lactating +950 +40 1.0-1.2 15 8,000 1.4 2.3 +2 150 400 Infants 0-1 (6)4/ (Age in 2-6 (9)kg X 115 See Foot- 0.5-0.6 5 1,500 0.3 0.4 5 30 400 months) 7-12 kg X 95 note 5/ 0.5-0.6 7 1,500 0.4 0.5 6 30 400 Children 1-3 1,240 40 1.0 7 2,000 0.6 1.0 8 35 400 4-6 1,620 50 1.0 8 2,500 0.8 1.3 11 50 400 7-9 2,000 60 1.0 10 3,500 1.0 1.5 13 60 400 10-12 2,380 70 1.2 12 4,500 1.2 1.8 16 75 400 Boys 13-15 2,950 85 1.4 15 5,000 1.5 2.1 19 90 400 16-19 3,420 100 1.4 15 5,000 1.7 2.5 23 100 400 Girls 13-15 2,470 80 1.3 15 5,000 1.2 2.0 16 80 400 16-19 2,280 75 1.3 15 5,000 1.1 1.9 15 80 400 1/ Estimated requirements of essential nutrients for individuals in Malaya, based on the recommendations of the Food and Nutrition Board, National Research Council, U.S.A. (1958; 3), and modified for local climatic conditions. 2/ IMR Report No. 64 (2). 3/ Niacin equivalents include dietary sources of the preformed vitamin and the precursor tryptophan (60 mg tryptophan = 1 mg niacin). 41 These figures represent ideal weights (in kg) for babies. 5 Needs can be met by 3.5 gm/kg in first 6 months and 3 gm/kg for remainder of first year. Source: https:/lwww.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5. BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and females Age (years) 5-14 Location Total BLOOD Total Plasma Protein gm/100 ml No. 45 18 29 43 58 42 32 267 Mean 7.0 8.1 7.3 7.3 7.3 7.3 7.1 7.3 Percent Distribution 6.00-6.39 6.7 -- - 1.7 -- 3.1 1.9 6.40-6.99 48.9 -- 24.1 27.9 20.7 28.6 37.5 28.8 >7.00 44.4 100.0 75.9 72.1 77.6 71.4 59.4 69.3 Albumin/Globulin Ratio No. 45 18 29 43 58 41 32 266 Mean 1.3 0.9 1.2 0.9 1.2 1.3 1.0 1.1 Percent Distribution <0.5 - - -- 2.3 -- -- -- 0.4 0.5-0.9 6.7 72.2 24.1 69.8 6.9 17.1 37.5 28.6 1.0-1.4 75.6 27.8 65.5 20.9 69.0 56.1 62.5 56.4 1.5-1.9 11.1 -- 10.3 7.0 24.1 24.4 -- 13.2 >2.0 6.7 -- -- -- -- 2.4 -- 1.5 Plasma Albumin gm/100 ml No. 45 18 29 43 58 41 32 266 Mean 3.9 3.8 3.9 3.3 4.0 4.0 3.5 3.8 Percent Distribution <2.5 - - -- 4.6 -- -- -- 0.8 2.5-3.4 15.6 22.2 17.2 60.5 1.7 9.8 43.8 22.9 3.5-5.0 84.4 77.8 82.8 34.9 98.3 90.2 56.2 76.3 >5.0 -- -- -- -- -- -- Plasma Globulin gm/100 ml No. 45 18 29 43 58 41 32 266 Mean 3.1 4.3 3.4 4.0 3.3 3.3 3.6 3.5 Percent Distribution 1.0-1.9 2.2 - -- -- -- -- - 0.4 2.0-2.9 31.1 - 13.8 7.0 29.3 36.6 12.5 21.4 3.0-3.5 55.6 5.6 55.2 14.0 39.6 39.0 40.6 37.6 >3.5 11.1 94.4 31.0 79.1 31.0 24.4 46.9 40.6 294 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and nonpregnant, nonlactating females 15+ Total BLOOD 52 40 50 22 34 24 2 14 238 7.2 7.8 7.4 7.6 7.4 7.4 7.8 7.7 7.5 Percent Distribution 11.5 -- -- 2.9 4.2 - -- 3.4 17.3 7.5 24.0 4.5 20.6 16.7 -- 7.1 15.5 71.2 92.5 76.0 95.4 76.5 79.2 100.0 92.8 81.1 52 40 50 22 34 24 2 13 237 1.2 1.2 1.1 1.1 1.1 1.2 1.0 0.8 1.1 Percent Distribution - - - 4.5 -- - -- - 0.4 13.5 25.0 22.0 27.3 35.3 29.2 50.0 61.5 26.2 67.3 52.5 66.0 54.5 61.8 54.2 50.0 38.5 59.5 17.3 22.5 12.0 9.1 2.9 12.5 -- 12.6 1.9 - -- 4.5 -- 4.2 -- -- 1.3 52 40 50 22 34 24 2 13 237 3.8 4.2 3.9 3.8 3.8 3.9 3.9 3.4 3.9 Percent Distribution -- -- 4.5 -- -- -- 0.4 11.5 2.5 12.0 22.7 20.6 4.2 -- 53.8 13.9 88.5 97.5 88.0 68.2 79.4 95.8 100.0 46.2 85.2 -- 4.5 -- -- -- -- 0.4 52 40 50 22 34 24 2 13 237 3.3 3.6 3.5 3.8 3.6 3.5 3.8 4.2 3.6 Percent Distribution - - - -- - - 30.8 17.5 16.0 13.6 5.9 16.7 - - 16.9 48.1 40.0 42.0 40.9 41.2 41.7 - 7.7 40.5 21.2 42.5 42.0 45.4 52.9 41.7 100.0 92.3 42.6 295 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and females Age (years) 5-14 Location Total BLOOD Hemoglobin gm/100 ml No. 45 18 30 40 58 43 32 266 Mean 13.5 13.5 12.6 13.6 12.8 13.8 12.8 13.2 Percent Distribution <12.0 6.7 11.1 20.0 10.0 24.1 7.0 6.3 12.8 12.0-13.9 71.1 55.6 63.3 42.5 50.0 48.8 78.1 57.5 14.0-14.9 13.3 11.1 16.7 30.0 22.4 37.2 15.6 22.2 >15.0 8.9 22.2 17.5 3.4 7.0 - 7.5 Hematocrit percent No. 45 18 29 34 58 42 32 258 Mean 39.8 41.5 38.4 37.5 39.3 40.3 38.0 39.2 Percent Distribution <36 6.7 5.6 10.3 20.6 10.3 2.4 18.8 10.5 36-41 73.3 38.9 75.9 67.6 60.3 73.8 68.8 67.0 42-44 8.9 38.9 10.3 11.8 27.6 14.3 9.4 16.7 >45 11.1 16.7 3.4 -- 1.7 9.5 3.1 5.8 Mean Corpuscular Hemoglobin Concentration, percent No. 45 18 29 34 58 42 32 258 Mean 34.0 32.7 32.7 36.0 32.5 34.2 33.6 33.7 Percent Distribution <28.0 13.8 5.9 5.2 4.8 3.1 4.6 28.0-29.9 2.2 5.6 3.4 2.9 8.6 -- -- 3.5 30.0-31.9 15.6 38.9 10.3 2.9 17.2 7.1 21.9 14.7 >32.0 82.2 55.6 72.4 88.2 69.0 88.1 75.0 77.1 Plasma Vitamin C mg/100 ml No. 45 18 28 25 58 42 32 248 Mean 0.65 0.60 0.79 0.30 0.79 1.11 0.59 0.73 Percent Distribution <0.10 - -- -- -- -- -- -- - 0.10-0.19 - -- -- 12.0 3.4 -- -- 2.0 0.20-0.39 28.9 22.2 17.8 72.0 6.9 4.8 37.5 23.4 >0.40 71.1 77.8 82.1 16.0 89.6 95.2 62.5 74.6 296 Source. https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and nonpregnant, nonlactating females 15+ Total BLOOD 50 40 46 21 35 24 6 14 236 14.5 14.2 12.4 14.6 12.7 13.9 12.8 14.0 13.6 Percent Distribution 4.0 5.0 41.3 9.5 22.8 12.5 33.3 14.3 16.9 32.0 40.0 37.0 9.5 48.6 37.5 50.0 21.4 35.2 24.0 30.0 13.0 47.6 20.0 25.0 -- 35.7 24.6 40.0 25.0 8.7 33.3 8.6 25.0 16.7 28.6 23.3 52 38 47 18 35 22 5 14 231 42.5 43.6 38.2 42.6 39.8 40.6 39.4 40.3 41.0 Percent Distribution 7.7 - 21.3 5.6 11.4 18.2 40.0 14.3 11.7 38.5 34.2 57.4 33.3 48.6 36.4 20.0 42.8 42.4 15.4 26.3 12.8 33.3 20.0 22.7 20.0 21.4 19.9 38.5 39.5 8.5 27.8 20.0 22.7 20.0 21.4 26.0 50 38 44 18 35 22 5 14 226 34.2 32.6 32.5 34.7 27.7 34.0 34.6 34.8 33.3 Percent Distribution 2.0 - 15.9 -- 8.6 4.5 40.0 .... 6.2 4.0 18.4 11.4 -- 11.4 -- -- -- 8.0 10.0 26.3 15.9 11.1 20.0 4.5 -- 14.3 15.0 84.0 55.3 56.8 88.9 60.0 90.9 60.0 85.7 70.8 52 40 50 16 35 24 -- 14 231 0.48 0.52 0.68 0.24 0.43 0.71 -- 0.48 0.53 Percent Distribution -- -- - -- 5.7 -- -- - 0.9 13.5 10.0 -- 50.0 5.7 -- -- 21.4 10.4 32.7 30.0 16.0 43.8 42.8 16.7 - 21.4 28.6 53.8 60.0 84.0 6.2 45.7 83.3 -- 57.1 60.2 297 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and females Age (years) 5-14 Location Total BLOOD Plasma Vitamin A g/100 ml No. 45 18 29 41 58 42 32 265 Mean 26.6 28.2 25.5 25. 8 41. 1 19.2 26.9 28.5 Percent Distribution <10 -- -- 3.4 - 23.8 -- 4.2 10-19 15.6 27.8 20.7 24.4 13.8 38.1 12.5 21.1 20-49 82.2 61.1 75.9 73.2 46.6 38.1 87.5 64.5 >50 2.2 11.1 -- 2.4 39.6 - -- 10.2 Plasma Carotene g/100 ml No. 45 18 29 41 58 42 32 265 Mean 80 64 64 90 71 74 78 76 Percent Distribution <20 -- -- -- -- - 3.1 0.4 20-39 6.7 27.8 20.7 4.9 12.1 11.9 9.4 11.7 40-99 68.9 55.6 75.9 61.0 72.4 76.2 62.5 68.7 >100 24.4 16.7 3.4 34.1 15.5 11.9 25.0 19.2 Cholesterol mg/100 ml No. 43 18 29 42 58 41 32 263 Mean 171 177 179 169 174 180 150 171 Percent Distribution 70-99 -- -- -- - -- 3.1 0.4 100-149 30.2 22.2 10.3 33.3 25.9 17.1 50.0 27.4 150-199 55.8 61.1 72.4 50.0 53.4 65.8 40.6 56.3 >200 14.0 16.7 17.2 16.7 20.7 17.1 6.2 16.0 P-Lipoprotein mm No. 44 - 30 42 4 42 32 194 Mean 2.5 - 2.7 2.7 2.3 2.4 2.5 2.6 Lipid Phosphorus mg/100 ml No. 43 18 28 42 58 42 32 263 Mean 9.8 8.0 9.4 8.6 10.2 10.5 10.4 9.7 298 Source: https://www.industrydocuments.ucsf.edu/docssnyco227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and nonpregnant, nonlactating females 1,5+ Total BLOOD 52 39 48 22 33 24 -- 14 232 39.9 38.2 30.6 43.7 51.8 26.3 -- 43.2 38.5 Percent Distribution -- -- 2.1 -- -- 12.5 -- 1.7 1.9 -- 10.4 4.5 -- 29.2 -- -- 6.0 86.5 87.2 83.3 63.6 48.5 45.8 -- 71.4 73.3 11.5 12.8 4.2 31.8 51.5 12.5 -- 28.6 19.0 52 39 48 22 33 24 -- 14 232 103 82 69 107 74 99 -- 126 90 Percent Distribution - -- 4.2 -- -- -- -- -- 0.9 1.9 7.7 8.3 - 18.2 4.2 -- -- 6.5 50.0 66.7 72.9 45.4 66.7 50.0 -- 28.6 58.2 48.1 25.6 14.6 54.5 15.2 45.8 -- 71.4 34.5 52 40 50 22 35 24 2 14 239 192 190 188 197 194 203 130 203 193 Percent Distribution 1.9 - - -- 50.0 - 0.8 17.3 15.0 12.0 9.1 17.1 8.3 - 13.0 36.5 50.0 56.0 45.4 45.7 45.8 50.0 57.1 47.3 44.2 35.0 32.0 45.4 37.1 45.8 -- 42.8 38.9 51 -- 50 22 3 23 2 14 165 2.7 2.9 3.4 2.9 2.8 2.8 2.6 2.8 52 40 48 22 35 24 2 13 236 11.5 9.0 9.4 7.2 10.7 10.8 8.8 11.7 10.0 299 Source: https:/lwww.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and females Age (years) 5-14 Location Total URINE Thiamine g/gm creatinine No. 38 12 26 37 41 27 22 203 Median 106 72 150 118 86 147 111 113 Percent Distribution <27 - -- -- -- 2.4 -- -- 0.5 27-65 18.4 50.0 3.8 18.9 36.6 3.7 27.3 21.2 66-129 50.0 33.3 34.6 37.8 34.1 40.7 31.8 38.4 >130 31.6 16.7 61.5 43.2 26.8 55.6 40.9 39.9 Riboflavin g/gm creatinine No. 41 16 27 35 49 29 28 225 Median 33 30 48 48 28 52 35 38 Percent Distribution <27 39.0 43.8 22.2 22.8 49.0 27.6 32.1 34.7 27-79 46.3 50.0 51.8 51.4 40.8 37.9 60.7 47.6 80-269 14.6 6.2 25.9 22.8 8.2 24.1 3.6 15.1 >270 -- - - 2.1 2.0 10.3 3.6 2.7 N' -Methylnicotinamide mg/gm creatinine No. 42 17 25 40 54 37 30 245 Median 6.4 8.3 9.0 6.2 8.6 6.2 7.0 7.3 Percent Distribution <0.50 -- -- -- - - 2.7 -- 0.4 0.50-1.59 -- -- - 10.0 -- - -- 1.6 1.60-4.29 14.3 -- 8.0 25.0 9.2 35.1 20.0 17.1 >4.30 85.7 100.0 92.0 65.0 90.7 62.2 80.0 80.8 300 Source: https://www.industrydocuments.ucst.edu/docsisnyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and nonpregnant, nonlactating females 15+ Total URINE 38 30 40 22 27 19 3 8 187 72 52 72 44 55 107 56 108 63 Percent Distribution 7.9 30.0 22.5 31.8 25.9 10.5 -- -- 19.8 42.1 30.0 27.5 40.9 33.3 15.8 66.7 25.0 32.6 26.3 33.3 27.5 4.5 11.1 36.8 -- 37.5 24.1 23.7 6.7 22.5 22.7 29.6 36.8 33.3 37.5 23.5 48 38 43 18 30 20 3 12 212 40 28 37 44 33 30 16 36 34 Percent Distribution 33.3 50.0 37.2 33.3 40.0 50.0 100.0 33.3 40.6 43.7 42.1 48.8 38.9 36.7 35.0 -- 58.3 42.4 20.8 5.3 7.0 27.8 10.0 10.0 -- 8.3 12.3 2.1 2.6 7.0 -- 13.3 5.0 -- -- 4.7 46 38 34 22 31 23 3 10 207 5.3 5.1 5.4 1.7 6.5 6.4 4.0 3.4 5.2 Percent Distribution -- -- -- -- - -- -- 2.2 -- 5.9 50.0 - -- -- 6.8 34.8 36.8 26.5 31.8 22.6 21.7 66.7 70.0 32.4 63.0 63.2 67.6 18.2 77.4 78.3 33.3 30.0 60.9 301 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-6. BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and Females Age (years) 6-16 Percent 70- 80- 90- 100- "Standard Weight" 79 89 99 109 110+ Unknown Total BLOOD Total Plasma Protein gm/100 ml No. 11 79 110 56 18 9 283 Mean 7.2 7.3 7.3 7.4 7.6 7.2 7.3 S.E.1/ 0.11 0.06 0.04 0.08 0.15 0.12 0.03 Percent Distribution 6.00-6.39 - 2.5 1.8 1.8 5.6 -- 2.1 6.40-6.99 36.4 26.6 29.1 28.6 5.6 22.2 26.8 >7.00 63.6 70.9 69.1 69.6 88.9 77.8 71.0 Albumin/Globulin Ratio No. 11 79 109 56 18 9 282 Mean 0.9 1.2 1.2 1.1 1.2 1.1 1.1 S.E. 0.13 0.04 0.03 0.03 0.06 0.06 0.02 Percent Distribution <0.5 - - 0.9 -- -- - 0.4 0.5-0.9 54.5 26.6 28.4 26.8 16.7 22.2 27.6 1.0-1.4 36.4 54.4 55.0 64.3 66.7 77.8 57.4 1.5-1.9 9.1 15.2 14.7 8.9 16.7 -- 13.1 >2.0 -- 3.8 0.9 - -- ... 1.4 Plasma Albumin gm/100 ml No. 11 79 109 56 18 9 282 Mean 3.4 3.8 3.8 3.8 4.0 3.8 3.8 S.E. 0.20 0.06 0.04 0.05 0.09 0.12 0.03 Percent Distribution <2.5 ... -- 1.8 -- -- -- 0.7 2.5=3.4 54.5 20.2 21.1 23.2 5.6 22.2 21.6 3.5-5.0 45.4 79.7 77.1 76.8 94.4 77.8 77.6 >5.0 - -- -- -- -- -- Plasma Globulin gm/100 ml No. 11 79 109 56 18 9 282 Mean 3.8 3.4 3.4 3.6 3.6 3.4 3.5 Percent Distribution 1.0-1.9 -- 1.3 -- -- -- -- 0.4 2.0-2.9 18.2 22.8 22.9 16.1 22.2 -- 20.6 3.0-3.5 18.2 38.0 41.3 37.5 22.2 77.8 38.6 >3.5 63.6 38.0 35.8 46.4 55.6 22.2 40.4 1/ S.E. = standard error. 302 Source: https://www.industrydocuments.ucst.edu/docs/snyc0227 APPENDIX TABLE VIII-6(Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and Nonpregnant, Nonlactating Females 17+ 80= 90- 100- <80 89 99 109 110+ Unknown Total BLOOD 30 68 58 28 28 3 215 7.4 7.4 7.4 7.6 7.4 8.3 7.4 0.08 0.07 0.08 0.09 0.11 -- 0.04 Percent Distribution -- 5.9 3.4 -- 3.6 3.2 16.7 11.8 20.7 7.1 21.4 -- 15.3 83.3 82.4 75.9 92.8 75.0 100.0 81.4 30 67 58 28 28 3 214 1.1 1.1 1.1 1.1 1.2 0.9 1.1 0.06 0.03 0.04 0.05 0.06 0.10 0.02 Percent Distribution - 1.5 - -- -- -- 0.5 20.0 31.3 29.3 21.4 21.4 66.7 27.1 63.3 59.7 58.6 71.4 50.0 33.3 59.8 13.3 7.5 12.1 3.6 25.0 - 11.2 3.3 --- -- 3.6 3.6 - 1.4 30 67 58 28 28 3 214 3.9 3.8 3.8 3.9 4.0 3.8 3.8 0.10 0.06 0.06 0.07 0.07 - 0.03 Percent Distribution -- 1.5 -- -- -- -- 0.5 13.3 19.4 17.2 7.1 7.1 -- 14.5 83.3 79.1 82.8 92.8 92.8 100.0 84.6 3.3 -- -- -- - - -- 0.5 30 67 58 28 28 3 214 3.5 3.6 3.6 3.7 3.4 4.4 3.6 Percent Distribution - -- -- -- -- - - - 16.7 13.4 19.0 3.6 32.1 -- 16.4 46.7 41.8 32.8 53.6 32.1 33.3 40.2 36.7 44.8 48.3 42.8 35.7 66.7 43.4 303 Source: https://www.industrydocuments.ucsf.edu/docsisnyc0227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and Females Age (years) 6-16 Percent 70- 80- 90- 100= "Standard Weight" 79 89 99 109 110+ Unknown Total Hemoglobin gm/100 ml No. 9 79 109 55 18 10 280 Mean 13.3 13.3 13.4 13.0 14.1 13.1 13.3 S.E. 1.15 0.19 0.14 0.22 0.27 0.43 0.10 Percent Distribution <12.0 22.2 12.6 11.9 12.7 - 20.0 12.1 12.0-13.9 44.4 51.9 55.0 60.0 44.4 70.0 54.6 14.0-14.9 27.8 24.8 23.6 33.3 - 24.3 >15.0 33.3 7.6 8.2 3.6 22.2 10.0 8.9 Hematocrit percent No. 10 74 106 54 18 10 272 Mean 35.3 40.0 40.0 39.0 40.7 41.3 39.4 S.E. 2.20 0.45 0.32 0.49 0.78 1.12 0.23 Percent Distribution <36 40.0 13.5 7.5 9.2 5.6 - 10.3 36-41 50.0 54.0 70.8 72.2 55.6 60.0 64.3 42-44 -- 24.3 15.1 14.8 27.8 20.0 18.0 >45 10.0 8.1 6.6 3.7 11.1 20.0 7.4 Mean Corpuscular Hemoglobin Concentration, percent No. 9 74 106 54 18 10 271 Mean 38.3 33.4 33.7 33.4 35.0 32.0 33.7 Percent Distribution <28.0 11.1 5.4 2.8 3.7 -- 10.0 4.0 28.0=29.9 -- 2.7 1.9 7.4 - 10.0 3.3 30.0-31.9 - 16.2 16.0 18.5 -- 20.0 15.1 >32.0 88.9 75.7 79.2 70.4 100.0 60.0 77.5 Plasma Vitamin C mg/100 ml No. 5 71 104 56 18 9 263 Mean 0.80 0.76 0.70 0.71 0.70 0.82 0.72 Percent Distribution <0.10 -- ... - -- -- -- -- 0.10~0.19 - 2.8 2.9 1.8 -- -- 2.3 0.20-0.39 -- 18.3 26.0 23.2 16.7 22.2 22.0 >0.40 100.0 78.9 71.2 75.0 83.3 77.8 75.7 304 Source: https:/lwww.industrydocuments.ucsf.edu/docsisnyc0227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and Nonpregnant, Nonlactating Females 17+ 80- 90- 100- <80 89 99 109 110+ Unknown Total 32 70 58 24 28 2 214 13.6 13.4 13.6 14.0 13.9 12.7 13.6 0.40 0.30 0.24 0.34 0.35 -- 0.14 Percent Distribution 25.0 22.8 13.8 16.7 10.7 -- 18.2 28.1 31.4 48.3 29.2 28.6 100.0 35.5 15.6 27.1 15.5 29.2 32.1 -- 22.9 31.2 18.6 22.4 25.0 28.6 (- 23.4 31 67 56 24 28 3 209 41.3 40.5 40.8 42.1 41.2 37.3 41.0 0.99 0.76 0.53 1.06 0.77 0.68 0.35 Percent Distribution 16.1 16.4 8.9 12.5 7.1 -- 12.4 35.5 34.3 51.8 29.2 53.6 100.0 42.1 16.1 19.4 19.6 16.7 25.0 19.1 32.2 29.8 19.6 41.7 14.3 -- 26.3 31 67 55 22 28 2 205 33.1 33.0 33.3 33.0 33.8 33.4 33.2 Percent Distribution 9.7 10.4 3.6 4.5 3.6 -- 6.8 12.9 9.0 5.4 4.5 14.3 - 8.8 16,1 11.9 14.5 18.2 14.3 50.0 14.6 61.3 68.6 76.4 72.7 67.8 50.0 69.8 29 67 56 26 28 3 209 0.58 0.53 0.46 0.52 0.53 0.51 0.52 Percent Distribution - 1.5 1.8 - -- -- 1.0 6.9 7.5 14.3 19.2 7.1 33.3 11.0 20.7 32.8 37.5 19.2 35.7 - 30.6 72.4 58.2 46.4 61.5 57.1 66.7 57.4 305 Source: https://www.industrydocuments.ucsi.edu/docsisnyco227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and Females Age (years) 6-16 Percent 70- 80- 90- 100- "Standard Weight" 79 89 99 109 110+ Unknown Total Plasma Vitamin A g/100 ml No. 10 79 108 56 17 9 279 Mean 28.9 29.6 28.5 30.7 36.5 27.3 29.7 Percent Distribution <10 -- -- 3.7 3.6 11.8 22.2 3.6 10-19 10.0 20.2 23.1 21.4 5.9 -- 19.7 20-49 80.0 72.2 64.8 58.9 58.8 66.7 65.9 >50 10.0 7.6 8.3 16.1 23.5 11.1 10.8 Plasma Carotene g/100 ml No. 10 79 108 56 17 9 279 Mean 86 82 74 76 78 59 77 Percent Distribution <20 -- -- 0.9 -- -- -- 0.4 20-39 7.6 11.1 12.5 17.6 22.2 10.8 40-99 90.0 65.8 71.3 66.1 58.8 77.8 68.8 >100 10.0 26.6 16.7 21.4 23.5 -- 20.1 Cholesterol mg/100 ml No. 11 78 107 56 18 9 279 Mean 165 176 170 172 182 173 173 Percent Distribution 70-99 -- -- -- -- -- -- - 100-149 45.4 21.8 29.9 25.0 27.8 22.2 26.9 150-199 36.4 56.4 54.2 58.9 44.4 77.8 55.2 >200 18.2 21.8 15.9 16.1 27.8 -- 17.9 B=Lipoprotein mm No. 10 59 70 31 8 8 196 Mean 2.5 2.5 2.9 2.5 2.5 2.4 2.6 Lipid Phosphorus mg/100 ml No. 11 78 107 56 18 9 279 Mean 9.4 9.6 9.6 9.8 9.4 9.7 9.6 306 Source: https:/lwww.industrydocuments.ucsf.edu/docsisnyc022/ APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and Nonpregnant, Nonlactating Females 17+ 80- 90- 100- <80 89 99 109 110+ Unknown Total 27 67 57 28 28 3 210 33.4 37.1 40.3 38.9 41.2 33.3 38.2 Percent Distribution -- 3.0 1.8 -- 3.6 -- 1.9 11.1 9.0 1.8 3.6 10.7 -- 6.7 74.1 71.6 70.2 82.1 60.7 100.0 71.9 14.8 16.4 26.3 14.3 25.0 -- 19.5 27 67 57 28 28 3 210 74 88 91 95 102 72 89 Percent Distribution 7.4 -- - -- -- 1.0 3.7 6.0 8.8 7.1 7.1 -- 6.7 59.2 61.2 56.1 50.0 53.6 100.0 57.6 29.6 32.8 35.1 42.8 39.3 -- 34.8 31 68 58 28 28 3 216 184 184 196 202 217 158 194 Percent Distribution -- 1.5 1.7 -- -- 0.9 12.9 16.2 6.9 10.7 7.1 66.7 12.0 58.0 51.5 48.3 50.0 28.6 -- 47.7 29.0 30.9 43.1 39.3 64.3 33.3 39.4 24 49 37 20 23 2 155 2.9 2.6 2.9 3.3 3.1 2.8 2.9 30 66 58 28 28 3 213 8.9 10.1 10.8 9.6 11.4 7.6 10.2 307 Source: https:/lwww.industrydocuments.ucsf.edu/docsisnyc0227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and Females Age (years) 6-16 Percent 70- 80- 90- 100- "Standard Weight" 79 89 99 109 110+ Unknown Total URINE Thiamine g/gm creatinine No. 9 60 84 46 12 6 217 Median 164 115 118 82 91 147 110 Percent Distribution <27 -- 1.7 1.2 -- -- -- 0.9 27=65 33.3 13.3 16.7 41.3 33.3 16.7 22.6 66-129 -- 45.0 39.3 34.8 41.7 16.7 37.8 >130 66.7 40.0 42.8 23.9 25.0 66.7 38.7 Riboflavin g/gm creatinine No. 10 63 95 48 16 7 239 Median 64 48 36 36 24 46 39 Percent Distribution <27 20.0 23.8 36.8. 33.3 62.5 14.3 33.0 27-79 40.0 55.6 45.3 58.3 37.5 42.8 49.8 80-269 40.0 20.6 13.7 6.2 - 42.8 15.1 >270 -- -- 4.2 2.1 -- -- 2.1 N'-Methylnicotinamide mg/gm creatinine No. 10 72 102 52 17 6 259 Median 7.3 8.3 7.0 6.4 7.0 5.4 7.2 Percent Distribution <0.50 -- 1.4 -- - - - 0.4 0.50-1.59 -- 4.2 1.0 3.8 -- -- 2.3 1.60-4.29 20.0 9.7 19.6 19.2 23.5 16.7 17.0 >4.30 80.0 84.7 79.4 76.9 76.5 83.3 80.3 308 Source: https:/lwww.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and Nonpregnant, Nonlactating Females 17+ 80- 90- 100- <80 89 99 109 110+ Unknown Total URINE 29 56 40 22 19 2 168 64 70 54 54 62 46 60 Percent Distribution 13.8 21.4 20.0 27.3 26.3 50.0 21.4 37.9 26.8 42.5 31.8 26.3 -- 32.7 31.0 23.2 12.5 27.3 31.6 50.0 23.8 17.2 28.6 25.0 13.6 15.8 -- 22.0 28 59 51 23 27 3 191 36 31 26 38 33 32 32 Percent Distribution 35.7 45.8 52.9 26.1 40.7 33.3 42.9 50.0 35.6 31.4 47.8 48.1 66.7 40.3 10.7 15.2 9.8 13.0 7.4 -- 11.5 3.6 3.4 5.9 13.0 3.7 -- 5.2 27 57 51 25 25 1 186 5.0 5.1 5.6 3.8 6.2 5.0 Percent Distribution -- -- -- - -- -- -- 3.7 7.0 3.9 16.0 4.0 -- 6.4 33.3 33.3 35.3 44.0 28.0 100.0 34.9 63.0 59.6 60.8 40.0 68.0 -- 58.6 309 Source: https://www.industrydocuments.ucst.edu/docsisnyc0227 APPENDIX TABLE VIII-7. SUGGESTED VALUES BY SEX AND AGE GROUPS FOR HEMOGLOBIN AND HEMATOCRIT Deficient Low Acceptable High Hemoglobin Males >13 years <12 12.0-13.9 14.0-14.9 >15.0 Females nonpregnant, nonlactating >13 years <10.0 10.0-10.9 11.0-14.4 >14.5 Children 3-12 years <10.0 10.0-10.9 11.0-12.4 >12.5 Hematocrit Males >13 years <36 36-41 42-44 >45 Females nonpregnant, nonlactating >13 years <30 30-37 38-42 >43 Children 3-12 years <30.0 30.0-33.9 34.0-36.9 >37.0 310 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-9. IODINE EXCRETION VS. PRESENCE OF GOITER, CIVILIANS AND MILITARY DEPENDENTS, MALAYA <15 Years 15+ Years Urinary Iodine Excretion Total Enlarged Thyroid Total Enlarged Thyroid g/gm creatinine Group No. Percent Group No. Percent 0-9 -- -- 10-19 5 1 20-29 20 1 7 1 30-39 19 1 12 3 40-49 11 1 9 50-99 20 2 16 2 100+ 7 8 Total 82 5 6.1 53 6 11.3 Mean 53 50 135 43 Total Enlarged Thyroid Urinary Iodine Group No. Percent <20 8 -- -- 20-29 37 2 5.4 30-39 44 4 9.1 40-49 30 1 3.3 50+ 72 4 5.6 Total 191 11 5.8 Source: https://wwww.industrydocuments.ucsf.edu/docs/snyc0227 1/ APPENDIX TABLE VIII-10. SUGGESTED GUIDE TO INTERPRETATION OF BIOCHEMICAL DATA Deficient Low Acceptable High Blood Total Plasma Protein, gm/100 ml < 6.00 6.00-6.39 6.40-6.99 >7.00 Plasma Albumin, gm/100 ml < 2.5 2.5-3.4 3.5-5.0 >5.0 Globulin, gm/100 ml < 2.0 2.0-2.9 3.0-3.5 >3.5 Albumin/Globulin Ratio < 1.0 1.0-1.4 1.5-1.9 >2.0 Hemoglobin, gm/100 ml <12.0 12.0-13.9 14.0-14.9 >15.0 Hematocrit, percent <36 36-41 42-44 >45 Mean Corpuscular Hemoglobin Concentration, percent <28.0 28.0-29.9 30.0-31.9 >32.0 Plasma Vitamin A, g/100 ml <10 10-19 20-49 >50 Plasma Carotene, g/100 ml <20 20-39 40-99 >100 Plasma Vitamin C, mg/100 ml < 0.10 0.10-0.19 0.20-0.39 >0.40 Urine Thiamine, g/gm creatinine <27 27-65 66-129 >130 Riboflavin, g/gm creatinine <27 27-79 80-269 >270 N'-Methylnicotinamide, mg/gm creatinine < 0.50 0.50-1.59 1.60-4.29 >4.30 1/ Based on ICNND suggested reference values. Source: https://www.industrydocuments.ucst.edu/docsisnyc0227

How many children are deficient in hemoglobin ?

snyc0227

snyc0227_p288, snyc0227_p289, snyc0227_p290, snyc0227_p291, snyc0227_p292, snyc0227_p293, snyc0227_p294, snyc0227_p295, snyc0227_p296, snyc0227_p297, snyc0227_p298, snyc0227_p299, snyc0227_p300, snyc0227_p301, snyc0227_p302, snyc0227_p303, snyc0227_p304, snyc0227_p305, snyc0227_p306, snyc0227_p307, snyc0227_p308

<10.0, <10

APPENDIX VII-1.GLOSSARY OF COMMONLY SERVED MALAY DISHES Sambal belachan Aged fish paste mixed with chillies, onions, etc. Sambal telor A fried dish of egg, belachan and sambal. Ikan goreng Fried fresh or salt fish. Tumis togei A common Malay dish made from bean sprouts, to which are added fried condiments and water. Quai kodok A breakfast food made from water, wheat flour and salt. The batter is dropped into coconut oil and deep=fried. Apam balek A common Malay breakfast food similar to a pancake. The batter is made of wheat flour, water and sliced bananas. The kuali is lightly oiled and then rubbed with a piece of fresh coconut. Enough batter for one apam balek is spread thinly over the surface. When cooked, a spoonful of a mixture of shredded fresh coconut and brown sugar is placed in the center and the cake is rolled up. Tumis Vegetables fried in coconut oil to which condiments and spices have been added. Pisang goreng Special varieties of bananas (green) sliced in half length wise and dipped in a batter of wheat flour and water, and deep=fried in coconut oil. Roti chanai A favorite breakfast item resembling a pancake, made from a soft dough of wheat flour, water and coconut oil. The oil is added by kneading and working the dough by hand. The dough is worked in individual amounts, pulled and stretched over a flat surface until paper thin and then rolled in a long thin strip and wound together in a spiral to give a circular flat cake about six inches in diameter which is fried in the kuali. Children eat them with sugar. Adar=adar A pancake batter of wheat flour and water. After frying, the pancake is spread with a previously fried mixture of shredded fresh coconut and brown and white sugar. Goreng keledeh Keledeh is similar to sweet potato. In Malaya it is often sliced raw, dipped in rice flour and water and deep fried in coconut oil for breakfast. Achar timun Raw cucumber mixed with raw onion and fresh chilli, re- sembling a pickle. Gulai ikan (fish Fish cooked in water or santan to which condiments and curry) spices are added. Goreng kajong Long green beans fried in coconut oil with ikan bilis. Sayor lemak paku Young fern shoots boiled in santan to which condiments are added. 292 Source: https://wwww.industrydocuments.ucsf.edu/docsisnyc0227 APPENDIX TABLE VII-2. RECOMMENDED DAILY DIETARY , Age Body Vita- Thia- Ribo- Ascorbic Vita- (years) Weight Calories Protein Calcium Iron min A mine flavin Niacin³/ Acid min D kg gm gm mg IU mg mg mg mg IU equiv- alent Men 25 55 2,570 55 0.5 10 5,000 1.3 1.4 17 75 45 55 2,430 55 0.5 10 5,000 1.2 1.4 16 75 65 55 2,050 55 0.5 10 5,000 1.0 1.4 14 75 Women 25 50 1,900 50 0.5 12 5,000 1.0 1.3 17 70 45 50 1,860 50 0.5 12 5,000 1.0 1.3 16 70 65 50 1,520 50 0.5 12 5,000 1.0 1.3 13 70 Pregnant (2d half) +285 +20 1.0-1.2 15 6,000 1.1 1.8 +3 100 400 Lactating +950 +40 1.0-1.2 15 8,000 1.4 2.3 +2 150 400 Infants 0-1 (6)4/ (Age in 2-6 (9)kg X 115 See Foot- 0.5-0.6 5 1,500 0.3 0.4 5 30 400 months) 7-12 kg X 95 note 5/ 0.5-0.6 7 1,500 0.4 0.5 6 30 400 Children 1-3 1,240 40 1.0 7 2,000 0.6 1.0 8 35 400 4-6 1,620 50 1.0 8 2,500 0.8 1.3 11 50 400 7-9 2,000 60 1.0 10 3,500 1.0 1.5 13 60 400 10-12 2,380 70 1.2 12 4,500 1.2 1.8 16 75 400 Boys 13-15 2,950 85 1.4 15 5,000 1.5 2.1 19 90 400 16-19 3,420 100 1.4 15 5,000 1.7 2.5 23 100 400 Girls 13-15 2,470 80 1.3 15 5,000 1.2 2.0 16 80 400 16-19 2,280 75 1.3 15 5,000 1.1 1.9 15 80 400 1/ Estimated requirements of essential nutrients for individuals in Malaya, based on the recommendations of the Food and Nutrition Board, National Research Council, U.S.A. (1958; 3), and modified for local climatic conditions. 2/ IMR Report No. 64 (2). 3/ Niacin equivalents include dietary sources of the preformed vitamin and the precursor tryptophan (60 mg tryptophan = 1 mg niacin). 41 These figures represent ideal weights (in kg) for babies. 5 Needs can be met by 3.5 gm/kg in first 6 months and 3 gm/kg for remainder of first year. Source: https:/lwww.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5. BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and females Age (years) 5-14 Location Total BLOOD Total Plasma Protein gm/100 ml No. 45 18 29 43 58 42 32 267 Mean 7.0 8.1 7.3 7.3 7.3 7.3 7.1 7.3 Percent Distribution 6.00-6.39 6.7 -- - 1.7 -- 3.1 1.9 6.40-6.99 48.9 -- 24.1 27.9 20.7 28.6 37.5 28.8 >7.00 44.4 100.0 75.9 72.1 77.6 71.4 59.4 69.3 Albumin/Globulin Ratio No. 45 18 29 43 58 41 32 266 Mean 1.3 0.9 1.2 0.9 1.2 1.3 1.0 1.1 Percent Distribution <0.5 - - -- 2.3 -- -- -- 0.4 0.5-0.9 6.7 72.2 24.1 69.8 6.9 17.1 37.5 28.6 1.0-1.4 75.6 27.8 65.5 20.9 69.0 56.1 62.5 56.4 1.5-1.9 11.1 -- 10.3 7.0 24.1 24.4 -- 13.2 >2.0 6.7 -- -- -- -- 2.4 -- 1.5 Plasma Albumin gm/100 ml No. 45 18 29 43 58 41 32 266 Mean 3.9 3.8 3.9 3.3 4.0 4.0 3.5 3.8 Percent Distribution <2.5 - - -- 4.6 -- -- -- 0.8 2.5-3.4 15.6 22.2 17.2 60.5 1.7 9.8 43.8 22.9 3.5-5.0 84.4 77.8 82.8 34.9 98.3 90.2 56.2 76.3 >5.0 -- -- -- -- -- -- Plasma Globulin gm/100 ml No. 45 18 29 43 58 41 32 266 Mean 3.1 4.3 3.4 4.0 3.3 3.3 3.6 3.5 Percent Distribution 1.0-1.9 2.2 - -- -- -- -- - 0.4 2.0-2.9 31.1 - 13.8 7.0 29.3 36.6 12.5 21.4 3.0-3.5 55.6 5.6 55.2 14.0 39.6 39.0 40.6 37.6 >3.5 11.1 94.4 31.0 79.1 31.0 24.4 46.9 40.6 294 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and nonpregnant, nonlactating females 15+ Total BLOOD 52 40 50 22 34 24 2 14 238 7.2 7.8 7.4 7.6 7.4 7.4 7.8 7.7 7.5 Percent Distribution 11.5 -- -- 2.9 4.2 - -- 3.4 17.3 7.5 24.0 4.5 20.6 16.7 -- 7.1 15.5 71.2 92.5 76.0 95.4 76.5 79.2 100.0 92.8 81.1 52 40 50 22 34 24 2 13 237 1.2 1.2 1.1 1.1 1.1 1.2 1.0 0.8 1.1 Percent Distribution - - - 4.5 -- - -- - 0.4 13.5 25.0 22.0 27.3 35.3 29.2 50.0 61.5 26.2 67.3 52.5 66.0 54.5 61.8 54.2 50.0 38.5 59.5 17.3 22.5 12.0 9.1 2.9 12.5 -- 12.6 1.9 - -- 4.5 -- 4.2 -- -- 1.3 52 40 50 22 34 24 2 13 237 3.8 4.2 3.9 3.8 3.8 3.9 3.9 3.4 3.9 Percent Distribution -- -- 4.5 -- -- -- 0.4 11.5 2.5 12.0 22.7 20.6 4.2 -- 53.8 13.9 88.5 97.5 88.0 68.2 79.4 95.8 100.0 46.2 85.2 -- 4.5 -- -- -- -- 0.4 52 40 50 22 34 24 2 13 237 3.3 3.6 3.5 3.8 3.6 3.5 3.8 4.2 3.6 Percent Distribution - - - -- - - 30.8 17.5 16.0 13.6 5.9 16.7 - - 16.9 48.1 40.0 42.0 40.9 41.2 41.7 - 7.7 40.5 21.2 42.5 42.0 45.4 52.9 41.7 100.0 92.3 42.6 295 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and females Age (years) 5-14 Location Total BLOOD Hemoglobin gm/100 ml No. 45 18 30 40 58 43 32 266 Mean 13.5 13.5 12.6 13.6 12.8 13.8 12.8 13.2 Percent Distribution <12.0 6.7 11.1 20.0 10.0 24.1 7.0 6.3 12.8 12.0-13.9 71.1 55.6 63.3 42.5 50.0 48.8 78.1 57.5 14.0-14.9 13.3 11.1 16.7 30.0 22.4 37.2 15.6 22.2 >15.0 8.9 22.2 17.5 3.4 7.0 - 7.5 Hematocrit percent No. 45 18 29 34 58 42 32 258 Mean 39.8 41.5 38.4 37.5 39.3 40.3 38.0 39.2 Percent Distribution <36 6.7 5.6 10.3 20.6 10.3 2.4 18.8 10.5 36-41 73.3 38.9 75.9 67.6 60.3 73.8 68.8 67.0 42-44 8.9 38.9 10.3 11.8 27.6 14.3 9.4 16.7 >45 11.1 16.7 3.4 -- 1.7 9.5 3.1 5.8 Mean Corpuscular Hemoglobin Concentration, percent No. 45 18 29 34 58 42 32 258 Mean 34.0 32.7 32.7 36.0 32.5 34.2 33.6 33.7 Percent Distribution <28.0 13.8 5.9 5.2 4.8 3.1 4.6 28.0-29.9 2.2 5.6 3.4 2.9 8.6 -- -- 3.5 30.0-31.9 15.6 38.9 10.3 2.9 17.2 7.1 21.9 14.7 >32.0 82.2 55.6 72.4 88.2 69.0 88.1 75.0 77.1 Plasma Vitamin C mg/100 ml No. 45 18 28 25 58 42 32 248 Mean 0.65 0.60 0.79 0.30 0.79 1.11 0.59 0.73 Percent Distribution <0.10 - -- -- -- -- -- -- - 0.10-0.19 - -- -- 12.0 3.4 -- -- 2.0 0.20-0.39 28.9 22.2 17.8 72.0 6.9 4.8 37.5 23.4 >0.40 71.1 77.8 82.1 16.0 89.6 95.2 62.5 74.6 296 Source. https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and nonpregnant, nonlactating females 15+ Total BLOOD 50 40 46 21 35 24 6 14 236 14.5 14.2 12.4 14.6 12.7 13.9 12.8 14.0 13.6 Percent Distribution 4.0 5.0 41.3 9.5 22.8 12.5 33.3 14.3 16.9 32.0 40.0 37.0 9.5 48.6 37.5 50.0 21.4 35.2 24.0 30.0 13.0 47.6 20.0 25.0 -- 35.7 24.6 40.0 25.0 8.7 33.3 8.6 25.0 16.7 28.6 23.3 52 38 47 18 35 22 5 14 231 42.5 43.6 38.2 42.6 39.8 40.6 39.4 40.3 41.0 Percent Distribution 7.7 - 21.3 5.6 11.4 18.2 40.0 14.3 11.7 38.5 34.2 57.4 33.3 48.6 36.4 20.0 42.8 42.4 15.4 26.3 12.8 33.3 20.0 22.7 20.0 21.4 19.9 38.5 39.5 8.5 27.8 20.0 22.7 20.0 21.4 26.0 50 38 44 18 35 22 5 14 226 34.2 32.6 32.5 34.7 27.7 34.0 34.6 34.8 33.3 Percent Distribution 2.0 - 15.9 -- 8.6 4.5 40.0 .... 6.2 4.0 18.4 11.4 -- 11.4 -- -- -- 8.0 10.0 26.3 15.9 11.1 20.0 4.5 -- 14.3 15.0 84.0 55.3 56.8 88.9 60.0 90.9 60.0 85.7 70.8 52 40 50 16 35 24 -- 14 231 0.48 0.52 0.68 0.24 0.43 0.71 -- 0.48 0.53 Percent Distribution -- -- - -- 5.7 -- -- - 0.9 13.5 10.0 -- 50.0 5.7 -- -- 21.4 10.4 32.7 30.0 16.0 43.8 42.8 16.7 - 21.4 28.6 53.8 60.0 84.0 6.2 45.7 83.3 -- 57.1 60.2 297 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and females Age (years) 5-14 Location Total BLOOD Plasma Vitamin A g/100 ml No. 45 18 29 41 58 42 32 265 Mean 26.6 28.2 25.5 25. 8 41. 1 19.2 26.9 28.5 Percent Distribution <10 -- -- 3.4 - 23.8 -- 4.2 10-19 15.6 27.8 20.7 24.4 13.8 38.1 12.5 21.1 20-49 82.2 61.1 75.9 73.2 46.6 38.1 87.5 64.5 >50 2.2 11.1 -- 2.4 39.6 - -- 10.2 Plasma Carotene g/100 ml No. 45 18 29 41 58 42 32 265 Mean 80 64 64 90 71 74 78 76 Percent Distribution <20 -- -- -- -- - 3.1 0.4 20-39 6.7 27.8 20.7 4.9 12.1 11.9 9.4 11.7 40-99 68.9 55.6 75.9 61.0 72.4 76.2 62.5 68.7 >100 24.4 16.7 3.4 34.1 15.5 11.9 25.0 19.2 Cholesterol mg/100 ml No. 43 18 29 42 58 41 32 263 Mean 171 177 179 169 174 180 150 171 Percent Distribution 70-99 -- -- -- - -- 3.1 0.4 100-149 30.2 22.2 10.3 33.3 25.9 17.1 50.0 27.4 150-199 55.8 61.1 72.4 50.0 53.4 65.8 40.6 56.3 >200 14.0 16.7 17.2 16.7 20.7 17.1 6.2 16.0 P-Lipoprotein mm No. 44 - 30 42 4 42 32 194 Mean 2.5 - 2.7 2.7 2.3 2.4 2.5 2.6 Lipid Phosphorus mg/100 ml No. 43 18 28 42 58 42 32 263 Mean 9.8 8.0 9.4 8.6 10.2 10.5 10.4 9.7 298 Source: https://www.industrydocuments.ucsf.edu/docssnyco227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and nonpregnant, nonlactating females 1,5+ Total BLOOD 52 39 48 22 33 24 -- 14 232 39.9 38.2 30.6 43.7 51.8 26.3 -- 43.2 38.5 Percent Distribution -- -- 2.1 -- -- 12.5 -- 1.7 1.9 -- 10.4 4.5 -- 29.2 -- -- 6.0 86.5 87.2 83.3 63.6 48.5 45.8 -- 71.4 73.3 11.5 12.8 4.2 31.8 51.5 12.5 -- 28.6 19.0 52 39 48 22 33 24 -- 14 232 103 82 69 107 74 99 -- 126 90 Percent Distribution - -- 4.2 -- -- -- -- -- 0.9 1.9 7.7 8.3 - 18.2 4.2 -- -- 6.5 50.0 66.7 72.9 45.4 66.7 50.0 -- 28.6 58.2 48.1 25.6 14.6 54.5 15.2 45.8 -- 71.4 34.5 52 40 50 22 35 24 2 14 239 192 190 188 197 194 203 130 203 193 Percent Distribution 1.9 - - -- 50.0 - 0.8 17.3 15.0 12.0 9.1 17.1 8.3 - 13.0 36.5 50.0 56.0 45.4 45.7 45.8 50.0 57.1 47.3 44.2 35.0 32.0 45.4 37.1 45.8 -- 42.8 38.9 51 -- 50 22 3 23 2 14 165 2.7 2.9 3.4 2.9 2.8 2.8 2.6 2.8 52 40 48 22 35 24 2 13 236 11.5 9.0 9.4 7.2 10.7 10.8 8.8 11.7 10.0 299 Source: https:/lwww.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and females Age (years) 5-14 Location Total URINE Thiamine g/gm creatinine No. 38 12 26 37 41 27 22 203 Median 106 72 150 118 86 147 111 113 Percent Distribution <27 - -- -- -- 2.4 -- -- 0.5 27-65 18.4 50.0 3.8 18.9 36.6 3.7 27.3 21.2 66-129 50.0 33.3 34.6 37.8 34.1 40.7 31.8 38.4 >130 31.6 16.7 61.5 43.2 26.8 55.6 40.9 39.9 Riboflavin g/gm creatinine No. 41 16 27 35 49 29 28 225 Median 33 30 48 48 28 52 35 38 Percent Distribution <27 39.0 43.8 22.2 22.8 49.0 27.6 32.1 34.7 27-79 46.3 50.0 51.8 51.4 40.8 37.9 60.7 47.6 80-269 14.6 6.2 25.9 22.8 8.2 24.1 3.6 15.1 >270 -- - - 2.1 2.0 10.3 3.6 2.7 N' -Methylnicotinamide mg/gm creatinine No. 42 17 25 40 54 37 30 245 Median 6.4 8.3 9.0 6.2 8.6 6.2 7.0 7.3 Percent Distribution <0.50 -- -- -- - - 2.7 -- 0.4 0.50-1.59 -- -- - 10.0 -- - -- 1.6 1.60-4.29 14.3 -- 8.0 25.0 9.2 35.1 20.0 17.1 >4.30 85.7 100.0 92.0 65.0 90.7 62.2 80.0 80.8 300 Source: https://www.industrydocuments.ucst.edu/docsisnyc0227 APPENDIX TABLE VIII-5 (Continued) BIOCHEMICAL FINDINGS BY AGE AND LOCATION, CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and nonpregnant, nonlactating females 15+ Total URINE 38 30 40 22 27 19 3 8 187 72 52 72 44 55 107 56 108 63 Percent Distribution 7.9 30.0 22.5 31.8 25.9 10.5 -- -- 19.8 42.1 30.0 27.5 40.9 33.3 15.8 66.7 25.0 32.6 26.3 33.3 27.5 4.5 11.1 36.8 -- 37.5 24.1 23.7 6.7 22.5 22.7 29.6 36.8 33.3 37.5 23.5 48 38 43 18 30 20 3 12 212 40 28 37 44 33 30 16 36 34 Percent Distribution 33.3 50.0 37.2 33.3 40.0 50.0 100.0 33.3 40.6 43.7 42.1 48.8 38.9 36.7 35.0 -- 58.3 42.4 20.8 5.3 7.0 27.8 10.0 10.0 -- 8.3 12.3 2.1 2.6 7.0 -- 13.3 5.0 -- -- 4.7 46 38 34 22 31 23 3 10 207 5.3 5.1 5.4 1.7 6.5 6.4 4.0 3.4 5.2 Percent Distribution -- -- -- -- - -- -- 2.2 -- 5.9 50.0 - -- -- 6.8 34.8 36.8 26.5 31.8 22.6 21.7 66.7 70.0 32.4 63.0 63.2 67.6 18.2 77.4 78.3 33.3 30.0 60.9 301 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-6. BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and Females Age (years) 6-16 Percent 70- 80- 90- 100- "Standard Weight" 79 89 99 109 110+ Unknown Total BLOOD Total Plasma Protein gm/100 ml No. 11 79 110 56 18 9 283 Mean 7.2 7.3 7.3 7.4 7.6 7.2 7.3 S.E.1/ 0.11 0.06 0.04 0.08 0.15 0.12 0.03 Percent Distribution 6.00-6.39 - 2.5 1.8 1.8 5.6 -- 2.1 6.40-6.99 36.4 26.6 29.1 28.6 5.6 22.2 26.8 >7.00 63.6 70.9 69.1 69.6 88.9 77.8 71.0 Albumin/Globulin Ratio No. 11 79 109 56 18 9 282 Mean 0.9 1.2 1.2 1.1 1.2 1.1 1.1 S.E. 0.13 0.04 0.03 0.03 0.06 0.06 0.02 Percent Distribution <0.5 - - 0.9 -- -- - 0.4 0.5-0.9 54.5 26.6 28.4 26.8 16.7 22.2 27.6 1.0-1.4 36.4 54.4 55.0 64.3 66.7 77.8 57.4 1.5-1.9 9.1 15.2 14.7 8.9 16.7 -- 13.1 >2.0 -- 3.8 0.9 - -- ... 1.4 Plasma Albumin gm/100 ml No. 11 79 109 56 18 9 282 Mean 3.4 3.8 3.8 3.8 4.0 3.8 3.8 S.E. 0.20 0.06 0.04 0.05 0.09 0.12 0.03 Percent Distribution <2.5 ... -- 1.8 -- -- -- 0.7 2.5=3.4 54.5 20.2 21.1 23.2 5.6 22.2 21.6 3.5-5.0 45.4 79.7 77.1 76.8 94.4 77.8 77.6 >5.0 - -- -- -- -- -- Plasma Globulin gm/100 ml No. 11 79 109 56 18 9 282 Mean 3.8 3.4 3.4 3.6 3.6 3.4 3.5 Percent Distribution 1.0-1.9 -- 1.3 -- -- -- -- 0.4 2.0-2.9 18.2 22.8 22.9 16.1 22.2 -- 20.6 3.0-3.5 18.2 38.0 41.3 37.5 22.2 77.8 38.6 >3.5 63.6 38.0 35.8 46.4 55.6 22.2 40.4 1/ S.E. = standard error. 302 Source: https://www.industrydocuments.ucst.edu/docs/snyc0227 APPENDIX TABLE VIII-6(Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and Nonpregnant, Nonlactating Females 17+ 80= 90- 100- <80 89 99 109 110+ Unknown Total BLOOD 30 68 58 28 28 3 215 7.4 7.4 7.4 7.6 7.4 8.3 7.4 0.08 0.07 0.08 0.09 0.11 -- 0.04 Percent Distribution -- 5.9 3.4 -- 3.6 3.2 16.7 11.8 20.7 7.1 21.4 -- 15.3 83.3 82.4 75.9 92.8 75.0 100.0 81.4 30 67 58 28 28 3 214 1.1 1.1 1.1 1.1 1.2 0.9 1.1 0.06 0.03 0.04 0.05 0.06 0.10 0.02 Percent Distribution - 1.5 - -- -- -- 0.5 20.0 31.3 29.3 21.4 21.4 66.7 27.1 63.3 59.7 58.6 71.4 50.0 33.3 59.8 13.3 7.5 12.1 3.6 25.0 - 11.2 3.3 --- -- 3.6 3.6 - 1.4 30 67 58 28 28 3 214 3.9 3.8 3.8 3.9 4.0 3.8 3.8 0.10 0.06 0.06 0.07 0.07 - 0.03 Percent Distribution -- 1.5 -- -- -- -- 0.5 13.3 19.4 17.2 7.1 7.1 -- 14.5 83.3 79.1 82.8 92.8 92.8 100.0 84.6 3.3 -- -- -- - - -- 0.5 30 67 58 28 28 3 214 3.5 3.6 3.6 3.7 3.4 4.4 3.6 Percent Distribution - -- -- -- -- - - - 16.7 13.4 19.0 3.6 32.1 -- 16.4 46.7 41.8 32.8 53.6 32.1 33.3 40.2 36.7 44.8 48.3 42.8 35.7 66.7 43.4 303 Source: https://www.industrydocuments.ucsf.edu/docsisnyc0227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and Females Age (years) 6-16 Percent 70- 80- 90- 100= "Standard Weight" 79 89 99 109 110+ Unknown Total Hemoglobin gm/100 ml No. 9 79 109 55 18 10 280 Mean 13.3 13.3 13.4 13.0 14.1 13.1 13.3 S.E. 1.15 0.19 0.14 0.22 0.27 0.43 0.10 Percent Distribution <12.0 22.2 12.6 11.9 12.7 - 20.0 12.1 12.0-13.9 44.4 51.9 55.0 60.0 44.4 70.0 54.6 14.0-14.9 27.8 24.8 23.6 33.3 - 24.3 >15.0 33.3 7.6 8.2 3.6 22.2 10.0 8.9 Hematocrit percent No. 10 74 106 54 18 10 272 Mean 35.3 40.0 40.0 39.0 40.7 41.3 39.4 S.E. 2.20 0.45 0.32 0.49 0.78 1.12 0.23 Percent Distribution <36 40.0 13.5 7.5 9.2 5.6 - 10.3 36-41 50.0 54.0 70.8 72.2 55.6 60.0 64.3 42-44 -- 24.3 15.1 14.8 27.8 20.0 18.0 >45 10.0 8.1 6.6 3.7 11.1 20.0 7.4 Mean Corpuscular Hemoglobin Concentration, percent No. 9 74 106 54 18 10 271 Mean 38.3 33.4 33.7 33.4 35.0 32.0 33.7 Percent Distribution <28.0 11.1 5.4 2.8 3.7 -- 10.0 4.0 28.0=29.9 -- 2.7 1.9 7.4 - 10.0 3.3 30.0-31.9 - 16.2 16.0 18.5 -- 20.0 15.1 >32.0 88.9 75.7 79.2 70.4 100.0 60.0 77.5 Plasma Vitamin C mg/100 ml No. 5 71 104 56 18 9 263 Mean 0.80 0.76 0.70 0.71 0.70 0.82 0.72 Percent Distribution <0.10 -- ... - -- -- -- -- 0.10~0.19 - 2.8 2.9 1.8 -- -- 2.3 0.20-0.39 -- 18.3 26.0 23.2 16.7 22.2 22.0 >0.40 100.0 78.9 71.2 75.0 83.3 77.8 75.7 304 Source: https:/lwww.industrydocuments.ucsf.edu/docsisnyc0227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and Nonpregnant, Nonlactating Females 17+ 80- 90- 100- <80 89 99 109 110+ Unknown Total 32 70 58 24 28 2 214 13.6 13.4 13.6 14.0 13.9 12.7 13.6 0.40 0.30 0.24 0.34 0.35 -- 0.14 Percent Distribution 25.0 22.8 13.8 16.7 10.7 -- 18.2 28.1 31.4 48.3 29.2 28.6 100.0 35.5 15.6 27.1 15.5 29.2 32.1 -- 22.9 31.2 18.6 22.4 25.0 28.6 (- 23.4 31 67 56 24 28 3 209 41.3 40.5 40.8 42.1 41.2 37.3 41.0 0.99 0.76 0.53 1.06 0.77 0.68 0.35 Percent Distribution 16.1 16.4 8.9 12.5 7.1 -- 12.4 35.5 34.3 51.8 29.2 53.6 100.0 42.1 16.1 19.4 19.6 16.7 25.0 19.1 32.2 29.8 19.6 41.7 14.3 -- 26.3 31 67 55 22 28 2 205 33.1 33.0 33.3 33.0 33.8 33.4 33.2 Percent Distribution 9.7 10.4 3.6 4.5 3.6 -- 6.8 12.9 9.0 5.4 4.5 14.3 - 8.8 16,1 11.9 14.5 18.2 14.3 50.0 14.6 61.3 68.6 76.4 72.7 67.8 50.0 69.8 29 67 56 26 28 3 209 0.58 0.53 0.46 0.52 0.53 0.51 0.52 Percent Distribution - 1.5 1.8 - -- -- 1.0 6.9 7.5 14.3 19.2 7.1 33.3 11.0 20.7 32.8 37.5 19.2 35.7 - 30.6 72.4 58.2 46.4 61.5 57.1 66.7 57.4 305 Source: https://www.industrydocuments.ucsi.edu/docsisnyco227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and Females Age (years) 6-16 Percent 70- 80- 90- 100- "Standard Weight" 79 89 99 109 110+ Unknown Total Plasma Vitamin A g/100 ml No. 10 79 108 56 17 9 279 Mean 28.9 29.6 28.5 30.7 36.5 27.3 29.7 Percent Distribution <10 -- -- 3.7 3.6 11.8 22.2 3.6 10-19 10.0 20.2 23.1 21.4 5.9 -- 19.7 20-49 80.0 72.2 64.8 58.9 58.8 66.7 65.9 >50 10.0 7.6 8.3 16.1 23.5 11.1 10.8 Plasma Carotene g/100 ml No. 10 79 108 56 17 9 279 Mean 86 82 74 76 78 59 77 Percent Distribution <20 -- -- 0.9 -- -- -- 0.4 20-39 7.6 11.1 12.5 17.6 22.2 10.8 40-99 90.0 65.8 71.3 66.1 58.8 77.8 68.8 >100 10.0 26.6 16.7 21.4 23.5 -- 20.1 Cholesterol mg/100 ml No. 11 78 107 56 18 9 279 Mean 165 176 170 172 182 173 173 Percent Distribution 70-99 -- -- -- -- -- -- - 100-149 45.4 21.8 29.9 25.0 27.8 22.2 26.9 150-199 36.4 56.4 54.2 58.9 44.4 77.8 55.2 >200 18.2 21.8 15.9 16.1 27.8 -- 17.9 B=Lipoprotein mm No. 10 59 70 31 8 8 196 Mean 2.5 2.5 2.9 2.5 2.5 2.4 2.6 Lipid Phosphorus mg/100 ml No. 11 78 107 56 18 9 279 Mean 9.4 9.6 9.6 9.8 9.4 9.7 9.6 306 Source: https:/lwww.industrydocuments.ucsf.edu/docsisnyc022/ APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and Nonpregnant, Nonlactating Females 17+ 80- 90- 100- <80 89 99 109 110+ Unknown Total 27 67 57 28 28 3 210 33.4 37.1 40.3 38.9 41.2 33.3 38.2 Percent Distribution -- 3.0 1.8 -- 3.6 -- 1.9 11.1 9.0 1.8 3.6 10.7 -- 6.7 74.1 71.6 70.2 82.1 60.7 100.0 71.9 14.8 16.4 26.3 14.3 25.0 -- 19.5 27 67 57 28 28 3 210 74 88 91 95 102 72 89 Percent Distribution 7.4 -- - -- -- 1.0 3.7 6.0 8.8 7.1 7.1 -- 6.7 59.2 61.2 56.1 50.0 53.6 100.0 57.6 29.6 32.8 35.1 42.8 39.3 -- 34.8 31 68 58 28 28 3 216 184 184 196 202 217 158 194 Percent Distribution -- 1.5 1.7 -- -- 0.9 12.9 16.2 6.9 10.7 7.1 66.7 12.0 58.0 51.5 48.3 50.0 28.6 -- 47.7 29.0 30.9 43.1 39.3 64.3 33.3 39.4 24 49 37 20 23 2 155 2.9 2.6 2.9 3.3 3.1 2.8 2.9 30 66 58 28 28 3 213 8.9 10.1 10.8 9.6 11.4 7.6 10.2 307 Source: https:/lwww.industrydocuments.ucsf.edu/docsisnyc0227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Sex Males and Females Age (years) 6-16 Percent 70- 80- 90- 100- "Standard Weight" 79 89 99 109 110+ Unknown Total URINE Thiamine g/gm creatinine No. 9 60 84 46 12 6 217 Median 164 115 118 82 91 147 110 Percent Distribution <27 -- 1.7 1.2 -- -- -- 0.9 27=65 33.3 13.3 16.7 41.3 33.3 16.7 22.6 66-129 -- 45.0 39.3 34.8 41.7 16.7 37.8 >130 66.7 40.0 42.8 23.9 25.0 66.7 38.7 Riboflavin g/gm creatinine No. 10 63 95 48 16 7 239 Median 64 48 36 36 24 46 39 Percent Distribution <27 20.0 23.8 36.8. 33.3 62.5 14.3 33.0 27-79 40.0 55.6 45.3 58.3 37.5 42.8 49.8 80-269 40.0 20.6 13.7 6.2 - 42.8 15.1 >270 -- -- 4.2 2.1 -- -- 2.1 N'-Methylnicotinamide mg/gm creatinine No. 10 72 102 52 17 6 259 Median 7.3 8.3 7.0 6.4 7.0 5.4 7.2 Percent Distribution <0.50 -- 1.4 -- - - - 0.4 0.50-1.59 -- 4.2 1.0 3.8 -- -- 2.3 1.60-4.29 20.0 9.7 19.6 19.2 23.5 16.7 17.0 >4.30 80.0 84.7 79.4 76.9 76.5 83.3 80.3 308 Source: https:/lwww.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-6 (Continued) BIOCHEMICAL FINDINGS BY AGE AND PERCENT "STANDARD WEIGHT, " CIVILIANS AND MILITARY DEPENDENTS, MALAYA Males and Nonpregnant, Nonlactating Females 17+ 80- 90- 100- <80 89 99 109 110+ Unknown Total URINE 29 56 40 22 19 2 168 64 70 54 54 62 46 60 Percent Distribution 13.8 21.4 20.0 27.3 26.3 50.0 21.4 37.9 26.8 42.5 31.8 26.3 -- 32.7 31.0 23.2 12.5 27.3 31.6 50.0 23.8 17.2 28.6 25.0 13.6 15.8 -- 22.0 28 59 51 23 27 3 191 36 31 26 38 33 32 32 Percent Distribution 35.7 45.8 52.9 26.1 40.7 33.3 42.9 50.0 35.6 31.4 47.8 48.1 66.7 40.3 10.7 15.2 9.8 13.0 7.4 -- 11.5 3.6 3.4 5.9 13.0 3.7 -- 5.2 27 57 51 25 25 1 186 5.0 5.1 5.6 3.8 6.2 5.0 Percent Distribution -- -- -- - -- -- -- 3.7 7.0 3.9 16.0 4.0 -- 6.4 33.3 33.3 35.3 44.0 28.0 100.0 34.9 63.0 59.6 60.8 40.0 68.0 -- 58.6 309 Source: https://www.industrydocuments.ucst.edu/docsisnyc0227 APPENDIX TABLE VIII-7. SUGGESTED VALUES BY SEX AND AGE GROUPS FOR HEMOGLOBIN AND HEMATOCRIT Deficient Low Acceptable High Hemoglobin Males >13 years <12 12.0-13.9 14.0-14.9 >15.0 Females nonpregnant, nonlactating >13 years <10.0 10.0-10.9 11.0-14.4 >14.5 Children 3-12 years <10.0 10.0-10.9 11.0-12.4 >12.5 Hematocrit Males >13 years <36 36-41 42-44 >45 Females nonpregnant, nonlactating >13 years <30 30-37 38-42 >43 Children 3-12 years <30.0 30.0-33.9 34.0-36.9 >37.0 310 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 APPENDIX TABLE VIII-9. IODINE EXCRETION VS. PRESENCE OF GOITER, CIVILIANS AND MILITARY DEPENDENTS, MALAYA <15 Years 15+ Years Urinary Iodine Excretion Total Enlarged Thyroid Total Enlarged Thyroid g/gm creatinine Group No. Percent Group No. Percent 0-9 -- -- 10-19 5 1 20-29 20 1 7 1 30-39 19 1 12 3 40-49 11 1 9 50-99 20 2 16 2 100+ 7 8 Total 82 5 6.1 53 6 11.3 Mean 53 50 135 43 Total Enlarged Thyroid Urinary Iodine Group No. Percent <20 8 -- -- 20-29 37 2 5.4 30-39 44 4 9.1 40-49 30 1 3.3 50+ 72 4 5.6 Total 191 11 5.8 Source: https://wwww.industrydocuments.ucsf.edu/docs/snyc0227 1/ APPENDIX TABLE VIII-10. SUGGESTED GUIDE TO INTERPRETATION OF BIOCHEMICAL DATA Deficient Low Acceptable High Blood Total Plasma Protein, gm/100 ml < 6.00 6.00-6.39 6.40-6.99 >7.00 Plasma Albumin, gm/100 ml < 2.5 2.5-3.4 3.5-5.0 >5.0 Globulin, gm/100 ml < 2.0 2.0-2.9 3.0-3.5 >3.5 Albumin/Globulin Ratio < 1.0 1.0-1.4 1.5-1.9 >2.0 Hemoglobin, gm/100 ml <12.0 12.0-13.9 14.0-14.9 >15.0 Hematocrit, percent <36 36-41 42-44 >45 Mean Corpuscular Hemoglobin Concentration, percent <28.0 28.0-29.9 30.0-31.9 >32.0 Plasma Vitamin A, g/100 ml <10 10-19 20-49 >50 Plasma Carotene, g/100 ml <20 20-39 40-99 >100 Plasma Vitamin C, mg/100 ml < 0.10 0.10-0.19 0.20-0.39 >0.40 Urine Thiamine, g/gm creatinine <27 27-65 66-129 >130 Riboflavin, g/gm creatinine <27 27-79 80-269 >270 N'-Methylnicotinamide, mg/gm creatinine < 0.50 0.50-1.59 1.60-4.29 >4.30 1/ Based on ICNND suggested reference values. Source: https://www.industrydocuments.ucst.edu/docsisnyc0227

which department has given designations for independent health department of smaller municipalities?

xhfg0227

xhfg0227_p25, xhfg0227_p26, xhfg0227_p27, xhfg0227_p28, xhfg0227_p29, xhfg0227_p30, xhfg0227_p31, xhfg0227_p32, xhfg0227_p33, xhfg0227_p34, xhfg0227_p35, xhfg0227_p36, xhfg0227_p37, xhfg0227_p38

the ohio department of health

of these kinds of services, though hard to measure, will decrease in 1963 because of cut-backs in funds for State personnel in all administrative agencies and at all pro- fessional levels. 3) Federal grants-in-aid Table V-13 shows the proportion of local public health funds received in 1962 from federal grant sources to be about 15%. Those funds administered by the State Health Depart- ment, and disbursed to local health districts by a distribution formula which considers both financial needs and population size, have applied to : Cancer, general health and community health services, heart, maternal and child health, and water pollution. Crippled children's program funds are administered by the State Department of Welfare. Portions of salaries of persönnel in state regional and central offices, and drugs distributed free to local health districts, are financed by federal formula grancs. Federal money has been used to finance special projects in local health districts, or aid general health services. The proportion of Cuyahoga County (and Cleveland) public health ser- vices financed through state administered federal grants is reflected in Table V-14 in the Appendix. This table also shows the federal assistance -22- Source: https://www.industrydocuments.ucsf.edu/docsixhfg022 portions of other health programs in Cuyahoga County, not administered by the Health Departments. It is possible that Ohio's 1963 austerity program will also result in a diminution of some of the federal grant funds accruing to local health districts. There were programs in the planning stages for which some federal funds had been received that cannot be carried out because of the cut-back in personnel, or the "freeze" order prohibiting the addition of new employees or the replacement of personnel retired, re- signed, or lost by death. Sources of Income to Local Health Districts, Other Than State Aid There are five sources from which local health districts may re- ceive funds other than state subsidies or federal grants-in-aid. They are: Deductions from property taxes distributed to town- ships and villages; licenses, permits and inspection fees; contractual agreements with cities and Boards of Education; agency grants; voted public health levies limited in County Districts to .5 mill Property Taxes - This is the traditional and major source of public health financing. Monies for health districts are deducted by the County Auditor from taxes levied within a 10 mill limitation. Figure V-3 shows that, in 1962, the Cuyahoga County General Health District derived 6% of its income from village and township taxation, and another 63% from contracts - 23 - Source: https://www.industrydocuments.ucsf.edu/docsxhfg0227 with cities and school boards. The contract funds are, in turn, derived from the tax funds of these jurisdictions, plus state subsidies, (which are re- flected separately in Figure V-3). The City of Cleveland's public health program received 76% of its financial support from taxation. Cuyahoga County voters have not had a health levy before them. Fees - Income is derived in some Ohio cities and counties from as many as forty different kinds of fees. In the Cuyahoga County General Health District fees are collected, for example, for licensing milk and meat handling establishments, food handling and processing, trailer parks. Fees are collected for issuing birth and death certificates. Fee collection is not specifically authorized by law, and in some counties, court decisions have prohibited or restricted the collection of such fees. Contracts - Only four General Health Districts in Ohio have contractual arrangements with one or more cities. Cuyahoga is one of these, providing services to 30 contracting cities. The law requires that it must be determined by the Ohio Department of Health that the General Health District is organized and equipped to provide adequate health services by this -24- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 Figure V-3 1962 INCOME BY SOURCE OF FUNDS City of Cleveland, Division of Health Cuyahoga County General Health District City of Cleveland Total: $1,964,801 MEDICAL CARE-INDIGENT - 1 % MISCELLANEOUS (including I A X E S cash balance) - 3% STATE SUBSIDY - 0.1 % from City; County and State 76% FEES AND LICENSES 20% Cuyahoga County Total: $531,331 MISCELLANEOUS (including cash balance) - 11% STATE SUBSIDY - 109 c/o I A X E S from cities; county FEES AND LICENSES - 5% Boards or Education 639 % FEDERAL - 5 % from villages and townships - 6 % -25- Source: https:I/www.industrydocuments.ucsf.edu/docs/xhfgo227 method. The Cuyahoga County General Health District also provides services by contract to 25 Boards of Education. There are four municipalities in Cuyahoga County, plus the city of Cleveland, maintaining independent municipal health departments - Shaker Heights, Cleveland Heights, East Cleveland and Lakewood. * Table V-15 CUYAHOGA COUNTY HEALTH DISTRICTS 19/ TOTAL LOCAL BUDGETS - 1963 Per Increase or Funds for Capita Decrease City Public Health Approp. From 1962 (less Fed. GIA) City of Cleveland 2,204,443 2.56 +10.5 Cuyahoga County General Health District and contracting cities 525,414 .81 + 4.0 Cleveland Heights 60,805 .97 + 1.5 East Cleveland 38,450 1.03 + 2.6 Shaker Heights 21,987 .57 + 3.0 Lakewood 52,525 .80 -14.7 The current recommendations of the American Public Health Assoc- iation are that per capita appropriations should exceed $2.50. *In its "Financial Report of Local Health Departments-1963", - the Ohio Department of Health has given these independent health departments of the smaller municipalities the following designations: Qualified (full-time) - Cleveland Heights and East Cleveland Unqualified (part-time) - Shaker Heights and Lakewood - 26 - Source: https://www.industrydocuments.ucsf.edu/docs/xhfg0227 PUBLIC HEALTH EXPENDITURE AND ABILITY TO PAY The per capita tax valuation can be used as a measure of a district's ability to appropriate funds for public health. The Ohio State Department of Health has ranked Health Districts in order of per capita assessed val- uation (1962) as compared with a rank order for per capita local appro- 20/ priation. There are 281 statutory Health Districts. In Table V-16 the rank order by assessed valuation and by local health appropriation of Cuyahoga County's General Health District and each separate municipal Health Department within the county, is compared with similar data for Summit County and the City of Akron. Cuyahoga County's General Health District is a contracting system; that is a number of city health districts within the geographic boundaries of the county contract with the General Health District for services. All municipalities eligible by statute for the designation "Health District" contract with the county except those four previously mentioned and the City of Cleveland as stated; twenty-five Boards of Education also contract for School Health Services. (This represents all Boards of Education with- in its jurisdiction, but two). The County General Health District Board of Health also serves all primary parochial schools in its jurisdiction. While the administrative structure of the Summit County General Health District follows the pattern known as combined, * it was chosen as the most appropriate for comparison with Cuyahoga County because its public health expenditures cover a similar array of services including comprehensive school health programs. (The Summit County General Health District serves all Boards of Education in its jurisdiction). The City of Cleveland provides comprehensive school health programs in primary parochial schools, and the Cleveland Board of Education in the public schools, but there is also good cooperation between the two juris- dictions. The City of Akron Health Department serves all public, private and parochial schools within the city limits. There is a combined Board of Health as provided in the Ohio Revised Code. Three municipalities within Summit County also contract with the General Health District for services, and each is entitled to one representative on the 7-man Board of Health. The cities of Akron and Barberton have independent Health Departments. - 27 - Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 TABLE V-16 HEALTH APPROPRIATIONS IN CUYAHOGA AND SUMMIT COUNTIES 1963 Rank By Per Capita Rank By Per Capita Assessed Health Health Local Health Valuation (1962) District Appropriation Appropriation CUYAHOGA COUNTY 41 General Health District .81 170 (with contracting municipalities ranging from 10th to 244th) 17 Shaker Heights .57 210 83 Cleveland Heights .97 143 118 East Cleveland 1.03 127 151 Lakewood .80 171 37 City of Cleveland 2.56 8 SUMMIT COUNTY 116 General Health District 1.82 29 109 City of Akron 2.08 15 - 28 - Source: https://www.industrydocuments.ucsf.edu/docs/xhfg0227 EXPENDITURES OF MAJOR CUYAHOGA COUNTY HEALTH DEPARTMENTS BY PROGRAM Figure V=4 analyzes the expenditures of the Cuyahoga County General Health District, including contracting cities, and of the City of Cleveland Division of Health, by program. It will be noted that both major Health Departments allocate a large proportion of budget to Public Healch nursing, and that, in the County, services by nurses to the public school health programs are included. In the city the public school health program is separate, staffed and financed by the Board of Education. The City of Cleveland is able to maintain a professionally staffed laboratory. The County uses state laboratory facilities. The city has a staff of full and part-time physicians` to cover both home care of the medically indigent population, and some preventive and control programs in communicable disease and venereal disease. The County uses state regional office services for V.D. control, and must rely even more heavily than the City of Cleveland on nursing services in, for example, infectious disease work. The vital statistics services which receive 6% of the Cleveland city budget, represent a geographic area for reporting greater than the city's confines, since registration districts fixed by separate state statutes are designated as this department's responsibility. The city's registrar is not, however, responsible for the entire county. Food and sanitation inspection services consume about 1/3 of each Health District budget. In the county this program includes: sampling and testing of water; inspection of sewage disposal facilities; inspection of garbage and refuse disposal arrangements; some housing inspection; -29- Source: https://www.industrydocuments.ucst.edu/docsixhfg0227 Figure V-4 1962 EXPENDITURES BY PROGRAM City of Cleveland, Division of Health Cuyahoga County General Health District City of Cleveland Total: $1,955,751 FOOD AND SANITATION CONTROL LABORATORY - 6 % SCHOOL MEDICAL 2 8 % SERVICES - 9 % (Est) VITAL STATISTICS - 6% MEDICAL SCHOOL HEALTH SERVICES NURSING - 9 % (Est) PUBLIC 16; % HEALTH NURSING 26% Cuyahoga County Total: $476,856 FOOD AND SANITATION CONTROL 30% MEDICAL SERVICES - 3 % PUBLIC SCHOOL MEDICAL SERVICES - 5 % HEALTH SCHOOL HEALTH NURSING NURSING 45% 17% -30- Source: https://www.industrydocuments.ucsf.edu/docs/xhfg0227 some vector control programs; and food and milk service and handling consultation and inspection programs. In the city food handler programs, milk, meat and poultry processing inspection; rat control; and some public building inspection (barber shops, laundries, hotels, trailer camps) are under the supervision of the Sanitary Unit of the City Division of Health. Collection and dis- posal of garbage and refuse is the responsibility of the Department of Public Service. The Division of Sewage Disposal is a section of the Public Utilities Department. The City Department of Urban Renewal and Housing is responsible for most programs of hygiene of housing, and for inspection of all nursing homes, hospitals and maternity wards as provided for in the Ohio codes. This Department also operates the Division of Air and Stream Pollution. No expenditures for such programs are reflected, then, in the food and sanitation budget of the Cleveland City Division of Health. -31- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 TRENDS IN EXPENDITURES FOR ALL HEALTH SERVICES IN CUYAHOGA COUNTY The Cleveland Welfare Federation has prepared an analysis of income and expenditures of all Health, Welfare and Recreation programs, according to United Community Funds and Councils of America classifications. Trends in health financing are demonstrated by comparing 1955 and 1960. Table V-17 summarizes these trends, and full details are recapi- tulated in Tables V-14 a & b in the Appendix. In the five year span, expenditures for health and medical care have increased in Cuyahoga County, by 72%, but the private philanthropic and agency self-support share of this has had to increase, while the tax dollar portion has actually de- creased. This trend holds for individual areas of health expenditure such as hospitals, including state and county=operated facilities. The medical vendor payments of family and child welfare programs did receive greater federal assistance in 1960 than in 1955, while the local tax share also increased and the state support decreased. Criteria for eligibility for payment of medical care costs, par- ticularly hospitalization, for the "medically indigent", were reduced in 1961, by a resolution of the County Commissioners to cover only those families whose income and resources did not exceed 80% of the State Wel- fare Department standards, and all persons over 65 were declared 21/ ineligible. As of 1963, state matching funds to General Relief were cut from 50% to 40%, putting medical vendor payments for both relief families and the undefined "medically indigent" into further jeopardy. Yet, from 1952 to 1962 medical and health care costs to public assistance 22/ programs in Cuyahoga County had risen 387%. -32- Source: https:/lwww.industrydocuments.ucsf.edu/docsixhfg0227 The question of defining medical indigency plus assessment of fiscal responsibility for payment is the current subject of litigation brought by certain hospitals. The only major public health program in which both local and private financial support showed a decrease, while total expenditures increased, was that of local health departments, but their total expenditures for public health services rose only 31% in the 5 years, while hospital expenditures rose 73.5% and those of public assistance programs - 167.5% (see figures V-5 to V-8). Table V-17 EXPENDITURES FOR HEALTH AND MEDICAL CARE UNDER ALL AUSPICES IN CUYAHOGA COUNTY, BY SOURCE OF FUNDS * 1955 - 1960 (In Thousands of Dollars) 1 9 6 0 % 1955 % of % of Increase Amount Total Amount Total 1955-1960 All Sources $ 72,728 100.0% $125,082 100.0% 72.0 Public (tax support) 22,337 30.7 29,130 23.3 30.4 Private (philanthropic 50,391 69.3 95,954 76.7 90.4 contributions, fees to hospitals, etc. SOURCES: 1. Expenditure Studies for Health, Welfare and Recreation Services, 1955 and 1960: Research Department, Welfare Federation of Cleveland 2. Financial Reports of Department of Public Welfare, State of Ohio 3. Ohio Citizens' Council 4. Fiscal Officers of Veterans Administration Does not include private out of pocket payments for direct medical and dental care, or for health insurance. -33- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227 Figure V - 5 EXPENDITURES FOR HEALTH CARE SERVICES UNDER ALL AUSPICES IN CUYAHOGA COUNTY, BY SOURCE OF FUNDS 1955 - 1960 DOLLARS (Millions) $125,082,000 120 110 23 100 4 90 80 $72,728,000 70 60 31 50 5 40 30 20 64 72 10 1955 1960 KEY: Self Public Support (Gov't) Contri- 9 Percent bution of Total -34- Source: https://www.industrydocuments.ucst.edu/docsixhfg227 Figure V-6 EXPENDITURES FOR HEALTH CARE SERVICES BY HOSPITALS IN CUYAHOGA COUNTY, BY SOURCE OF FUNDS 1955 - 1960 DOLLARS (Millions) $116,666,000 110 20 100 90 3 80 70 $67,238,000 60 29 50 3 40 77 30 68 20 10 1955 1960 KEY: Self Public Support (Gov't) Contri- 5 Percent bution of Total -35- Source: https://www.industrydocuments.ucsf.edu/docsixhfg0227

How much is "calorie allowance" AT BIRTH?

qtpg0227

qtpg0227_p0

125 per kg, 125 per Kg

lst Working Draft Food and Nutrition Board, National Academy of Sciences-National Research Council Recommended Daily Dietary Allowances¹, , Revised 1963 Designed for the maintenance of good nutrition of practically all healthy persons in the U.S.A. (Allowances are intended for persons normally active in a temperate climate) Pro- Cal- Vita- Equiv 3 2 Thia- Ribo= Ascores Vita- Age Weight He ght Calo tein cium Iron min A mine flavin Niacin bic Acid min D years kg. (lbs.) cm. (in. ries gm. gm. mg. I.U. mg. mg. mg. me. I.U. Men 25 70 (154) 175 (69) 3000 70 0.8 5000 1.2 1.8 20 70 45 70 (154) 175 (69) 2700 70 0.8 5000 1.1 1.6 18 70 65 70 (154) 175 (69) 2400 70 0.8 5000 1.0 1.4 16 70 Women 25 58 (128) 163 (64) 2200 58 0.8 5000 0.9 1.3 15 70 45 58 (128) 163 (64) 2000 58 0.8 5000 0.8 1.2 13 70 65 58 (128) 163 (64) 1800 58 0.8 5000 0.8 1.1 12 70 Pregnant (last Trimester) +200 +20 +0.5 + 1000 +0.2 +0.3 + 3 + 30 400 Lactating + 1000 +40 +0.5 +3000 + 0.4 +0.6 +' 7 +30 400 Infants O-1 Kgx115 Kgx2.5 0.7 30 1144 -0.5 4 Children 1-3 12 (27) 87 (34) 1400 35 0.8 2000 0.6 0.8 9 40 400 3-6 18 (40) 107 (42) 1600 40 0.8 2500 0.6 1.0 11 50 400 6.9 24 (53) 124 (49) 2100 52 0.8 3500 0.8 1.3 14 60 400 Boys 9-12 33 (72) 140 (55) 2400 60 1.1 4500 1.0 1.4 16 70 400 12-15 45 (98) 156 (61.) 3000 75 1.4 5000 1.2 1.8 20 8o 400 15-18 61 (134) 172 (68) 3400 85 1.4 5000 1.4 2.0 22 80 400 Girls 9-12 33 (72) 140 (55) 2200 55 1.1 4500 0.9 1.3 15 80 400 12-15 47 (103) 158 (62) 2500 62 1.3 5000 1.0 1.5 17 8o 400 15-18 53 (117) 163 (64) 2200 55 1.3 5000 0.9 1.3 15 70 400 the allowance levels are intended to cover individual is from beginning of lst year to end of 2nd year; variations among most normal persons as they live in the 3-6 (representing 43 years) is from beginning of United States under usual environmental stresses. The 3rd to end of 5th year, etc. recommended allowances can be attained with a variety of common foods, providing other nutrients for which human 3Niacin equivalents include dietary sources of the requirements have been less well defined. See text for preformed vitamin and the precursor, tryptophan. 60 more detailed discussion of allowances and of nutrients milligrams tryptophan equals 1 milligram niacin. not tabulated. The calorie and protein allowances per kilogram for 2adult age entry 25 is for period 18-35, 45 is for infants are considered to decrease progressively from 35-55, 65 for 55=75. The age entries for infants and birth; i.e., at birth calorie allowance is 125 per kg. children mark the beginning of each age, e.ge: 0.1 is protein allowance is 3.0 gm. kg. Protein allowance from birth to end of lst year; 1-3 (representing 2 years) for infants and children approximate 10% of total calories from protein. Source: https://www.industrydocuments.ucst.edu/docs/qtpg022

How much is "protein allowance" AT BIRTH?

qtpg0227

qtpg0227_p0

3.0 gm. per Kg, 3.0 gm. per kg

lst Working Draft Food and Nutrition Board, National Academy of Sciences-National Research Council Recommended Daily Dietary Allowances¹, , Revised 1963 Designed for the maintenance of good nutrition of practically all healthy persons in the U.S.A. (Allowances are intended for persons normally active in a temperate climate) Pro- Cal- Vita- Equiv 3 2 Thia- Ribo= Ascores Vita- Age Weight He ght Calo tein cium Iron min A mine flavin Niacin bic Acid min D years kg. (lbs.) cm. (in. ries gm. gm. mg. I.U. mg. mg. mg. me. I.U. Men 25 70 (154) 175 (69) 3000 70 0.8 5000 1.2 1.8 20 70 45 70 (154) 175 (69) 2700 70 0.8 5000 1.1 1.6 18 70 65 70 (154) 175 (69) 2400 70 0.8 5000 1.0 1.4 16 70 Women 25 58 (128) 163 (64) 2200 58 0.8 5000 0.9 1.3 15 70 45 58 (128) 163 (64) 2000 58 0.8 5000 0.8 1.2 13 70 65 58 (128) 163 (64) 1800 58 0.8 5000 0.8 1.1 12 70 Pregnant (last Trimester) +200 +20 +0.5 + 1000 +0.2 +0.3 + 3 + 30 400 Lactating + 1000 +40 +0.5 +3000 + 0.4 +0.6 +' 7 +30 400 Infants O-1 Kgx115 Kgx2.5 0.7 30 1144 -0.5 4 Children 1-3 12 (27) 87 (34) 1400 35 0.8 2000 0.6 0.8 9 40 400 3-6 18 (40) 107 (42) 1600 40 0.8 2500 0.6 1.0 11 50 400 6.9 24 (53) 124 (49) 2100 52 0.8 3500 0.8 1.3 14 60 400 Boys 9-12 33 (72) 140 (55) 2400 60 1.1 4500 1.0 1.4 16 70 400 12-15 45 (98) 156 (61.) 3000 75 1.4 5000 1.2 1.8 20 8o 400 15-18 61 (134) 172 (68) 3400 85 1.4 5000 1.4 2.0 22 80 400 Girls 9-12 33 (72) 140 (55) 2200 55 1.1 4500 0.9 1.3 15 80 400 12-15 47 (103) 158 (62) 2500 62 1.3 5000 1.0 1.5 17 8o 400 15-18 53 (117) 163 (64) 2200 55 1.3 5000 0.9 1.3 15 70 400 the allowance levels are intended to cover individual is from beginning of lst year to end of 2nd year; variations among most normal persons as they live in the 3-6 (representing 43 years) is from beginning of United States under usual environmental stresses. The 3rd to end of 5th year, etc. recommended allowances can be attained with a variety of common foods, providing other nutrients for which human 3Niacin equivalents include dietary sources of the requirements have been less well defined. See text for preformed vitamin and the precursor, tryptophan. 60 more detailed discussion of allowances and of nutrients milligrams tryptophan equals 1 milligram niacin. not tabulated. The calorie and protein allowances per kilogram for 2adult age entry 25 is for period 18-35, 45 is for infants are considered to decrease progressively from 35-55, 65 for 55=75. The age entries for infants and birth; i.e., at birth calorie allowance is 125 per kg. children mark the beginning of each age, e.ge: 0.1 is protein allowance is 3.0 gm. kg. Protein allowance from birth to end of lst year; 1-3 (representing 2 years) for infants and children approximate 10% of total calories from protein. Source: https://www.industrydocuments.ucst.edu/docs/qtpg022

"Protein allowance for infants and children approximate" what "percentage of total calories from protein"?

qtpg0227

qtpg0227_p0

10%

lst Working Draft Food and Nutrition Board, National Academy of Sciences-National Research Council Recommended Daily Dietary Allowances¹, , Revised 1963 Designed for the maintenance of good nutrition of practically all healthy persons in the U.S.A. (Allowances are intended for persons normally active in a temperate climate) Pro- Cal- Vita- Equiv 3 2 Thia- Ribo= Ascores Vita- Age Weight He ght Calo tein cium Iron min A mine flavin Niacin bic Acid min D years kg. (lbs.) cm. (in. ries gm. gm. mg. I.U. mg. mg. mg. me. I.U. Men 25 70 (154) 175 (69) 3000 70 0.8 5000 1.2 1.8 20 70 45 70 (154) 175 (69) 2700 70 0.8 5000 1.1 1.6 18 70 65 70 (154) 175 (69) 2400 70 0.8 5000 1.0 1.4 16 70 Women 25 58 (128) 163 (64) 2200 58 0.8 5000 0.9 1.3 15 70 45 58 (128) 163 (64) 2000 58 0.8 5000 0.8 1.2 13 70 65 58 (128) 163 (64) 1800 58 0.8 5000 0.8 1.1 12 70 Pregnant (last Trimester) +200 +20 +0.5 + 1000 +0.2 +0.3 + 3 + 30 400 Lactating + 1000 +40 +0.5 +3000 + 0.4 +0.6 +' 7 +30 400 Infants O-1 Kgx115 Kgx2.5 0.7 30 1144 -0.5 4 Children 1-3 12 (27) 87 (34) 1400 35 0.8 2000 0.6 0.8 9 40 400 3-6 18 (40) 107 (42) 1600 40 0.8 2500 0.6 1.0 11 50 400 6.9 24 (53) 124 (49) 2100 52 0.8 3500 0.8 1.3 14 60 400 Boys 9-12 33 (72) 140 (55) 2400 60 1.1 4500 1.0 1.4 16 70 400 12-15 45 (98) 156 (61.) 3000 75 1.4 5000 1.2 1.8 20 8o 400 15-18 61 (134) 172 (68) 3400 85 1.4 5000 1.4 2.0 22 80 400 Girls 9-12 33 (72) 140 (55) 2200 55 1.1 4500 0.9 1.3 15 80 400 12-15 47 (103) 158 (62) 2500 62 1.3 5000 1.0 1.5 17 8o 400 15-18 53 (117) 163 (64) 2200 55 1.3 5000 0.9 1.3 15 70 400 the allowance levels are intended to cover individual is from beginning of lst year to end of 2nd year; variations among most normal persons as they live in the 3-6 (representing 43 years) is from beginning of United States under usual environmental stresses. The 3rd to end of 5th year, etc. recommended allowances can be attained with a variety of common foods, providing other nutrients for which human 3Niacin equivalents include dietary sources of the requirements have been less well defined. See text for preformed vitamin and the precursor, tryptophan. 60 more detailed discussion of allowances and of nutrients milligrams tryptophan equals 1 milligram niacin. not tabulated. The calorie and protein allowances per kilogram for 2adult age entry 25 is for period 18-35, 45 is for infants are considered to decrease progressively from 35-55, 65 for 55=75. The age entries for infants and birth; i.e., at birth calorie allowance is 125 per kg. children mark the beginning of each age, e.ge: 0.1 is protein allowance is 3.0 gm. kg. Protein allowance from birth to end of lst year; 1-3 (representing 2 years) for infants and children approximate 10% of total calories from protein. Source: https://www.industrydocuments.ucst.edu/docs/qtpg022

What is on the x-axis of all graphs?

lglg0227

lglg0227_p34, lglg0227_p35, lglg0227_p36, lglg0227_p37, lglg0227_p38, lglg0227_p39, lglg0227_p40, lglg0227_p41

Days

SLEEP REVERSAL I, JANUARY 1963 FIVE SUBJECTS 120 100 80 60 140 120 100 80 I 2 3 4 5 6 7 8 9 I 2 3 4 5 I II III BASELINE REVERSAL Source: https://www.industrydocuments.ucsf.edu/docs/Iglg0227 SLEEP REVERSAL II, MARCH 1963 FIVE SUBJECTS 70 69 68 86 84 82 80 78 76 74 72 70 68 66 1.2 1.1 1.0 0.9 0.8 0.7 0.6 1.90 1,80 . . 1.70 . T T T 1 T I 2 3 4 5 6 7 8 9 I 2 3 4 5. - - BASELINE I II III REVERSAL Source: https://www.industrydocuments.ucst.edu/docs//glg0227 SLEEP REVERSAL II, MARCH 1963 FIVE SUBJECTS 6.0 DAYTIME 5.0 NIGHT TIME 4.0 14 for 13 12 700 600 21 20 19 18 3.0 2.0 1.0 o -1.0 I 2 3 4 5 6 7 8 9 I 2 3 4 5 - - BASELINE I II III REVERSAL Source: https://www.industrydocuments.ucsf.edu/docs//glg0227 NITROGEN BALANCE POTASSIUM SODIUM g/24 hr (m Eq 24hr) (m Eq. 24 hr) O - 2 3 1 2 3 1 4 5 6 1 R 2 3 D 1 E 5 6 MAY 1861 FRESHMEN EXAMINATION MAY 1963 FIFTEEN SUBJECTS 73 72 . - 71 78 76 74 72 70 1.3 1.2 1.1 1.0 has 0.9 1.80 1.70 1.60 I T T I 2 3 4 5 6 7 I 2 3 4 5 6 7 * one value missing BL R E weighted mean used DAYS Source: https://www.industrydocuments.ucsf.edu/docs/lglg0227 FRESHMEN EXAMINATION MAY 1963 FIFTEEN SUBJECTS 6.0 DAY 5.0 NIGHT 4.0 10.0 . 9.0 8.0 14.0 13.0 . 12.0 700 600 500 .- 20 19 18 I 2 3 4 5 6 I 2 3 4 5 6 BL R E DAYS Source: https://www.industrydocuments.ucst.edu/docs/glg0227 SLEEP REVERSAL II, MARCH 1963 FIVE SUBJECTS 100 80 60 E 40 120 100 E 80 I 2 3 4 5 6 7 8 9 I 2 3 4 5 I II III Source: https://www.industrydocuments.ucsf.edu/docs/Iglg0227 FRESHMEN EXAMINATION MAY 1963 EIGHT SUBJECTS ONLY 70 69 68 80 79 78 - 77 - 76 - M 75 74 73 72 1.2 1.1 1.0 0.9 0.8 1.80 1.70 1.60 1.50 T' I 2 3 4 5 6 7 I 2 3 4 5 6 7 8 9 * one value missing BL R E PE weighted mean used DAYS Source: https://www.industrydocuments.ucsf.edu/docs/Iglg0227

What is the chart number?

tkyg0227

tkyg0227_p12, tkyg0227_p13, tkyg0227_p14, tkyg0227_p15

Chart 18., 18

CHART 21. - PER CAPITA CONSUMPTION OF GRAIN PRODUCTS AND POTATOES (WHITE AND SWEET) - FROM 1879 * (Calories per day) 1,800 1,800 1,600 1,600 1,400 I,400 Grain products 1,200 1,200 1,000 1,000 800 800 600 600 400 400 Total potatoes 200 200 Sweet potatoes White potatoes o 1.1 o 1875 1885 1895 1905 1915 1925 1935 1945 1955 * Data from Part E, Tables VI-A, VIII, IX. Source: https://www.industrydocuments.ucsf.edu/docs/tkyg227 CHART 16. - PER CAPITA CONSUMPTION OF GRAIN PRODUCTS AND SUGAR, FROM 1879* (Calories per day) 1,800 1,800 1,600 1,600 1,400 1,400 Grain products 1,200 1,200 1,000 1,000 800 800 600 600 Sugar 400 400 200 200 o o -8758851895905915925935 1945 1955 * Data from Part E, Tables VI-A, VIII, VIII-A, IX. Source: https://www.industrydocuments.ucsf.edu/docs/tkyg0227 CHART 17. - PER CAPITA CONSUMPTION OF GRAIN PRODUCTS AND VISIBLE FATS, FROM 1879* (Calories per day) 1,800 1,800 1,600 1,600 1,400 I,400 Grain products 1,200 1,200 1,000 1,000 800 800 600 600 Total visible fats 400 Vegetable shortening 400 Lard 200 200 Margarine Butter o o 1875 1885 1895 1905 1915 1925 1935 1945 1955 "Data from Part E, Tables VI-A, VIII, IX. Source: https://www.industrydocuments.ucsf.edu/docs/tkyg0227 CHART 18. - PER CAPITA CONSUMPTION OF GRAIN PRODUCTS AND "MEATS," * FROM 1879 (Calories per day) 1,800 1,800 1,600 1,600 1,400 1,400 Grain products 1,200 1,200 1,000 1,000 800 800 Total "meats" 600 Other "meats" 600 400 400 Pork 200 200 Beef, veal, mutton, lamb o o 1875 1885 1895 1905 1915 1925 1935 1945 1955 * Data from Part E, Tables VI-A, VIII, IX. Source: https://www.industrydocuments.ucsf.edu/docs/tkyg0227

What is the part number?

tkyg0227

tkyg0227_p12, tkyg0227_p13, tkyg0227_p14, tkyg0227_p15

Part E, E

CHART 21. - PER CAPITA CONSUMPTION OF GRAIN PRODUCTS AND POTATOES (WHITE AND SWEET) - FROM 1879 * (Calories per day) 1,800 1,800 1,600 1,600 1,400 I,400 Grain products 1,200 1,200 1,000 1,000 800 800 600 600 400 400 Total potatoes 200 200 Sweet potatoes White potatoes o 1.1 o 1875 1885 1895 1905 1915 1925 1935 1945 1955 * Data from Part E, Tables VI-A, VIII, IX. Source: https://www.industrydocuments.ucsf.edu/docs/tkyg227 CHART 16. - PER CAPITA CONSUMPTION OF GRAIN PRODUCTS AND SUGAR, FROM 1879* (Calories per day) 1,800 1,800 1,600 1,600 1,400 1,400 Grain products 1,200 1,200 1,000 1,000 800 800 600 600 Sugar 400 400 200 200 o o -8758851895905915925935 1945 1955 * Data from Part E, Tables VI-A, VIII, VIII-A, IX. Source: https://www.industrydocuments.ucsf.edu/docs/tkyg0227 CHART 17. - PER CAPITA CONSUMPTION OF GRAIN PRODUCTS AND VISIBLE FATS, FROM 1879* (Calories per day) 1,800 1,800 1,600 1,600 1,400 I,400 Grain products 1,200 1,200 1,000 1,000 800 800 600 600 Total visible fats 400 Vegetable shortening 400 Lard 200 200 Margarine Butter o o 1875 1885 1895 1905 1915 1925 1935 1945 1955 "Data from Part E, Tables VI-A, VIII, IX. Source: https://www.industrydocuments.ucsf.edu/docs/tkyg0227 CHART 18. - PER CAPITA CONSUMPTION OF GRAIN PRODUCTS AND "MEATS," * FROM 1879 (Calories per day) 1,800 1,800 1,600 1,600 1,400 1,400 Grain products 1,200 1,200 1,000 1,000 800 800 Total "meats" 600 Other "meats" 600 400 400 Pork 200 200 Beef, veal, mutton, lamb o o 1875 1885 1895 1905 1915 1925 1935 1945 1955 * Data from Part E, Tables VI-A, VIII, IX. Source: https://www.industrydocuments.ucsf.edu/docs/tkyg0227

What is the number of observations in battalion 1?

zznc0227

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Alaska An Appraisal of the Health and Nutritional Status of the Eskimo A REPORT BY THE INTERDEPARTMENTAL COMMITTEE ON NUTRITION FOR NATIONAL DEFENSE AUGUST 1959 OF ASSISTANT SECRETARY OF DEFENSE WASHINGTON 25, D.C. HEALTH AND MEDICAL, August 31, 1959 On behalf of the Interdepartmental Committee on Nutrition for National Defense (ICNND), it is my pleasure to transmit this report, An Appraisal of the Health and Nutritional Status of the Eskimo in Alaska. The clinical and biochemical phases of the survey, conducted in March-April 1958, included the Eskimo National Guardsmen and a random sampling of eight Eskimo and two Indian villages. This was a cooperative undertaking of the ICNND with the Arctic Health Research Center, the Division of Indian Health of the U. S. Department of Health, Education, and Welfare, the Alaska Command of the U. S. Armed Forces, and the Alaska National Guard. A detailed report of the dietary studies conducted in the ten Alaskan villages will be published at a future date by the Arctic Health Research Center. Dr. Christine Heller of the Arctic Health Research Center is continuing these investigations. The evaluation of the dietary intake, customs, and habits of these few remaining native villages will enable a much more meaningful evaluation of the clinical data. The Alaskan aboriginal people have and will continue to have a remarkably successful adaptation to their environ- ment and unique food supply. The purpose of this study was to establish a baseline of nutritional appraisal in order to evaluate in future years the effects of cultural transition in relation to health. Continued assistance to provide medical and dental care, housing, and economic development is most essential. I wish to call your attention to the general conclusions of this report on page 118. Frankisterry Frank B. Berry, M. D. Source: https://www.industrydocuments.ucst.edu/docsizznc022 V INTERDEPARTMENTAL COMMITTEE ON NUTRITION FOR NATIONAL DEFENSE Department of Defense: Dr. Frank B. Berry, Assistant Secretary of Defense (Health and Medical), Chairman Dr. E. H. Cushing, Deputy Assistant Secretary of Defense (Health and Medical) Brig. Gen. Sheldon S. Brownton, USAF (MC) Army: Dr. John B. Youmans Lt. Col. William J. Wilson, MC Navy: Dr. Howard T. Karsner Rear Admiral Calvin B. Galloway, MC Air Force: Major George W. Powell, MC Department of State: Mr. Walter M. Rudolph Department of Agriculture: Mr. Clarence M. Purves Dr. Hazel K. Stiebeling Department of Health, Education, and Welfare: Dr. Floyd S. Daft Dr. H. van Zile Hyde International Cooperation Administration: Dr. Eugene P. Campbell Dr. Katharine Holtzclaw Atomic Energy Commission: Dr. James L. Liverman Secretariat Dr. Arnold E. Schaefer, Executive Director Dr. Ernest M. Parrott, Deputy Executive Director Dr. Arthur G. Peterson, Agricultural Economist Consultants Dr. William F. Ashe Dr. William J. Darby Dr. William McGanity Dr. S. Bayne-Jones Dr. Cyrus E. French Dr. William N. Pearson Dr. M. K. Bennett Dr. Wendell H. Griffith Dr. Herbert Pollack Dr. George H. Berryman Dr. David B. Hand Dr. W. H. Sebrell, Jr. Mr. Edwin B. Bridgforth Dr. D. Mark Hegsted Dr. Fredrick J. Stare Dr. Joseph S. Butts Dr. Norman Jolliffe Dr. Philip L. White Dr. Gerald F. Combs Dr. z. I. Kertesz Dr. Robert R. Williams Dr. L. A. Maynard Source: https:llwww.industrydocuments.ucsi.edu/docsizznc022 VII VI LIST OF FIGURES TABLE OF CONTENTS Page Page Title Number Part I Preface XI Frontispiece Guzema Wassilie, Medicine Man at Napaskiak 1. Administrative History XI 2. Acknowledgments XI Figure I Northern Cultural Areas and Tundra Region Facing 1 3. Objectives XIII 4. Explanatory Addendum XIII Figure II Tuberculosis Mortality for Alaska by Race, 11 1952-1957 Part II Introduction 1 1. The Cultural Background 1 Figure III Principal Ethnographic Divisions of Alaska, 14 2. Demographic Factors 4 and the Villages Studied 3. Health Facilities 7 4. General Plan of Study 13 Figure IV Plan of the Study with Numbers Examined 16 5. Clinical Calibration Studies 15 Figure V Enlargement of the Submaxillary Glands 30 Part III Native Men in the National Guard 20 1. The Population Studied 20 Figure VI Pigmentary Changes in a Young Eskimo Man 31 2. Clinical Findings 21 3. The Dental Study 34 Figure VII Dental Attrition in a 32-Year-Old Eskimo 46 Woman Part IV The Village Studies 42 1. Bethel Area - The Situation in Akiak, Kasigluk, Figure VIII Height by Age and Sex, Eskimo Villages, 1958, 42 Compared to Canadian Population 61 Napaskiak, Newktok and Hooper Bay 2. Kotzebue Area - The Situation in Noatak, Point Hope, Shishmaref, Allakaket and Hislia 49 Figure IX Weight by Age and Sex, Eskimo Villages, 1958, 62 3. Clinical Findings in the Villages 52 Compared to Canadian Population 4. Discussion of Clinical Findings 67 Eskimo and Indian Villages in Alaska, 1958, Figure X Part V Dietary Measurements 72 Blood Pressures and Pulse Rates, by Age 65 1. National Guardsmen - Camp Denali (Ft. Richardson) 72 2. Villages (Preliminary) 74 Figure XI Eskimo and Indian Villages in Alaska, 1958, 3. Discussion 91 Arm and Scapula Skinfold Thickness, by 70 Age and Sex Part VI Biochemical Findings 99 1. Methods 100 2. Results 100 3. Discussion 111 4. Summary 118 Part VII General Conclusions 120 Part VIII Specific Recommendations 121 Part IX Appendices 122 A - Criteria for Oral Examinations 122 B - Food Consumption, Males - Alaska, 1956-1958 124 C - Food Patterns by Village 134 D - National Research Council, Recommended Dietary Allowances 160 Bibliography 161 Source: ttps://www.industrydocuments.ucst.edu/docs zznc022 VIII IX LIST OF TABLES LIST OF TABLES (continued) Table Title Page Table Title Page Introduction Table 1 The Village Studies Eskimos, Indians and Aleuts in Alaska in 1950 1 Table 17 Eskimo and Indian Villages in Alaska, 1958; Percent 2 Alaska: Characterization of the Villages in the Study, Prevalence of Clinical Findings 54-55 and the Size of the Samples Examined, 1958 6 18 Eskimo and Indian Villages in Alaska, 1958; Percent 3 Eskimo Men, Alaska National Guard, 1958; Clinical Prevalence, Selected Clinical Findings by Age Calibration Studies 17 and Sex 57 4 Eskimo Men, Alaska National Guard, 1958; Summary of 19a Eskimos and Athabascan Indians in Alaska, 1958; Calibration Studies for the Clinical Examinations 19 Percentage of "Standard Weight" by Age and Sex 58 19b Eskimos and Athabascan Indians in Alaska, 1958; Native Men in the National Guard Table 5 "Obesity" in Adults by Age and Sex 59 Eskimo Men, Alaska National Guard, 1958, by Battalion; 20 Average Height and Weight of Eskimos and Athabascan Origin, Age, Height, Weight, Weight Status, Skinfolds, Indians in Alaska, 1958, Compared to Canadian Blood Pressure and Pulse 22 1953 Survey 60 6 Eskimo Men, Alaska National Guard, 1958, by Battalion 21 Eskimo and Indian Villages in Alaska, 1958; Pulse and Age; Height, Weight, Weight Status, Skinfolds, (Mean + S.E.) by Age, for Villages by Ethnographic Blood Pressure and Pulse 23 Groups 64 7 Eskimo Men, Alaska National Guard, 1958, by Battalion, 22 Eskimo Men, Alaska National Guard, 1958, by Battalion; Blood Pressure (Mean + Standard Error) by Height 23 Blood Pressure and Pulse Measurements, by Examiner 66 8 Eskimo Men, Alaska National Guard, 1958, by Battalion; 23 Eskimo and Indian Villages in Alaska, 1958; Blood Percent Prevalence of Clinical Findings, by Examiner 26-27 9 Pressure (Mean + S.E.) by Age, for Villages by Eskimo Men, Alaska National Guard, 1958, by Battalion Ethnographic Groups 68 and Age; Percent Prevalence of Selected Clinical 24 Eskimo and Indian Villages in Alaska, 1958; Arm and Findings 28 10 Scapula Skinfold Thickness by Age and Sex, for Eskimo Men, Alaska National Guard, 1958, by Region of Villages by Ethnographic Groups 69 Origin; Age, Height, Weight, Weight Status, Blood Pressure and Selected Clinical Findings 29 11 Dietary Measurements Relation of Clinical Signs and Biochemical Findings, Table 25 Eskimo Men, Alaska National Guard, Ft. Richardson, 1958; Serum Vitamin A, Alaska, 1958 33 12 Food Consumption from the Mess Hall Alone, Average Relation of Clinical Signs and Biochemical Findings, Per Man Per Day 72 Serum Vitamin C, Alaska, 1958 34 26 13 Eskimo Men, Alaska National Guard, Ft. Richardson, 1958; Eskimo Men, Alaska National Guard, 1958; Comparison of Plate Waste, Average Per Man Per Day 73 Dental Caries and Periodontal Status of 713 Eskimo 27 Eskimo Men, Alaska National Guard, Ft Richardson, 1958; Guardsmen with 1,400 White Male Residents of Birmingham Food Consumption from all Sources, Average Per Man and Baltimore 35 14 Per Day 73 Eskimo Men, Alaska National Guard, 1958; Mean Numbers of 28 Nutrient Composition of Recipes for Eskimo Dishes, as Decayed, Missing, or Filled Permanent Teeth in Four Calculated 75-81 Groups from the First and Second Battalions 36 15 29 Chemical Composition of Alaskan Foods, 1958 83-87 Eskimo Men, Alaska National Guard, 1958; Oral Status of 30 Food Consumption of Men in Villages, Alaska, 1956-1958 89 Members of First and Second Battalions 37-39 16 31 Food Consumption of Alaskan and Indian Men by Villages, Eskimo Men, Alaska National Guard, 1958; Gingival 1956-1958 90 Recession Scores, Men 35 Years of Age or Older, First 32 and Second Battalions Fat Content of Commonly Eaten Meats 93 41 33 Guide to Interpretation of Nutrient Intake Data 94 Source: https://www.industrydocuments.ucst.edu/docsizznc0227 X XI LIST OF TABLES (continued) I PREFACE Table Title Page 1. Administrative History Biochemical Findings A program of research on the nutritional status of Alaskan natives Table 34a Alaska, Nutrition Survey, March 1958; Biochemical has been under way in the Arctic Health Research Center, Anchorage, Findings, for National Guard and Villages, by Alaska, for several years. The present study arose from the interests Sex and Age Groups; Total Serum Protein and of the Department of Defense. Hematology 101 34b Alaska, Nutrition Survey, March 1958; Biochemical At a meeting of the Interdepartmental Committee on Nutrition for Findings, for National Guard and Villages, by National Defense (ICNND) 28 May 1956, Dr. Frank B. Berry reported that Sex and Age Groups; Serum Vitamin c, A and Carotene 102 the Secretary of Defense had inquired if the ICNND would be interested 34c Alaska, Nutrition Survey, March 1958; Biochemical in conducting a nutrition survey of the Alaskan natives. This proposal Findings, for National Guard and Villages, by was considered favorably by the Committee, and the Secretariat was Sex and Age Groups; Total Fatty Acids, Phospholipids authorized to explore the possibilities further. Discussions were held and Cholesterol 103 with Dr. Jack Haldeman, Chief, General Health Service, Public Health 34d Alaska, Nutrition Survey, March 1958; Biochemical Service, Department of Health, Education, and Welfare (HEW) and Dr. Findings, for National Guard and Villages, by John C. Cutler, Program Officer, Bureau of State Services, HEW. Toward Sex and Age Groups; Urinary Excretions 104 the end of 1956, the Committee received a formal request from the 35 Alaska, Nutrition Survey, March 1958; Comparison of Arctic Health Research Center for assistance in financing and con- Methods for Determination of N'Methylnicotinamide 106 ducting a nutrition survey of the Alaska National Guardsmen while they 36a Alaska, Nutrition Survey, March 1958; Total Serum were in their annual encampment in Anchorage and also in completing a Protein and Hematology by Village, for Men, Women survey of the inhabitants of ten native villages. The Commi ttee and Children 107 appointed an ad hoc group, with representatives from the General Health 36b Alaska, Nutrition Survey, March 1958; Serum Vitamin c, Service, Bureau of State Services and the Division of Indian Health of A and Carotene, by Village 108 the Public Health Service; and including Dr. E. M. Scott of the Arctic 36c Alaska, Nutrition Survey, March 1958; Mean Blood Fat Health Research Center, Anchorage, and Dr. John B. Youmans, Consultant Levels, by Village and Age 109 to the ICNND, to meet in April 1957 to draft a proposal for Committee 36d Alaska, Nutrition Survey, March 1958; Urinary Excretions action. by Villages, for Men, Women and Children 110 37 Alaska, Nutrition Survey, March 1958; Mean Blood Fat At a meeting in May 1957 the Committee agreed to serve as a co- Levels, by Survey Area and by Age 114 ordinating and sponsoring agency for a nutrition survey of the two 38 Alaska, Nutrition Survey, March 1958; Urinary Excretions National Guard Battalions during their 1958 encampment and a clinical of B-Vitamins, Village Areas, by Age and Sex 116 and biochemical survey of the inhabitants of the ten native villages 39 Alaska, Nutrition Survey, March 1958; Biochemical in which the Arctic Health Research Center, with the aid of the Findings, by Reproductive Status, Eskimo Villagers Division of Indian Health, had been conducting a survey of food intake in the Bethel Area 117 and dietary habits. 40 Suggested Guide to Interpretation of Biochemical Data 119 2. Acknowledgments Many people have contributed to the work of this study. The names are arranged here according to their respective organizations. Arctic Health Research Center, Anchorage, Alaska Dr. A. B. Colyar - Director, Arctic Health Research Center Alaska National Guard Brig. General Thomas P. Carroll, Adjutant General, Alaska National Guard Major William H. Crawford, Commander, First Scout Battalion Major Harry E. Voelker, Commander, Second Scout Battalion Source: ittps://www.industrydocuments.ucst.edu/docsizznc022 XII XIII Alaska Native Health Service Team Members (continued) Dr. Joseph A. Gallagher - Area Officer in Charge, Anchorage Mrs. Isabelle V. Griffith - Chemist, Arctic Health Research Center Dr. Robert I. Frazier - Medical Officer, Kotzebue Miss Anna J. Pitney - Chemist, Arctic Health Research Center Dr. Elmer E. Gaede - Medical Officer, Tanana Mr. Lyndon Sikes - Chemist, Arctic Health Research Center Dr. William A. Brownlee - Medical Officer, Bethel Dr. Milton Silverman - Biochemist, n/ National Institutes of Health Dr. Albert L. Russell - Dentist, National Institutes of Health Village Teachers Mr. Carl L. White - Statistician, National Institute of Health M/Sgt. Dale o. Starr - NCO in Charge, Dispensary, Fort Richardson Mr. and Mrs. Roman W. Kinney, Akiak M/Sgt. Harold G. Coffman - X-ray Technician, Dispensary, Fort Richardson Mr. and Mrs. Emil Kowalczyk, Kasigluk SP-5 Ronald J. Murphy - Technician, Dispensary, Fort Richardson Mrs. Mary McDougall, Napaskiak Mr. and Mrs. John F. Gordon, Hooper Bay 3. Objectives Mrs. Ida A. Hunter, Newktok Mr. and Mrs. Fred G. Fisher, Point Hope The extent of success of the adaptation of the Eskimo to a uniquely Mr. and Mrs. Russell McLaughlin, Shishmaref limited and precarious food supply in a harsh environment has been a Mr. and Mrs. Walter A. Ortman, Allakaket challenging question to physiologists for over a century. Arctic ex- Mr. and Mrs. Ley M. Kahl, Huslia plorers have often discussed this problem and some have taken highly Mr. and Mrs. S. William Benton, Noatak controversial positions based on their estimates either of the merits of the Eskimo dietary regimen or the status of the natives' health. U.S. Military Organizations - Alaskan Command The present study was undertaken to investigate this question in co- operation with the Arctic Health Research Center (AHRC) of the Lt. General Frank A. Armstrong, USAF - Commander in Chief, Alaskan Command Department of Health, Education, and Welfare, the Alaska Command of Maj. General G. C. Mudgett - Commander, U.S. Army, Alaska the U.S. Armed Forces, and the Alaska National Guard. Brig. General John R. Copenhaver - USAF Surgeon, Alaskan Command Colonel Sterrett E. Dietrich - U.S. Army, Surgeon Members of the AHRC with the support of the Indian Health Service Lt. Colonel Wade F. Heritage - U.S. Army, Deputy Surgeon have been conducting systematic studies of the dietary habits of the Lt. Colonel George D. Pleasants - Post Surgeon, Ft. Richardson Eskimo and, in particular, their hematological disorders. The present work was intended to complement those studies. The work described here Finally, the subjects themselves should be complimented for their was designed to evaluate the nutritional status of the Eskimo of all pleasant welcomes, patient forbearance and altogether cheerful and ages and both sexes by carrying out physical appraisals and biochemical intelligent willingness to help with the tasks at hand. measurements of specific nutrients in blood and urine. These data were then to be evaluated along with the dietary evaluations and food Team Members analyses made available by continuing studies of the Arctic Health Research Center. Additional measurements of consumption of food in Dr. John B. Youmans - Field Director, Army Medical Research and Develop- the mess halls were made among the native members of the Armed Forces ment Command Lt. Colonel Laurence M. Hursh - Director, 1 Army Medical Research and 4. Explanatory Addendum Nutrition Laboratory Dr. Edward M. Scott - Deputy Director, Arctic Health Research Center Since the present study was done and much of the report was written Dr. George V. Mann - Clinician, National Institutes of Health before or during the emergence of Alaska as the 49th state, there may Mr. C. Frank Consolazio - Biochemist, Army Medical Research and be descriptions herein or references to agencies or procedures which Nutritio; Laboratory have been superseded by new organizational arrangements. SP-3 Edward J. Sheehan - Technician, Army Medical Research and Nutrition Laboratory Pfc. Jay M. Jamison - Technician, 1 Army Medical Research and Nutrition Laboratory Dr. Donald B. Kettlecamp - Clinician, Alaska Native Health Service Dr. Ruth Coffin - Clinician, 2 Alaska Native Health Service 2 Field Team Member, Bethel party. Dr. Christine A. Heller - Nutritionist, 1 Arctic Health Research Center 1/ Field Team Member, Kotzebue party. Field Team Member, Bethel party. Source: htps.//www.industrydocuments.ucsi.edu/docsizznc022 1 30 60 40 50 50 of II - INTRODUCTION in 50 Alex 1. The Cultural Background The Eskimos, Indians and Aleuts of Alaska vary widely in their U 2 cultural traditions and present day mode of living. At the time or or the white man's arrival, the Eskimos occupied all the northern and western coasts of Alaska, and lived on the southern coast as far east a as Prince William Sound and on Kodiak Island. The Eskimos were divided culturally into a Northern group, the Thule culture, and a Southern group, the Old Bering culture, with the dividing line situated on 8 80 Norton Sound in the vicinity of Unalakleet. Northern Eskimos still a speak the same language as the Siberian, Canadian and Greenland Eskimos, E while the Southern Eskimo language is quite different. The Aleuts originally occupied the western half of the Alaska Peninsula and the Aleutian Islands. Thlingit Indians lived in southeast Alaska, while AND 06 Athabascan Indians occupied the interior regions of the territory. The map in Figure I shows these regions while Table 1 gives the population of these cultural groups in 1950. I 000 TABLE 1 ESKIMOS, INDIANS AND ALEUTS IN ALASKA IN 1950 Population Median Age 10 Eskimos 15,882 17.7 Athabascan Indians 6,783 -- Aleuts 3,892 17.9 20 Source: U.S. Census of Population, 1950, Vol. II, Parts 51- COAST 53. (1) The Eskimo culture in North America has been traced back through the Christian era. The "Thule" culture based on whaling seems to have of spread eastward from Alaska to Greenland during the period 500 to 1000 .D. In the saga of Eric the Red, reference is made to "skraelings" NEWARK (Eskimos) in Labrador in 1003. Possibly because of the disappearance 3MR of whales from the Central Arctic, a deviant culture based on fishing AIO and sealing spread back to Alaska. These migrations appear to account a for the presence of a single, primitive, Stone Age people with a com- : mon language and tools who occupied the 6,000 miles from Alaska to Greenland when Rink explored the latter area in about 1850. The oldest Eskimo culture is the "old Bering" culture which flourished on both 50 sides of the Bering Strait. This culture was based on the hunting of 60 21 0 00 00 00 fish and sea mammals. In Eurasia the Arctic culture was based on reindeer breeding, as in Lapland, except for a limited area of Eskimo culture on the Chukchi peninsula (2), The Eskimos, like the American Indians, are of Mongoloid ethnic origin. Eskimo skulls are narrow and oblong with a definite sagittal ridge. The lower jaws and maxillary bones are highly developed and Source: https://www.industrydocuments.ucsf.edu/docsizznc0227 2 3 prominent. The skin, hair, epicanthal folds and lumbar pigment testify to their Mongoloid origin. In contrast to the Negro the It is important to recognize that Alaskan Eskimos are not nomadic Eskimos have narrow noses. As in the American Indian, blood group people: They live in one or a few permanent homesites or campsites type o predominates among the Eskimos. Most of the sod houses have now been replaced by small frame or log structures. In one village in 1953 there were 36 houses with 47 rooms. The present study was concerned primarily with the two groups The floor space per fami ly was 227 square feet or an average of 51 square feet per person (3) Often these frame houses are poorly insu- of Eskimos, defined by geographic areas, and to a lesser extent with Athabascan Indians and Aleuts. In order to understand the situation lated and are therefore more difficult to heat adequately in winter of these people today it is important to review the primitive con- than were the primitive sod houses. ditions under which they once lived, since all of them are now in transition between the primitive and a modern way of life. This Each village had its own seasonal schedule for hunting and fishing, transition began in the 18th century for the Aleuts with their intro- but as in all hunting-fishing economies, there was a large element of duction to the Russian explorers and traders who followed Vitus Bering chance in this activity. The welfare of the people who depended on into their territory. For the Indians and Eskimos the transition hunting and fishing for food, clothing and fuel fluctuated accordingly. began later and at different times for different groups. The coastal Through the summer most Eskimo and Indian families found it necessary Eskimos who lived on marine mammals were exposed to the whit whalers to move from place to place in search of their supply of food. This and explorers of the 18th and 19th centuries, while some of the was particularly necessary for the tundral people who often traveled inland Eskimo and Indian villages have had important contact with considerable distances from the village in order to obtain sufficient white culture only during the past 60 years. The extent of accultu- food. These campsites, usually family affairs, were visited year after ration is thus variable. year as long as they yielded food. Almost all edible foods were eaten, and since food resources varied in different regions, there were wide Eskimos have managed by a number of ingenious methods to maintain geographic differences in diets. their numbers and to carry on a marginal existence under exceptionally adverse conditions. In order to survive in the Arctic, they have had There were three general types of Eskimo diets under the conditions to utilize every available resource. The primary consideration for of the primitive culture (2). On the northern and northwestern coasts the location of an Eskimo or Indian village in Alaska was the available of Alaska, Eskimos were primarily dependent on sea mammals -- seal, food, fuel and water supply. The population balance in such an walrus and whale -- for food. Farther south, chief dependence was on economy was important since overpopulation meant hunger and sometimes fish, while smaller numbers of interior Eskimos lived on land mammals, starvation. When the population became too large for the available primarily on caribou. In none of these areas was there total depen- food supply or if the food supply became scarce because of persistently dence on any one type of food. Use of fish was universal, while unfavorable weather conditions or some other accident of nature, shellfish, birds, birds' eggs, small mammals (including hares, porcupine, family groups would break away and try to find a more favorable place rabbits, muskrats, mink and beaver), berries, roots and green plants to establish themselves. were eaten when available. In retrospect these diets would seem to have had certain things in common. All of them were probably very high Winter homes were half buried in the ground and made of logs or in protein, moderate to high in fat content, and they contained very whale ribs covered with sod. The walls and ceiling of the main living little carbohydrate. They were beasonally low in ascorbic acid, and room were often lined with split driftwood, vegetable matting or skins. must have been on occasion deficient in calories. Such diets, however, Existing examples of these homes, when well constructed, are surpris- had no known nutritional disadvantages and no known advantages except ingly comfortable and can be heated with a minimum of fuel. They are, that they are generally believed responsible for the fact that Eskimo however, dark and small. Such houses were usually buili at permanent teeth were very nearly free of caries. The Eskimo did not usually have living sites and were then occupied only in the winter when they could a choice of foods from which to make a selection. Instead, his problem be kept reasonably free from condensation and seepage. In the spring, was the fundamental one of assuring a continuity of food and to this with the coming of the thaw, many of them became untenable. Because problem he devoted his energy, intelligence and ingenuity. of dampness of the house and because of the necessity to search for food, the people moved out of the sod huts into tents at camp sites, often at considerable distances from the village. In the early days, 1 tents were made of animal skins secured tightly over a willow frame. The tundra is the vast, treeless area of western and northern Alaska. For many years now the great majority of Eskimos have used canvas It is generally flat, dotted with ponds and sloughs and underlaid tents. Even today, though a family may not wish to move away from wi th permafrost. The vegetation in the summer consists of low shrubs the village for sealing or other activities, they will often move out and grasses and in the winter the surface may be buried to a depth of their winter residence into a tent pitched nearby. of several feet with snow. The winds pack and drift this snow almost continually. An approximate outline of the tundra is shown in Figure I. Source: tps:/lwww.industrydocuments.ucsi.edu/docs zznc0227 4 5 2. Demographic Factors creation of schools, stores, churches and postoffices in some villages Eskimos today live on a combination of foods obtained from the has tended to attract native families and to enlarge the villages, traditional sources and foods bought from stores. The latter are for whereas many small villages listed in 1950 are no longer in existence. the most part cereals and sugars. Some of the factors which presently affect the food habits of Eskimos are as follows: Eskimos seemed to accept Christianity readily and today every village has at least one church which is an important part of the social Eskimos now live at a low economic level. In a study made in life. Denomination of the churches is shown in Table 2 for the villages 1955(4), the estimated annual per capita cash income in 23 Eskimo vil- included in the present study. lages ranged from $69 to $475. Unless the Eskimo lives in one of the larger towns and has some education, he has little or no opportunit ty Schools have been in existence in Alaska for many years, but there for a job with a steady income. The income for a village comes from was never enough money to provide one for each of the smaller villages, a variety of sources. Fishing for profit provides income for many and until the past ten years there was little opportunity for a high families in the Bristol Bay area and at the mouth of the Yukon. While school education except in towns with a permanent white population. such fishing may require considerable capital for a boat, the profits Village schools (formerly called "Territorial Schools") are operated are large if the fishing is good. However, the trend in recent years by the State or by the Bureau of Indian Affairs (BIA). In recent years has been toward smaller catches of salmon. Some men from villages in the latter agency has started a special type of school -- The Instruc- the Kuskokwim area obtain employment in the canneries on Bristol Bay. tional Aid School in certain villages. In these schools the village The pay is high, averaging $600 for the month or six weeks when the furnishes the building, and a teacher is provided by the Bureau of cannery operates. Trapping provides part of the income of most vil- Indian Affairs. Such teachers are often not fully qualified. lages. Fur prices are now low, however, and only mink, muskrat and beaver are profitable enough to encourage the effort involved in Stores or trading posts were established in Alaska by the Russians, trapping. Twenty mink, 700 muskrat, or 20 beaver would represent a and traders have since been an important part of village life. Starting good year's trapping for one man in some areas. Generally, however, in the late 1930's, the Bureau of Indian Affairs helped to establish fewer than this are obtained. During the 1957-58 season, average cooperative stores in many of the large villages. There are several market prices for mink were $30, muskrat $0.25 and beaver $25. communities, however, which still have no store, and people must go varying distances for supplies. The typical village store has a very Service in the National Guard produces an appreciable proportion limited stock of supplies and limited storage facilities. In the of the total income in the villages. In addition, a few Eskimos work usual case, there is no place for storage where freezing can be on river barges in the summer or as storekeepers or janitors. Crafts, avoided in the winter or where food can be kept frozen in the summer. such as ivory carving, basket weaving and making of souvenirs, provide some income for Eskimos. A major source of income in all villages is The water supply of the Eskimo and Indian is traditionally the welfare. A large number of Eskimos are eligible for various forms of nearest river, lake, or pond. A hole is cut in the ice in winter to public assistance including Old Age Assistance and Aid-to-Dependent- dip water, or cakes of ice are cut, hauled on sleds to the home and Children. Welfare payments amount to between one fifth and one third then melted for use. Melting of ice is difficult in most areas because of the cash income in most communities. In four of the villages of the fuel shortage. The usual method of obtaining water in the included in the present survey, mean per capita income in 1955 (4) was winter is with a tank or barrel of ice in a corner of the house near estimated as follows: the stove. The room temperature slowly melts this ice and the water is drawn off from the bottom. The difficulty of obtaining uncontami- Village Mean Income Percent of Income nated ice plus this melting process may contribute to the prevalence per Capita from Welfare of enteric diseases. The true prevalence of these diseases has been difficult to measure since they occur sporadically and require long- Napaskiak $173 28 term surveillance for measurement. In Napaskiak, one of the villages in the present study, an investigation was made which indicated a Akiak 475 32 Kasigluk 138 35 seasonal variation in the prevalence of diarrhea(5). The high level Hooper Bay 137 30 occurred in the summer and affected especially the children under 10 years of age (6). The infection rates for Endamoeba histolytica The population in Alaska is sparse and the communities are small. and Diphylobothrium sp. were found to be 8.6 and 34.5 percent, respectively. In 1950 about 80 percent of the 287 places named in the census had fewer than 199 persons (1). This smallness was probably originally related to the availability of food in the surrounding area. The Most of the coastal people have to depend on driftwood for their fuel. Some portions of the coast have a good supply but in others this wood is almost nonexistent In some villages, where seal are Source: https://www.industrydocuments.ucsi.edu/docsizznc022 TABLE 2 ALASKA: CHARACTERIZATION OF THE VILLAGES IN THE STUDY, AND THE SIZE OF THE SAMPLES EXAMINED, 1958 Name Type Popu- No. of Persons Churches School Store or Distance Distance lation Examined to Nearest Store to Hospital Allakaket Indian 120 75 Episcopalian State Co-op. 150 miles Akiak Southern 187 76 Moravian Bureau of 1 Trader + 20 miles Eskimo Indian Affairs Co-op. Hooper Bay Southern 435 96 Roman Catholic Bureau of 2 Traders + 155 miles Eskimo Swedish Covenant Indian Affairs Co-op. Huslia Indian 145 90 Episcopalian State Trader 135 miles Kasigluk Southern 180 94 Russian Orthodox Bureau of (None) 35 miles Eskimo Moravian Indian Affairs (4 miles) Napaskiak Southern 137 81 Russian Orthodox Bureau of (None) 6 miles 6 Eskimo Indian Affairs (1 mile) Newktok Southern 118 59 Roman Catholic Bureau of 3 Traders 115 miles Eskimo Indian Affairs Instructional Aid Noatak Northern 400 69 Friends Bureau of Co-op. 50 miles Eskimo Indian Affairs Point Hope Northern 315 88 Episcopalian Bureau of Co-op. 150 mi les Eskimo Indian Affairs Shi shmaref Northern 200 77 Lutheran Bureau of Co-op. 110 mi les Eskimo Indian Affairs Totals 2,237 805 8 9 Village Complaint included experts in anthropology, nursing care, medical social services, tuberculosis control, hospital and medical care, sanitation, laboratory Hooper Bay 1. A woman, eight months pregnant, with pain, services and mental health. fever and dysuria suggesting pyelitis. Members of the party traveled through the major areas of Alaska. 2. A young man rith fever and malaise con- The observations were generally more concerned with the health organiza- sidered to be "flu. " tions and demographic and environmental conditions than with clinical problems. The study was done at a critical time, because in July 1955 3. A young boy with penile swelling and the responsibility for the health problems of the natives of Alaska was urinary obstruction, considered to be transferred by Public Law 568 from the Bureau of Indian Affairs of the balanitis. Department of the Interior to the Department of .Health, Education, and Welfare. The Pittsburgh report thus reflects the conditions of an older 4. A woman with pleurisy. system. Tanunak 1. An 18 month old child with a swollen and When Secretary Seward purchased Alaska in 1867, the contract wit] inflamed throat. the Czar stipulated, "The uncivilized tribes will be subject to such laws and regulations as the United States may from time to time adopt Pilot Station 1. A man with obstipation. in regard to aboriginal tribes of that country." Health services and regulations were almost nonexistent until 1914 when a medical program 2. A child with extensive eczema. was established in the Bureau of Education which was then the only governmental agency directly concerned with the natives. In 1916 this o 3. A fever of 105` F. in a 4 month old baby - Bureau established a migratory medical boat on the Yukon, but during no localizing signs of infection. the first summer the physician, Dr. J. W. Houston, fell overboard and was drowned. Small health surveys indicated that tuberculosis, syphilis Goodnews Bay 1. A woman with "flu." and "trachoma" were common. There is now reason to doubt that trachoma did, in fact, exist. 2. The supply of drugs very low. The first hospital for natives was built in Juneau in 1916. In Kipnuk 1. Query from the doctor concerning the con- 1931 when the Office of Indian Affairs assumed responsibility there dition of a patient with tuberculosis were five Alaska Native Health Service (ANHS) hospitals for the Alaskan recently returned to the village on Indians and Eskimos with six doctors and 15 nurses for the entire isoniazid therapy. population. There are now five general hospitals under the U.S. Public Health Service and these are located at Point Barrow, Bethel, 2. Query about the three villagers who were Kanakanak, Kotzebue and Tanana. There are, in addition, two medical sent to Bethel last month for medical care. centers, one at Anchorage and another at Mt. Edgecumbe in southeastern What are their conditions? Alaska near Sitka. Some specialized care, as for tuberculosis and mental disease, is obtained by contract in hospitals both in and outside Mountain Village 1. Query for news about a man recently sent Alaska. The 1958 budget of the Division of Indian Health, Public Health to the Anchorage Hospital. Service, for Alaska was: Scammon Bay 1. A 14 year old girl with pain in the right Activity lower abdomen, vomiting and with fever. Hospital Operations $ 8,702,000 A general description of the ecological and social factors which Contract Patient Care 694,000 bear upon the health problems in western Alaska has been outlined in the Field Health 784,000 report of a survey carried out in 1953-54 by the Graduate School of Management Services 122,000 Public Health of the University of Pittsburgh (7). The Department of the Interior, which was then responsible for the health problems and pro- Total $10,302,000 grams in the nátive population of Alaska, invited the faculty of the School of Public Health of the University of Pittsburgh to survey the situation and make suggestions for improvement. In the summers of 1953 and 1954 such a survey was carried out by medical specialists. These Source: https://www.industrydocuments.ucst.edu/docsizznc022 FIGURE II TUBERCULOSIS MORTALITY FOR ALASKA BY RACE 1952-- 1957 I50 140 130 WHITE 120 ESKIMO 110 INDIAN ALEUT 100 90 80 70 60 50 40 30 20 10 O NITION NITTION Sis 000000 or 13 The birth rates of racial groups in Alaska in 1956 are shown here (9) : Whites 32 per 1,000 population Eskimos, Indians, Aleuts 52 per 1,000 population The burden of disease in Alaska in 1950 and today bears a remark- able resemblance to that recorded for the United States in 1900. The opportunity for the application of modern medical skills and knowledge is obvious. "Native Alaska" could and should be made an almost ideal laboratory workshop for teaching, research and service. 4. General Plan of Study A large proportion of the able-bodied Eskimo men are members of two battalions of a National Guard Reserve Unit which is brought to Camp Denali (at Fort Richardson near Anchorage) each year for a two-week training period. In good weather when the widely scattered villages are accessible the men are often away on sealing expedition or tending traplines, so the period of National Guard duty offered a unique op- portunity to study these Eskimo men. This was also an economical way of assembling data on people from many widely separated villages. It was fortuitous that the Guard training period occurred in late winter when native food supplies might be expected to be diminished and limited, thus placing the nutritional status of the people at a low ebb. The clinical and biochemical methods used were those described in the "Manual for Nutrition Surveys" of the ICNND(10) Clinical observa- tions were recorded on data cards for the "detailed clinical examination. No abbreviated clinical examinations were done. The neurological, cardiovascular and abdominal examinations and the skinfold measurements were made by two members of the Alaska Native Health Service medical staff. Battalion 2 of the Eskimo Guardsmen arrived at Anchorage on March 1 and 2, 1958. The noncommissioned officers had arrived two weeks earlier. This unit comprises men from southwestern Alaska including the Aleutian chain and the Bering Sea islands except St. Lawrence and King Islands. Bethel and the Kuskokwim valley may be considered as its center. The men come from as far south as Dillingham, from west to Unalaska and the Pribilofs, and from north to Hooper Bay and the lower Yukon. They include two distinct ethnic groups, the Eskimos -- both inland and coastal -- and the Aleuts, who are few in number (Figure III). These men were examined during three days at Camp Denali. The group of examiners was then divided into two sections. One team proceeded to Bethel on March 7. In the following ten days they studied five villages in that area. A second team went to Kotzebue on March 7 where they undertook studies in five villages of that region. Upon completion of these field studies the two parties returned to Camp Denali and on March 24-27 examined Battalion 1 of the Eskimo Guardsmen. These men were assembled from the northern villages of Alaska extending from Barter Island near the Canadian border to Nome Source: https:llwww.industrydocuments.ucsi.edu/docsizznc0227 FIGURE III PRINCIPAL ETHNOGRAPHIC DIVISIONS OF ALASKA, AND THE VILLAGES STUDIED Pt. Barrow Point Hopee 52 Woatak 3 so I. Aleuts East Cape Shishmaref Allakaket 2. Southern Eskimos 3. Northern Eskimos 3 Huslia 4. Athabascan Indians River Nome (ukon Foirbanks 5. Thlingit, Tsimshian, St Lowrence and Haida Indians 14 Island Hooper Bay Newktok Kosigluk (Anchorage Nunivak Bethel Napaskiak Island 2 Juneau e Pribilof Bristol 8 Isls. Bay Kodiak Island 5 goo chain 08.. & joint 50 150 250 I I Miles pure 15 230 16 17 FIGURE IV TABLE 3 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 PLAN OF THE STUDY WITH NUMBERS CLINICAL CALIBRATION STUDIES 1/ EXAMINED (1) (2) (3) (4) Replicates Trials Bn 2 Bn 1 Total Duplicates N 16 N 20 A N 16 N 32 N 68 Examiner No. 1 - + + - + + - + + - + + Classification No. 2 - + + - - + + - - + + - + + Attribute BATTALION 2 General appearance 21 13 3 - - 16 4 - - 26 6 - - 55 13 - - Thyroid enlarged 16 - - - 19 - 1 - 26 1 4 1 61 1 5 1 B =20 Submaxillary enlarged 16 - - - 18 1 1 - 29 - - N = 323 3 63 1 4 - Nasolabial seborrhea 16 - - - 17 - 2 1 32 - - - 65 - 2 1 BETHEL KOTZEBUE Other seborrhea 16 - - - 20 - 28 - 4 - 64 - 4 - Erythema head 14 1 - 1 13 4 3 28 2 2 55 7 - 6 AREA AREA Pigmentation - head 14 2 - - 20 - - 28 3 1 62 5 - 1 Thickened conjunctivae 15 1 - 16 4 - 21 6 1 4 52 11 1 4 AKIAK NOATAK Pingueculae - 2 4 10 - 2 18 9 4 4 15 9 8 8 43 76 69 (6) Bitot's spots 15 - 1 - 19 - 1 - 32 - - - 66 - 2 - (I) Conjunctival injection 16 - - - 19 1 - - 26 4 2 - 61 5 2 - Angular scars 14 1 1 - 17 - 3 - 32 - - - 63 1 4 - Cheilosis 16 - - 19 - 1 - 32 - - - 67 - 1 - Filiform strophy, KASIGLUK PT. HOPE slight 16 - - 16 - 4 - 30 - 2 - 62 - 6 e 94 88 Glossal furrows 16 - - 15 4 1 23 5 2 2 54 9 2 3 (2) (7) Red gums 16 - - - 11 - 7 2 30 - 1 1 57 - 8 3 Swollen gums 16 - - 13 6 1 29 - 3 - 58 - 9 1 Gum recession 6 2 1 7 3 1 12 4 19 1 8 4 28 42 1 15 Unfilled caries 7 3 6 14 2 4 12 3 6 11 33 8 6 21 Worn teeth 1 8 1 6 2 3 1 14 16 5 2 9 19 16 4 29 NAPASKIAK SHISH MAREF Follicular 8I 77 hyperkeratosis 15 1 - - - (8) 15 5 28 - 4 58 10 - (3) Xerosis 16 - - 19 1 - - 28 3 1 - 63 4 1 - Acne 15 1 - - 18 1 - 1 25 2 2 3 58 4 2 4 The 43 items recorded for the detailed examination which were used exclusively NEWKTOK ALLA KAKET in the Alaska Survey have been abridged here to include only the 23 items which (4) 59 75 showed sufficient prevalence of a sign to allow comparison of observers. (9) 2/ Positive means less than "good general appearance.' HOOPER BAY HUSLIA 96 90 (5) (10) BATTALION I C N=32 N = 390 Source: https://www.industrydocuments.ucsi.edu/docsizznc022 18 19 follicular hyperkeratosis is an important area of dyscalibration. It will be shown later that this particular examiner difference is partially accounted for by an assignment of lesions by examiner 2 to follicular TABLE 4 hyperkeratosis whereas examiner 1 assigned similar conditions to xerosis. ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 A similar estimate of examiner difference was carried out with the Battalion 1 men after the survey parties returned from the village SUMMARY OF CALIBRATION STUDIES FOR THE CLINICAL EXAMINATIONS-/ surveys (column 3 in Table 3). The extent of the differences between examiners is both large and important. If the average difference between examiners in percent of subjects in which they disagree for all items is obtained for Battalion 2 and Battalion 1, the averages are respectively Number Examiner's Reaction of 16.6 N=25 and 14.0 N=25. There is no clear indication of a trend of Disagree examiner difference. For the total duplicate examinations (68 in all, Trial Observations Agree Positive No. 1 + No. 2 + Agree Negative column 4, Table 3), the examiners exceed 15 percent divergence for N % N % N % N % thickened conjunctivae and pingueculae, glossal furrows, gum atrophy and recession, unfilled caries, worn teeth and dental malposition. The Trial 1 368 30 8.2 24 6.5 92.4 289 78.6 divergence on follicular hyperkeratosis is just at 15 percent, but one 460 examiner identified all of these (N=10) whereas the other examiner Battalion 2 49 10.7 28 6.1 44 9.6 319 69.5 diagnosed 4 subjects with xerosis, not indicated by the first. These data are further condensed in Table 4. The secular consistency of the Battalion 1 736 53 7.2 45 6.1 49 6.7 557 75.6 examiners is notable. These clinical calibration studies were done on 5 percent of the Totals 1564 132 8.4 97 6.2 102 6.5 1165 74.5 subjects studied at Camp Denali. This approach will always be limited by the scarcity of clinical material showing a range of manifestations for many of the important clinical signs. The problem then is one of measuring the ability of individuals to fix their criteria for recogni - tion of threshold levels of clinical signs. It appears that a more Conclusion - In 1564 observations recorded in duplicate after independent rigorous set of definitions should be used. It is also necessary that evaluation by examiner 1 and examiner 2: more extensive estimates of observer differences be made. The present data suggest that perhaps 10 percent of all the clinical appraisals Both agree positive findings in 8% should have been replicates, and this process should have been arranged Both agree negative findings 75% to measure self-duplication as well as inter-examiner duplication. Disagree 13% With examiner 1 positive 6.2% The present studies appear to disqualify observation of thickened With examiner 2 positive 6.5% conjunctivae, pingueculae and follicular hyperkeratosis because of observational imprecision. The dental information will need to come from the independent dental examination. 1 Using the 23 items shown in Table 3. Source: https:/lwww.industrydocuments.ucsf.edu/docs/zznc0227 20 21 III - NATIVE MEN IN THE NATIONAL GUARD 2. Clinical Findings 1. The Population Studied The general impression of physical appearance obtained from casual observation of the two battalions was that these men were active, rugged, The Eskimo Guardsmen represent the majority of all the able-bodied deeply tanned and well-conditioned. They were short in stature, with Eskimo men in Alaska. They appear to find membership in the Alaska "Oriental" faces, short limbs and long trunks, and they generally had a National Guard (ANG) attractive because the service furnishes a cash mesomorphic body type. The men in Battalion 1 who came from northwestern income and also it supplies a pleasant social diversion for them. Alaska seemed somewhat taller, obesity was more frequent among them, and they more commonly had lighter eyes, hair and skin than the men in It appears that no medical screening is done in the villages when Battalion 2. The men in Battalion 1 were also more at ease, better ac- the groups are assembled for the annual duty at Anchorage. It is likely quainted with English, and their behavior was more like that of American that known tuberculosis and obvious crippling or chronic disease are troops. The height-weight measurements bear out some of these observa- causes for rejection, but the men are generally sworn in and assembled tions. A summary of the height, weight, skinfold, blood pressure and in Anchorage before application of the usual medical standards for mil- pulse measurements is shown in Table 5. itary acceptance (11). The frequency and severity of grossly visible defects strongly suggested that these battalions were composed of "able- The relationship of weight to age is shown in Table 6. The small bodied volunteers" who had not been subjected to effective medical gains of weight with age are in contrast to the usual findings in white screening. In Battalion 2, four cases of active pulmonary tuberculosis males in the United States. As noted above the men from northwestern were diagnosed by symptoms and x-ray among the 350 men present. Alaska (Battalion 1) were a little taller than those in Battalion 2, but no important trends were demonstrated. In particular, there is no The Division of Tuberculosis Control of the Alaska Department of evidence that Eskimo men are taller as their race becomes acculturated. Health, as part of its tuberculosis case finding mechanism, has three These data also indicate there is very little obesity. (It should be itinerant x-ray technicians who travel to villages of known high incidence remembered in using the U.S. Medico-Actuarial Tables of Standard Weight (13) to take chest x-rays of all available inhabitants. Active and probably that an appreciable increase of weight with age is incorporated in the active cases diagnosed in this manner, as well as by laboratory or "standard weight. The fall of percent "standard weight" with age clinical means, are placed under medical supervision, and their known shown in Table 18a is thus largely an artifact due to the use of these contacts are also examined. In 1958 this program identified 44 new J.S. reference tables(13). The percent distribution of men exceeding the active cases throughout Alaska among the Eskimos and Indians(la calculated "standard weight" is shown in Table 5. The physical appearance of these men suggests that the percent "standard weight" in excess of 100 The noneffective rates at Camp Denali among the Eskimo National is often an artifact due to excessive bone and muscle mass; that is, the Guardsmen were not made available. Since the survey examination consequence of high activity rather than of fat deposits. Body composi- facility was also the battalion dispensary, it was observed that from tion data on these people are not available, but body composition may 8 to 30 men appeared for sick call each morning from a battalion have some relevance to the physiological problem of adaptation to a cold strength of about 400. During the work with each battalion small epi- environment. This interpretation of the small elevation of percent demics of what seemed to be a contagious respiratory disease occurred "standard weight" is also supported by the relation of weight to age a few days after the men arrived in camp. This was variously called shown for the village groups in Figure IX where the weights are es- "flu,' "pneumonia" and "measles" by the orderlies. The medical facil- sentially constant after age 25 to 29. ities available to these men were the same as those for all U.S. military personnel in Alaska. These facilities and the local mess and The pulse rates have little clinical interest, although there was sanitary facilities would not be expected to have any lasting effect, evidence for important observer differences. however, since the men are in camp for only 14 days. As is usually true of blood pressure data, the observers showed a There is no question that duty with the Alaska National Guard has predilection for the end digits o, 5, and even numbers. For example, an important impact on these men, especially those from the Bethel area 76 percent of the diastolic blood pressures were recorded with a zero where acculturization has been slower. The Eskimos acceptance of end digit and 82 percent of the systolic pressures recorded ended with military food, clothing, customs and equipment is immediate and total. zero. This recording artifact requires a careful selection of groups They are sometimes said to dislike beans and they often find cheese in the analysis and also influences the positioning of an arbitrary revolting, but mess sergeants find they eat anything offered them and criterion of normalcy because it will affect the distribution of they eat this completely. It has been said that the word "Eskimo, subgroups. which means "one who eats raw meat" in the Athabascan language, would be more appropriately called "one who eats everything. " The mean systolic blood pressures are remarkably constant with age (Table 6). Furthermore, the number of men with systolic pressure of 160 or over comprises a very small percentage (8 men, 1.1 percent) Source: https://www.industrydocuments.ucsf.edu/docs/zznc0227 S 22 TABLE 6 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION AND AGE HEIGHT, WEIGHT, WEIGHT STATUS, SKINFOLDS, BLOOD PRESSURE & PULSE Battalion 2 Battalion 1 Age (years) Age (years) 17-19 20-39 40-54 Total 17-19 20-39 40-54 Total Number examined 21 255 47 323 42 318 30 390 I/ Height (inches) 65.5+0.4 64.5+0.1 63.8+0.3 64.5+0.1 65.8+0.3 66.2+0.1 65.840.4 66.2+0.1 Weight (pounds) 1/ 140 + 3 141 + 1 144 + 2 142 + 1 140 + 2 150 + 3 150 + 3 149 + 1 % of "Standard Weight" 108 + 2 104 +1 1 102 + 1 104+1 107 + 1 106 + 1 100 + 1 106 + 1 Median Arm 6.3 5.9 5.4 5.9 8.9 6.7 7.1 6.9 Skinfold Thickness Scapula 8.3 7.7 7.6 7.8 10.7 9.5 8.8 9.7 (mm) 23 Systolic Blood Pressure (mm Hg) 17 125 + 4 126 + 1 122 + 2 125 + 1 119 + 2 121 + 1 120 + 3 121 + 1 Diastolic Blood Pressure (mm Hg) I/ 73 + 2 73 + 1 72 + 2 67 + 1 67 + 2 70 + 1 74 + 1 70 + 1 % with B.P. > 140/90 0.0 6. 6.4 5.9 0.0 1.9 0.0 1.5 Pulse (beats/minute) 78 2 78 + 1 74 + 1 78 1 79 + 2 77 + 1 76 + 1 77 + 1 1/ Mean + Standard Error. TABLE 7 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION BLOOD PRESSURE (Mean I Standard Error), BY HEIGHT Height (inches) 59-63 64-67 68-73 Systolic Bn 2 122.3 + 1.4 127.1 + 1.1 127.8 + 3.0 Blood Pressure (mm Hg) Bn 1 117.6 + 2.1 119.7 + 0.9 125.1 I 1.5 Diastolic Bn 2 70.7 + 1.0 73.0 + 1.0 75.2 + 1.9 Blood Pressure (mm Hg) Bn 1 67.4 + 1.6 69.9 + 0.6 70.5 + 1.1 24 of the entire group examined. In neither group was there a significant number of men with diastolic pressures over 90 mm Hg and there were only five men with pressures over 100 mm. Since these were casual blood pressure measurements taken under moderately stressful conditions they may be presumed to be high estimates. They suggest that hypertensive heart disease is not an important problem among these men. Rodahl has also made this observation This fact is of particular interest because of the high protein diet which these men seem to have. It is of some interest that when systolic blood pressure is considered for each battalion by inch of height a definite trend is observed for higher mean pressure with increasing height. Grouping and comparing heights reveals mean differences as shown in Table 7. Diastolic pressures re- veal a similar trend. It may be concluded that the observed blood pressure readings reveal little or no signs of high blood pressure as an indicator of cardiovascular disease and that the minor fluctuations of blood pressure observed are reasonably related to small differences of a.m thickness. The absence of hypertension among the Eskimos may be of some importance in relation to the problem of causation of hyper- tensive heart disease among white cultures. The summary of other clinical findings for the Eskimo Guardsmen is shown in Tables 8, 9 and 10. The data are shown for the battalions separately (Table 8) because they seem to represent two distinct popu- lations. The examiners are also distinguished because of the procedural divergencies demonstrated above. Certain selected clinical signs are presented by battalion and age in Table 9 and by ethnographic origin in Table 10. The significant findings are as follows: No important prevalence of goiter was observed in the men of Battalion 2 but an average prevalence of 10 percent was seen in Bat- talion 1. These were, without exception, small goiters which were judged to be enlarged either with nodules or symmetrically. A 9.9 percent incidence of goiter was found among northern Eskimos, and 14.3 percent of the Athabascan Indians had enlarged thyroid glands. No instance of thyrotoxicosis was seen. The prevalence of enlarged sali- vary glands was low; the glands were not grossly enlarged and the sign did not seem important (Figure v). Erythema of the exposed parts was common, but this could be adequately explained by the known degree of exposure to sun, cold and wind. It was noted particularly among the Eskimos (Table 10). The late cutaneous results of cold injury which the men describe collectively as "ice" re- semble x-ray injury, with cicatrization, depilation and dilatation of venules. Excessive pigmentation of exposed parts was also common in the older men and was sometimes dramatic about the face. Over the trunk and especially the back it assumed a mottled effect with an irregular depo- sition of pigment (Figure VI). This change strongly resembled the erythema ab igne more often seen about the shins in some U.S. rural populations. In these people this sign, restricted to males, is probably related to the "kashim" or sweat bath procedure. Source: ttps://www.industrydocuments.ucsf.edu/docs/zznc0227 TABLE 8 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION PERCENT PREVALENCE OF CLINICAL FINDINGS , BY EXAMINER II Battalion 2 Battalion 1 Total Examiner Examiner Examiner # 1 # 2 Total # 1 # 2 Total # 1 # 2 Total Number examined 155 168 323 211 179 390 366 347 713 Suspected Disease Tuberculosis 3.9 1.8 2.8 1.9 3.9 2.8 2.7 2.9 2.8 Good 85.8 100.0 93.2 83.4 98.9 90.5 84.4 99.4 91.7 General Appearance Fair 12.9 0.0 6.2 16.1 1.1 9.2 14.8 0.6 7.9 Poor 1.3 0.0 0.6 0.5 0.0 0.3 0.8 0.0 0.4 Hair Staring hair 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Thyroid 0.7 1.2 0.9 11.4 8.9 10.3 6.8 5.2 6.0 Glands Enlarged Submaxillary 2.6 2.4 2.5 2.4 5.0 3.6 2.5 3.7 3.1 Nasolabial seborrhea 0.0 5.4 2.8 0.5 2.2 1.3 0.3 3.7 2.0 Other seborrhea 0.0 1.8 0.9 2.4 7.3 4.6 1.4 4.6 2.9 Skin - Face & Neck Erythema, face/neck 21.9 6.0 13.6 13.7 7.8 11.0 17.2 6.9 12,2 26 Pigmentation, face/neck 5.8 0.6 3.1 3.8 7.8 5.6 4.6 4.3 4.5 Thickened conjunctivae 11.0 1.2 5.9 31.8 19.0 25.9 23.0 10.4 16.8 Pingueculae 84.5 57.7 70.6 61.1 54.7 58.2 71.0 56.2 63.8 Bitot' spots 1.3 0.6 0.9 0.0 0.0 0.0 0.5 0.3 0.4 Eyes Circumcorneal injection 0.0 0.6 0.3 0.0 0.6 0.3 0.0 0.6 0.3 Conjunctival injection 4.5 0.0 2.2 9.0 3.4 6.4 7.1 1.7 4.5 Blepharitis 0.0 0.0 0.0 0.5 0.0 0.3 0.3 0.0 0.1 Corneal scarring 6.5 9.5 8.0 4.3 2.2 3.3 5.2 5.8 5.5 Angular lesions 0.7 0.0 0.3 0.5 1.7 1.0 0.5 0.9 0.7 Lips Angular scars 3.2 5.4 4.3 0.0 0.0 0.0 1.4 2.6 2.0 Cheilosis 0.0 1.2 0.6 0.0 0.0 0.0 0.0 0.6 0.3 Filiform atrophy, s1. 0.7 13.1 7.1 9.5 10.6 10.0 5.7 11.8 8.7 Filiform atrophy, mod. 1.3 1.8 1.5 2.8 2.8 2.8 2.2 2.3 2.2 Fungiform atrophy 2.6 0.0 1.2 0.0 0.0 0.0 1.1 0.0 0.6 Tongue Papillary hypertrophy 1.3 1.2 1.2 0.0 1.1 0.5 0.5 1.2 0.8 Furrows 7.1 1.2 4.0 12.8 6.7 10.0 10.4 4.0 7.3 Fissures, erosions, ulcers 2.6 0.0 1.2 1.4 0.0 0.8 1.9 0.0 1.0 Serrations or swellings 5.8 8.9 7.4 1.9 9.5 5.4 3.6 9.2 6.3 Red, tip or lat. margins 3.2 0.0 1.5 7.6 1.1 4.6 5.7 0.6 3.2 Geographic tongue 1.3 0.0 0.6 2.4 1.1 1.8 1.9 0.6 1.3 TABLE 8 (Cont inued) Red or swollen gums 9.7 25.6 18.0 5.2 14.0 9.2 7.1 19.6 13.2 Gums Atrophy or recession, pap. 40.0 66.7 53.9 23.7 43.6 32.8 30.6 54.8 42.4 Bleeding gums 0.0 2.4 1.2 0.0 0.0 0.0 0.0 1.2 0.6 Unfilled caries 27.0 20.9 23.8 42.2 44.1 43.1 36.8 34.4 35.6 Filled caries 10.4 12.4 11.5 30.8 45.3 37.4 23.6 31.5 27.4 Carious teeth, 0 62.6 65.1 63.9 32.7 20.1 26.9 43.3 39.0 41.2 " " 1-2 13.0 14.0 Teeth , 13.5 16.1 31.8 23.3 15.0 24.4 19.6 " " , 3-4 15.7 9.3 12.3 20.4 21.8 21.0 18.7 16.6 17.7 " " , 5+ 7.0 7.0 7.0 26.1 24.0 25.1 19.3 16.9 18.1 Edentulous 1.7 4.7 3.3 4.7 2.2 3.6 3.7 3.2 3.5 Worn 60.0 45.7 52.5 34.1 30.2 32.3 43.3 36.7 40.1 Fluorosis 0.0 0.0 0.0 1.4 2.2 1.8 0.9 1.3 1.1 Malposition 7.8 4.7 6.1 19,9 5.0 13.1 15.6 4.9 10.4 Follicular hyperkeratosis 3.9 11.3 7.7 0.0 10.6 4.9 1.6 11.0 6.2 22 Xerosis 1.3 0.0 0.6 14.2 0.6 7.9 8.7 0.3 4.6 Acneform eruption 5.2 1.8 3.4 9.0 5.0 7.2 7.4 3.5 5.5 Skin General Scrotal dermatitis 0.0 0.0 0.0 0.5 1.1 0.8 0.3 0.6 0.4 Thickened pressure points 1.3 0.0 0.6 1.4 5.6 3.3 1.4 2.9 2.1 Purpura or petechiae 0.6 0.0 0.3 0.0 0.0 0.0 0.3 0.0 0.1 Hyperpigmentation 0.0 2.4 1.2 1.9 0.6 1.3 1.1 1.4 1.3 Abdomen Hepatomegalia 0.0 2.4 1.2 0.5 0.0 0.3 0.3 1.2 0.7 Vibration sensation absent 1.3 0.0 0.6 0.0 0.0 0.0 0.5 0.0 0.3 Lower Extremities Loss of ankle jerk 0.6 0.6 0.6 0.5 0.0 0.3 0.5 0.3 0.4 1/ No findings of enlarged parotids, xerophthalmia, magenta tongue, "scorbutic-type"gums, crackled skin, pellagrous lesions, splenomegalia, ascites, or calf tenderness. Findings of 1 case each of glossitis, perifolliculosis and depigmentation of hair also omitted. Source: https://www.industrydocuments.ucsf.edu/docs/zznc022) TABLE 9 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION AND AGE PERCENT PREVALENCE OF SELECTED CLINICAL FINDINGS Battalion 2 Battalion 1 Age (years) Age (years) 17-19 20-39 40-54 Total 17-19 20-39 40-54 Total Number examined 21 255 47 323 42 318 30 390 Suspected Disease Tuberculosis 4.8 2.4 4.3 2.8 4.8 2.8 0.0 2.8 Good 90.5 92.9 95.8 93.2 83.3 91.5 90.0 90.5 General Appearance Fair 9.5 6.7 2.1 6.2 14.3 8.5 10.0 9.2 Poor 0.0 0.4 2.1 0.6 2.4 0.0 0.0 0.3 Thyroid 0.0 0.8 2.1 0.9 9.5 9.7 16.7 10.3 Glands Enlarged Submaxillary 0.0 2.7 2.1 2.5 0.0 3.5 10.0 3.6 Nasolabial seborrhea 4.8 3.1 0.0 2.8 4.8 0.9 0.0 1.3 Skin - Face & Neck Erythema, face/neck 9.5 13.7 14.9 13.6 2.4 12.3 10.0 11.0 Pigmentation, face/neck 4.8 2.7 4.3 3.1 2.4 6.3 3.3 5.6 2 8 Thickened conjunctivae 0.0 6.3 6.4 5.9 11.9 26.4 40.0 25.9 Pingueculae 38.1 69.4 91.5 70.6 23.8 61.0 76.7 58.2 Eyes Conjunctival injection 0.0 2.4 2.1 2.2 11.9 5.7 6.7 6.4 Corneal scarring 0.0 8.6 8.5 8.0 7.1 2.5 6.7 3.3 Filiform atrophy, s1. 0.0 7.8 6.4 7.1 14.3 9.7 6.7 10.0 " " mod. 0.0 1.6 2.1 1.5 0.0 2.8 6.7 2.8 , Tongue Furrows 0.0 3.5 8.5 4.0 9.5 10.4 6.7 10.0 Serrations and swellings 0.0 7.5 10.6 7.4 0.0 6.3 3.3 5.4 Red, tip, or lat. margins 0.0 1.6 2.1 1.5 4.8 5.0 0.0 4.6 Geographic tongue 4.8 0.4 0.0 0.6 2.4 1.9 0.0 1.8 Red or swollen gums 0.0 17.3 29.8 18.0 7.1 10.4 0.0 9.2 Gums Atrophy or recession 54.9 66.0 53.9 14.3 33.6 50.0 32.8 No carious teeth 36.8 64.6 75.0 63.9 14.3 26.7 46.7 26.9 Caries, filled 1-2 15.8 13.8 11.1 13.5 19.0 23.3 30.0 23.3 Teeth or unfilled 3+ 47.4 19.0 5.6 19.3 66.7 45.9 20.0 46.2 Edentulous 0.0 2.6 8.3 3.3 0.0 4.1 3.3 3.6 Worn 15.8 48.7 91.7 52.5 2.4 31.8 80.0 32.3 Follicular hyperkeratosis 9.5 8.6 2.1 7.7 7.1 4.7 3.3 4.9 Skin General Xerosis 0.0 0.8 0.0 0.6 7.1 8.2 6.7 7.9 Acneform eruption 9.5 3.5 0.0 3.4 11.9 6.6 6.7 7.2 29 PUEW ONNOVI VNWN w 006 oanoww wava NW the WNY PPOOP- compa FUN NWF oaitor JNWF via 3.6 over NFL OF JNN boing 00 0 FOUOND FOOUOD TE 000wooowwe coovoo ING HUYAN FN WNWWN- NVIN ONIXS ONnOX V NI SHONVHO GHL HO IA A 32 33 Thickening of the conjunctivae, especially in the palpebral fissures, because of the tendency of Eskimos to show a normocytic anemia of unknown occurred commonly in the men and was difficult to judge. In general, it cause(3). No true glossitis was seen. The other glossal changes are was diagnosed as present if lateral orbital pressure, through the lid, considered unimportant; the glossal serrations may possibly reflect a would cause definite folds to appear. Similarly, pingueculae of one thick muscular tongue, developed by vigorous eating habits. or both palpebral fissures were both common and extensive. These sometimes The dental data gathered by the clinicians are of interest in protruded between the closed lids medially and were dry and lichenified on the surface. Although over half the men showed these ocular lesions, demonstrating the need for a specialized appraisal of oral manifesta- it seemed they could be reasonably attributed to environmental irritation tions. The clinicians did suspect both age and geographic gradients rather than to nutritional causes. An age analysis (Table 9) conforms for dental caries (Tables 9 and 10). The extent of dental attrition with this interpretation, the prevalence increasing regularly with age. was remarkable and strongly age-related. Fluorosis, even though rarely The incidence was greatest among Eskimos from southern Alaska. diagnosed, seems to have been mistaken for hereditary hypoplasia of enamel. Results of the dental study are presented on pages 33-40. The Bitot's spots seen were rare, in the early examinations, and are in retrospect only suggestive of vitamin A deficiency. However, other Both follicular hyperkeratosis and xerosis were seen and probably corroborative evidence will be discussed in the section on the villages. often confused by two examiners (see discussion above). In Table 11 is shown a. summary of these clinical findings along with the rare Conjunctival injection was noted in 11.9 percent of men 17 to 19 diagnosis of Bitot's spots. The latter cannot be taken as conclusive years of age in Battalion 1 (Table 9), and in 26.7 percent of northern evidence of past or present vitamin A deficiency, but they do require Eskimos, and 19 percent of Athabascan Indians. This is attributed to biochemical evaluation. The lack of correlation between presence of environmental trauma rather than nutritional deficiency. Bitot's spots and serum vitamin A levels shown in Table 11 illustrates the imprecision of this clinical attribute as an indicator of vitamin A nutriture. Corneal scarring represents an important cause of morbidity among the Eskimos. No signs of trachoma were seen in the present studies. Neither were there evidences of "snow blindness, although there were several young people in the villages who had active phlyctenular kerato- TABLE 11 conjunctivitis (PKC) with typical photophobia. The exact nature of snow blindness seems not to be established. Whether there is a distinct entity, precipitated by excessive light and without corneal ulceration, RELATION OF CLINICAL SIGNS AND BIOCHEMICAL FINDINGS, is not clear. Certainly the Eskimos have been making and using narrow SERUM VITAMIN A, ALASKA, 1958 aperture "glasses" for many centuries, since these tools have been (Serum Vitamin A in micrograms per 100 ml. Mean + standard error) excavated by archeologists. Nevertheless, the occurrence of PKC has been very common in these people as judged by the presence of residual scars, Villages and it is a continuing, although lessening, medical problem. The causa- tion is not established, but it appears at least as probable that dietary National Guard Bethel Area Kotzebue Area factors are important as that the doctrinal assignment of cause to No. Serum A No. Serum A No. Serum A tuberculosis is true (15,16). The evidence indicates that while tubercu- losis is often associated with PKC this is not invariably the case. In Total Survey 574 37 + 1 196 31 + 1 220 29 + 1 the present study the frequency of corneal scars was somewhat greater among Battalion 2 men from the less acculturated area of southwestern Persons with follicular Alaska than in Battalion 1 (Tables 8 and 10). However, both groups had hyperkeratosis 34 37 + 2 7 28 + 7 69 30 + 1 significant numbers of men with such scars. Casual observation suggested an age gradient, the lesions being more common in older men than in young Persons with xerosis 30 38 + 2 26 35 + 3 o men. An analysis of the prevalence of this stigma by age and battalion is shown in Table 9. These questions will be considered again with the Persons with Bitot's village data. spots 3 40 + 13 2 12 + 10 o Angular scars were rarely seen in Battalion 2 and none were observed 1/ Two of five subjects recorded as having Bitot's spots had serum vitamin in Battalion 1. Slight filiform atrophy of the tongue was occasionally A levels below 20 mcg/100 ml; this is not a significant difference reported. Moderate atrophy, being more consistent, is better considered. (P= . 16). About two percent of the men showed this lesion to the latter degree. A moderate degree of filiform atrophy was found in 5.3 percent of the Aleuts and 3.2 percent of northern Eskimos. The finding is of interest Source: Ittps://www.industrydocuments.ucsf.edu/docs/zznc227 34 35 A similar comment may be made in regard to the lack of evidence of in field studies of fluoride-caries relations. The race and exact age of a relationship of serum ascorbic acid levels to the presence of red or the examinee and the village from which he came were unknown to the ob- swollen and bleeding gums (see Table 12). server at the time of examination. b. Results TABLE 12 The criteria used to appraise the conditions reported here are RELATION OF CLINICAL SIGNS AND BIOCHEMICAL FINDINGS, described in Appendix A. For the entire group of Alaskan males the life- SERUM VITAMIN C, ALASKA, 1958 time caries experience was generally lower, and diseases of the periodontal tissues generally were more prevalent and severe, than in approximately (Serum Vitamin C in milligrams per 100 ml. Mean + standard error) 1,400 white males examined in Baltimore (17) and in Birmingham(18) in the United States. The caries experience in these two latter groups is con- Villages sidered to be moderate, and periodontal conditions possibly typical, for National Guard Bethel Area Kotzebue Area U.S. white males in general. These specific data were selected as a basis for comparison because the same criteria and methods were used as No. Serum C No. Serum C No. Serum C in Alaska, and because the Alaska examiner participated in all three Total Survey 648 .52 + .01 222 .40 + .02 208 .47 + .02 studies. Comparative findings are shown in Table 13. Persons with red or swollen gums 86 .56+.03 18 .42 + .06 37 .49 + .03 TABLE 13 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 Persons with bleeding gums 4 .65 + .04 o 3 .44 + .06 COMPARISON OF DENTAL CARIES AND PERIODONTAL STATUS OF 713 ESKIMO GUARDSMEN WITH 1, 400 WHITE MALE RESIDENTS OF BIRMINGHAM AND BALTIMORE Mean Numbers of Decayed, In summary, the important clinical findings consisted of occasional Missing and Filled Per- thyroid enlargement in Battalion 1 and among northern Eskimos and Numbers manent Teeth per Man Mean Periodontal Scores 1/ Athabascan Indians, rare Bitot's spots, xerosis, phlyctenular corneal Age Examined Baltimore- Baltimore- scarring, markedly extensive and variable caries, attrition of the teeth (years) Alaska Birmingham Alaska Birmingham Alaska and periodontal disease, and cutaneous hyperpigmentation. The important negative findings were the lack of signs of inanition, anemia, or cardio- 15-19 63 11.3 10.2 .43 .40 vascular disease, or of specific signs of deficiency of B-vitamins or 20-29 359 12.9 9.5 .66 .69 protein. The most serious medical problems observed were the high 30-39 214 13.3 7.7 .82 1.39 prevalence of infectious diseases, especially tuberculosis, the frequency 40-49 68 15.8 6.3 1.25 1.44 of corneal scars and the generally poor teeth. Many of the observed 50-59 9 19.5 9.8 1.73 1.06 defects suggested strong age and geographic patterns which promise to enlighten the search for causation. Nonetheless, these men appeared fit 1/ The periodontal score for each individual is the average for the and rugged and in better physical condition than one might expect to teeth present in the mouth. The criteria for scoring are given in find in a group of U.S. Caucasian recruits. Appendix A. 3. The Dental Study This comparison is useful, however, only for general orientation of the a. Methods findings. There were four independent and geographically distinct pat- terns of dental caries experience, as measured by mean numbers of decayed, All of the dental examinations were carried out by a single missing and filled permanent teeth per man. These patterns are sum- observer. The men were seated in a portable dental chair under a standard, marized in Table 14. color-corrected examination light. Dental mouth mirrors and explorers were employed. Observations were dictated in code to an experienced recorder, who entered the data for each man upon an individual examination card separate from that used for the rest of the clinical observations and originally designed in the National Institute of Dental Research for use Source: https://www.industrydocuments.ucsf.edu/docs/zznc0227 25-34 15-24 OF se TABLE 15 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 ORAL STATUS OF MEMBERS OF FIRST AND SECOND BATTALIONS : Mean DMF Teeth : Mean Periodontal Score : Mean Recession Score Number Mean Age Age : Age Village Examined Age : Adjusted Observed1 : Adjusted Observed: : Adjusted Observed 1/ Group I: principal centers of population Bethel 14 26.6 11.0 7.9 + 1.89 0.63 0.65 + 0.20 8 7 + 3.0 Barrow 69 26.0 13.1 13.6 + 0.90 1.11 0.89 + 0.15 18 14 + 2.5 Kotzebue 19 26.2 14.2 14.2 + 1.63 1.96 1.12 + 0.51 30 18 + 7.5 Dillingham 7 22.1 15.7 12.1 + 2.97 0.21 0.37 + 0.27 0 0 Unalaska 12 25.8 16.7 15.5 + 1.76 1.40 0.80 + 0.38 12 8 + 3.5 Nome 17 22.1 17.1 14.5 + 1.82 1.02 065 + 0.16 6 8 + 6.6 St. Paul 26 31.8 20.2 20.6 + 1.27 1.34 1.34 + 0.39 16 16 + 4.7 All Group I 164 26.5 14.9 14.5 + 0.60 1.22 0.90 + .11 17 12 + 1.7 White U. S. Males 26.5 13.0 .69 13 37 Group II: villages near the principal centers of population Noatak 22 29.0 11.3 11.8 + 1.85 0.68 0.69 + 0.20 10 11 + 3.1 Deering 3 29.5 12.7 13.0 + 4.93 0.84 1.47 + 1.27 15 15 +11.8 Tuluksak 8 33.1 12.8 11.1 + 2.36 1.59 1.59 + 0.46 18 18 + 7.6 Wainwright 17 28.8 13.3 13.2 + 2.01 1.49 1.57 + 0.50 27 28 + 7.9 Napaskiak 14 26.8 13.9 14.2 + 1.98 1.29 1.24 + 0.31 18 13 + 5.3 Akiak 6 30.7 14.5 15.0 + 4.24 1.36 1.26 + 0.62 17 15 +14.1 White Mountain 5 30.7 15.3 14.8 + 2.22 0.71 0.90 + 0.16 7 10 + 5.7 Shishmaref 8 31.6 15.4 13.8 + 3.41 0.44 0.59 + 0.41 12 12 + 4.0 Unalakleet 13 28.5 15.6 16.2 + 2.43 0.86 0.90 + 0.47 25 23 +11.7 Elim 2 29.5 17.0 17.0 + 1.00 0.75 0.75 + 0.65 8 8 + 3.0 Shaktoolik 2 33.5 21.5 21.5 + 1.50 0.41 1.15 + 1.15 21 29 +29.0 All Group II 100 29.4 13.6 13.7 + 0.81 1.04 1.08 + 0.14 17 17 + 2.5 White U. S. Males 29.4 13.1 0.74 15 TABLE 15 (Continued) ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 ORAL STATUS OF MEMBERS OF FIRST AND SECOND BATTALIONS Group III: relatively remote villages, except those in the Yukon-Kuskokwim - delta area Shungnak 16 29.1 2.1 1.8 + 0.59 0.37 0.34 + 0.12 3 4 + 2.1 Little Diomede 7 29.2 3.3 4.4 + 0.90 1.32 1.01 + 0.67 19 16 + 10.0 Kasigluk 7 26.9 5.4 5.4 + 1.15 0.56 0.77 + 0.22 5 4 + 1.9 Akiachak 16 30.7 5.5 5.1 + 0.83 1.38 1.60 + 0.21 14 16 + 6.1 Barter Island 5 31.7 5.6 5.6 + 2.34 0.45 0.46 + 0.29 9 9 + 5.3 Alakanuk 16 32.1 5.9 5.3 + 1.21 1.59 1.88 + 0.47 10 13 + 4.0 Teller 9 27.9 5.9 5.6 + 1.51 0.58 0.54 + 0.22 12 11 + 3.9 Koyuk 4 23.8 6.1 6.5 + 3.23 2.04 2.05 + 0.53 11 12 + 12.0 Kwethluk 17 31.3 6.2 5.1 + 1.40 1.37 1.57 + 0.37 12 14 + 4.3 Stebbins 12 33.4 6.2 6.7 + 1.81 1.35 1.68 + 0.36 26 34 + 8.7 Selawik 14 29.5 6.3 6.6 + 1.48 0.49 0.50 + 0.12 10 10 + 4.6 Meade River 4 25.5 6.6 6.8 + 3.04 0.52 0.55 + 0.42 5 5 + 4.8 Eek 14 28.7 6.8 6.9 + 1.78 0.92 0.89 + 0.20 8 7 + 2.6 Mountain Village 14 36.7 6.8 7.5 + 1.61 0.78 0.94 + 0.28 15 20 + 4.6 Wales 5 43.9 6.8 6.8 + 1.32 1.22 1.22 + 0.49 30 30 + 11.8 Kivalina 11 26.8 7.9 7.7 + 1.91 1.81 1.31 + 0.56 28 19 + 9.9 Gambell 22 27.6 8.4 9.2 + 1.46 1.30 0.96 + 0.30 19 16 + 4.2 Kiana 8 22.8 8.8 7.4 + 2.71 0.34 0.36 + 0.15 4 3 + 1.5 Noorvik 11 26.3 8.9 9.0 + 2.64 0.78 0.55 + 0.25 2 1 + 0.8 Fort Yukon 21 28.3 9.2 9.0 + 1.46 0.36 0.32 + 0.17 9 4 + 2.3 Savoonga 27 25.7 9.3 8.4 + 1.08 0.88 0.70 + 0.20 17 13 + 2.6 King Island 5 33.5 9.6 9.4 + 2.79 1.37 1.40 + 0.32 13 15 + 6.7 St. Michael 12 29.2 9.6 9.6 + 1.63 1.64 1.72 + 0.45 27 28 + 9.3 Point Hope 20 32.0 10.4 10.1 + 1.57 1.18 1.20 + 0.32 14 15 + 4.7 All Group III 297 29.6 7.1 7.1 +1 .35 1.00 1.00 + .07 13 13 + 1.1 White U. S. Males 29.6 13.1 .74 15 1/ Standard error of the mean is included in the observed values. TABLE 15 (Continued) ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 ORAL STATUS OF MEMBERS OF FIRST AND SECOND BATTALIONS : Mean DMF Teeth : Mean Periodontal Score : Mean Recession Score Number Mean : Age : Age : Age Village Examined Age : Adjusted Observed 1/ : Adjusted Observed 1/ : Adjusted Observed Group IV: villages in the Yukon-Kuskokwim delta area Newktok 5 28.5 0 0 0.93 0.82 +0.52 12 11 + 9.2 Chevak 6 29.3 0.4 0.2 + 0.16 0.96 1.02 +0.25 16 18 + 6.2 Tanunak 11 37.8 0.4 0.6 + 0.36 0.23 0.31 +0.16 9 13 + 3.2 Mekoryuk 15 37.4 0.6 0.9 + 0.38 0.03 0.02 +0.01 4 5 + 2.0 Chefornak 5 22.3 1.1 0.4 + 0.40 0.90 0.38 +0.31 16 6 + 6.0 Kwillingnak 20 30.9 1.8 1.5 + 0.42 1.06 1.06 +0.19 10 11 + 2.4 Kipnuk 13 30.8 2,1 2.0 + 0.60 0.65 0.71 +0.17 15 15 + 4.7 Hooper Bay 25 30.8 3.3 3.3 + 0.88 0.73 0.88 + 0.28 10 13 + 3,1 Tuntutulial: 11 30.1 3.4 3.2 + 0.98 1.39 1.32 +0.29 12 13 + 4.6 Quinhagak 22 33.0 3.7 3.4 + 0.76 0.97 0.95 +0.17 6 7 + 2.1 Napaskiak 7 27.4 4.1 4.1 + 2.09 0.76 0.76 +0.32 6 6 + 3.9 Togiak 10 30.8 4.3 4.1 + 1.46 1.54 1.65 +0.55 4 4 + 1.6 Scammon Bay 2 31.5 4.5 4.5 + 2.50 0.20 0.20 +0.20 12 12 + 5.0 All Group I.V 152 31.7 2.6 2.3 + 0.27 0.76 0.83 +0.08 9 10 + 1.0 White U. S. Males 31.7 13.2 .77 17 1 Standard error of the mean is included in the observed values. Source: https://www.industrydocuments.ucsf.edu/docsizznc0227 40 41 these two villages more nearly resemble men from group IV villages, and (2) Periodontal disease the villages are similarly isolated. Shungnak is located near the head- waters of the Kobuk River about 100 air miles east of Kotzebue, and For the whole world population periodontal disease probably Little Diomede is an island in Bering Strait near the boundary with outranks dental caries in importance. Commonly called "pyorrhea, this Soviet Russia. disease attacks the soft and hard tissues supporting the teeth in the dental arch so that they loosen, become painful and ineffective in Age-corrected scores are more appropriate for comparisons between chewing, and are eventually lost. In this study periodontal disease villages, and observed scores for comparison with findings for white was assessed by two measures the periodontal index or score which is U.S. males. a morbidity index of present and active disease, and gingival recession, a cumulative measure reflecting past loss of tissue, particularly bone. (1) Dental caries There was no relation, in the total population, between group findings for either of these measures and group findings for dental caries. There was, as a rule, remarkably little variation in dental caries experience between men of a given age and village. The means for In 38 of the 55 villages periodontal scores (i.e., ratings of decayed, missing, filled (DMF) teeth of Eskimo men living in the seven present disease) were higher than would be expected on comparison with principal villages were slightly but unimportantly higher than those for scores for white males in the U.S., and in only five villages -- Mekoryuk, white U.S. males, rising with age in similar fashion. Means for men Scammon Bay, Fort Yukon, Tanunak and Shungnak were scores signifi- living in villages near these seven principal centers a.re about the same, cantly or importantly lower. The typical clinical picture was one of but show a tendency for caries experience to be lower in men of older age. moderate to severe gingivitis with widespread pocket formation, abundant This tendency becomes marked in the two successive groups; in each group oral debris, and heavy deposits of calculus, although some villages stood DMF means are progressively lower in progressively older groups of men. out as marked exceptions to this rule. Here, as in dental caries, there Since the DMF mean is a cumulative measure, this can occur only in popu- tended to be little variation between men from a given village. lations where caries prevalence is on the increase, and the patterns seen here suggest that this increase is occurring at a relatively rapid rate. 11 The recession score is a relatively weak population measure when young persons are studied, since gingival recession is rarely marked in The dental caries pattern cuts across ethnic boundaries; location for individuals prior to the middle and later years of life. Recession location, there is little difference in DMF means between Aleuts from findings for the whole groups were neither markedly nor importantly Unalaska and the Pribilofs, southern Eskimos from the region generally different from the patterns reported (by an independent team of observers) south of Alakanuk, northern Eskimos from the region generally north of for U.S. Army troops. Findings for the whole of group IV were, in fact, St. Michael, and Athabascan Indians from Fort Yukon. There is a loose significantly lower. tendency (possibly an artifact due to sampling variation) for DMF means in group III to increase from south to north, but there is no clear In men 35 years of age or older, however, recession scores as out- transition across an ethnic boundary. Neither does the term "isolation, " lined in Table 16 for the main groups are generally related to group as used here, denote lack of contact with other groups; in the course of caries scores. The series of differences shown might occur by chance summer migration nearly all of the men in groups III and IV leave their slightly less than once in one hundred trials. homes and live for a time in or near one of the principal villages. At this point in analysis no clear relationship between caries patterns and dietary habits or nutritional status has been developed. TABLE 16 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 GINGIVAL RECESSION SCORES, MEN 35 YEARS OF AGE OR OLDER, 1 The means for group DMF typically rise in essentially straight-line FIRST AND SECOND BATTALIONS fashion with age after permanent teeth begin to erupt at the age of six, gradually becoming asymptotic after the mean reaches a value Number Mean Mean of 15 to 18. Extrapolation of the present data suggest that after Group Examined Age Recession Score a generation, caries may become as prevalent in the group III vil- lages as in villages in or near the principal centers of population, I 15 41.9 39 + 1.7 and that caries in the group IV villages may rise to about the levels II 17 40.4 now seen in group III. If this occurs the disease will then present 31 + 6.9 a public health problem for these people quite as difficult as the III 68 41.2 28 + 3.3 present dental caries problem in the U.S. IV 57 40.5 17 + 2.0 White U.S. males 41.0 26 Source: tps://www.industrydocuments.ucst.edu/docs/zznc0227 42 43 IV - THE VILLAGE STUDIES Twice each year, in spring and fall, ships bring in supplies. Supplies for the year must be anticipated at this time, since the only 1. Bethel Area - the Situation in Akiak, Kasigluk, Napaskiak, Newktok recourse is to costly shipment by air from Anchorage. Mail order houses and Hooper Bay have an active year-round business in this area. An adult education class in one village had as two of its projects the following 1) how Bethel is the principal trading center of a large area of south- to write an order to a mail order house; 2) how to fill out a U.S. income western Alaska which includes most of the lower Yukon and Kuskokwim River tax return. areas. The town is on the Kuskokwim River at the head of deep water navigation. It is the air terminal for the only outside contact of the In Eskimo villages the dogs are an essential part of the economy, area during eight months of the year. The population is mixed white and for they are the only beasts of burden. Wood, one of the few sources Eskimo people. An electric service, high school and many other small- of fuel, must be hauled long distances from the river bottoms. People town facilities are available. travel and supplies are hauled by dog sled. Some freighting for cash income is done with dogs. The average size of a team is five dogs. In winter the main occupation of many Eskimos in this area is Fish are fed to them at variable times and in limited amounts so the trapping for mink, beaver and muskrat. In summer many find temporary dogs are generally thin and ravenous. They eat snow for water, snatching work in canneries on Bristol Bay. In some cases almost the entire able- it as they run. The Kuskokwim dogs are small, averaging 30 to 50 pounds, bodied population is transported to these canneries for a period of six and are nondescript in appearance. The dog population is threatened with weeks or more. Those who remain behind in the villages catch herring, canine distemper because of inadequate immunization. smelt, pike, whitefish and salmon for their own use. The larger fish are filleted and air-dried for the winter cache, to be consumed by both The population counts for the villages included in the Bethel por- dogs and humans. The tundra is dotted with small ponds and sloughs tion of the study and the numbers given clinical examinations in this which are a source of whitefish, ling cod, blackfish and needlefish. survey are shown in Table 2. The sampling within the villages was done Often these fish are eaten raw, and are thus a source of tapeworm with the help of the resident teacher; who selected one or two adolescent infestation. boys as runners. They were instructed to bring into the schoolroom entire families, including all ages. The selection of families and their Hooper Bay and Newktok are sealing communities of coastal Eskimos. order of appearance was not controlled. Clinical appraisals were done on Since the seal kill is variable and uncertain depending upon the movement all persons 2 years old and over. Blood and urine samples were obtained of the pack ice and tolerable sealing weather, this food supply is un- from all persons 6 years of age and over, until 50 blood samples had been certain. The coastal Eskimos collect seal pokes, inverted seal skins obtained in each village. At the end of the day the villagers were filled with seal oil, which they take up the Kuskokwim for sale and advised to bring forward the people who were sick or those with medical barter to the river communities. The subcutaneous fat of newly complaints who had not previously been seen. These persons were not butchered seal is cut into small portions about one by three inches in included in the nutritional appraisal The invitation invariably pro- size and pressed into the inverted seal skin (which has had all the duced an assorted clinic. No assessment was made of the number who apertures, except the anus, tied off with string). After the poke is stayed away from the nutritional appraisals deliberately. In Hooper filled with these small pieces of blubber, it is plugged and left inside Bay most of the men were away sealing. In Kasigluk many men had gone the Eskimo house at moderately high room temperatures and the oil is for wood. thus gradually rendered. When the contents of the poke have been re- moved, a sponge-like connective tissue residue representing the original The presence of a school and one or more teachers has had an stroma in which the oil was contained is left within the poke. This is important influence upon the Eskimo communities. While introduction of considered a food delicacy. No applied heat is used in the rendering a school has generally caused the villages to increase in size and thus process. The tendency of the seal poke to collapse as oil is withdrawn often overburdened the available food supply it has also stimulated the for use maintains a minimum of air within and probably delays rancidity. acculturization of the community. Community leaders who have whi te On some occasions other foods, such as partially dried salmon or herring, customs, clothing, food and ideas have no doubt been important models are placed in seal oil in the poke and stored for considerable periods. for emulation. The school lunch programs, the mail which comes once or Salmonberries, blueberries and wild greens may be stored in a seal poke twice a week, the radio communication with the Alaska Native Health or in barrels without the oil. Service Hospital each evening and the formal instruction in English with material and methods very like those of schools in the rest of the United A seal poke weighing 100 pounds may bring $140 and will last a States all increasingly influence the life and health of the Eskimo family a year. Seal oil is used as a major ingredient of such dishes people. There is a large age gradient in the use of English in the as agutuk (Eskimo ice cream) or oknuk (soup). Other foods, especially Bethel area; almost all school children speak English, but only rarely dried fish, may be dipped into it at serving time. Hunters are con- do adults over 40 years of age. vinced that it is more calorific than other foods and it is thought essential for a trip in intense cold. Source: s://www.industrydocuments.ucsf.edu/docsizznc0227 45 44 Bureau of Indian Affairs School Program for about eight years. Vi tami There are no physicians permanently located in the villages although These administration is more recent. No active keratitis was seen in this there are three physicians associated with the hospital in Bethel. indi- village but there were many children with the corneal scars which are physicians, a dentist and an x-ray technician visit the villages attributed to phlyctenular keratoconjunctivitis (PKC). The lesion was vidually at irregular intervals of several months. The x-ray technician films especially common in children over 7 years of age. Dry skin on the carries a portable x-ray machine which is largely used for chest extensor surfaces and mild follicular hyperkeratosis were seen occasionally in a tuberculosis control program. Public health nurses also visit the in children 8 to 16 years of age. The condition of the teeth varied villages at irregular intervals. A sanitary engineer of the Alaskan the markedly. Caries were rampant in many families, involving both deciduous Department of Health is presently working in certain villages of and permanent teeth. People past 30 tended to have worn but intact and Bethel area in order to improve the water supply. noncarious teeth (see Figure VII). In most villages the teacher is the medical representative who mans A man in his 40's was seen with incipient cardiac failure and a the two-way radio contact. The costs of transportation to Bethel, loud aortic diastolic murmur, probably a result of rheumatic heart Anchorage, or even to other states for medical treatment are borne by disease. A middle-aged woman with typical active rheumatoid arthritis patient, if that is possible; by the ANHS, if it is not. Since the was examined. distances the are great such trips are expensive. Midwifery is done by women in the villages except for those areas near the Bethel hospital The 77 clinical appraisals done in Akiak indicated the calorie where some women may prefer to go for delivery when possible. About supply was adequate, and that there had been a large incidence of 225 babies are delivered annually to native women in the Bethel hospital. phlyctenular keratoconjunctivitis in the past, although no acute cases were seen. Follicular changes suggested a mild or borderline vitamin A The largest single health problem in the villages is tuberculosis. deficiency. Both the caries and the corneal scarring seen in this About 7 to 10 percent of the Eskimo population is being treated with village suggested a familial pattern of prevalence. drug therapy for this disease. In Akiak, for example, 13 of 130 people in records indicate that 38 other villagers have received this therapy the village were receiving chemotherapy in August 1958 and the Kasigluk is a village of 227 Eskimos about 35 miles west of Bethel on the tundra, a few miles from the Johnson River. The latter is an lation and about one tenth of one percent of the population dies of since 1954. The annual incidence is now about one percent of the popu- abundant source of fish in the summer. Nunapitchuk, a somewhat larger village, is four miles away across a small lake. Kasigluk has been tuberculosis each year. The first figure has been reduced by one half, moved in recent times from a location six miles north to be better ac- the second by four fifths since 1952(8). The trends are shown in cessible by boat. The village has a typical onion-turreted Russian Church and a smaller Moravian Church. There are many Russian names in Figure II. the village and people with Mongoloid faces and light hazel eyes. The Akiak is a community of 130 people on the Kuskokwim River about in people seemed poor but were generally clean. The men showed signs of 30 miles upstream from Bethel. Most of the people were dressed recent use of their steam baths, a custom which is thought by some to excellent furs and mukluks, and there was evidence of a plentiful food be a Russian importation but is more likely an intrinsic part of the Eskimo culture. supply. There were no signs of caloric deficiency. Some obese women past These people at Kasigluk must go long distances to the Kuskokwim 30 years of age were seen. There were many children with draining ears flats for wood. The dogs were lean but strong; a team of five brought and impetigo was common, especially in children. One child with ex- in a load of green poles weighing 300 to 400 pounds. The village has tensive bronchitis and fever was given sulfa drug therapy. a poor water supply, consisting only of melted ice from nearby ponds. An epidemic of dysentery had occurred in this village during the two Each school child receives a hot lunch and a therapeutic multivitamin weeks prior to the survey team visit. The school children receive tablet every dayl/. The lunch program has been in effect in the lunches and a multivitamir tablet each school day. New mothers also receive vitamin solutions for the babies and iron pills for themselves, but the teacher was uncertain that these materials are used. The Contents of Multivitamin Tablet: calóric intake of the people seemed adequate. 1 Vitamin A - 5,000 U.S.P. units Ascorbic acid - 50 mg. Vitamin D - 500 U.S.P. units Vitamin E - 5 I.U. Impetigo was common, and several children were put on courses of Thiamine mononitrate - 3 mg. Calcium carbonate - 250 mg. penicillin for treatment. The dispensation of sulfonamide ointment Ferrous sulfate - 234 mg. Riboflavin - 3 mg. which is usually applied over the crusts is useless and possibly harmful. Pyridoxine hydrochloride - 0.5 mg. Potassium iodide - 0.15 mg. Two instances of atopic eczema were seen in children. Corneal scars Potassium sulfate - 5 mg. were not common and were generally seen in subjects 10 years of age and Vitamin B12 - 2 mcg. Copper sulfate - 1 mg. over but not in younger children, and no active phlyctenular Folic acid - 100 mcg. Niacinamide - 25 mg. Magnesium oxide - 6 mg. Calcium pantothenate - 5 mg. Zinc sulfate - 1.5 mg. Source: 47 keratoconjunctivitis was seen. The teeth were generally carious in the FIGURE VIII children, and worn but intact in people past 30. Some skin dryness was noted in children but no follicular hyperkeratosis was seen. One woman of 40 with aortic insufficiency and mitral stenosis was examined. A recent history of migratory arthritis was elicited in one youth. He showed no signs of carditis. Prophylactic penicillin was recommended. Napaskiak is a village of 152 persons on the south bank of the Kuskokwim River eight miles below Bethel. It has close contact with Bethel. Two other Eskimo villages are in the vicinity -- Oscarville, across the river, and Napakiak, down river. River fishing is the attraction. Napaskiak has been moved in recent-times from a nearby and ancient site that had become susceptible to flooding due to channel changes of the river. Napaskiak has one of the few remaining "medicine men" or shaman (Frontispiece). The role of this man in the communi ty' health could not be determined. There were great extremes in the families here, some being thin, while others were well fed. The thin families were usually dirty. The teacher gives 60 children their lunch at 8:30 a.m. Half then go home and return for an afternoon teaching session. The others remain for the morning session. All students receive a multivitamin tablet in school each day. This village has been included in a tuberculosis prophylaxis pro- gram since early 1958. A program for control of tuberculosis by ambulatory chemotherapy was begun in 1953 as a result of a recommendation of the Pittsburgh Health Survey(7) to the Secretary of the Interior. At the time of its inception the program was ambulatory because there DENTAL ATTRITION IN A 32-YEAR-OLD - were not enough hospital beds for all those needing the therapy. When ESKIMO WOMAN more beds were available more of those who needed hospital treatment were admitted. The prophylactic control study mentioned at the begin- ning of this paragraph was started in 1958 as a separate project under the direction of Dr. George Comstock, Tuberculosis Control Program, Bureau of State Services of the U.S. Public Health Service. This is a research study on the prophylactic use of isoniazid being conducted in selected parts of the U.S., Alaska and Puerto Rico. Every person in the villages selected for the study is given medication each day for one year, half receiving isoniazid at a level of about 5 mg per kilogram of body weight and half receiving a placebo. All told about 0,000 people are participating in this study. It is hoped to measure the suppressive action of such medication upon the incidence of tuberculosis. No signs of isoniazid-induced seborrhea or dermatitis were seen in this or any village, although perhaps as many as 10 percent of the total native population are on isoniazid therapy. The teeth were carious in Napaskiak except among people over 40 years of age. Exceptions to this were seen in a few Kipnuk women who had come here from the coast after marriage and generally had fine teeth. Again several cases of atopic eczema were seen. The teacher believes it is increasing in frequency. The males showed signs of the effects of taking steam baths (petechiae on the backs and shoulders), Source: ittps://www.industrydocuments.ucsf.edu/docs/zznc022 48 49 but the women and children did not. Petechiae occurred commonly among The school lunch program and daily vitamin pill are administered older male children and adults but was uncommon in children under 10. here. Because of exceptionally good sealing, the people appeared pros- No active keratitis was seen. Corneal scarring seemed to occur in perous and adequately nourished. There were many plump women and families; dry skin and follicular changes were uncommon. The adult children. Teeth were good but worn in people past 20 years of age and women often seemed pale. Tongue papillation was good. An old man with carious in many children. There were many corneal scars, again seen in aortic stenosis was examined but heart murmurs were generally rare. families and generally in people 12 to 20 years old. Children under A sick baby was brought back with the party to the Bethel Hospital and 12 were not often so affected. Many of the women were pregnant. Some a diagnosis of meningococcal meningitis was confirmed. After a stormy evidence of hypochondriasis was noted in adults. There was a single course she recovered. Prophylactic sulfadiazine seemed to prevent instance of goiter, a large soft gland in a 40 year old woman who had additional cases in the village. This treatment was arranged by radio a history of thyrotoxicosis treated with N-propylthiouracil. Scleral communication from Bethel after the bacteriologic diagnosis was thickening in the palpebral fissures and pingueculae were noted in many established. individuals. Here as in the other villages it was apparent that dental fillings meant tuberculosis because almost the only people who had had Newktok is an isolated village of 121 coastal Eskimos about 120 dental care were those who had gone outside for tuberculosis therapy miles west of Bethel on the tundra, a few miles from Baird Inlet and the Bering Sea. The nearest postoffice is at Tanunak, 40 miles to the 2. Kotzebue Area - the Situation in Noatak, Point Hope, Shishmaref, southwest on Nelson Island. There were many sod houses in the village. Allakaket and Huslia The people at Newktok seemed very primitive; their faces were The Kotzebue phase of the present study centered among the northern Mongoloid with prominent epicanthal folds. Very few could speak English. or Arctic Eskimos who are for present purposes considered to be in Their clothing was worn and poor. Both people and dogs were thin. The ethnic area III (see Figure III). The Kotzebue study also included sleds were hand-hewn and lashed together with thongs. In one sod house observations in two Indian villages in the mountains of the middle Yukon the children were seen to scoop a frozen blackfish out of a tub in the region lying in area IV. anteroom and swallow it with a minimum of chewing. The lids were off the cans containing flour and sugar, and the contents were spread about The Eskimos north of Norton Sound (Nome) are much more sparsely the table top as though the children had been eating directly from the distributed. The principal activity of the males is hunting, and seal, cans. Since this was the first tolerable weather for a week, the men walrus and several species of whale are the chief game. The Eskimos were away sealing. along the Arctic coast find the whale kill highly variable since it depends strictly upon weather and hunting conditions. Polar bear have Many of the children in this village were grossly underfed, and always been important not only as a source of food for man and dogs, but pale and thin. Several families were heavily infested vith head lice. also as a source of income from sale of skins. St. Lawrence Island has With a few exceptions, the teeth were excellent. There were several an abundant supply of walrus in the spring, a good source of both meat slightly but definitely enlarged thyroid glands observed but no gross and ivory. The people of St. Lawrence Island, Diomede Island and King goiters. Many children had marked follicular hyperkeratosis and many Island are well known for their fine ivory carving which provides them others had dry skin. There were several adults with Bitot's spots. with an important part of their cash income. The materials they make No signs of water-soluble vitamin deficiency or of scurvy were seen. are taken to Nome in the summer and marketed. Hooper Bay is an ancient Eskimo settlement on the Bering Sea south The Arctic fox is trapped on the ice pack for its fur but neither of Cape Romanzof, with a population of 430. It is located on two low this nor any other land carnivore is used for food except in dire hills at the tip of a spit of land which encloses Hooper Bay from the emergency. The polar bear is a partial exception, for its meat is often north. The main source of livelihood is the sea, especially sealing. eaten, although the liver seems never to be eaten and is widely regarded There are many dog teams for hauling the skin boats and meat to and from as poisonous. There is a collection of recent evidence to support the the open water a few miles away. Water is obtained by melting ice from idea that polar bear liver is, in fact, poisonous for human consumption. a fresh-water pond a few miles back of the village on the tundra. Fuel Dr. William Rausch of the Arctic Health Research Center on one occasion is obtained from driftwood which is now plentiful, coming largely from ate 100 grams of polar bear liver and immediately became ill. Dr. the mouth of the Yukon which lies to the north. The houses are well Edward Scott of the same institution fed polar bear liver to white mice built but without a semblance of orderly arrangement either among houses and an equivalent amount of vitamin A from fish oil to a control group or within them. The indoor temperatures and humidity are very high. of mice. Both groups of mice died (19). The concept of the toxicity of These, together with many unwashed Eskimos, unbutchered seals, drying polar bear liver and that it is due to an excessive vitamin A content skins and oozing seal oil pokes, produce an overpowering atmosphere for is widely accepted in scientific circles in Alaska. a white person. Source: https://www.industrydocuments.ucsi.edu/docsizznc022 50 51 The Indian villages, Huslia and Allakaket, which were included in before he goes out on the ice pack for the day, or takes no more than a the present study, are settlements on the Koyukuk River. These people cup of tea or coffee. He believes eating would make him sluggish, less are Athabascan Indians who range through the forested and mountainous agile and less acute. Since he may stay out one to three days under areas of northwestern Alaska. Their principal activity is trapping rigorous conditions of activity and temperature, it is clear that he has beaver, mink and muskrat. The beavers are taken through holes in the both great stamina and efficient gluconeogenesis. When he returns he ice in the late winter and spring with snares which are baited with takes a very large meal. This ability to carry on while fasting may be willow twigs. Each trapper is allowed a seasonal limit of 20 beavers which average $40 per pelt. The beaver is a large animal weighing 30 related physiologically to the ability to consume a very high fat, high protein, low carbohydrate diet. It may also be a factor in prohibiting to 60 pounds, and is widely used for food. The meat is said to resemble youths (who might be more susceptible to ketosis) from going out on the pork. The skins are stretched flat in an almost perfect circle for ice pack. drying and are hauled about in large wafer-like stacks wrapped in burlap. The sampling procedures in the Kotzebue area were carried out as Caribou are migratory animals taken seasonally and somewhat unpre- described for the Bethel study above. Clinical studies were done on dictably. Their meat is dried in the sun for storage in caches and the all persons 2 years of age and over; blood and urine samples were ob- skins are widely used for clothing. tained from all persons 6 years and over, the urine samples being clean catch samples. In the Kotzebue area those members of the National Guard Fish are taken from the rivers with nets or fish wheels, a white who were home were excluded from the village examinations in order for man's invention and a useful one, for -- powered by the current -- it them to be seen at Camp Denali with their battalion. scoops up the teeming fish and deposits them in a tub requiring the fisherman only to empty the tub once he has properly placed the wheel Noatak is a village of 300 Eskimos on the Noatak River 60 niles and the diversionary fence. north of Kotzebue. The food supply at Noatak is largely caribou which are hunted inland on the tundra, fish from the Noatak River, and seal The northern Eskimos have been more exposed to the white man than and beluga whale from Kotzebue Sound. The teacher at Noatak gives each have the southern Eskimos through efforts of 18th century sailors to school child a lunch and a vitamin pill every school day. The principal find a Northwest Passage, and subsequently through the extensive whaling clinical impairments found here were carious teeth and follicular activities which took place in the Arctic Ocean. Contacts with sailing hyperkeratosis. ships reached a maximum in the middle of the 19th century. Possibly as a consequence, the northern Eskimos are advanced at least a generation Point Hope, which the natives call Tigara, often experiences severe over the Kuskokwim people in their cultural adaptation to the white race. Almost all speak English; they tend more strongly to adopt white men's weather. It is the main polar bear-hunting area for sportsmen, an clothing and habits of food and often have noticeable admixtures of white activity which is a source of income for the Eskimos. A typical polar blood as reflected in coloration and conformation. The northern Eskimos bear hunt has facetiously been described as follows: The sportsman are larger and less Asiatic-appearing than the southern Eskimos, although pays $2, ,500 and is guaranteed a bear. The hunter and his pilot go out there are many exceptions to this generalization. Some of the village over the ice pack in a light plane until they spot a bear which they sites, such as that at Shishmaref Inlet, are very old, dating back 500 pursue in the plane until it falls exhausted on the ice. They then years or more. The attraction of these sites can only have been their land, shoot the bear and take the skin. The sport seems more expensive than dangerous. convenience to the essential food supply. Eskimo villages are sometimes moved, but generally only to a better food supply. The main articles in the diet at Point Hope are seal and whale meat with some bear meat and fish. Caribou are taken in the fall and Hunting on the ice pack is a dangerous occupation and the extent of this danger varies in different areas depending upon currents and weather winter. The whale meat collected in the spring is cut up and stored conditions. In the Hooper Bay area young men do not go on the hunting in pits in the permafrost for later use. This natural refrigeration expeditions until they are about 18 years of age. North of Bering Strait and not the perpetual cold, for the summers are actually quite warm they. go at 15 years. Since these boys are physically well developed at is the basis for the legendary test of salesmanship in Alaska. A few Eskimos do have refrigerators, especially the traders. Many Eskimos 15 years it appears that a maturation of judgment is recognized as es- sential. The active hunters are men 20 through 45 years, older hunters have outboard motors. Almost every Eskimo boy dreams of becoming an airplane pilot. The men are clever mechanics and are said to have being rare. fashioned broken motor parts from ivory or bone when metal replacements were unavailable. These Eskimo men stripped down resemble professional athletes. They are heavily muscled, relaxed and loose-jointed, and have the ap- pearance of finely trained men. Unlike the white man's concept of Sod houses are common in Point Hope. Alaskan Eskimos never build snow igloos except to amuse visitors from the outside and the results preparation for a physical ordeal, the Eskimo either does not eat are often ludicrous. Whale ribs are often used for rafters for sod houses. No village planning is discernible. Snow drifts range up to 25 feet after a storm and the children slide down these on short baleen skis. Source: https://www.industrydocuments.ucst.edu/docsizznc0227 52 The children receive a school lunch and a daily multivitamin tablet. Clinical examinations here revealed many carious teeth and much follicular hyperkeratosis. Shishmaref is a village of 200 people on a small island just off Shishmaref Inlet. The principal food is seal, which was plentiful during the winter preceding the survey, since the pack ice had been pushed toward the Siberian side by favorable winds. Some fish are also available. Many carious teeth were seen here and there was much dental attrition. Follicular hyperkeratosis was common. A school lunch and multivitamin pill are given to the children. Allakaket is an Indian village of 100 people 150 miles north of Tanana. It consists of 10 to 15 log cabins, a school and an Episcopal Church. The main occupations and food sources are moose hunting, fishing and beaver snaring with a wire loop snare. The trap lines are 50 to 150 miles in length. The calorie supply seemed limited in this village. The teeth were carious and follicular hyperkeratosis was common. Some filiform atrophy of the tongue was also noted, although it was of mild degree. No evidence of goiter was seen. One 18 month old child with rickets was seen here. Huslia is an Indian village of 137 people. The diet consists mainly of beaver, dried fish, moose and caribou. Moose meat is much like beef in form and flavor while caribou is distinctive, resembling mutton. The calorie intake at Huslia seemed marginal, since many people were thin and the children appeared stunted. Follicular hyper- keratosis was common. The teeth were carious. This is the home of the most f'amous sled dog racer in Alaska, George Atla, known as the "Huslia Hustler. The schools in these two Indian villages do not give the children school lunches or vitamin supplements. 3. Clinical Findings in the Villages Since the men in the National Guard had recently come from the villages they were also representative of those nutritional environments. However, the 713 men came from 55 villages. The number from each vil- lage was thus so small that no useful purpose was served by relating them to their village of origin. An exception is Point Barrow, from which there were 69 men in the Guard. Throughout the evaluation of the data this axis of analysis has been considered, however (see Table 10, which presents selected clinical findings for men in the two battalions according to their area of origin). A summary of the clinical findings in the villages is shown in Table 17. The northern and southern areas are shown separately, but all ages and both sexes are combined. This summary emphasizes certain negative findings. There was no scurvy and no gross inanition, although in certain villages, especially Newktok, the people seemed by their thinness to be Source: https:/lwww.industrydocuments.ucsi.edu/docsizznc0227 TABLE 17 ESKIMO AND INDIAN VILLAGES IN ALASKA, 1958, PERCENT PREVALENCE OF CLINICAL FINDINGS Bethel Area - Examiner # 1 Kotzebue Area - Examiner # 2 Villages / 1 2 3 4 5 Total 6 7 8 9 10 Total Number Examined 76 94 81 59 96 406 69 88 77 75 90 399 Suspected Tuberculosis Disease 30.3 10.6 7.4 8.5 12.5 13.8 5.8 10.2 6.5 6.7 2.2 6.3 General Good 82.9 87.2 79.0 66.1 82.3 80.5 98.6 100.0 98.7 98.7 100.0 99.2 Appearance Fair 17.1 9.6 14.8 25.4 16.7 16.0 1.4 0.0 1.3 1.3 0.0 0.8 Poor 0.0 3.2 6.2 8.5 1.0 3.4 0.0 0.0 0.0 0.0 0.0 0.0 Hair Staring hair 0.0 0.0 0.0 18.6 0.0 2.7 0.0 0.0 0.0 0.0 0.0 0.0 Glands Thyroid 3.9 0.0 2.5 10.2 4.2 3.7 1.4 0.0 0.0 0.0 0.0 0.3 Enlarged Submaxillary 0.0 1.1 0.0 0.0 0.0 0.2 5.8 6.8 3.9 1.3 2.2 4.0 Nasolabial seborrhea 0.0 0.0 0.0 0.0 0.0 0.0 5.8 2.3 2.6 0.0 1.1 2.3 54 Skin- Other seborrhea 0.0 0.0 1.2 0.0 0.0 0.2 1.4 0.0 1.3 0.0 0.0 0.5 Face & Neck Erythema 14.5 25.5 7.4 61.0 17.7 23.2 11.6 21.6 33.8 5.3 3.3 15.0 Pigmentation 0.0 2.1 2.5 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 Thickened conjunctivae 7.9 6.4 16.0 13.6 15.6 11.8 7.2 5.7 10.4 8.0 11.1 8.5 Pingueculae 31.6 31.9 22.2 27.1 28.1 28.3 34.8 27.3 28.6 29.3 14.4 26.3 Bitot's spots 0.0 0.0 0.0 3.4 0.0 0.5 0.0 0.0 0.0 0.0 0.0 0.0 Eyes Circumcorneal injection 0.0 0.0 0.0 0.0 1.0 0.2 0.0 1.1 0.0 0.0 0.0 0.3 Conjunctival injection 3.9 0.0 2.5 5.1 1.0 2.2 0.0 5.7 0.0 0.0 0.0 1.3 Blepharitis 0.0 0.0 0.0 8.5 0.0 1.2 0.0 2.3 0.0 0.0 0.0 0.5 Corneal scarring 21.1 12.8 11.1 20.3 9.4 14.3 8.7 5.7 5.2 4.0 7.8 6.3 Angular lesions 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Lips Angular scars 0.0 0.0 0.0 1.7 0.0 0.2 2.9 0.0 0.0 0.0 0.0 0.5 Cheilosis 0.0 0.0 1.2 0.0 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 TABLE 17 (continued) Filiform atrophy, sl. 9.2 6.4 9.9 13.6 6.2 8.6 7.2 4.5 2.6 12.0 5.6 6.3 Filiform atrophy, mod. 3.9 0.0 2.5 1.7 0.0 1.5 0.0 0.0 0.0 2.7 0.0 0.5 Fungiform atrophy 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Papillary hypertrophy 0.0 0.0 0.0 0.0 1.0 0.2 1.4 2.3 1.3 0.0 1.1 1.3 Furrows 1.3 7.4 9.9 3.4 3.1 5.2 4.3 2.3 2.6 2.7 1.1 2.5 Tongue Fissures, erosions, ulcers 1.3 1.1 1.2 0.0 0.0 0.7 0.0 0.0 0.0 0.0 0.0 0.0 Serrations or swellings 0.0 6.4 3.7 0.0 0.0 2.2 0.0 0.0 0.0 1.3 3.3 1.0 Red, tip, or lat. margins 3.9 4.3 4.9 0.0 0.0 2.7 0.0 0.0 0.0 0.0 0.0 0.0 Geographic tongue 1.3 0.0 1.2 0.0 3.1 1.2 2.9 0.0 3.9 0.0 0.0 1.3 Red or swollen 1.3 3.2 9.9 8.5 7.3 5.9 17.4 2.3 7.8 13.3 18.9 11.8 Gums Atrophy or recession 9.2 8.5 16.0 1.7 5.2 8.4 23.2 19.3 27.3 17.3 18.9 21.1 Bleeding gums 0.0 0.0 0.0 0.0 0.0 0.0 1.4 0.0 0.0 0.0 4.4 1.3 Unfilled caries 30.3 60.6 48.1 23.7 31.2 40.1 31.9 40.9 58.4 34.7 47.8 43.1 Filled caries 17.1 9.6 13.6 0.0 12.5 11.1 46.4 23.9 11.7 9.3 13.3 20.3 No carious teeth -5550.031.944.476.357.350.223.237.529.957.3 41.1 38.1 Tee th Caries, filled or 1-2 13.2 7.4 6.2 3.4 7.3 7.6 24.6 18.2 28.6 21.3 22.2 22.8 unfilled 3-4 18.4 36.2 24.7 11.9 24.0 24.1 23.2 23.9 20.8 14.7 22.2 21.1 SS 5+ 11.8 23.4 23.5 8.5 11.5 16.3 24.6 18.2 18.2 6.7 14.4 16.3 Edentulous 6.6 1.1 1.2 0.0 0.0 1.7 4.3 2.3 2.6 0.0 0.0 1.8 Worn 30.3 33.0 35.8 23.7 29.2 30.8 14.5 12.5 27.3 12.0 6.7 14.3 0.0 0.0 Fluorosis 0.0 0.0 0.0 0.0 1.0 0.2 0.0 0.0 0.0 0.0 Malposition 2.6 1.1 12.3 6.8 12.5 7.1 0.0 0.0 1.3 0.0 0.0 0.3 Follicular hyperkeratosis 3.9 1.1 1.2 10.2 0.0 2.7 40.6 34.1 20.8 20.0 45.6 32.6 10.4 0.0 0.0 0.0 0.0 0.0 0.0 Xerosis 19.7 21.3 11.1 22.0 16.5 Skin- Acneform eruption 0.0 1.1 1.2 0.0 2.1 1.0 0.0 0.0 1.3 0.0 1.1 0.5 Thickened press. points 1.3 2.1 0.0 0.0 0.0 0.7 0.0 0.0 1.3 0.0 0.0 0.3 General 0.0 0.0 1.0 0.5 0.0 0.0 0.0 0.0 0.0 0.0 Purpura or petechia 0.0 1.1 Hyperpigmentation 2.6 0.0 0.0 0.0 3.1 1.2 0.0 1.1 0.0 0.0 0.0 0.3 Abdomen Hepatomegalia 0.0 0.0 2.5 5.1 0.0 1.2 Examination of abdomen and Lower extremities omitted. Lower Extremities Loss of ankle jerk 1.3 0.0 1.2 1.7 0.0 0.7 1 No findings of enlarged parotids, xerophthalmia, magenta tongue, "scorbutic-type' gums, crackled skin, pellagrous 2) Villages referred to by number: Southern Eskimos: 1. Akiak 2. Kasigluk 3. Napaskiak 4. Newktok 5. Hooper Bay lesions, splenomegalia, ascites, or calf tenderness. Scrotal dermatitis not examined for Northern Eskimos: 6. Noatak 7. Point Hope 8. Shishmaref Athabascan Indians: 9. Huslia 10. Allakaket Source. Ittps://www.industrydocuments.ucsf.edu/docs/zznc022

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Alaska An Appraisal of the Health and Nutritional Status of the Eskimo A REPORT BY THE INTERDEPARTMENTAL COMMITTEE ON NUTRITION FOR NATIONAL DEFENSE AUGUST 1959 OF ASSISTANT SECRETARY OF DEFENSE WASHINGTON 25, D.C. HEALTH AND MEDICAL, August 31, 1959 On behalf of the Interdepartmental Committee on Nutrition for National Defense (ICNND), it is my pleasure to transmit this report, An Appraisal of the Health and Nutritional Status of the Eskimo in Alaska. The clinical and biochemical phases of the survey, conducted in March-April 1958, included the Eskimo National Guardsmen and a random sampling of eight Eskimo and two Indian villages. This was a cooperative undertaking of the ICNND with the Arctic Health Research Center, the Division of Indian Health of the U. S. Department of Health, Education, and Welfare, the Alaska Command of the U. S. Armed Forces, and the Alaska National Guard. A detailed report of the dietary studies conducted in the ten Alaskan villages will be published at a future date by the Arctic Health Research Center. Dr. Christine Heller of the Arctic Health Research Center is continuing these investigations. The evaluation of the dietary intake, customs, and habits of these few remaining native villages will enable a much more meaningful evaluation of the clinical data. The Alaskan aboriginal people have and will continue to have a remarkably successful adaptation to their environ- ment and unique food supply. The purpose of this study was to establish a baseline of nutritional appraisal in order to evaluate in future years the effects of cultural transition in relation to health. Continued assistance to provide medical and dental care, housing, and economic development is most essential. I wish to call your attention to the general conclusions of this report on page 118. Frankisterry Frank B. Berry, M. D. Source: https://www.industrydocuments.ucst.edu/docsizznc022 V INTERDEPARTMENTAL COMMITTEE ON NUTRITION FOR NATIONAL DEFENSE Department of Defense: Dr. Frank B. Berry, Assistant Secretary of Defense (Health and Medical), Chairman Dr. E. H. Cushing, Deputy Assistant Secretary of Defense (Health and Medical) Brig. Gen. Sheldon S. Brownton, USAF (MC) Army: Dr. John B. Youmans Lt. Col. William J. Wilson, MC Navy: Dr. Howard T. Karsner Rear Admiral Calvin B. Galloway, MC Air Force: Major George W. Powell, MC Department of State: Mr. Walter M. Rudolph Department of Agriculture: Mr. Clarence M. Purves Dr. Hazel K. Stiebeling Department of Health, Education, and Welfare: Dr. Floyd S. Daft Dr. H. van Zile Hyde International Cooperation Administration: Dr. Eugene P. Campbell Dr. Katharine Holtzclaw Atomic Energy Commission: Dr. James L. Liverman Secretariat Dr. Arnold E. Schaefer, Executive Director Dr. Ernest M. Parrott, Deputy Executive Director Dr. Arthur G. Peterson, Agricultural Economist Consultants Dr. William F. Ashe Dr. William J. Darby Dr. William McGanity Dr. S. Bayne-Jones Dr. Cyrus E. French Dr. William N. Pearson Dr. M. K. Bennett Dr. Wendell H. Griffith Dr. Herbert Pollack Dr. George H. Berryman Dr. David B. Hand Dr. W. H. Sebrell, Jr. Mr. Edwin B. Bridgforth Dr. D. Mark Hegsted Dr. Fredrick J. Stare Dr. Joseph S. Butts Dr. Norman Jolliffe Dr. Philip L. White Dr. Gerald F. Combs Dr. z. I. Kertesz Dr. Robert R. Williams Dr. L. A. Maynard Source: https:llwww.industrydocuments.ucsi.edu/docsizznc022 VII VI LIST OF FIGURES TABLE OF CONTENTS Page Page Title Number Part I Preface XI Frontispiece Guzema Wassilie, Medicine Man at Napaskiak 1. Administrative History XI 2. Acknowledgments XI Figure I Northern Cultural Areas and Tundra Region Facing 1 3. Objectives XIII 4. Explanatory Addendum XIII Figure II Tuberculosis Mortality for Alaska by Race, 11 1952-1957 Part II Introduction 1 1. The Cultural Background 1 Figure III Principal Ethnographic Divisions of Alaska, 14 2. Demographic Factors 4 and the Villages Studied 3. Health Facilities 7 4. General Plan of Study 13 Figure IV Plan of the Study with Numbers Examined 16 5. Clinical Calibration Studies 15 Figure V Enlargement of the Submaxillary Glands 30 Part III Native Men in the National Guard 20 1. The Population Studied 20 Figure VI Pigmentary Changes in a Young Eskimo Man 31 2. Clinical Findings 21 3. The Dental Study 34 Figure VII Dental Attrition in a 32-Year-Old Eskimo 46 Woman Part IV The Village Studies 42 1. Bethel Area - The Situation in Akiak, Kasigluk, Figure VIII Height by Age and Sex, Eskimo Villages, 1958, 42 Compared to Canadian Population 61 Napaskiak, Newktok and Hooper Bay 2. Kotzebue Area - The Situation in Noatak, Point Hope, Shishmaref, Allakaket and Hislia 49 Figure IX Weight by Age and Sex, Eskimo Villages, 1958, 62 3. Clinical Findings in the Villages 52 Compared to Canadian Population 4. Discussion of Clinical Findings 67 Eskimo and Indian Villages in Alaska, 1958, Figure X Part V Dietary Measurements 72 Blood Pressures and Pulse Rates, by Age 65 1. National Guardsmen - Camp Denali (Ft. Richardson) 72 2. Villages (Preliminary) 74 Figure XI Eskimo and Indian Villages in Alaska, 1958, 3. Discussion 91 Arm and Scapula Skinfold Thickness, by 70 Age and Sex Part VI Biochemical Findings 99 1. Methods 100 2. Results 100 3. Discussion 111 4. Summary 118 Part VII General Conclusions 120 Part VIII Specific Recommendations 121 Part IX Appendices 122 A - Criteria for Oral Examinations 122 B - Food Consumption, Males - Alaska, 1956-1958 124 C - Food Patterns by Village 134 D - National Research Council, Recommended Dietary Allowances 160 Bibliography 161 Source: ttps://www.industrydocuments.ucst.edu/docs zznc022 VIII IX LIST OF TABLES LIST OF TABLES (continued) Table Title Page Table Title Page Introduction Table 1 The Village Studies Eskimos, Indians and Aleuts in Alaska in 1950 1 Table 17 Eskimo and Indian Villages in Alaska, 1958; Percent 2 Alaska: Characterization of the Villages in the Study, Prevalence of Clinical Findings 54-55 and the Size of the Samples Examined, 1958 6 18 Eskimo and Indian Villages in Alaska, 1958; Percent 3 Eskimo Men, Alaska National Guard, 1958; Clinical Prevalence, Selected Clinical Findings by Age Calibration Studies 17 and Sex 57 4 Eskimo Men, Alaska National Guard, 1958; Summary of 19a Eskimos and Athabascan Indians in Alaska, 1958; Calibration Studies for the Clinical Examinations 19 Percentage of "Standard Weight" by Age and Sex 58 19b Eskimos and Athabascan Indians in Alaska, 1958; Native Men in the National Guard Table 5 "Obesity" in Adults by Age and Sex 59 Eskimo Men, Alaska National Guard, 1958, by Battalion; 20 Average Height and Weight of Eskimos and Athabascan Origin, Age, Height, Weight, Weight Status, Skinfolds, Indians in Alaska, 1958, Compared to Canadian Blood Pressure and Pulse 22 1953 Survey 60 6 Eskimo Men, Alaska National Guard, 1958, by Battalion 21 Eskimo and Indian Villages in Alaska, 1958; Pulse and Age; Height, Weight, Weight Status, Skinfolds, (Mean + S.E.) by Age, for Villages by Ethnographic Blood Pressure and Pulse 23 Groups 64 7 Eskimo Men, Alaska National Guard, 1958, by Battalion, 22 Eskimo Men, Alaska National Guard, 1958, by Battalion; Blood Pressure (Mean + Standard Error) by Height 23 Blood Pressure and Pulse Measurements, by Examiner 66 8 Eskimo Men, Alaska National Guard, 1958, by Battalion; 23 Eskimo and Indian Villages in Alaska, 1958; Blood Percent Prevalence of Clinical Findings, by Examiner 26-27 9 Pressure (Mean + S.E.) by Age, for Villages by Eskimo Men, Alaska National Guard, 1958, by Battalion Ethnographic Groups 68 and Age; Percent Prevalence of Selected Clinical 24 Eskimo and Indian Villages in Alaska, 1958; Arm and Findings 28 10 Scapula Skinfold Thickness by Age and Sex, for Eskimo Men, Alaska National Guard, 1958, by Region of Villages by Ethnographic Groups 69 Origin; Age, Height, Weight, Weight Status, Blood Pressure and Selected Clinical Findings 29 11 Dietary Measurements Relation of Clinical Signs and Biochemical Findings, Table 25 Eskimo Men, Alaska National Guard, Ft. Richardson, 1958; Serum Vitamin A, Alaska, 1958 33 12 Food Consumption from the Mess Hall Alone, Average Relation of Clinical Signs and Biochemical Findings, Per Man Per Day 72 Serum Vitamin C, Alaska, 1958 34 26 13 Eskimo Men, Alaska National Guard, Ft. Richardson, 1958; Eskimo Men, Alaska National Guard, 1958; Comparison of Plate Waste, Average Per Man Per Day 73 Dental Caries and Periodontal Status of 713 Eskimo 27 Eskimo Men, Alaska National Guard, Ft Richardson, 1958; Guardsmen with 1,400 White Male Residents of Birmingham Food Consumption from all Sources, Average Per Man and Baltimore 35 14 Per Day 73 Eskimo Men, Alaska National Guard, 1958; Mean Numbers of 28 Nutrient Composition of Recipes for Eskimo Dishes, as Decayed, Missing, or Filled Permanent Teeth in Four Calculated 75-81 Groups from the First and Second Battalions 36 15 29 Chemical Composition of Alaskan Foods, 1958 83-87 Eskimo Men, Alaska National Guard, 1958; Oral Status of 30 Food Consumption of Men in Villages, Alaska, 1956-1958 89 Members of First and Second Battalions 37-39 16 31 Food Consumption of Alaskan and Indian Men by Villages, Eskimo Men, Alaska National Guard, 1958; Gingival 1956-1958 90 Recession Scores, Men 35 Years of Age or Older, First 32 and Second Battalions Fat Content of Commonly Eaten Meats 93 41 33 Guide to Interpretation of Nutrient Intake Data 94 Source: https://www.industrydocuments.ucst.edu/docsizznc0227 X XI LIST OF TABLES (continued) I PREFACE Table Title Page 1. Administrative History Biochemical Findings A program of research on the nutritional status of Alaskan natives Table 34a Alaska, Nutrition Survey, March 1958; Biochemical has been under way in the Arctic Health Research Center, Anchorage, Findings, for National Guard and Villages, by Alaska, for several years. The present study arose from the interests Sex and Age Groups; Total Serum Protein and of the Department of Defense. Hematology 101 34b Alaska, Nutrition Survey, March 1958; Biochemical At a meeting of the Interdepartmental Committee on Nutrition for Findings, for National Guard and Villages, by National Defense (ICNND) 28 May 1956, Dr. Frank B. Berry reported that Sex and Age Groups; Serum Vitamin c, A and Carotene 102 the Secretary of Defense had inquired if the ICNND would be interested 34c Alaska, Nutrition Survey, March 1958; Biochemical in conducting a nutrition survey of the Alaskan natives. This proposal Findings, for National Guard and Villages, by was considered favorably by the Committee, and the Secretariat was Sex and Age Groups; Total Fatty Acids, Phospholipids authorized to explore the possibilities further. Discussions were held and Cholesterol 103 with Dr. Jack Haldeman, Chief, General Health Service, Public Health 34d Alaska, Nutrition Survey, March 1958; Biochemical Service, Department of Health, Education, and Welfare (HEW) and Dr. Findings, for National Guard and Villages, by John C. Cutler, Program Officer, Bureau of State Services, HEW. Toward Sex and Age Groups; Urinary Excretions 104 the end of 1956, the Committee received a formal request from the 35 Alaska, Nutrition Survey, March 1958; Comparison of Arctic Health Research Center for assistance in financing and con- Methods for Determination of N'Methylnicotinamide 106 ducting a nutrition survey of the Alaska National Guardsmen while they 36a Alaska, Nutrition Survey, March 1958; Total Serum were in their annual encampment in Anchorage and also in completing a Protein and Hematology by Village, for Men, Women survey of the inhabitants of ten native villages. The Commi ttee and Children 107 appointed an ad hoc group, with representatives from the General Health 36b Alaska, Nutrition Survey, March 1958; Serum Vitamin c, Service, Bureau of State Services and the Division of Indian Health of A and Carotene, by Village 108 the Public Health Service; and including Dr. E. M. Scott of the Arctic 36c Alaska, Nutrition Survey, March 1958; Mean Blood Fat Health Research Center, Anchorage, and Dr. John B. Youmans, Consultant Levels, by Village and Age 109 to the ICNND, to meet in April 1957 to draft a proposal for Committee 36d Alaska, Nutrition Survey, March 1958; Urinary Excretions action. by Villages, for Men, Women and Children 110 37 Alaska, Nutrition Survey, March 1958; Mean Blood Fat At a meeting in May 1957 the Committee agreed to serve as a co- Levels, by Survey Area and by Age 114 ordinating and sponsoring agency for a nutrition survey of the two 38 Alaska, Nutrition Survey, March 1958; Urinary Excretions National Guard Battalions during their 1958 encampment and a clinical of B-Vitamins, Village Areas, by Age and Sex 116 and biochemical survey of the inhabitants of the ten native villages 39 Alaska, Nutrition Survey, March 1958; Biochemical in which the Arctic Health Research Center, with the aid of the Findings, by Reproductive Status, Eskimo Villagers Division of Indian Health, had been conducting a survey of food intake in the Bethel Area 117 and dietary habits. 40 Suggested Guide to Interpretation of Biochemical Data 119 2. Acknowledgments Many people have contributed to the work of this study. The names are arranged here according to their respective organizations. Arctic Health Research Center, Anchorage, Alaska Dr. A. B. Colyar - Director, Arctic Health Research Center Alaska National Guard Brig. General Thomas P. Carroll, Adjutant General, Alaska National Guard Major William H. Crawford, Commander, First Scout Battalion Major Harry E. Voelker, Commander, Second Scout Battalion Source: ittps://www.industrydocuments.ucst.edu/docsizznc022 XII XIII Alaska Native Health Service Team Members (continued) Dr. Joseph A. Gallagher - Area Officer in Charge, Anchorage Mrs. Isabelle V. Griffith - Chemist, Arctic Health Research Center Dr. Robert I. Frazier - Medical Officer, Kotzebue Miss Anna J. Pitney - Chemist, Arctic Health Research Center Dr. Elmer E. Gaede - Medical Officer, Tanana Mr. Lyndon Sikes - Chemist, Arctic Health Research Center Dr. William A. Brownlee - Medical Officer, Bethel Dr. Milton Silverman - Biochemist, n/ National Institutes of Health Dr. Albert L. Russell - Dentist, National Institutes of Health Village Teachers Mr. Carl L. White - Statistician, National Institute of Health M/Sgt. Dale o. Starr - NCO in Charge, Dispensary, Fort Richardson Mr. and Mrs. Roman W. Kinney, Akiak M/Sgt. Harold G. Coffman - X-ray Technician, Dispensary, Fort Richardson Mr. and Mrs. Emil Kowalczyk, Kasigluk SP-5 Ronald J. Murphy - Technician, Dispensary, Fort Richardson Mrs. Mary McDougall, Napaskiak Mr. and Mrs. John F. Gordon, Hooper Bay 3. Objectives Mrs. Ida A. Hunter, Newktok Mr. and Mrs. Fred G. Fisher, Point Hope The extent of success of the adaptation of the Eskimo to a uniquely Mr. and Mrs. Russell McLaughlin, Shishmaref limited and precarious food supply in a harsh environment has been a Mr. and Mrs. Walter A. Ortman, Allakaket challenging question to physiologists for over a century. Arctic ex- Mr. and Mrs. Ley M. Kahl, Huslia plorers have often discussed this problem and some have taken highly Mr. and Mrs. S. William Benton, Noatak controversial positions based on their estimates either of the merits of the Eskimo dietary regimen or the status of the natives' health. U.S. Military Organizations - Alaskan Command The present study was undertaken to investigate this question in co- operation with the Arctic Health Research Center (AHRC) of the Lt. General Frank A. Armstrong, USAF - Commander in Chief, Alaskan Command Department of Health, Education, and Welfare, the Alaska Command of Maj. General G. C. Mudgett - Commander, U.S. Army, Alaska the U.S. Armed Forces, and the Alaska National Guard. Brig. General John R. Copenhaver - USAF Surgeon, Alaskan Command Colonel Sterrett E. Dietrich - U.S. Army, Surgeon Members of the AHRC with the support of the Indian Health Service Lt. Colonel Wade F. Heritage - U.S. Army, Deputy Surgeon have been conducting systematic studies of the dietary habits of the Lt. Colonel George D. Pleasants - Post Surgeon, Ft. Richardson Eskimo and, in particular, their hematological disorders. The present work was intended to complement those studies. The work described here Finally, the subjects themselves should be complimented for their was designed to evaluate the nutritional status of the Eskimo of all pleasant welcomes, patient forbearance and altogether cheerful and ages and both sexes by carrying out physical appraisals and biochemical intelligent willingness to help with the tasks at hand. measurements of specific nutrients in blood and urine. These data were then to be evaluated along with the dietary evaluations and food Team Members analyses made available by continuing studies of the Arctic Health Research Center. Additional measurements of consumption of food in Dr. John B. Youmans - Field Director, Army Medical Research and Develop- the mess halls were made among the native members of the Armed Forces ment Command Lt. Colonel Laurence M. Hursh - Director, 1 Army Medical Research and 4. Explanatory Addendum Nutrition Laboratory Dr. Edward M. Scott - Deputy Director, Arctic Health Research Center Since the present study was done and much of the report was written Dr. George V. Mann - Clinician, National Institutes of Health before or during the emergence of Alaska as the 49th state, there may Mr. C. Frank Consolazio - Biochemist, Army Medical Research and be descriptions herein or references to agencies or procedures which Nutritio; Laboratory have been superseded by new organizational arrangements. SP-3 Edward J. Sheehan - Technician, Army Medical Research and Nutrition Laboratory Pfc. Jay M. Jamison - Technician, 1 Army Medical Research and Nutrition Laboratory Dr. Donald B. Kettlecamp - Clinician, Alaska Native Health Service Dr. Ruth Coffin - Clinician, 2 Alaska Native Health Service 2 Field Team Member, Bethel party. Dr. Christine A. Heller - Nutritionist, 1 Arctic Health Research Center 1/ Field Team Member, Kotzebue party. Field Team Member, Bethel party. Source: htps.//www.industrydocuments.ucsi.edu/docsizznc022 1 30 60 40 50 50 of II - INTRODUCTION in 50 Alex 1. The Cultural Background The Eskimos, Indians and Aleuts of Alaska vary widely in their U 2 cultural traditions and present day mode of living. At the time or or the white man's arrival, the Eskimos occupied all the northern and western coasts of Alaska, and lived on the southern coast as far east a as Prince William Sound and on Kodiak Island. The Eskimos were divided culturally into a Northern group, the Thule culture, and a Southern group, the Old Bering culture, with the dividing line situated on 8 80 Norton Sound in the vicinity of Unalakleet. Northern Eskimos still a speak the same language as the Siberian, Canadian and Greenland Eskimos, E while the Southern Eskimo language is quite different. The Aleuts originally occupied the western half of the Alaska Peninsula and the Aleutian Islands. Thlingit Indians lived in southeast Alaska, while AND 06 Athabascan Indians occupied the interior regions of the territory. The map in Figure I shows these regions while Table 1 gives the population of these cultural groups in 1950. I 000 TABLE 1 ESKIMOS, INDIANS AND ALEUTS IN ALASKA IN 1950 Population Median Age 10 Eskimos 15,882 17.7 Athabascan Indians 6,783 -- Aleuts 3,892 17.9 20 Source: U.S. Census of Population, 1950, Vol. II, Parts 51- COAST 53. (1) The Eskimo culture in North America has been traced back through the Christian era. The "Thule" culture based on whaling seems to have of spread eastward from Alaska to Greenland during the period 500 to 1000 .D. In the saga of Eric the Red, reference is made to "skraelings" NEWARK (Eskimos) in Labrador in 1003. Possibly because of the disappearance 3MR of whales from the Central Arctic, a deviant culture based on fishing AIO and sealing spread back to Alaska. These migrations appear to account a for the presence of a single, primitive, Stone Age people with a com- : mon language and tools who occupied the 6,000 miles from Alaska to Greenland when Rink explored the latter area in about 1850. The oldest Eskimo culture is the "old Bering" culture which flourished on both 50 sides of the Bering Strait. This culture was based on the hunting of 60 21 0 00 00 00 fish and sea mammals. In Eurasia the Arctic culture was based on reindeer breeding, as in Lapland, except for a limited area of Eskimo culture on the Chukchi peninsula (2), The Eskimos, like the American Indians, are of Mongoloid ethnic origin. Eskimo skulls are narrow and oblong with a definite sagittal ridge. The lower jaws and maxillary bones are highly developed and Source: https://www.industrydocuments.ucsf.edu/docsizznc0227 2 3 prominent. The skin, hair, epicanthal folds and lumbar pigment testify to their Mongoloid origin. In contrast to the Negro the It is important to recognize that Alaskan Eskimos are not nomadic Eskimos have narrow noses. As in the American Indian, blood group people: They live in one or a few permanent homesites or campsites type o predominates among the Eskimos. Most of the sod houses have now been replaced by small frame or log structures. In one village in 1953 there were 36 houses with 47 rooms. The present study was concerned primarily with the two groups The floor space per fami ly was 227 square feet or an average of 51 square feet per person (3) Often these frame houses are poorly insu- of Eskimos, defined by geographic areas, and to a lesser extent with Athabascan Indians and Aleuts. In order to understand the situation lated and are therefore more difficult to heat adequately in winter of these people today it is important to review the primitive con- than were the primitive sod houses. ditions under which they once lived, since all of them are now in transition between the primitive and a modern way of life. This Each village had its own seasonal schedule for hunting and fishing, transition began in the 18th century for the Aleuts with their intro- but as in all hunting-fishing economies, there was a large element of duction to the Russian explorers and traders who followed Vitus Bering chance in this activity. The welfare of the people who depended on into their territory. For the Indians and Eskimos the transition hunting and fishing for food, clothing and fuel fluctuated accordingly. began later and at different times for different groups. The coastal Through the summer most Eskimo and Indian families found it necessary Eskimos who lived on marine mammals were exposed to the whit whalers to move from place to place in search of their supply of food. This and explorers of the 18th and 19th centuries, while some of the was particularly necessary for the tundral people who often traveled inland Eskimo and Indian villages have had important contact with considerable distances from the village in order to obtain sufficient white culture only during the past 60 years. The extent of accultu- food. These campsites, usually family affairs, were visited year after ration is thus variable. year as long as they yielded food. Almost all edible foods were eaten, and since food resources varied in different regions, there were wide Eskimos have managed by a number of ingenious methods to maintain geographic differences in diets. their numbers and to carry on a marginal existence under exceptionally adverse conditions. In order to survive in the Arctic, they have had There were three general types of Eskimo diets under the conditions to utilize every available resource. The primary consideration for of the primitive culture (2). On the northern and northwestern coasts the location of an Eskimo or Indian village in Alaska was the available of Alaska, Eskimos were primarily dependent on sea mammals -- seal, food, fuel and water supply. The population balance in such an walrus and whale -- for food. Farther south, chief dependence was on economy was important since overpopulation meant hunger and sometimes fish, while smaller numbers of interior Eskimos lived on land mammals, starvation. When the population became too large for the available primarily on caribou. In none of these areas was there total depen- food supply or if the food supply became scarce because of persistently dence on any one type of food. Use of fish was universal, while unfavorable weather conditions or some other accident of nature, shellfish, birds, birds' eggs, small mammals (including hares, porcupine, family groups would break away and try to find a more favorable place rabbits, muskrats, mink and beaver), berries, roots and green plants to establish themselves. were eaten when available. In retrospect these diets would seem to have had certain things in common. All of them were probably very high Winter homes were half buried in the ground and made of logs or in protein, moderate to high in fat content, and they contained very whale ribs covered with sod. The walls and ceiling of the main living little carbohydrate. They were beasonally low in ascorbic acid, and room were often lined with split driftwood, vegetable matting or skins. must have been on occasion deficient in calories. Such diets, however, Existing examples of these homes, when well constructed, are surpris- had no known nutritional disadvantages and no known advantages except ingly comfortable and can be heated with a minimum of fuel. They are, that they are generally believed responsible for the fact that Eskimo however, dark and small. Such houses were usually buili at permanent teeth were very nearly free of caries. The Eskimo did not usually have living sites and were then occupied only in the winter when they could a choice of foods from which to make a selection. Instead, his problem be kept reasonably free from condensation and seepage. In the spring, was the fundamental one of assuring a continuity of food and to this with the coming of the thaw, many of them became untenable. Because problem he devoted his energy, intelligence and ingenuity. of dampness of the house and because of the necessity to search for food, the people moved out of the sod huts into tents at camp sites, often at considerable distances from the village. In the early days, 1 tents were made of animal skins secured tightly over a willow frame. The tundra is the vast, treeless area of western and northern Alaska. For many years now the great majority of Eskimos have used canvas It is generally flat, dotted with ponds and sloughs and underlaid tents. Even today, though a family may not wish to move away from wi th permafrost. The vegetation in the summer consists of low shrubs the village for sealing or other activities, they will often move out and grasses and in the winter the surface may be buried to a depth of their winter residence into a tent pitched nearby. of several feet with snow. The winds pack and drift this snow almost continually. An approximate outline of the tundra is shown in Figure I. Source: tps:/lwww.industrydocuments.ucsi.edu/docs zznc0227 4 5 2. Demographic Factors creation of schools, stores, churches and postoffices in some villages Eskimos today live on a combination of foods obtained from the has tended to attract native families and to enlarge the villages, traditional sources and foods bought from stores. The latter are for whereas many small villages listed in 1950 are no longer in existence. the most part cereals and sugars. Some of the factors which presently affect the food habits of Eskimos are as follows: Eskimos seemed to accept Christianity readily and today every village has at least one church which is an important part of the social Eskimos now live at a low economic level. In a study made in life. Denomination of the churches is shown in Table 2 for the villages 1955(4), the estimated annual per capita cash income in 23 Eskimo vil- included in the present study. lages ranged from $69 to $475. Unless the Eskimo lives in one of the larger towns and has some education, he has little or no opportunit ty Schools have been in existence in Alaska for many years, but there for a job with a steady income. The income for a village comes from was never enough money to provide one for each of the smaller villages, a variety of sources. Fishing for profit provides income for many and until the past ten years there was little opportunity for a high families in the Bristol Bay area and at the mouth of the Yukon. While school education except in towns with a permanent white population. such fishing may require considerable capital for a boat, the profits Village schools (formerly called "Territorial Schools") are operated are large if the fishing is good. However, the trend in recent years by the State or by the Bureau of Indian Affairs (BIA). In recent years has been toward smaller catches of salmon. Some men from villages in the latter agency has started a special type of school -- The Instruc- the Kuskokwim area obtain employment in the canneries on Bristol Bay. tional Aid School in certain villages. In these schools the village The pay is high, averaging $600 for the month or six weeks when the furnishes the building, and a teacher is provided by the Bureau of cannery operates. Trapping provides part of the income of most vil- Indian Affairs. Such teachers are often not fully qualified. lages. Fur prices are now low, however, and only mink, muskrat and beaver are profitable enough to encourage the effort involved in Stores or trading posts were established in Alaska by the Russians, trapping. Twenty mink, 700 muskrat, or 20 beaver would represent a and traders have since been an important part of village life. Starting good year's trapping for one man in some areas. Generally, however, in the late 1930's, the Bureau of Indian Affairs helped to establish fewer than this are obtained. During the 1957-58 season, average cooperative stores in many of the large villages. There are several market prices for mink were $30, muskrat $0.25 and beaver $25. communities, however, which still have no store, and people must go varying distances for supplies. The typical village store has a very Service in the National Guard produces an appreciable proportion limited stock of supplies and limited storage facilities. In the of the total income in the villages. In addition, a few Eskimos work usual case, there is no place for storage where freezing can be on river barges in the summer or as storekeepers or janitors. Crafts, avoided in the winter or where food can be kept frozen in the summer. such as ivory carving, basket weaving and making of souvenirs, provide some income for Eskimos. A major source of income in all villages is The water supply of the Eskimo and Indian is traditionally the welfare. A large number of Eskimos are eligible for various forms of nearest river, lake, or pond. A hole is cut in the ice in winter to public assistance including Old Age Assistance and Aid-to-Dependent- dip water, or cakes of ice are cut, hauled on sleds to the home and Children. Welfare payments amount to between one fifth and one third then melted for use. Melting of ice is difficult in most areas because of the cash income in most communities. In four of the villages of the fuel shortage. The usual method of obtaining water in the included in the present survey, mean per capita income in 1955 (4) was winter is with a tank or barrel of ice in a corner of the house near estimated as follows: the stove. The room temperature slowly melts this ice and the water is drawn off from the bottom. The difficulty of obtaining uncontami- Village Mean Income Percent of Income nated ice plus this melting process may contribute to the prevalence per Capita from Welfare of enteric diseases. The true prevalence of these diseases has been difficult to measure since they occur sporadically and require long- Napaskiak $173 28 term surveillance for measurement. In Napaskiak, one of the villages in the present study, an investigation was made which indicated a Akiak 475 32 Kasigluk 138 35 seasonal variation in the prevalence of diarrhea(5). The high level Hooper Bay 137 30 occurred in the summer and affected especially the children under 10 years of age (6). The infection rates for Endamoeba histolytica The population in Alaska is sparse and the communities are small. and Diphylobothrium sp. were found to be 8.6 and 34.5 percent, respectively. In 1950 about 80 percent of the 287 places named in the census had fewer than 199 persons (1). This smallness was probably originally related to the availability of food in the surrounding area. The Most of the coastal people have to depend on driftwood for their fuel. Some portions of the coast have a good supply but in others this wood is almost nonexistent In some villages, where seal are Source: https://www.industrydocuments.ucsi.edu/docsizznc022 TABLE 2 ALASKA: CHARACTERIZATION OF THE VILLAGES IN THE STUDY, AND THE SIZE OF THE SAMPLES EXAMINED, 1958 Name Type Popu- No. of Persons Churches School Store or Distance Distance lation Examined to Nearest Store to Hospital Allakaket Indian 120 75 Episcopalian State Co-op. 150 miles Akiak Southern 187 76 Moravian Bureau of 1 Trader + 20 miles Eskimo Indian Affairs Co-op. Hooper Bay Southern 435 96 Roman Catholic Bureau of 2 Traders + 155 miles Eskimo Swedish Covenant Indian Affairs Co-op. Huslia Indian 145 90 Episcopalian State Trader 135 miles Kasigluk Southern 180 94 Russian Orthodox Bureau of (None) 35 miles Eskimo Moravian Indian Affairs (4 miles) Napaskiak Southern 137 81 Russian Orthodox Bureau of (None) 6 miles 6 Eskimo Indian Affairs (1 mile) Newktok Southern 118 59 Roman Catholic Bureau of 3 Traders 115 miles Eskimo Indian Affairs Instructional Aid Noatak Northern 400 69 Friends Bureau of Co-op. 50 miles Eskimo Indian Affairs Point Hope Northern 315 88 Episcopalian Bureau of Co-op. 150 mi les Eskimo Indian Affairs Shi shmaref Northern 200 77 Lutheran Bureau of Co-op. 110 mi les Eskimo Indian Affairs Totals 2,237 805 8 9 Village Complaint included experts in anthropology, nursing care, medical social services, tuberculosis control, hospital and medical care, sanitation, laboratory Hooper Bay 1. A woman, eight months pregnant, with pain, services and mental health. fever and dysuria suggesting pyelitis. Members of the party traveled through the major areas of Alaska. 2. A young man rith fever and malaise con- The observations were generally more concerned with the health organiza- sidered to be "flu. " tions and demographic and environmental conditions than with clinical problems. The study was done at a critical time, because in July 1955 3. A young boy with penile swelling and the responsibility for the health problems of the natives of Alaska was urinary obstruction, considered to be transferred by Public Law 568 from the Bureau of Indian Affairs of the balanitis. Department of the Interior to the Department of .Health, Education, and Welfare. The Pittsburgh report thus reflects the conditions of an older 4. A woman with pleurisy. system. Tanunak 1. An 18 month old child with a swollen and When Secretary Seward purchased Alaska in 1867, the contract wit] inflamed throat. the Czar stipulated, "The uncivilized tribes will be subject to such laws and regulations as the United States may from time to time adopt Pilot Station 1. A man with obstipation. in regard to aboriginal tribes of that country." Health services and regulations were almost nonexistent until 1914 when a medical program 2. A child with extensive eczema. was established in the Bureau of Education which was then the only governmental agency directly concerned with the natives. In 1916 this o 3. A fever of 105` F. in a 4 month old baby - Bureau established a migratory medical boat on the Yukon, but during no localizing signs of infection. the first summer the physician, Dr. J. W. Houston, fell overboard and was drowned. Small health surveys indicated that tuberculosis, syphilis Goodnews Bay 1. A woman with "flu." and "trachoma" were common. There is now reason to doubt that trachoma did, in fact, exist. 2. The supply of drugs very low. The first hospital for natives was built in Juneau in 1916. In Kipnuk 1. Query from the doctor concerning the con- 1931 when the Office of Indian Affairs assumed responsibility there dition of a patient with tuberculosis were five Alaska Native Health Service (ANHS) hospitals for the Alaskan recently returned to the village on Indians and Eskimos with six doctors and 15 nurses for the entire isoniazid therapy. population. There are now five general hospitals under the U.S. Public Health Service and these are located at Point Barrow, Bethel, 2. Query about the three villagers who were Kanakanak, Kotzebue and Tanana. There are, in addition, two medical sent to Bethel last month for medical care. centers, one at Anchorage and another at Mt. Edgecumbe in southeastern What are their conditions? Alaska near Sitka. Some specialized care, as for tuberculosis and mental disease, is obtained by contract in hospitals both in and outside Mountain Village 1. Query for news about a man recently sent Alaska. The 1958 budget of the Division of Indian Health, Public Health to the Anchorage Hospital. Service, for Alaska was: Scammon Bay 1. A 14 year old girl with pain in the right Activity lower abdomen, vomiting and with fever. Hospital Operations $ 8,702,000 A general description of the ecological and social factors which Contract Patient Care 694,000 bear upon the health problems in western Alaska has been outlined in the Field Health 784,000 report of a survey carried out in 1953-54 by the Graduate School of Management Services 122,000 Public Health of the University of Pittsburgh (7). The Department of the Interior, which was then responsible for the health problems and pro- Total $10,302,000 grams in the nátive population of Alaska, invited the faculty of the School of Public Health of the University of Pittsburgh to survey the situation and make suggestions for improvement. In the summers of 1953 and 1954 such a survey was carried out by medical specialists. These Source: https://www.industrydocuments.ucst.edu/docsizznc022 FIGURE II TUBERCULOSIS MORTALITY FOR ALASKA BY RACE 1952-- 1957 I50 140 130 WHITE 120 ESKIMO 110 INDIAN ALEUT 100 90 80 70 60 50 40 30 20 10 O NITION NITTION Sis 000000 or 13 The birth rates of racial groups in Alaska in 1956 are shown here (9) : Whites 32 per 1,000 population Eskimos, Indians, Aleuts 52 per 1,000 population The burden of disease in Alaska in 1950 and today bears a remark- able resemblance to that recorded for the United States in 1900. The opportunity for the application of modern medical skills and knowledge is obvious. "Native Alaska" could and should be made an almost ideal laboratory workshop for teaching, research and service. 4. General Plan of Study A large proportion of the able-bodied Eskimo men are members of two battalions of a National Guard Reserve Unit which is brought to Camp Denali (at Fort Richardson near Anchorage) each year for a two-week training period. In good weather when the widely scattered villages are accessible the men are often away on sealing expedition or tending traplines, so the period of National Guard duty offered a unique op- portunity to study these Eskimo men. This was also an economical way of assembling data on people from many widely separated villages. It was fortuitous that the Guard training period occurred in late winter when native food supplies might be expected to be diminished and limited, thus placing the nutritional status of the people at a low ebb. The clinical and biochemical methods used were those described in the "Manual for Nutrition Surveys" of the ICNND(10) Clinical observa- tions were recorded on data cards for the "detailed clinical examination. No abbreviated clinical examinations were done. The neurological, cardiovascular and abdominal examinations and the skinfold measurements were made by two members of the Alaska Native Health Service medical staff. Battalion 2 of the Eskimo Guardsmen arrived at Anchorage on March 1 and 2, 1958. The noncommissioned officers had arrived two weeks earlier. This unit comprises men from southwestern Alaska including the Aleutian chain and the Bering Sea islands except St. Lawrence and King Islands. Bethel and the Kuskokwim valley may be considered as its center. The men come from as far south as Dillingham, from west to Unalaska and the Pribilofs, and from north to Hooper Bay and the lower Yukon. They include two distinct ethnic groups, the Eskimos -- both inland and coastal -- and the Aleuts, who are few in number (Figure III). These men were examined during three days at Camp Denali. The group of examiners was then divided into two sections. One team proceeded to Bethel on March 7. In the following ten days they studied five villages in that area. A second team went to Kotzebue on March 7 where they undertook studies in five villages of that region. Upon completion of these field studies the two parties returned to Camp Denali and on March 24-27 examined Battalion 1 of the Eskimo Guardsmen. These men were assembled from the northern villages of Alaska extending from Barter Island near the Canadian border to Nome Source: https:llwww.industrydocuments.ucsi.edu/docsizznc0227 FIGURE III PRINCIPAL ETHNOGRAPHIC DIVISIONS OF ALASKA, AND THE VILLAGES STUDIED Pt. Barrow Point Hopee 52 Woatak 3 so I. Aleuts East Cape Shishmaref Allakaket 2. Southern Eskimos 3. Northern Eskimos 3 Huslia 4. Athabascan Indians River Nome (ukon Foirbanks 5. Thlingit, Tsimshian, St Lowrence and Haida Indians 14 Island Hooper Bay Newktok Kosigluk (Anchorage Nunivak Bethel Napaskiak Island 2 Juneau e Pribilof Bristol 8 Isls. Bay Kodiak Island 5 goo chain 08.. & joint 50 150 250 I I Miles pure 15 230 16 17 FIGURE IV TABLE 3 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 PLAN OF THE STUDY WITH NUMBERS CLINICAL CALIBRATION STUDIES 1/ EXAMINED (1) (2) (3) (4) Replicates Trials Bn 2 Bn 1 Total Duplicates N 16 N 20 A N 16 N 32 N 68 Examiner No. 1 - + + - + + - + + - + + Classification No. 2 - + + - - + + - - + + - + + Attribute BATTALION 2 General appearance 21 13 3 - - 16 4 - - 26 6 - - 55 13 - - Thyroid enlarged 16 - - - 19 - 1 - 26 1 4 1 61 1 5 1 B =20 Submaxillary enlarged 16 - - - 18 1 1 - 29 - - N = 323 3 63 1 4 - Nasolabial seborrhea 16 - - - 17 - 2 1 32 - - - 65 - 2 1 BETHEL KOTZEBUE Other seborrhea 16 - - - 20 - 28 - 4 - 64 - 4 - Erythema head 14 1 - 1 13 4 3 28 2 2 55 7 - 6 AREA AREA Pigmentation - head 14 2 - - 20 - - 28 3 1 62 5 - 1 Thickened conjunctivae 15 1 - 16 4 - 21 6 1 4 52 11 1 4 AKIAK NOATAK Pingueculae - 2 4 10 - 2 18 9 4 4 15 9 8 8 43 76 69 (6) Bitot's spots 15 - 1 - 19 - 1 - 32 - - - 66 - 2 - (I) Conjunctival injection 16 - - - 19 1 - - 26 4 2 - 61 5 2 - Angular scars 14 1 1 - 17 - 3 - 32 - - - 63 1 4 - Cheilosis 16 - - 19 - 1 - 32 - - - 67 - 1 - Filiform strophy, KASIGLUK PT. HOPE slight 16 - - 16 - 4 - 30 - 2 - 62 - 6 e 94 88 Glossal furrows 16 - - 15 4 1 23 5 2 2 54 9 2 3 (2) (7) Red gums 16 - - - 11 - 7 2 30 - 1 1 57 - 8 3 Swollen gums 16 - - 13 6 1 29 - 3 - 58 - 9 1 Gum recession 6 2 1 7 3 1 12 4 19 1 8 4 28 42 1 15 Unfilled caries 7 3 6 14 2 4 12 3 6 11 33 8 6 21 Worn teeth 1 8 1 6 2 3 1 14 16 5 2 9 19 16 4 29 NAPASKIAK SHISH MAREF Follicular 8I 77 hyperkeratosis 15 1 - - - (8) 15 5 28 - 4 58 10 - (3) Xerosis 16 - - 19 1 - - 28 3 1 - 63 4 1 - Acne 15 1 - - 18 1 - 1 25 2 2 3 58 4 2 4 The 43 items recorded for the detailed examination which were used exclusively NEWKTOK ALLA KAKET in the Alaska Survey have been abridged here to include only the 23 items which (4) 59 75 showed sufficient prevalence of a sign to allow comparison of observers. (9) 2/ Positive means less than "good general appearance.' HOOPER BAY HUSLIA 96 90 (5) (10) BATTALION I C N=32 N = 390 Source: https://www.industrydocuments.ucsi.edu/docsizznc022 18 19 follicular hyperkeratosis is an important area of dyscalibration. It will be shown later that this particular examiner difference is partially accounted for by an assignment of lesions by examiner 2 to follicular TABLE 4 hyperkeratosis whereas examiner 1 assigned similar conditions to xerosis. ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 A similar estimate of examiner difference was carried out with the Battalion 1 men after the survey parties returned from the village SUMMARY OF CALIBRATION STUDIES FOR THE CLINICAL EXAMINATIONS-/ surveys (column 3 in Table 3). The extent of the differences between examiners is both large and important. If the average difference between examiners in percent of subjects in which they disagree for all items is obtained for Battalion 2 and Battalion 1, the averages are respectively Number Examiner's Reaction of 16.6 N=25 and 14.0 N=25. There is no clear indication of a trend of Disagree examiner difference. For the total duplicate examinations (68 in all, Trial Observations Agree Positive No. 1 + No. 2 + Agree Negative column 4, Table 3), the examiners exceed 15 percent divergence for N % N % N % N % thickened conjunctivae and pingueculae, glossal furrows, gum atrophy and recession, unfilled caries, worn teeth and dental malposition. The Trial 1 368 30 8.2 24 6.5 92.4 289 78.6 divergence on follicular hyperkeratosis is just at 15 percent, but one 460 examiner identified all of these (N=10) whereas the other examiner Battalion 2 49 10.7 28 6.1 44 9.6 319 69.5 diagnosed 4 subjects with xerosis, not indicated by the first. These data are further condensed in Table 4. The secular consistency of the Battalion 1 736 53 7.2 45 6.1 49 6.7 557 75.6 examiners is notable. These clinical calibration studies were done on 5 percent of the Totals 1564 132 8.4 97 6.2 102 6.5 1165 74.5 subjects studied at Camp Denali. This approach will always be limited by the scarcity of clinical material showing a range of manifestations for many of the important clinical signs. The problem then is one of measuring the ability of individuals to fix their criteria for recogni - tion of threshold levels of clinical signs. It appears that a more Conclusion - In 1564 observations recorded in duplicate after independent rigorous set of definitions should be used. It is also necessary that evaluation by examiner 1 and examiner 2: more extensive estimates of observer differences be made. The present data suggest that perhaps 10 percent of all the clinical appraisals Both agree positive findings in 8% should have been replicates, and this process should have been arranged Both agree negative findings 75% to measure self-duplication as well as inter-examiner duplication. Disagree 13% With examiner 1 positive 6.2% The present studies appear to disqualify observation of thickened With examiner 2 positive 6.5% conjunctivae, pingueculae and follicular hyperkeratosis because of observational imprecision. The dental information will need to come from the independent dental examination. 1 Using the 23 items shown in Table 3. Source: https:/lwww.industrydocuments.ucsf.edu/docs/zznc0227 20 21 III - NATIVE MEN IN THE NATIONAL GUARD 2. Clinical Findings 1. The Population Studied The general impression of physical appearance obtained from casual observation of the two battalions was that these men were active, rugged, The Eskimo Guardsmen represent the majority of all the able-bodied deeply tanned and well-conditioned. They were short in stature, with Eskimo men in Alaska. They appear to find membership in the Alaska "Oriental" faces, short limbs and long trunks, and they generally had a National Guard (ANG) attractive because the service furnishes a cash mesomorphic body type. The men in Battalion 1 who came from northwestern income and also it supplies a pleasant social diversion for them. Alaska seemed somewhat taller, obesity was more frequent among them, and they more commonly had lighter eyes, hair and skin than the men in It appears that no medical screening is done in the villages when Battalion 2. The men in Battalion 1 were also more at ease, better ac- the groups are assembled for the annual duty at Anchorage. It is likely quainted with English, and their behavior was more like that of American that known tuberculosis and obvious crippling or chronic disease are troops. The height-weight measurements bear out some of these observa- causes for rejection, but the men are generally sworn in and assembled tions. A summary of the height, weight, skinfold, blood pressure and in Anchorage before application of the usual medical standards for mil- pulse measurements is shown in Table 5. itary acceptance (11). The frequency and severity of grossly visible defects strongly suggested that these battalions were composed of "able- The relationship of weight to age is shown in Table 6. The small bodied volunteers" who had not been subjected to effective medical gains of weight with age are in contrast to the usual findings in white screening. In Battalion 2, four cases of active pulmonary tuberculosis males in the United States. As noted above the men from northwestern were diagnosed by symptoms and x-ray among the 350 men present. Alaska (Battalion 1) were a little taller than those in Battalion 2, but no important trends were demonstrated. In particular, there is no The Division of Tuberculosis Control of the Alaska Department of evidence that Eskimo men are taller as their race becomes acculturated. Health, as part of its tuberculosis case finding mechanism, has three These data also indicate there is very little obesity. (It should be itinerant x-ray technicians who travel to villages of known high incidence remembered in using the U.S. Medico-Actuarial Tables of Standard Weight (13) to take chest x-rays of all available inhabitants. Active and probably that an appreciable increase of weight with age is incorporated in the active cases diagnosed in this manner, as well as by laboratory or "standard weight. The fall of percent "standard weight" with age clinical means, are placed under medical supervision, and their known shown in Table 18a is thus largely an artifact due to the use of these contacts are also examined. In 1958 this program identified 44 new J.S. reference tables(13). The percent distribution of men exceeding the active cases throughout Alaska among the Eskimos and Indians(la calculated "standard weight" is shown in Table 5. The physical appearance of these men suggests that the percent "standard weight" in excess of 100 The noneffective rates at Camp Denali among the Eskimo National is often an artifact due to excessive bone and muscle mass; that is, the Guardsmen were not made available. Since the survey examination consequence of high activity rather than of fat deposits. Body composi- facility was also the battalion dispensary, it was observed that from tion data on these people are not available, but body composition may 8 to 30 men appeared for sick call each morning from a battalion have some relevance to the physiological problem of adaptation to a cold strength of about 400. During the work with each battalion small epi- environment. This interpretation of the small elevation of percent demics of what seemed to be a contagious respiratory disease occurred "standard weight" is also supported by the relation of weight to age a few days after the men arrived in camp. This was variously called shown for the village groups in Figure IX where the weights are es- "flu,' "pneumonia" and "measles" by the orderlies. The medical facil- sentially constant after age 25 to 29. ities available to these men were the same as those for all U.S. military personnel in Alaska. These facilities and the local mess and The pulse rates have little clinical interest, although there was sanitary facilities would not be expected to have any lasting effect, evidence for important observer differences. however, since the men are in camp for only 14 days. As is usually true of blood pressure data, the observers showed a There is no question that duty with the Alaska National Guard has predilection for the end digits o, 5, and even numbers. For example, an important impact on these men, especially those from the Bethel area 76 percent of the diastolic blood pressures were recorded with a zero where acculturization has been slower. The Eskimos acceptance of end digit and 82 percent of the systolic pressures recorded ended with military food, clothing, customs and equipment is immediate and total. zero. This recording artifact requires a careful selection of groups They are sometimes said to dislike beans and they often find cheese in the analysis and also influences the positioning of an arbitrary revolting, but mess sergeants find they eat anything offered them and criterion of normalcy because it will affect the distribution of they eat this completely. It has been said that the word "Eskimo, subgroups. which means "one who eats raw meat" in the Athabascan language, would be more appropriately called "one who eats everything. " The mean systolic blood pressures are remarkably constant with age (Table 6). Furthermore, the number of men with systolic pressure of 160 or over comprises a very small percentage (8 men, 1.1 percent) Source: https://www.industrydocuments.ucsf.edu/docs/zznc0227 S 22 TABLE 6 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION AND AGE HEIGHT, WEIGHT, WEIGHT STATUS, SKINFOLDS, BLOOD PRESSURE & PULSE Battalion 2 Battalion 1 Age (years) Age (years) 17-19 20-39 40-54 Total 17-19 20-39 40-54 Total Number examined 21 255 47 323 42 318 30 390 I/ Height (inches) 65.5+0.4 64.5+0.1 63.8+0.3 64.5+0.1 65.8+0.3 66.2+0.1 65.840.4 66.2+0.1 Weight (pounds) 1/ 140 + 3 141 + 1 144 + 2 142 + 1 140 + 2 150 + 3 150 + 3 149 + 1 % of "Standard Weight" 108 + 2 104 +1 1 102 + 1 104+1 107 + 1 106 + 1 100 + 1 106 + 1 Median Arm 6.3 5.9 5.4 5.9 8.9 6.7 7.1 6.9 Skinfold Thickness Scapula 8.3 7.7 7.6 7.8 10.7 9.5 8.8 9.7 (mm) 23 Systolic Blood Pressure (mm Hg) 17 125 + 4 126 + 1 122 + 2 125 + 1 119 + 2 121 + 1 120 + 3 121 + 1 Diastolic Blood Pressure (mm Hg) I/ 73 + 2 73 + 1 72 + 2 67 + 1 67 + 2 70 + 1 74 + 1 70 + 1 % with B.P. > 140/90 0.0 6. 6.4 5.9 0.0 1.9 0.0 1.5 Pulse (beats/minute) 78 2 78 + 1 74 + 1 78 1 79 + 2 77 + 1 76 + 1 77 + 1 1/ Mean + Standard Error. TABLE 7 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION BLOOD PRESSURE (Mean I Standard Error), BY HEIGHT Height (inches) 59-63 64-67 68-73 Systolic Bn 2 122.3 + 1.4 127.1 + 1.1 127.8 + 3.0 Blood Pressure (mm Hg) Bn 1 117.6 + 2.1 119.7 + 0.9 125.1 I 1.5 Diastolic Bn 2 70.7 + 1.0 73.0 + 1.0 75.2 + 1.9 Blood Pressure (mm Hg) Bn 1 67.4 + 1.6 69.9 + 0.6 70.5 + 1.1 24 of the entire group examined. In neither group was there a significant number of men with diastolic pressures over 90 mm Hg and there were only five men with pressures over 100 mm. Since these were casual blood pressure measurements taken under moderately stressful conditions they may be presumed to be high estimates. They suggest that hypertensive heart disease is not an important problem among these men. Rodahl has also made this observation This fact is of particular interest because of the high protein diet which these men seem to have. It is of some interest that when systolic blood pressure is considered for each battalion by inch of height a definite trend is observed for higher mean pressure with increasing height. Grouping and comparing heights reveals mean differences as shown in Table 7. Diastolic pressures re- veal a similar trend. It may be concluded that the observed blood pressure readings reveal little or no signs of high blood pressure as an indicator of cardiovascular disease and that the minor fluctuations of blood pressure observed are reasonably related to small differences of a.m thickness. The absence of hypertension among the Eskimos may be of some importance in relation to the problem of causation of hyper- tensive heart disease among white cultures. The summary of other clinical findings for the Eskimo Guardsmen is shown in Tables 8, 9 and 10. The data are shown for the battalions separately (Table 8) because they seem to represent two distinct popu- lations. The examiners are also distinguished because of the procedural divergencies demonstrated above. Certain selected clinical signs are presented by battalion and age in Table 9 and by ethnographic origin in Table 10. The significant findings are as follows: No important prevalence of goiter was observed in the men of Battalion 2 but an average prevalence of 10 percent was seen in Bat- talion 1. These were, without exception, small goiters which were judged to be enlarged either with nodules or symmetrically. A 9.9 percent incidence of goiter was found among northern Eskimos, and 14.3 percent of the Athabascan Indians had enlarged thyroid glands. No instance of thyrotoxicosis was seen. The prevalence of enlarged sali- vary glands was low; the glands were not grossly enlarged and the sign did not seem important (Figure v). Erythema of the exposed parts was common, but this could be adequately explained by the known degree of exposure to sun, cold and wind. It was noted particularly among the Eskimos (Table 10). The late cutaneous results of cold injury which the men describe collectively as "ice" re- semble x-ray injury, with cicatrization, depilation and dilatation of venules. Excessive pigmentation of exposed parts was also common in the older men and was sometimes dramatic about the face. Over the trunk and especially the back it assumed a mottled effect with an irregular depo- sition of pigment (Figure VI). This change strongly resembled the erythema ab igne more often seen about the shins in some U.S. rural populations. In these people this sign, restricted to males, is probably related to the "kashim" or sweat bath procedure. Source: ttps://www.industrydocuments.ucsf.edu/docs/zznc0227 TABLE 8 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION PERCENT PREVALENCE OF CLINICAL FINDINGS , BY EXAMINER II Battalion 2 Battalion 1 Total Examiner Examiner Examiner # 1 # 2 Total # 1 # 2 Total # 1 # 2 Total Number examined 155 168 323 211 179 390 366 347 713 Suspected Disease Tuberculosis 3.9 1.8 2.8 1.9 3.9 2.8 2.7 2.9 2.8 Good 85.8 100.0 93.2 83.4 98.9 90.5 84.4 99.4 91.7 General Appearance Fair 12.9 0.0 6.2 16.1 1.1 9.2 14.8 0.6 7.9 Poor 1.3 0.0 0.6 0.5 0.0 0.3 0.8 0.0 0.4 Hair Staring hair 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Thyroid 0.7 1.2 0.9 11.4 8.9 10.3 6.8 5.2 6.0 Glands Enlarged Submaxillary 2.6 2.4 2.5 2.4 5.0 3.6 2.5 3.7 3.1 Nasolabial seborrhea 0.0 5.4 2.8 0.5 2.2 1.3 0.3 3.7 2.0 Other seborrhea 0.0 1.8 0.9 2.4 7.3 4.6 1.4 4.6 2.9 Skin - Face & Neck Erythema, face/neck 21.9 6.0 13.6 13.7 7.8 11.0 17.2 6.9 12,2 26 Pigmentation, face/neck 5.8 0.6 3.1 3.8 7.8 5.6 4.6 4.3 4.5 Thickened conjunctivae 11.0 1.2 5.9 31.8 19.0 25.9 23.0 10.4 16.8 Pingueculae 84.5 57.7 70.6 61.1 54.7 58.2 71.0 56.2 63.8 Bitot' spots 1.3 0.6 0.9 0.0 0.0 0.0 0.5 0.3 0.4 Eyes Circumcorneal injection 0.0 0.6 0.3 0.0 0.6 0.3 0.0 0.6 0.3 Conjunctival injection 4.5 0.0 2.2 9.0 3.4 6.4 7.1 1.7 4.5 Blepharitis 0.0 0.0 0.0 0.5 0.0 0.3 0.3 0.0 0.1 Corneal scarring 6.5 9.5 8.0 4.3 2.2 3.3 5.2 5.8 5.5 Angular lesions 0.7 0.0 0.3 0.5 1.7 1.0 0.5 0.9 0.7 Lips Angular scars 3.2 5.4 4.3 0.0 0.0 0.0 1.4 2.6 2.0 Cheilosis 0.0 1.2 0.6 0.0 0.0 0.0 0.0 0.6 0.3 Filiform atrophy, s1. 0.7 13.1 7.1 9.5 10.6 10.0 5.7 11.8 8.7 Filiform atrophy, mod. 1.3 1.8 1.5 2.8 2.8 2.8 2.2 2.3 2.2 Fungiform atrophy 2.6 0.0 1.2 0.0 0.0 0.0 1.1 0.0 0.6 Tongue Papillary hypertrophy 1.3 1.2 1.2 0.0 1.1 0.5 0.5 1.2 0.8 Furrows 7.1 1.2 4.0 12.8 6.7 10.0 10.4 4.0 7.3 Fissures, erosions, ulcers 2.6 0.0 1.2 1.4 0.0 0.8 1.9 0.0 1.0 Serrations or swellings 5.8 8.9 7.4 1.9 9.5 5.4 3.6 9.2 6.3 Red, tip or lat. margins 3.2 0.0 1.5 7.6 1.1 4.6 5.7 0.6 3.2 Geographic tongue 1.3 0.0 0.6 2.4 1.1 1.8 1.9 0.6 1.3 TABLE 8 (Cont inued) Red or swollen gums 9.7 25.6 18.0 5.2 14.0 9.2 7.1 19.6 13.2 Gums Atrophy or recession, pap. 40.0 66.7 53.9 23.7 43.6 32.8 30.6 54.8 42.4 Bleeding gums 0.0 2.4 1.2 0.0 0.0 0.0 0.0 1.2 0.6 Unfilled caries 27.0 20.9 23.8 42.2 44.1 43.1 36.8 34.4 35.6 Filled caries 10.4 12.4 11.5 30.8 45.3 37.4 23.6 31.5 27.4 Carious teeth, 0 62.6 65.1 63.9 32.7 20.1 26.9 43.3 39.0 41.2 " " 1-2 13.0 14.0 Teeth , 13.5 16.1 31.8 23.3 15.0 24.4 19.6 " " , 3-4 15.7 9.3 12.3 20.4 21.8 21.0 18.7 16.6 17.7 " " , 5+ 7.0 7.0 7.0 26.1 24.0 25.1 19.3 16.9 18.1 Edentulous 1.7 4.7 3.3 4.7 2.2 3.6 3.7 3.2 3.5 Worn 60.0 45.7 52.5 34.1 30.2 32.3 43.3 36.7 40.1 Fluorosis 0.0 0.0 0.0 1.4 2.2 1.8 0.9 1.3 1.1 Malposition 7.8 4.7 6.1 19,9 5.0 13.1 15.6 4.9 10.4 Follicular hyperkeratosis 3.9 11.3 7.7 0.0 10.6 4.9 1.6 11.0 6.2 22 Xerosis 1.3 0.0 0.6 14.2 0.6 7.9 8.7 0.3 4.6 Acneform eruption 5.2 1.8 3.4 9.0 5.0 7.2 7.4 3.5 5.5 Skin General Scrotal dermatitis 0.0 0.0 0.0 0.5 1.1 0.8 0.3 0.6 0.4 Thickened pressure points 1.3 0.0 0.6 1.4 5.6 3.3 1.4 2.9 2.1 Purpura or petechiae 0.6 0.0 0.3 0.0 0.0 0.0 0.3 0.0 0.1 Hyperpigmentation 0.0 2.4 1.2 1.9 0.6 1.3 1.1 1.4 1.3 Abdomen Hepatomegalia 0.0 2.4 1.2 0.5 0.0 0.3 0.3 1.2 0.7 Vibration sensation absent 1.3 0.0 0.6 0.0 0.0 0.0 0.5 0.0 0.3 Lower Extremities Loss of ankle jerk 0.6 0.6 0.6 0.5 0.0 0.3 0.5 0.3 0.4 1/ No findings of enlarged parotids, xerophthalmia, magenta tongue, "scorbutic-type"gums, crackled skin, pellagrous lesions, splenomegalia, ascites, or calf tenderness. Findings of 1 case each of glossitis, perifolliculosis and depigmentation of hair also omitted. Source: https://www.industrydocuments.ucsf.edu/docs/zznc022) TABLE 9 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958, BY BATTALION AND AGE PERCENT PREVALENCE OF SELECTED CLINICAL FINDINGS Battalion 2 Battalion 1 Age (years) Age (years) 17-19 20-39 40-54 Total 17-19 20-39 40-54 Total Number examined 21 255 47 323 42 318 30 390 Suspected Disease Tuberculosis 4.8 2.4 4.3 2.8 4.8 2.8 0.0 2.8 Good 90.5 92.9 95.8 93.2 83.3 91.5 90.0 90.5 General Appearance Fair 9.5 6.7 2.1 6.2 14.3 8.5 10.0 9.2 Poor 0.0 0.4 2.1 0.6 2.4 0.0 0.0 0.3 Thyroid 0.0 0.8 2.1 0.9 9.5 9.7 16.7 10.3 Glands Enlarged Submaxillary 0.0 2.7 2.1 2.5 0.0 3.5 10.0 3.6 Nasolabial seborrhea 4.8 3.1 0.0 2.8 4.8 0.9 0.0 1.3 Skin - Face & Neck Erythema, face/neck 9.5 13.7 14.9 13.6 2.4 12.3 10.0 11.0 Pigmentation, face/neck 4.8 2.7 4.3 3.1 2.4 6.3 3.3 5.6 2 8 Thickened conjunctivae 0.0 6.3 6.4 5.9 11.9 26.4 40.0 25.9 Pingueculae 38.1 69.4 91.5 70.6 23.8 61.0 76.7 58.2 Eyes Conjunctival injection 0.0 2.4 2.1 2.2 11.9 5.7 6.7 6.4 Corneal scarring 0.0 8.6 8.5 8.0 7.1 2.5 6.7 3.3 Filiform atrophy, s1. 0.0 7.8 6.4 7.1 14.3 9.7 6.7 10.0 " " mod. 0.0 1.6 2.1 1.5 0.0 2.8 6.7 2.8 , Tongue Furrows 0.0 3.5 8.5 4.0 9.5 10.4 6.7 10.0 Serrations and swellings 0.0 7.5 10.6 7.4 0.0 6.3 3.3 5.4 Red, tip, or lat. margins 0.0 1.6 2.1 1.5 4.8 5.0 0.0 4.6 Geographic tongue 4.8 0.4 0.0 0.6 2.4 1.9 0.0 1.8 Red or swollen gums 0.0 17.3 29.8 18.0 7.1 10.4 0.0 9.2 Gums Atrophy or recession 54.9 66.0 53.9 14.3 33.6 50.0 32.8 No carious teeth 36.8 64.6 75.0 63.9 14.3 26.7 46.7 26.9 Caries, filled 1-2 15.8 13.8 11.1 13.5 19.0 23.3 30.0 23.3 Teeth or unfilled 3+ 47.4 19.0 5.6 19.3 66.7 45.9 20.0 46.2 Edentulous 0.0 2.6 8.3 3.3 0.0 4.1 3.3 3.6 Worn 15.8 48.7 91.7 52.5 2.4 31.8 80.0 32.3 Follicular hyperkeratosis 9.5 8.6 2.1 7.7 7.1 4.7 3.3 4.9 Skin General Xerosis 0.0 0.8 0.0 0.6 7.1 8.2 6.7 7.9 Acneform eruption 9.5 3.5 0.0 3.4 11.9 6.6 6.7 7.2 29 PUEW ONNOVI VNWN w 006 oanoww wava NW the WNY PPOOP- compa FUN NWF oaitor JNWF via 3.6 over NFL OF JNN boing 00 0 FOUOND FOOUOD TE 000wooowwe coovoo ING HUYAN FN WNWWN- NVIN ONIXS ONnOX V NI SHONVHO GHL HO IA A 32 33 Thickening of the conjunctivae, especially in the palpebral fissures, because of the tendency of Eskimos to show a normocytic anemia of unknown occurred commonly in the men and was difficult to judge. In general, it cause(3). No true glossitis was seen. The other glossal changes are was diagnosed as present if lateral orbital pressure, through the lid, considered unimportant; the glossal serrations may possibly reflect a would cause definite folds to appear. Similarly, pingueculae of one thick muscular tongue, developed by vigorous eating habits. or both palpebral fissures were both common and extensive. These sometimes The dental data gathered by the clinicians are of interest in protruded between the closed lids medially and were dry and lichenified on the surface. Although over half the men showed these ocular lesions, demonstrating the need for a specialized appraisal of oral manifesta- it seemed they could be reasonably attributed to environmental irritation tions. The clinicians did suspect both age and geographic gradients rather than to nutritional causes. An age analysis (Table 9) conforms for dental caries (Tables 9 and 10). The extent of dental attrition with this interpretation, the prevalence increasing regularly with age. was remarkable and strongly age-related. Fluorosis, even though rarely The incidence was greatest among Eskimos from southern Alaska. diagnosed, seems to have been mistaken for hereditary hypoplasia of enamel. Results of the dental study are presented on pages 33-40. The Bitot's spots seen were rare, in the early examinations, and are in retrospect only suggestive of vitamin A deficiency. However, other Both follicular hyperkeratosis and xerosis were seen and probably corroborative evidence will be discussed in the section on the villages. often confused by two examiners (see discussion above). In Table 11 is shown a. summary of these clinical findings along with the rare Conjunctival injection was noted in 11.9 percent of men 17 to 19 diagnosis of Bitot's spots. The latter cannot be taken as conclusive years of age in Battalion 1 (Table 9), and in 26.7 percent of northern evidence of past or present vitamin A deficiency, but they do require Eskimos, and 19 percent of Athabascan Indians. This is attributed to biochemical evaluation. The lack of correlation between presence of environmental trauma rather than nutritional deficiency. Bitot's spots and serum vitamin A levels shown in Table 11 illustrates the imprecision of this clinical attribute as an indicator of vitamin A nutriture. Corneal scarring represents an important cause of morbidity among the Eskimos. No signs of trachoma were seen in the present studies. Neither were there evidences of "snow blindness, although there were several young people in the villages who had active phlyctenular kerato- TABLE 11 conjunctivitis (PKC) with typical photophobia. The exact nature of snow blindness seems not to be established. Whether there is a distinct entity, precipitated by excessive light and without corneal ulceration, RELATION OF CLINICAL SIGNS AND BIOCHEMICAL FINDINGS, is not clear. Certainly the Eskimos have been making and using narrow SERUM VITAMIN A, ALASKA, 1958 aperture "glasses" for many centuries, since these tools have been (Serum Vitamin A in micrograms per 100 ml. Mean + standard error) excavated by archeologists. Nevertheless, the occurrence of PKC has been very common in these people as judged by the presence of residual scars, Villages and it is a continuing, although lessening, medical problem. The causa- tion is not established, but it appears at least as probable that dietary National Guard Bethel Area Kotzebue Area factors are important as that the doctrinal assignment of cause to No. Serum A No. Serum A No. Serum A tuberculosis is true (15,16). The evidence indicates that while tubercu- losis is often associated with PKC this is not invariably the case. In Total Survey 574 37 + 1 196 31 + 1 220 29 + 1 the present study the frequency of corneal scars was somewhat greater among Battalion 2 men from the less acculturated area of southwestern Persons with follicular Alaska than in Battalion 1 (Tables 8 and 10). However, both groups had hyperkeratosis 34 37 + 2 7 28 + 7 69 30 + 1 significant numbers of men with such scars. Casual observation suggested an age gradient, the lesions being more common in older men than in young Persons with xerosis 30 38 + 2 26 35 + 3 o men. An analysis of the prevalence of this stigma by age and battalion is shown in Table 9. These questions will be considered again with the Persons with Bitot's village data. spots 3 40 + 13 2 12 + 10 o Angular scars were rarely seen in Battalion 2 and none were observed 1/ Two of five subjects recorded as having Bitot's spots had serum vitamin in Battalion 1. Slight filiform atrophy of the tongue was occasionally A levels below 20 mcg/100 ml; this is not a significant difference reported. Moderate atrophy, being more consistent, is better considered. (P= . 16). About two percent of the men showed this lesion to the latter degree. A moderate degree of filiform atrophy was found in 5.3 percent of the Aleuts and 3.2 percent of northern Eskimos. The finding is of interest Source: Ittps://www.industrydocuments.ucsf.edu/docs/zznc227 34 35 A similar comment may be made in regard to the lack of evidence of in field studies of fluoride-caries relations. The race and exact age of a relationship of serum ascorbic acid levels to the presence of red or the examinee and the village from which he came were unknown to the ob- swollen and bleeding gums (see Table 12). server at the time of examination. b. Results TABLE 12 The criteria used to appraise the conditions reported here are RELATION OF CLINICAL SIGNS AND BIOCHEMICAL FINDINGS, described in Appendix A. For the entire group of Alaskan males the life- SERUM VITAMIN C, ALASKA, 1958 time caries experience was generally lower, and diseases of the periodontal tissues generally were more prevalent and severe, than in approximately (Serum Vitamin C in milligrams per 100 ml. Mean + standard error) 1,400 white males examined in Baltimore (17) and in Birmingham(18) in the United States. The caries experience in these two latter groups is con- Villages sidered to be moderate, and periodontal conditions possibly typical, for National Guard Bethel Area Kotzebue Area U.S. white males in general. These specific data were selected as a basis for comparison because the same criteria and methods were used as No. Serum C No. Serum C No. Serum C in Alaska, and because the Alaska examiner participated in all three Total Survey 648 .52 + .01 222 .40 + .02 208 .47 + .02 studies. Comparative findings are shown in Table 13. Persons with red or swollen gums 86 .56+.03 18 .42 + .06 37 .49 + .03 TABLE 13 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 Persons with bleeding gums 4 .65 + .04 o 3 .44 + .06 COMPARISON OF DENTAL CARIES AND PERIODONTAL STATUS OF 713 ESKIMO GUARDSMEN WITH 1, 400 WHITE MALE RESIDENTS OF BIRMINGHAM AND BALTIMORE Mean Numbers of Decayed, In summary, the important clinical findings consisted of occasional Missing and Filled Per- thyroid enlargement in Battalion 1 and among northern Eskimos and Numbers manent Teeth per Man Mean Periodontal Scores 1/ Athabascan Indians, rare Bitot's spots, xerosis, phlyctenular corneal Age Examined Baltimore- Baltimore- scarring, markedly extensive and variable caries, attrition of the teeth (years) Alaska Birmingham Alaska Birmingham Alaska and periodontal disease, and cutaneous hyperpigmentation. The important negative findings were the lack of signs of inanition, anemia, or cardio- 15-19 63 11.3 10.2 .43 .40 vascular disease, or of specific signs of deficiency of B-vitamins or 20-29 359 12.9 9.5 .66 .69 protein. The most serious medical problems observed were the high 30-39 214 13.3 7.7 .82 1.39 prevalence of infectious diseases, especially tuberculosis, the frequency 40-49 68 15.8 6.3 1.25 1.44 of corneal scars and the generally poor teeth. Many of the observed 50-59 9 19.5 9.8 1.73 1.06 defects suggested strong age and geographic patterns which promise to enlighten the search for causation. Nonetheless, these men appeared fit 1/ The periodontal score for each individual is the average for the and rugged and in better physical condition than one might expect to teeth present in the mouth. The criteria for scoring are given in find in a group of U.S. Caucasian recruits. Appendix A. 3. The Dental Study This comparison is useful, however, only for general orientation of the a. Methods findings. There were four independent and geographically distinct pat- terns of dental caries experience, as measured by mean numbers of decayed, All of the dental examinations were carried out by a single missing and filled permanent teeth per man. These patterns are sum- observer. The men were seated in a portable dental chair under a standard, marized in Table 14. color-corrected examination light. Dental mouth mirrors and explorers were employed. Observations were dictated in code to an experienced recorder, who entered the data for each man upon an individual examination card separate from that used for the rest of the clinical observations and originally designed in the National Institute of Dental Research for use Source: https://www.industrydocuments.ucsf.edu/docs/zznc0227 25-34 15-24 OF se TABLE 15 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 ORAL STATUS OF MEMBERS OF FIRST AND SECOND BATTALIONS : Mean DMF Teeth : Mean Periodontal Score : Mean Recession Score Number Mean Age Age : Age Village Examined Age : Adjusted Observed1 : Adjusted Observed: : Adjusted Observed 1/ Group I: principal centers of population Bethel 14 26.6 11.0 7.9 + 1.89 0.63 0.65 + 0.20 8 7 + 3.0 Barrow 69 26.0 13.1 13.6 + 0.90 1.11 0.89 + 0.15 18 14 + 2.5 Kotzebue 19 26.2 14.2 14.2 + 1.63 1.96 1.12 + 0.51 30 18 + 7.5 Dillingham 7 22.1 15.7 12.1 + 2.97 0.21 0.37 + 0.27 0 0 Unalaska 12 25.8 16.7 15.5 + 1.76 1.40 0.80 + 0.38 12 8 + 3.5 Nome 17 22.1 17.1 14.5 + 1.82 1.02 065 + 0.16 6 8 + 6.6 St. Paul 26 31.8 20.2 20.6 + 1.27 1.34 1.34 + 0.39 16 16 + 4.7 All Group I 164 26.5 14.9 14.5 + 0.60 1.22 0.90 + .11 17 12 + 1.7 White U. S. Males 26.5 13.0 .69 13 37 Group II: villages near the principal centers of population Noatak 22 29.0 11.3 11.8 + 1.85 0.68 0.69 + 0.20 10 11 + 3.1 Deering 3 29.5 12.7 13.0 + 4.93 0.84 1.47 + 1.27 15 15 +11.8 Tuluksak 8 33.1 12.8 11.1 + 2.36 1.59 1.59 + 0.46 18 18 + 7.6 Wainwright 17 28.8 13.3 13.2 + 2.01 1.49 1.57 + 0.50 27 28 + 7.9 Napaskiak 14 26.8 13.9 14.2 + 1.98 1.29 1.24 + 0.31 18 13 + 5.3 Akiak 6 30.7 14.5 15.0 + 4.24 1.36 1.26 + 0.62 17 15 +14.1 White Mountain 5 30.7 15.3 14.8 + 2.22 0.71 0.90 + 0.16 7 10 + 5.7 Shishmaref 8 31.6 15.4 13.8 + 3.41 0.44 0.59 + 0.41 12 12 + 4.0 Unalakleet 13 28.5 15.6 16.2 + 2.43 0.86 0.90 + 0.47 25 23 +11.7 Elim 2 29.5 17.0 17.0 + 1.00 0.75 0.75 + 0.65 8 8 + 3.0 Shaktoolik 2 33.5 21.5 21.5 + 1.50 0.41 1.15 + 1.15 21 29 +29.0 All Group II 100 29.4 13.6 13.7 + 0.81 1.04 1.08 + 0.14 17 17 + 2.5 White U. S. Males 29.4 13.1 0.74 15 TABLE 15 (Continued) ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 ORAL STATUS OF MEMBERS OF FIRST AND SECOND BATTALIONS Group III: relatively remote villages, except those in the Yukon-Kuskokwim - delta area Shungnak 16 29.1 2.1 1.8 + 0.59 0.37 0.34 + 0.12 3 4 + 2.1 Little Diomede 7 29.2 3.3 4.4 + 0.90 1.32 1.01 + 0.67 19 16 + 10.0 Kasigluk 7 26.9 5.4 5.4 + 1.15 0.56 0.77 + 0.22 5 4 + 1.9 Akiachak 16 30.7 5.5 5.1 + 0.83 1.38 1.60 + 0.21 14 16 + 6.1 Barter Island 5 31.7 5.6 5.6 + 2.34 0.45 0.46 + 0.29 9 9 + 5.3 Alakanuk 16 32.1 5.9 5.3 + 1.21 1.59 1.88 + 0.47 10 13 + 4.0 Teller 9 27.9 5.9 5.6 + 1.51 0.58 0.54 + 0.22 12 11 + 3.9 Koyuk 4 23.8 6.1 6.5 + 3.23 2.04 2.05 + 0.53 11 12 + 12.0 Kwethluk 17 31.3 6.2 5.1 + 1.40 1.37 1.57 + 0.37 12 14 + 4.3 Stebbins 12 33.4 6.2 6.7 + 1.81 1.35 1.68 + 0.36 26 34 + 8.7 Selawik 14 29.5 6.3 6.6 + 1.48 0.49 0.50 + 0.12 10 10 + 4.6 Meade River 4 25.5 6.6 6.8 + 3.04 0.52 0.55 + 0.42 5 5 + 4.8 Eek 14 28.7 6.8 6.9 + 1.78 0.92 0.89 + 0.20 8 7 + 2.6 Mountain Village 14 36.7 6.8 7.5 + 1.61 0.78 0.94 + 0.28 15 20 + 4.6 Wales 5 43.9 6.8 6.8 + 1.32 1.22 1.22 + 0.49 30 30 + 11.8 Kivalina 11 26.8 7.9 7.7 + 1.91 1.81 1.31 + 0.56 28 19 + 9.9 Gambell 22 27.6 8.4 9.2 + 1.46 1.30 0.96 + 0.30 19 16 + 4.2 Kiana 8 22.8 8.8 7.4 + 2.71 0.34 0.36 + 0.15 4 3 + 1.5 Noorvik 11 26.3 8.9 9.0 + 2.64 0.78 0.55 + 0.25 2 1 + 0.8 Fort Yukon 21 28.3 9.2 9.0 + 1.46 0.36 0.32 + 0.17 9 4 + 2.3 Savoonga 27 25.7 9.3 8.4 + 1.08 0.88 0.70 + 0.20 17 13 + 2.6 King Island 5 33.5 9.6 9.4 + 2.79 1.37 1.40 + 0.32 13 15 + 6.7 St. Michael 12 29.2 9.6 9.6 + 1.63 1.64 1.72 + 0.45 27 28 + 9.3 Point Hope 20 32.0 10.4 10.1 + 1.57 1.18 1.20 + 0.32 14 15 + 4.7 All Group III 297 29.6 7.1 7.1 +1 .35 1.00 1.00 + .07 13 13 + 1.1 White U. S. Males 29.6 13.1 .74 15 1/ Standard error of the mean is included in the observed values. TABLE 15 (Continued) ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 ORAL STATUS OF MEMBERS OF FIRST AND SECOND BATTALIONS : Mean DMF Teeth : Mean Periodontal Score : Mean Recession Score Number Mean : Age : Age : Age Village Examined Age : Adjusted Observed 1/ : Adjusted Observed 1/ : Adjusted Observed Group IV: villages in the Yukon-Kuskokwim delta area Newktok 5 28.5 0 0 0.93 0.82 +0.52 12 11 + 9.2 Chevak 6 29.3 0.4 0.2 + 0.16 0.96 1.02 +0.25 16 18 + 6.2 Tanunak 11 37.8 0.4 0.6 + 0.36 0.23 0.31 +0.16 9 13 + 3.2 Mekoryuk 15 37.4 0.6 0.9 + 0.38 0.03 0.02 +0.01 4 5 + 2.0 Chefornak 5 22.3 1.1 0.4 + 0.40 0.90 0.38 +0.31 16 6 + 6.0 Kwillingnak 20 30.9 1.8 1.5 + 0.42 1.06 1.06 +0.19 10 11 + 2.4 Kipnuk 13 30.8 2,1 2.0 + 0.60 0.65 0.71 +0.17 15 15 + 4.7 Hooper Bay 25 30.8 3.3 3.3 + 0.88 0.73 0.88 + 0.28 10 13 + 3,1 Tuntutulial: 11 30.1 3.4 3.2 + 0.98 1.39 1.32 +0.29 12 13 + 4.6 Quinhagak 22 33.0 3.7 3.4 + 0.76 0.97 0.95 +0.17 6 7 + 2.1 Napaskiak 7 27.4 4.1 4.1 + 2.09 0.76 0.76 +0.32 6 6 + 3.9 Togiak 10 30.8 4.3 4.1 + 1.46 1.54 1.65 +0.55 4 4 + 1.6 Scammon Bay 2 31.5 4.5 4.5 + 2.50 0.20 0.20 +0.20 12 12 + 5.0 All Group I.V 152 31.7 2.6 2.3 + 0.27 0.76 0.83 +0.08 9 10 + 1.0 White U. S. Males 31.7 13.2 .77 17 1 Standard error of the mean is included in the observed values. Source: https://www.industrydocuments.ucsf.edu/docsizznc0227 40 41 these two villages more nearly resemble men from group IV villages, and (2) Periodontal disease the villages are similarly isolated. Shungnak is located near the head- waters of the Kobuk River about 100 air miles east of Kotzebue, and For the whole world population periodontal disease probably Little Diomede is an island in Bering Strait near the boundary with outranks dental caries in importance. Commonly called "pyorrhea, this Soviet Russia. disease attacks the soft and hard tissues supporting the teeth in the dental arch so that they loosen, become painful and ineffective in Age-corrected scores are more appropriate for comparisons between chewing, and are eventually lost. In this study periodontal disease villages, and observed scores for comparison with findings for white was assessed by two measures the periodontal index or score which is U.S. males. a morbidity index of present and active disease, and gingival recession, a cumulative measure reflecting past loss of tissue, particularly bone. (1) Dental caries There was no relation, in the total population, between group findings for either of these measures and group findings for dental caries. There was, as a rule, remarkably little variation in dental caries experience between men of a given age and village. The means for In 38 of the 55 villages periodontal scores (i.e., ratings of decayed, missing, filled (DMF) teeth of Eskimo men living in the seven present disease) were higher than would be expected on comparison with principal villages were slightly but unimportantly higher than those for scores for white males in the U.S., and in only five villages -- Mekoryuk, white U.S. males, rising with age in similar fashion. Means for men Scammon Bay, Fort Yukon, Tanunak and Shungnak were scores signifi- living in villages near these seven principal centers a.re about the same, cantly or importantly lower. The typical clinical picture was one of but show a tendency for caries experience to be lower in men of older age. moderate to severe gingivitis with widespread pocket formation, abundant This tendency becomes marked in the two successive groups; in each group oral debris, and heavy deposits of calculus, although some villages stood DMF means are progressively lower in progressively older groups of men. out as marked exceptions to this rule. Here, as in dental caries, there Since the DMF mean is a cumulative measure, this can occur only in popu- tended to be little variation between men from a given village. lations where caries prevalence is on the increase, and the patterns seen here suggest that this increase is occurring at a relatively rapid rate. 11 The recession score is a relatively weak population measure when young persons are studied, since gingival recession is rarely marked in The dental caries pattern cuts across ethnic boundaries; location for individuals prior to the middle and later years of life. Recession location, there is little difference in DMF means between Aleuts from findings for the whole groups were neither markedly nor importantly Unalaska and the Pribilofs, southern Eskimos from the region generally different from the patterns reported (by an independent team of observers) south of Alakanuk, northern Eskimos from the region generally north of for U.S. Army troops. Findings for the whole of group IV were, in fact, St. Michael, and Athabascan Indians from Fort Yukon. There is a loose significantly lower. tendency (possibly an artifact due to sampling variation) for DMF means in group III to increase from south to north, but there is no clear In men 35 years of age or older, however, recession scores as out- transition across an ethnic boundary. Neither does the term "isolation, " lined in Table 16 for the main groups are generally related to group as used here, denote lack of contact with other groups; in the course of caries scores. The series of differences shown might occur by chance summer migration nearly all of the men in groups III and IV leave their slightly less than once in one hundred trials. homes and live for a time in or near one of the principal villages. At this point in analysis no clear relationship between caries patterns and dietary habits or nutritional status has been developed. TABLE 16 ESKIMO MEN, ALASKA NATIONAL GUARD, 1958 GINGIVAL RECESSION SCORES, MEN 35 YEARS OF AGE OR OLDER, 1 The means for group DMF typically rise in essentially straight-line FIRST AND SECOND BATTALIONS fashion with age after permanent teeth begin to erupt at the age of six, gradually becoming asymptotic after the mean reaches a value Number Mean Mean of 15 to 18. Extrapolation of the present data suggest that after Group Examined Age Recession Score a generation, caries may become as prevalent in the group III vil- lages as in villages in or near the principal centers of population, I 15 41.9 39 + 1.7 and that caries in the group IV villages may rise to about the levels II 17 40.4 now seen in group III. If this occurs the disease will then present 31 + 6.9 a public health problem for these people quite as difficult as the III 68 41.2 28 + 3.3 present dental caries problem in the U.S. IV 57 40.5 17 + 2.0 White U.S. males 41.0 26 Source: tps://www.industrydocuments.ucst.edu/docs/zznc0227 42 43 IV - THE VILLAGE STUDIES Twice each year, in spring and fall, ships bring in supplies. Supplies for the year must be anticipated at this time, since the only 1. Bethel Area - the Situation in Akiak, Kasigluk, Napaskiak, Newktok recourse is to costly shipment by air from Anchorage. Mail order houses and Hooper Bay have an active year-round business in this area. An adult education class in one village had as two of its projects the following 1) how Bethel is the principal trading center of a large area of south- to write an order to a mail order house; 2) how to fill out a U.S. income western Alaska which includes most of the lower Yukon and Kuskokwim River tax return. areas. The town is on the Kuskokwim River at the head of deep water navigation. It is the air terminal for the only outside contact of the In Eskimo villages the dogs are an essential part of the economy, area during eight months of the year. The population is mixed white and for they are the only beasts of burden. Wood, one of the few sources Eskimo people. An electric service, high school and many other small- of fuel, must be hauled long distances from the river bottoms. People town facilities are available. travel and supplies are hauled by dog sled. Some freighting for cash income is done with dogs. The average size of a team is five dogs. In winter the main occupation of many Eskimos in this area is Fish are fed to them at variable times and in limited amounts so the trapping for mink, beaver and muskrat. In summer many find temporary dogs are generally thin and ravenous. They eat snow for water, snatching work in canneries on Bristol Bay. In some cases almost the entire able- it as they run. The Kuskokwim dogs are small, averaging 30 to 50 pounds, bodied population is transported to these canneries for a period of six and are nondescript in appearance. The dog population is threatened with weeks or more. Those who remain behind in the villages catch herring, canine distemper because of inadequate immunization. smelt, pike, whitefish and salmon for their own use. The larger fish are filleted and air-dried for the winter cache, to be consumed by both The population counts for the villages included in the Bethel por- dogs and humans. The tundra is dotted with small ponds and sloughs tion of the study and the numbers given clinical examinations in this which are a source of whitefish, ling cod, blackfish and needlefish. survey are shown in Table 2. The sampling within the villages was done Often these fish are eaten raw, and are thus a source of tapeworm with the help of the resident teacher; who selected one or two adolescent infestation. boys as runners. They were instructed to bring into the schoolroom entire families, including all ages. The selection of families and their Hooper Bay and Newktok are sealing communities of coastal Eskimos. order of appearance was not controlled. Clinical appraisals were done on Since the seal kill is variable and uncertain depending upon the movement all persons 2 years old and over. Blood and urine samples were obtained of the pack ice and tolerable sealing weather, this food supply is un- from all persons 6 years of age and over, until 50 blood samples had been certain. The coastal Eskimos collect seal pokes, inverted seal skins obtained in each village. At the end of the day the villagers were filled with seal oil, which they take up the Kuskokwim for sale and advised to bring forward the people who were sick or those with medical barter to the river communities. The subcutaneous fat of newly complaints who had not previously been seen. These persons were not butchered seal is cut into small portions about one by three inches in included in the nutritional appraisal The invitation invariably pro- size and pressed into the inverted seal skin (which has had all the duced an assorted clinic. No assessment was made of the number who apertures, except the anus, tied off with string). After the poke is stayed away from the nutritional appraisals deliberately. In Hooper filled with these small pieces of blubber, it is plugged and left inside Bay most of the men were away sealing. In Kasigluk many men had gone the Eskimo house at moderately high room temperatures and the oil is for wood. thus gradually rendered. When the contents of the poke have been re- moved, a sponge-like connective tissue residue representing the original The presence of a school and one or more teachers has had an stroma in which the oil was contained is left within the poke. This is important influence upon the Eskimo communities. While introduction of considered a food delicacy. No applied heat is used in the rendering a school has generally caused the villages to increase in size and thus process. The tendency of the seal poke to collapse as oil is withdrawn often overburdened the available food supply it has also stimulated the for use maintains a minimum of air within and probably delays rancidity. acculturization of the community. Community leaders who have whi te On some occasions other foods, such as partially dried salmon or herring, customs, clothing, food and ideas have no doubt been important models are placed in seal oil in the poke and stored for considerable periods. for emulation. The school lunch programs, the mail which comes once or Salmonberries, blueberries and wild greens may be stored in a seal poke twice a week, the radio communication with the Alaska Native Health or in barrels without the oil. Service Hospital each evening and the formal instruction in English with material and methods very like those of schools in the rest of the United A seal poke weighing 100 pounds may bring $140 and will last a States all increasingly influence the life and health of the Eskimo family a year. Seal oil is used as a major ingredient of such dishes people. There is a large age gradient in the use of English in the as agutuk (Eskimo ice cream) or oknuk (soup). Other foods, especially Bethel area; almost all school children speak English, but only rarely dried fish, may be dipped into it at serving time. Hunters are con- do adults over 40 years of age. vinced that it is more calorific than other foods and it is thought essential for a trip in intense cold. Source: s://www.industrydocuments.ucsf.edu/docsizznc0227 45 44 Bureau of Indian Affairs School Program for about eight years. Vi tami There are no physicians permanently located in the villages although These administration is more recent. No active keratitis was seen in this there are three physicians associated with the hospital in Bethel. indi- village but there were many children with the corneal scars which are physicians, a dentist and an x-ray technician visit the villages attributed to phlyctenular keratoconjunctivitis (PKC). The lesion was vidually at irregular intervals of several months. The x-ray technician films especially common in children over 7 years of age. Dry skin on the carries a portable x-ray machine which is largely used for chest extensor surfaces and mild follicular hyperkeratosis were seen occasionally in a tuberculosis control program. Public health nurses also visit the in children 8 to 16 years of age. The condition of the teeth varied villages at irregular intervals. A sanitary engineer of the Alaskan the markedly. Caries were rampant in many families, involving both deciduous Department of Health is presently working in certain villages of and permanent teeth. People past 30 tended to have worn but intact and Bethel area in order to improve the water supply. noncarious teeth (see Figure VII). In most villages the teacher is the medical representative who mans A man in his 40's was seen with incipient cardiac failure and a the two-way radio contact. The costs of transportation to Bethel, loud aortic diastolic murmur, probably a result of rheumatic heart Anchorage, or even to other states for medical treatment are borne by disease. A middle-aged woman with typical active rheumatoid arthritis patient, if that is possible; by the ANHS, if it is not. Since the was examined. distances the are great such trips are expensive. Midwifery is done by women in the villages except for those areas near the Bethel hospital The 77 clinical appraisals done in Akiak indicated the calorie where some women may prefer to go for delivery when possible. About supply was adequate, and that there had been a large incidence of 225 babies are delivered annually to native women in the Bethel hospital. phlyctenular keratoconjunctivitis in the past, although no acute cases were seen. Follicular changes suggested a mild or borderline vitamin A The largest single health problem in the villages is tuberculosis. deficiency. Both the caries and the corneal scarring seen in this About 7 to 10 percent of the Eskimo population is being treated with village suggested a familial pattern of prevalence. drug therapy for this disease. In Akiak, for example, 13 of 130 people in records indicate that 38 other villagers have received this therapy the village were receiving chemotherapy in August 1958 and the Kasigluk is a village of 227 Eskimos about 35 miles west of Bethel on the tundra, a few miles from the Johnson River. The latter is an lation and about one tenth of one percent of the population dies of since 1954. The annual incidence is now about one percent of the popu- abundant source of fish in the summer. Nunapitchuk, a somewhat larger village, is four miles away across a small lake. Kasigluk has been tuberculosis each year. The first figure has been reduced by one half, moved in recent times from a location six miles north to be better ac- the second by four fifths since 1952(8). The trends are shown in cessible by boat. The village has a typical onion-turreted Russian Church and a smaller Moravian Church. There are many Russian names in Figure II. the village and people with Mongoloid faces and light hazel eyes. The Akiak is a community of 130 people on the Kuskokwim River about in people seemed poor but were generally clean. The men showed signs of 30 miles upstream from Bethel. Most of the people were dressed recent use of their steam baths, a custom which is thought by some to excellent furs and mukluks, and there was evidence of a plentiful food be a Russian importation but is more likely an intrinsic part of the Eskimo culture. supply. There were no signs of caloric deficiency. Some obese women past These people at Kasigluk must go long distances to the Kuskokwim 30 years of age were seen. There were many children with draining ears flats for wood. The dogs were lean but strong; a team of five brought and impetigo was common, especially in children. One child with ex- in a load of green poles weighing 300 to 400 pounds. The village has tensive bronchitis and fever was given sulfa drug therapy. a poor water supply, consisting only of melted ice from nearby ponds. An epidemic of dysentery had occurred in this village during the two Each school child receives a hot lunch and a therapeutic multivitamin weeks prior to the survey team visit. The school children receive tablet every dayl/. The lunch program has been in effect in the lunches and a multivitamir tablet each school day. New mothers also receive vitamin solutions for the babies and iron pills for themselves, but the teacher was uncertain that these materials are used. The Contents of Multivitamin Tablet: calóric intake of the people seemed adequate. 1 Vitamin A - 5,000 U.S.P. units Ascorbic acid - 50 mg. Vitamin D - 500 U.S.P. units Vitamin E - 5 I.U. Impetigo was common, and several children were put on courses of Thiamine mononitrate - 3 mg. Calcium carbonate - 250 mg. penicillin for treatment. The dispensation of sulfonamide ointment Ferrous sulfate - 234 mg. Riboflavin - 3 mg. which is usually applied over the crusts is useless and possibly harmful. Pyridoxine hydrochloride - 0.5 mg. Potassium iodide - 0.15 mg. Two instances of atopic eczema were seen in children. Corneal scars Potassium sulfate - 5 mg. were not common and were generally seen in subjects 10 years of age and Vitamin B12 - 2 mcg. Copper sulfate - 1 mg. over but not in younger children, and no active phlyctenular Folic acid - 100 mcg. Niacinamide - 25 mg. Magnesium oxide - 6 mg. Calcium pantothenate - 5 mg. Zinc sulfate - 1.5 mg. Source: 47 keratoconjunctivitis was seen. The teeth were generally carious in the FIGURE VIII children, and worn but intact in people past 30. Some skin dryness was noted in children but no follicular hyperkeratosis was seen. One woman of 40 with aortic insufficiency and mitral stenosis was examined. A recent history of migratory arthritis was elicited in one youth. He showed no signs of carditis. Prophylactic penicillin was recommended. Napaskiak is a village of 152 persons on the south bank of the Kuskokwim River eight miles below Bethel. It has close contact with Bethel. Two other Eskimo villages are in the vicinity -- Oscarville, across the river, and Napakiak, down river. River fishing is the attraction. Napaskiak has been moved in recent-times from a nearby and ancient site that had become susceptible to flooding due to channel changes of the river. Napaskiak has one of the few remaining "medicine men" or shaman (Frontispiece). The role of this man in the communi ty' health could not be determined. There were great extremes in the families here, some being thin, while others were well fed. The thin families were usually dirty. The teacher gives 60 children their lunch at 8:30 a.m. Half then go home and return for an afternoon teaching session. The others remain for the morning session. All students receive a multivitamin tablet in school each day. This village has been included in a tuberculosis prophylaxis pro- gram since early 1958. A program for control of tuberculosis by ambulatory chemotherapy was begun in 1953 as a result of a recommendation of the Pittsburgh Health Survey(7) to the Secretary of the Interior. At the time of its inception the program was ambulatory because there DENTAL ATTRITION IN A 32-YEAR-OLD - were not enough hospital beds for all those needing the therapy. When ESKIMO WOMAN more beds were available more of those who needed hospital treatment were admitted. The prophylactic control study mentioned at the begin- ning of this paragraph was started in 1958 as a separate project under the direction of Dr. George Comstock, Tuberculosis Control Program, Bureau of State Services of the U.S. Public Health Service. This is a research study on the prophylactic use of isoniazid being conducted in selected parts of the U.S., Alaska and Puerto Rico. Every person in the villages selected for the study is given medication each day for one year, half receiving isoniazid at a level of about 5 mg per kilogram of body weight and half receiving a placebo. All told about 0,000 people are participating in this study. It is hoped to measure the suppressive action of such medication upon the incidence of tuberculosis. No signs of isoniazid-induced seborrhea or dermatitis were seen in this or any village, although perhaps as many as 10 percent of the total native population are on isoniazid therapy. The teeth were carious in Napaskiak except among people over 40 years of age. Exceptions to this were seen in a few Kipnuk women who had come here from the coast after marriage and generally had fine teeth. Again several cases of atopic eczema were seen. The teacher believes it is increasing in frequency. The males showed signs of the effects of taking steam baths (petechiae on the backs and shoulders), Source: ittps://www.industrydocuments.ucsf.edu/docs/zznc022 48 49 but the women and children did not. Petechiae occurred commonly among The school lunch program and daily vitamin pill are administered older male children and adults but was uncommon in children under 10. here. Because of exceptionally good sealing, the people appeared pros- No active keratitis was seen. Corneal scarring seemed to occur in perous and adequately nourished. There were many plump women and families; dry skin and follicular changes were uncommon. The adult children. Teeth were good but worn in people past 20 years of age and women often seemed pale. Tongue papillation was good. An old man with carious in many children. There were many corneal scars, again seen in aortic stenosis was examined but heart murmurs were generally rare. families and generally in people 12 to 20 years old. Children under A sick baby was brought back with the party to the Bethel Hospital and 12 were not often so affected. Many of the women were pregnant. Some a diagnosis of meningococcal meningitis was confirmed. After a stormy evidence of hypochondriasis was noted in adults. There was a single course she recovered. Prophylactic sulfadiazine seemed to prevent instance of goiter, a large soft gland in a 40 year old woman who had additional cases in the village. This treatment was arranged by radio a history of thyrotoxicosis treated with N-propylthiouracil. Scleral communication from Bethel after the bacteriologic diagnosis was thickening in the palpebral fissures and pingueculae were noted in many established. individuals. Here as in the other villages it was apparent that dental fillings meant tuberculosis because almost the only people who had had Newktok is an isolated village of 121 coastal Eskimos about 120 dental care were those who had gone outside for tuberculosis therapy miles west of Bethel on the tundra, a few miles from Baird Inlet and the Bering Sea. The nearest postoffice is at Tanunak, 40 miles to the 2. Kotzebue Area - the Situation in Noatak, Point Hope, Shishmaref, southwest on Nelson Island. There were many sod houses in the village. Allakaket and Huslia The people at Newktok seemed very primitive; their faces were The Kotzebue phase of the present study centered among the northern Mongoloid with prominent epicanthal folds. Very few could speak English. or Arctic Eskimos who are for present purposes considered to be in Their clothing was worn and poor. Both people and dogs were thin. The ethnic area III (see Figure III). The Kotzebue study also included sleds were hand-hewn and lashed together with thongs. In one sod house observations in two Indian villages in the mountains of the middle Yukon the children were seen to scoop a frozen blackfish out of a tub in the region lying in area IV. anteroom and swallow it with a minimum of chewing. The lids were off the cans containing flour and sugar, and the contents were spread about The Eskimos north of Norton Sound (Nome) are much more sparsely the table top as though the children had been eating directly from the distributed. The principal activity of the males is hunting, and seal, cans. Since this was the first tolerable weather for a week, the men walrus and several species of whale are the chief game. The Eskimos were away sealing. along the Arctic coast find the whale kill highly variable since it depends strictly upon weather and hunting conditions. Polar bear have Many of the children in this village were grossly underfed, and always been important not only as a source of food for man and dogs, but pale and thin. Several families were heavily infested vith head lice. also as a source of income from sale of skins. St. Lawrence Island has With a few exceptions, the teeth were excellent. There were several an abundant supply of walrus in the spring, a good source of both meat slightly but definitely enlarged thyroid glands observed but no gross and ivory. The people of St. Lawrence Island, Diomede Island and King goiters. Many children had marked follicular hyperkeratosis and many Island are well known for their fine ivory carving which provides them others had dry skin. There were several adults with Bitot's spots. with an important part of their cash income. The materials they make No signs of water-soluble vitamin deficiency or of scurvy were seen. are taken to Nome in the summer and marketed. Hooper Bay is an ancient Eskimo settlement on the Bering Sea south The Arctic fox is trapped on the ice pack for its fur but neither of Cape Romanzof, with a population of 430. It is located on two low this nor any other land carnivore is used for food except in dire hills at the tip of a spit of land which encloses Hooper Bay from the emergency. The polar bear is a partial exception, for its meat is often north. The main source of livelihood is the sea, especially sealing. eaten, although the liver seems never to be eaten and is widely regarded There are many dog teams for hauling the skin boats and meat to and from as poisonous. There is a collection of recent evidence to support the the open water a few miles away. Water is obtained by melting ice from idea that polar bear liver is, in fact, poisonous for human consumption. a fresh-water pond a few miles back of the village on the tundra. Fuel Dr. William Rausch of the Arctic Health Research Center on one occasion is obtained from driftwood which is now plentiful, coming largely from ate 100 grams of polar bear liver and immediately became ill. Dr. the mouth of the Yukon which lies to the north. The houses are well Edward Scott of the same institution fed polar bear liver to white mice built but without a semblance of orderly arrangement either among houses and an equivalent amount of vitamin A from fish oil to a control group or within them. The indoor temperatures and humidity are very high. of mice. Both groups of mice died (19). The concept of the toxicity of These, together with many unwashed Eskimos, unbutchered seals, drying polar bear liver and that it is due to an excessive vitamin A content skins and oozing seal oil pokes, produce an overpowering atmosphere for is widely accepted in scientific circles in Alaska. a white person. Source: https://www.industrydocuments.ucsi.edu/docsizznc022 50 51 The Indian villages, Huslia and Allakaket, which were included in before he goes out on the ice pack for the day, or takes no more than a the present study, are settlements on the Koyukuk River. These people cup of tea or coffee. He believes eating would make him sluggish, less are Athabascan Indians who range through the forested and mountainous agile and less acute. Since he may stay out one to three days under areas of northwestern Alaska. Their principal activity is trapping rigorous conditions of activity and temperature, it is clear that he has beaver, mink and muskrat. The beavers are taken through holes in the both great stamina and efficient gluconeogenesis. When he returns he ice in the late winter and spring with snares which are baited with takes a very large meal. This ability to carry on while fasting may be willow twigs. Each trapper is allowed a seasonal limit of 20 beavers which average $40 per pelt. The beaver is a large animal weighing 30 related physiologically to the ability to consume a very high fat, high protein, low carbohydrate diet. It may also be a factor in prohibiting to 60 pounds, and is widely used for food. The meat is said to resemble youths (who might be more susceptible to ketosis) from going out on the pork. The skins are stretched flat in an almost perfect circle for ice pack. drying and are hauled about in large wafer-like stacks wrapped in burlap. The sampling procedures in the Kotzebue area were carried out as Caribou are migratory animals taken seasonally and somewhat unpre- described for the Bethel study above. Clinical studies were done on dictably. Their meat is dried in the sun for storage in caches and the all persons 2 years of age and over; blood and urine samples were ob- skins are widely used for clothing. tained from all persons 6 years and over, the urine samples being clean catch samples. In the Kotzebue area those members of the National Guard Fish are taken from the rivers with nets or fish wheels, a white who were home were excluded from the village examinations in order for man's invention and a useful one, for -- powered by the current -- it them to be seen at Camp Denali with their battalion. scoops up the teeming fish and deposits them in a tub requiring the fisherman only to empty the tub once he has properly placed the wheel Noatak is a village of 300 Eskimos on the Noatak River 60 niles and the diversionary fence. north of Kotzebue. The food supply at Noatak is largely caribou which are hunted inland on the tundra, fish from the Noatak River, and seal The northern Eskimos have been more exposed to the white man than and beluga whale from Kotzebue Sound. The teacher at Noatak gives each have the southern Eskimos through efforts of 18th century sailors to school child a lunch and a vitamin pill every school day. The principal find a Northwest Passage, and subsequently through the extensive whaling clinical impairments found here were carious teeth and follicular activities which took place in the Arctic Ocean. Contacts with sailing hyperkeratosis. ships reached a maximum in the middle of the 19th century. Possibly as a consequence, the northern Eskimos are advanced at least a generation Point Hope, which the natives call Tigara, often experiences severe over the Kuskokwim people in their cultural adaptation to the white race. Almost all speak English; they tend more strongly to adopt white men's weather. It is the main polar bear-hunting area for sportsmen, an clothing and habits of food and often have noticeable admixtures of white activity which is a source of income for the Eskimos. A typical polar blood as reflected in coloration and conformation. The northern Eskimos bear hunt has facetiously been described as follows: The sportsman are larger and less Asiatic-appearing than the southern Eskimos, although pays $2, ,500 and is guaranteed a bear. The hunter and his pilot go out there are many exceptions to this generalization. Some of the village over the ice pack in a light plane until they spot a bear which they sites, such as that at Shishmaref Inlet, are very old, dating back 500 pursue in the plane until it falls exhausted on the ice. They then years or more. The attraction of these sites can only have been their land, shoot the bear and take the skin. The sport seems more expensive than dangerous. convenience to the essential food supply. Eskimo villages are sometimes moved, but generally only to a better food supply. The main articles in the diet at Point Hope are seal and whale meat with some bear meat and fish. Caribou are taken in the fall and Hunting on the ice pack is a dangerous occupation and the extent of this danger varies in different areas depending upon currents and weather winter. The whale meat collected in the spring is cut up and stored conditions. In the Hooper Bay area young men do not go on the hunting in pits in the permafrost for later use. This natural refrigeration expeditions until they are about 18 years of age. North of Bering Strait and not the perpetual cold, for the summers are actually quite warm they. go at 15 years. Since these boys are physically well developed at is the basis for the legendary test of salesmanship in Alaska. A few Eskimos do have refrigerators, especially the traders. Many Eskimos 15 years it appears that a maturation of judgment is recognized as es- sential. The active hunters are men 20 through 45 years, older hunters have outboard motors. Almost every Eskimo boy dreams of becoming an airplane pilot. The men are clever mechanics and are said to have being rare. fashioned broken motor parts from ivory or bone when metal replacements were unavailable. These Eskimo men stripped down resemble professional athletes. They are heavily muscled, relaxed and loose-jointed, and have the ap- pearance of finely trained men. Unlike the white man's concept of Sod houses are common in Point Hope. Alaskan Eskimos never build snow igloos except to amuse visitors from the outside and the results preparation for a physical ordeal, the Eskimo either does not eat are often ludicrous. Whale ribs are often used for rafters for sod houses. No village planning is discernible. Snow drifts range up to 25 feet after a storm and the children slide down these on short baleen skis. Source: https://www.industrydocuments.ucst.edu/docsizznc0227 52 The children receive a school lunch and a daily multivitamin tablet. Clinical examinations here revealed many carious teeth and much follicular hyperkeratosis. Shishmaref is a village of 200 people on a small island just off Shishmaref Inlet. The principal food is seal, which was plentiful during the winter preceding the survey, since the pack ice had been pushed toward the Siberian side by favorable winds. Some fish are also available. Many carious teeth were seen here and there was much dental attrition. Follicular hyperkeratosis was common. A school lunch and multivitamin pill are given to the children. Allakaket is an Indian village of 100 people 150 miles north of Tanana. It consists of 10 to 15 log cabins, a school and an Episcopal Church. The main occupations and food sources are moose hunting, fishing and beaver snaring with a wire loop snare. The trap lines are 50 to 150 miles in length. The calorie supply seemed limited in this village. The teeth were carious and follicular hyperkeratosis was common. Some filiform atrophy of the tongue was also noted, although it was of mild degree. No evidence of goiter was seen. One 18 month old child with rickets was seen here. Huslia is an Indian village of 137 people. The diet consists mainly of beaver, dried fish, moose and caribou. Moose meat is much like beef in form and flavor while caribou is distinctive, resembling mutton. The calorie intake at Huslia seemed marginal, since many people were thin and the children appeared stunted. Follicular hyper- keratosis was common. The teeth were carious. This is the home of the most f'amous sled dog racer in Alaska, George Atla, known as the "Huslia Hustler. The schools in these two Indian villages do not give the children school lunches or vitamin supplements. 3. Clinical Findings in the Villages Since the men in the National Guard had recently come from the villages they were also representative of those nutritional environments. However, the 713 men came from 55 villages. The number from each vil- lage was thus so small that no useful purpose was served by relating them to their village of origin. An exception is Point Barrow, from which there were 69 men in the Guard. Throughout the evaluation of the data this axis of analysis has been considered, however (see Table 10, which presents selected clinical findings for men in the two battalions according to their area of origin). A summary of the clinical findings in the villages is shown in Table 17. The northern and southern areas are shown separately, but all ages and both sexes are combined. This summary emphasizes certain negative findings. There was no scurvy and no gross inanition, although in certain villages, especially Newktok, the people seemed by their thinness to be Source: https:/lwww.industrydocuments.ucsi.edu/docsizznc0227 TABLE 17 ESKIMO AND INDIAN VILLAGES IN ALASKA, 1958, PERCENT PREVALENCE OF CLINICAL FINDINGS Bethel Area - Examiner # 1 Kotzebue Area - Examiner # 2 Villages / 1 2 3 4 5 Total 6 7 8 9 10 Total Number Examined 76 94 81 59 96 406 69 88 77 75 90 399 Suspected Tuberculosis Disease 30.3 10.6 7.4 8.5 12.5 13.8 5.8 10.2 6.5 6.7 2.2 6.3 General Good 82.9 87.2 79.0 66.1 82.3 80.5 98.6 100.0 98.7 98.7 100.0 99.2 Appearance Fair 17.1 9.6 14.8 25.4 16.7 16.0 1.4 0.0 1.3 1.3 0.0 0.8 Poor 0.0 3.2 6.2 8.5 1.0 3.4 0.0 0.0 0.0 0.0 0.0 0.0 Hair Staring hair 0.0 0.0 0.0 18.6 0.0 2.7 0.0 0.0 0.0 0.0 0.0 0.0 Glands Thyroid 3.9 0.0 2.5 10.2 4.2 3.7 1.4 0.0 0.0 0.0 0.0 0.3 Enlarged Submaxillary 0.0 1.1 0.0 0.0 0.0 0.2 5.8 6.8 3.9 1.3 2.2 4.0 Nasolabial seborrhea 0.0 0.0 0.0 0.0 0.0 0.0 5.8 2.3 2.6 0.0 1.1 2.3 54 Skin- Other seborrhea 0.0 0.0 1.2 0.0 0.0 0.2 1.4 0.0 1.3 0.0 0.0 0.5 Face & Neck Erythema 14.5 25.5 7.4 61.0 17.7 23.2 11.6 21.6 33.8 5.3 3.3 15.0 Pigmentation 0.0 2.1 2.5 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 Thickened conjunctivae 7.9 6.4 16.0 13.6 15.6 11.8 7.2 5.7 10.4 8.0 11.1 8.5 Pingueculae 31.6 31.9 22.2 27.1 28.1 28.3 34.8 27.3 28.6 29.3 14.4 26.3 Bitot's spots 0.0 0.0 0.0 3.4 0.0 0.5 0.0 0.0 0.0 0.0 0.0 0.0 Eyes Circumcorneal injection 0.0 0.0 0.0 0.0 1.0 0.2 0.0 1.1 0.0 0.0 0.0 0.3 Conjunctival injection 3.9 0.0 2.5 5.1 1.0 2.2 0.0 5.7 0.0 0.0 0.0 1.3 Blepharitis 0.0 0.0 0.0 8.5 0.0 1.2 0.0 2.3 0.0 0.0 0.0 0.5 Corneal scarring 21.1 12.8 11.1 20.3 9.4 14.3 8.7 5.7 5.2 4.0 7.8 6.3 Angular lesions 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Lips Angular scars 0.0 0.0 0.0 1.7 0.0 0.2 2.9 0.0 0.0 0.0 0.0 0.5 Cheilosis 0.0 0.0 1.2 0.0 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 TABLE 17 (continued) Filiform atrophy, sl. 9.2 6.4 9.9 13.6 6.2 8.6 7.2 4.5 2.6 12.0 5.6 6.3 Filiform atrophy, mod. 3.9 0.0 2.5 1.7 0.0 1.5 0.0 0.0 0.0 2.7 0.0 0.5 Fungiform atrophy 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Papillary hypertrophy 0.0 0.0 0.0 0.0 1.0 0.2 1.4 2.3 1.3 0.0 1.1 1.3 Furrows 1.3 7.4 9.9 3.4 3.1 5.2 4.3 2.3 2.6 2.7 1.1 2.5 Tongue Fissures, erosions, ulcers 1.3 1.1 1.2 0.0 0.0 0.7 0.0 0.0 0.0 0.0 0.0 0.0 Serrations or swellings 0.0 6.4 3.7 0.0 0.0 2.2 0.0 0.0 0.0 1.3 3.3 1.0 Red, tip, or lat. margins 3.9 4.3 4.9 0.0 0.0 2.7 0.0 0.0 0.0 0.0 0.0 0.0 Geographic tongue 1.3 0.0 1.2 0.0 3.1 1.2 2.9 0.0 3.9 0.0 0.0 1.3 Red or swollen 1.3 3.2 9.9 8.5 7.3 5.9 17.4 2.3 7.8 13.3 18.9 11.8 Gums Atrophy or recession 9.2 8.5 16.0 1.7 5.2 8.4 23.2 19.3 27.3 17.3 18.9 21.1 Bleeding gums 0.0 0.0 0.0 0.0 0.0 0.0 1.4 0.0 0.0 0.0 4.4 1.3 Unfilled caries 30.3 60.6 48.1 23.7 31.2 40.1 31.9 40.9 58.4 34.7 47.8 43.1 Filled caries 17.1 9.6 13.6 0.0 12.5 11.1 46.4 23.9 11.7 9.3 13.3 20.3 No carious teeth -5550.031.944.476.357.350.223.237.529.957.3 41.1 38.1 Tee th Caries, filled or 1-2 13.2 7.4 6.2 3.4 7.3 7.6 24.6 18.2 28.6 21.3 22.2 22.8 unfilled 3-4 18.4 36.2 24.7 11.9 24.0 24.1 23.2 23.9 20.8 14.7 22.2 21.1 SS 5+ 11.8 23.4 23.5 8.5 11.5 16.3 24.6 18.2 18.2 6.7 14.4 16.3 Edentulous 6.6 1.1 1.2 0.0 0.0 1.7 4.3 2.3 2.6 0.0 0.0 1.8 Worn 30.3 33.0 35.8 23.7 29.2 30.8 14.5 12.5 27.3 12.0 6.7 14.3 0.0 0.0 Fluorosis 0.0 0.0 0.0 0.0 1.0 0.2 0.0 0.0 0.0 0.0 Malposition 2.6 1.1 12.3 6.8 12.5 7.1 0.0 0.0 1.3 0.0 0.0 0.3 Follicular hyperkeratosis 3.9 1.1 1.2 10.2 0.0 2.7 40.6 34.1 20.8 20.0 45.6 32.6 10.4 0.0 0.0 0.0 0.0 0.0 0.0 Xerosis 19.7 21.3 11.1 22.0 16.5 Skin- Acneform eruption 0.0 1.1 1.2 0.0 2.1 1.0 0.0 0.0 1.3 0.0 1.1 0.5 Thickened press. points 1.3 2.1 0.0 0.0 0.0 0.7 0.0 0.0 1.3 0.0 0.0 0.3 General 0.0 0.0 1.0 0.5 0.0 0.0 0.0 0.0 0.0 0.0 Purpura or petechia 0.0 1.1 Hyperpigmentation 2.6 0.0 0.0 0.0 3.1 1.2 0.0 1.1 0.0 0.0 0.0 0.3 Abdomen Hepatomegalia 0.0 0.0 2.5 5.1 0.0 1.2 Examination of abdomen and Lower extremities omitted. Lower Extremities Loss of ankle jerk 1.3 0.0 1.2 1.7 0.0 0.7 1 No findings of enlarged parotids, xerophthalmia, magenta tongue, "scorbutic-type' gums, crackled skin, pellagrous 2) Villages referred to by number: Southern Eskimos: 1. Akiak 2. Kasigluk 3. Napaskiak 4. Newktok 5. Hooper Bay lesions, splenomegalia, ascites, or calf tenderness. Scrotal dermatitis not examined for Northern Eskimos: 6. Noatak 7. Point Hope 8. Shishmaref Athabascan Indians: 9. Huslia 10. Allakaket Source. Ittps://www.industrydocuments.ucsf.edu/docs/zznc022

What is the rent?

zjcf0227

zjcf0227_p3, zjcf0227_p4, zjcf0227_p5, zjcf0227_p6, zjcf0227_p7, zjcf0227_p8

15,725

VNA OF GREATER ST. LOUIS STATEMENT OF RECEIPTS & DISBURSEMENTS FOR THE MONTH OF SEPTEMBER, 1982 Beginning Balance August 31, 1982 $ 21,448 September Receipts: PIP $777,694 United Way 35,551 Medicaid 47,557 Other 47,556 Miscellaneous 1,143 909,501 September Disbursements: Payroll, Taxes and Benefits $632,459 Accounts Payable 274,727 Rent 15,725 Lindell Trust - North Office 854 Lindell Trust - South L.H.I. 1,912 Lindell Trust - Computer 1,925 Bridgeton Investment 529 Capital Equipment Purchases 2,704 930,835 Total Operating Fund Checking Acct. -Lindell Trust $ 114 Payroll Checking Account-Bal. Centerre Bank $ 2,500 Petty Cash 600 3,100 Ending Balance September 30, 1982 $ 3,214 Source: https://wwww.industrydocuments.ucsf.edu/docs/zjcf022 VNA OF GREATER ST. LOUIS ACTUAL VS PROJECTED CASH FLOW STATEMENT YEAR TO DATE SEPTEMBER 30, 1982 ACTUAL PROJECTED VARIANCE Beginning Balance January 1, 1982 $ 29,361 $ 29,361 $ - RECEIPTS PIP $7,214,564 $7,444,622 $ (230,058) Medicare Cost Report Settlement 120,000 - 120,000 United Way 312,599 319,961 ( 7,362) Medicaid 185,233 226,865 ( 41,632) Others 395,533 392,234 3,299 Miscellaneous 46,828 10,500 36,328 Designated Cash 200,000 200,000 - Loan-Line of Credit 100,000 100,000 - TOTAL RECEIPTS $8,574,757 $8,694,182 $ (119,425) DISBURSEMENTS Payroll, Taxes and Benefits $6,053,864 $5,934,522 $ 119,342 Accounts Payable 2,237,482 2,294,066 ( 56,584) Pension - 110,000 (110,000) Rent 109,940 104,574 5,366 Lindell Trust - North Ofc. 7,686 7,686 - Lindell Trust - South L.H.I. 17,208 17,208 - Lindell Trust - Computer 17,325 17,325 - Bridgeton Investment Co. 4,761 4,761 - Designated Cash 100,000 100,000 - Capital Equipment Purchases 55,738 61,500 ( 5,762) $8,604,004 $8,651,642 $(47,638) ENDING BALANCE SEPTEMBER 30, 1982 $ 114 $ 71,901 $( 71,787) Source: https://www.industrydocuments.ucsf.edu/docs/zicf227 VNA OF GREATER ST. LOUIS CAPITAL BUDGET 1 9 8 2 Balance Capital Equipment, January 1, 1982 $720,744 Additions: Furniture & Fixtures - See Attached $30,954 Leasehold Improvements 24,784 $55,738 Reductions: Sale of 3 CRT's (3,450) 52,288 Balance Capital Equipment, September 30, 1982 $773,032 Source: https://www.industrydocuments.ucsf.edu/docsiz)cf0227 VNA OF GREATER ST. LOUIS CAPITAL EQUIPMENT BUDGET 1 9 8 2 No. of Unita Cost Purchased Executive Videocassette 1 $ - $ 390 Bookcase Credenza 1 - 313 Durable Medical Equipasnt Card Cabinets with Bases 15 700 Plant Operations Paper Shredder 1 1,290 Shelf Unita 12 600 1,200 Snow Blowar 1 - 550 Illuminatad aign 1 - 608 Communications Refrigerator 1 - 665 Planning Office Deak and Chair 1 600 Central Admissione Carousel and Chair 1 1,500 Secretary Chair 3 300 Lateral File Cabinet 1 360 Table 1 350 CRT Work Station 1 - 432 Human Resources Desk and Chair, Bookshelf 1 750 297 Table and Chairs 1 - 421 Education Food Model 1 300 Recording Anne 1 1,000 35MM Camera 1 400 497 Selectric Typewriter 1 1,100 Office and Clasaroom Furnitura 6,450 7,914 Consultanta Daska and Chairs 5 3,850 1,028 Lateral File Cabinat 1 520 358 Bookcase 2 - 361 North Office Dextrometer with Accessories 3 1,000 3,481 Deak and Chair 1 550 1,895 Selectric Typewriter 5 5,500 Refrigerator with Icemaker 1 - 599 Imprinter 1 - 309 Lateral File Cabinet 2 - 718 Calculatore 6 - 426 Bookcase 3 - 542 South Office Copier with Stand 1 3,000 Dextrometer with Accessorias 5 1,700 1,880 Selectric Typewriter 1 1,100 Imprinter 1 - 309 Desk and Chair 3 - 1,871 Lateral File Cabinet 1 - 533 Draperies 1 - 340 Social Service Selectric Typewriter 1 1,100 Rehabilitation Office Selectric Typewriter 1 1,100 Desk and Chair 1 600 Imprinter 1 300 312 Medical Records Shelving 1 - 2,136 Fiscal Office File Cabinet 2 1,100 Selectric Typewriter 1 1,500 Deak 1 - 569 Accounting Selectric Typewriter 2 1,800 Desk 1 360 Calculator 1 300 Billing Selectric Typewriter 8 7,200 Lateral File Cabinet 1 720 Total $49,000 $30,954 Source: https://www.industrydocuments.ucst.edu/docs/z)cf0227 VNA OF GREATER ST. LOUIS VENDOR ACCOUNTS PAYABLE ANALYSIS FOR THE MONTH OF SEPTEMBER, 1982 Vendor Accounts Payable Vouchering: August $256,113 September 288,190 $544,303 Total Vendor Accounts Payable at 61 days. $544,303 = $ 61 8,923 Vendor Accounts Payable per day. Vendor Accounts Payable per September 30, 1982 Balance Sheet divided by Vendor Accounts Payable per day = Number of outstanding accounts payable days. $601,570 = $ 8,923 67 Outstanding Accounts Payable days as of September 30, 1982. The above analysis show that Vendor Accounts Payable are being maintained at a level higher than 60 days as of September 30, 1982. 1981 1982 January 69 60 February 70 74 March 73 69 April 68 60 May 66 66 June 76 73 July 70 65 August 77 68 September 59 67 October 53 November 61 December 59 Source: https:llwww.industrydocuments.ucst.edu/docsizjcf0227 VNA OF GREATER ST. LOUIS PRODUCTIVITY REPORT FOR THE MONTH OF SEPTEMBER, 1982 1981 1982 1982 VISIT BREAKDOWN PER ACTUAL ACTUAL BUDGET FULL TIME EQUIVALENT FTE FTE FTE 1. TOTAL VISITS RN/LPN 12,065 13,251 11,739 HHA 6,413 7,131 6,908 Rehab 3,358 3,393 2,953 Social Service 555 677 492 Consultant 332 379 268 Total Service 22,723 24,831 22,360 2. FTE STAFF RN/LPN 104.5 115.8 110.1 HHA 95.6 104.0 106.0 Rehab 26.9 29.5 35.0 Social Service 10.0 10.0 10.0 Consultant 9.0 11.0 11.0 Visiting Staff 246.0 270.3 272.1 Support Staff 130.5 141.0 144.7 Total Staff 376.5 411.3 416.8 3. VISIT PER FWD/FTE RN/LPN 5.5 5.4 5.1 HHA 3.2 3.3 3.1 Rehab 5.9 5.5 4.0 Social Service 2.6 3.2 2.3 Consultant 1.8 1.6 1.2 Visiting Staff 4.4 4.4 3.9 Support Staff 8.3 8.4 7.4 Total Staff 2.9 2.9 2.6 4. AVG. MONTHLY VISITS PER FTE RN/LPN 115.5 114.4 106.6 HHA 67.1 68.6 65.2 Rehab 124.8 115.0 84.4 Social Service 55.5 67.7 49.2 Consultant 36.9 34.5 24.4 Visiting Staff 92.4 91.9 82.2 Support Staff 174.1 176.1 154.5 Total Staff 60.4 60.4 53.6 Source 1. General Revenue Report - September, 1981 and 1982 2. Human Resources Report - August, 1982 Source: https:/lwww.industrydocuments.ucsf.edu/docs/zjcf0227

Mention "AVERAGAE 1938-9 DELIVERIES, SHORT TONS, RAW VALUE" of "Beet Processors"?

xqgl0226

xqgl0226_p6, xqgl0226_p7

1,629,660

B REFINERS' RECEIPTS BY SOURCES OF SUPPLY (SHORT TONS) Figures from U.S.D.A. (RAW VALUE) PUERTO PHILIPPINE ALL CUBA RICO U.S. HAWAII ISLANDS OTHERS TOTAL 1937 1,769,443 771,465 301,214 959,936 924,958 127,780 4,854,707 1938 1,576,693 779,864 352,027 899,340 911,255 128,361 4,647,540 1939 1,553,765 817,699 442,214 890,178 902,510 78,086 4,684,452 1940 1,586,917 690,140 272,416 980,641 931,636 52,459 4,514,209 1941 2,521,039 805,389 319,262 906,284 786,321 247,711 5,586,006 Average of 3 best years 1,959,133 800,984 371,168 948,954 922,616 167,951 5,170,800 % 37.8 15.7 7.2 18.4 17.7 3.2 100.0 1938-9 Average 1,565,229 798,782 397,121 894,759 906,883 103,224 4,665,998 % 33.5 17.2 8.5 19.2 19.4 2.2 100.0 edu/d 02 C ESTIMATED ANNUAL REVENUE OF SUGAR RESEARCH FOUNDATION, INC., BASED ON MAXIMUM ASSESSMENT SET FORTH IN TENTATIVE PLAN*, ASSUMING 100% PARTICIPATION FOR EACH GROUP THEREIN AVERAGE 1938-9 DELIVERIES, SHORT TONS, RAW VALUE Beet Processors 1,629,660 $ 152,304.60 Offshores 567,730 53,058.85 U. S. Cane Refiners 4,441,345 251,484.50 Raw Sugar Producers: Cuba 1,565,229 $ 59,085.83 Puerto Rico 798,782 30,153.22 Hawaii 894,759 33,776.26 123,015.31 $ 579,863.26 .5€ per bag, refined, for beet processors and producers of refined from their own cane. .30 per bag, refined, for refiners .26 per bag, refined, for raw producers Additional Revenue Which Would Be Available From Other Groups Not Included Above, If All Participate. Mainland D/C Cane 116,650 $ 10,901.96 La. - Fla. Raw Producers 470,783 17,771.59 All Other Raw Producers 119,916 4,526.71 $ 33,200.16 1938-9 Deliveries for domestic consumption and receipts of raws from various areas by U. s. cane refiners from U. S. Department of Agriculture figures. Short tons raw value converted to refined by factor of 1.0596295 for U. S. cane refiners (Average of 1938-9 government figures), and 1.07 for all others. iindustrydocuments.ucskedu/docsxqgl0226

Mention "AVERAGAE 1938-9 DELIVERIES, SHORT TONS, RAW VALUE" of "Offshores"?

xqgl0226

xqgl0226_p6, xqgl0226_p7

567,730

B REFINERS' RECEIPTS BY SOURCES OF SUPPLY (SHORT TONS) Figures from U.S.D.A. (RAW VALUE) PUERTO PHILIPPINE ALL CUBA RICO U.S. HAWAII ISLANDS OTHERS TOTAL 1937 1,769,443 771,465 301,214 959,936 924,958 127,780 4,854,707 1938 1,576,693 779,864 352,027 899,340 911,255 128,361 4,647,540 1939 1,553,765 817,699 442,214 890,178 902,510 78,086 4,684,452 1940 1,586,917 690,140 272,416 980,641 931,636 52,459 4,514,209 1941 2,521,039 805,389 319,262 906,284 786,321 247,711 5,586,006 Average of 3 best years 1,959,133 800,984 371,168 948,954 922,616 167,951 5,170,800 % 37.8 15.7 7.2 18.4 17.7 3.2 100.0 1938-9 Average 1,565,229 798,782 397,121 894,759 906,883 103,224 4,665,998 % 33.5 17.2 8.5 19.2 19.4 2.2 100.0 edu/d 02 C ESTIMATED ANNUAL REVENUE OF SUGAR RESEARCH FOUNDATION, INC., BASED ON MAXIMUM ASSESSMENT SET FORTH IN TENTATIVE PLAN*, ASSUMING 100% PARTICIPATION FOR EACH GROUP THEREIN AVERAGE 1938-9 DELIVERIES, SHORT TONS, RAW VALUE Beet Processors 1,629,660 $ 152,304.60 Offshores 567,730 53,058.85 U. S. Cane Refiners 4,441,345 251,484.50 Raw Sugar Producers: Cuba 1,565,229 $ 59,085.83 Puerto Rico 798,782 30,153.22 Hawaii 894,759 33,776.26 123,015.31 $ 579,863.26 .5€ per bag, refined, for beet processors and producers of refined from their own cane. .30 per bag, refined, for refiners .26 per bag, refined, for raw producers Additional Revenue Which Would Be Available From Other Groups Not Included Above, If All Participate. Mainland D/C Cane 116,650 $ 10,901.96 La. - Fla. Raw Producers 470,783 17,771.59 All Other Raw Producers 119,916 4,526.71 $ 33,200.16 1938-9 Deliveries for domestic consumption and receipts of raws from various areas by U. s. cane refiners from U. S. Department of Agriculture figures. Short tons raw value converted to refined by factor of 1.0596295 for U. S. cane refiners (Average of 1938-9 government figures), and 1.07 for all others. iindustrydocuments.ucskedu/docsxqgl0226

Mention "AVERAGAE 1938-9 DELIVERIES, SHORT TONS, RAW VALUE" of "U.S. Cane Refiners"?

xqgl0226

xqgl0226_p6, xqgl0226_p7

4,441,345

B REFINERS' RECEIPTS BY SOURCES OF SUPPLY (SHORT TONS) Figures from U.S.D.A. (RAW VALUE) PUERTO PHILIPPINE ALL CUBA RICO U.S. HAWAII ISLANDS OTHERS TOTAL 1937 1,769,443 771,465 301,214 959,936 924,958 127,780 4,854,707 1938 1,576,693 779,864 352,027 899,340 911,255 128,361 4,647,540 1939 1,553,765 817,699 442,214 890,178 902,510 78,086 4,684,452 1940 1,586,917 690,140 272,416 980,641 931,636 52,459 4,514,209 1941 2,521,039 805,389 319,262 906,284 786,321 247,711 5,586,006 Average of 3 best years 1,959,133 800,984 371,168 948,954 922,616 167,951 5,170,800 % 37.8 15.7 7.2 18.4 17.7 3.2 100.0 1938-9 Average 1,565,229 798,782 397,121 894,759 906,883 103,224 4,665,998 % 33.5 17.2 8.5 19.2 19.4 2.2 100.0 edu/d 02 C ESTIMATED ANNUAL REVENUE OF SUGAR RESEARCH FOUNDATION, INC., BASED ON MAXIMUM ASSESSMENT SET FORTH IN TENTATIVE PLAN*, ASSUMING 100% PARTICIPATION FOR EACH GROUP THEREIN AVERAGE 1938-9 DELIVERIES, SHORT TONS, RAW VALUE Beet Processors 1,629,660 $ 152,304.60 Offshores 567,730 53,058.85 U. S. Cane Refiners 4,441,345 251,484.50 Raw Sugar Producers: Cuba 1,565,229 $ 59,085.83 Puerto Rico 798,782 30,153.22 Hawaii 894,759 33,776.26 123,015.31 $ 579,863.26 .5€ per bag, refined, for beet processors and producers of refined from their own cane. .30 per bag, refined, for refiners .26 per bag, refined, for raw producers Additional Revenue Which Would Be Available From Other Groups Not Included Above, If All Participate. Mainland D/C Cane 116,650 $ 10,901.96 La. - Fla. Raw Producers 470,783 17,771.59 All Other Raw Producers 119,916 4,526.71 $ 33,200.16 1938-9 Deliveries for domestic consumption and receipts of raws from various areas by U. s. cane refiners from U. S. Department of Agriculture figures. Short tons raw value converted to refined by factor of 1.0596295 for U. S. cane refiners (Average of 1938-9 government figures), and 1.07 for all others. iindustrydocuments.ucskedu/docsxqgl0226

What is the name of the first "Raw Sugar Producers:" given?

xqgl0226

xqgl0226_p6, xqgl0226_p7

cuba, Cuba

B REFINERS' RECEIPTS BY SOURCES OF SUPPLY (SHORT TONS) Figures from U.S.D.A. (RAW VALUE) PUERTO PHILIPPINE ALL CUBA RICO U.S. HAWAII ISLANDS OTHERS TOTAL 1937 1,769,443 771,465 301,214 959,936 924,958 127,780 4,854,707 1938 1,576,693 779,864 352,027 899,340 911,255 128,361 4,647,540 1939 1,553,765 817,699 442,214 890,178 902,510 78,086 4,684,452 1940 1,586,917 690,140 272,416 980,641 931,636 52,459 4,514,209 1941 2,521,039 805,389 319,262 906,284 786,321 247,711 5,586,006 Average of 3 best years 1,959,133 800,984 371,168 948,954 922,616 167,951 5,170,800 % 37.8 15.7 7.2 18.4 17.7 3.2 100.0 1938-9 Average 1,565,229 798,782 397,121 894,759 906,883 103,224 4,665,998 % 33.5 17.2 8.5 19.2 19.4 2.2 100.0 edu/d 02 C ESTIMATED ANNUAL REVENUE OF SUGAR RESEARCH FOUNDATION, INC., BASED ON MAXIMUM ASSESSMENT SET FORTH IN TENTATIVE PLAN*, ASSUMING 100% PARTICIPATION FOR EACH GROUP THEREIN AVERAGE 1938-9 DELIVERIES, SHORT TONS, RAW VALUE Beet Processors 1,629,660 $ 152,304.60 Offshores 567,730 53,058.85 U. S. Cane Refiners 4,441,345 251,484.50 Raw Sugar Producers: Cuba 1,565,229 $ 59,085.83 Puerto Rico 798,782 30,153.22 Hawaii 894,759 33,776.26 123,015.31 $ 579,863.26 .5€ per bag, refined, for beet processors and producers of refined from their own cane. .30 per bag, refined, for refiners .26 per bag, refined, for raw producers Additional Revenue Which Would Be Available From Other Groups Not Included Above, If All Participate. Mainland D/C Cane 116,650 $ 10,901.96 La. - Fla. Raw Producers 470,783 17,771.59 All Other Raw Producers 119,916 4,526.71 $ 33,200.16 1938-9 Deliveries for domestic consumption and receipts of raws from various areas by U. s. cane refiners from U. S. Department of Agriculture figures. Short tons raw value converted to refined by factor of 1.0596295 for U. S. cane refiners (Average of 1938-9 government figures), and 1.07 for all others. iindustrydocuments.ucskedu/docsxqgl0226

Mention "AVERAGAE 1938-9 DELIVERIES, SHORT TONS, RAW VALUE" of "Cuba"?

xqgl0226

xqgl0226_p6, xqgl0226_p7

1,565,229

B REFINERS' RECEIPTS BY SOURCES OF SUPPLY (SHORT TONS) Figures from U.S.D.A. (RAW VALUE) PUERTO PHILIPPINE ALL CUBA RICO U.S. HAWAII ISLANDS OTHERS TOTAL 1937 1,769,443 771,465 301,214 959,936 924,958 127,780 4,854,707 1938 1,576,693 779,864 352,027 899,340 911,255 128,361 4,647,540 1939 1,553,765 817,699 442,214 890,178 902,510 78,086 4,684,452 1940 1,586,917 690,140 272,416 980,641 931,636 52,459 4,514,209 1941 2,521,039 805,389 319,262 906,284 786,321 247,711 5,586,006 Average of 3 best years 1,959,133 800,984 371,168 948,954 922,616 167,951 5,170,800 % 37.8 15.7 7.2 18.4 17.7 3.2 100.0 1938-9 Average 1,565,229 798,782 397,121 894,759 906,883 103,224 4,665,998 % 33.5 17.2 8.5 19.2 19.4 2.2 100.0 edu/d 02 C ESTIMATED ANNUAL REVENUE OF SUGAR RESEARCH FOUNDATION, INC., BASED ON MAXIMUM ASSESSMENT SET FORTH IN TENTATIVE PLAN*, ASSUMING 100% PARTICIPATION FOR EACH GROUP THEREIN AVERAGE 1938-9 DELIVERIES, SHORT TONS, RAW VALUE Beet Processors 1,629,660 $ 152,304.60 Offshores 567,730 53,058.85 U. S. Cane Refiners 4,441,345 251,484.50 Raw Sugar Producers: Cuba 1,565,229 $ 59,085.83 Puerto Rico 798,782 30,153.22 Hawaii 894,759 33,776.26 123,015.31 $ 579,863.26 .5€ per bag, refined, for beet processors and producers of refined from their own cane. .30 per bag, refined, for refiners .26 per bag, refined, for raw producers Additional Revenue Which Would Be Available From Other Groups Not Included Above, If All Participate. Mainland D/C Cane 116,650 $ 10,901.96 La. - Fla. Raw Producers 470,783 17,771.59 All Other Raw Producers 119,916 4,526.71 $ 33,200.16 1938-9 Deliveries for domestic consumption and receipts of raws from various areas by U. s. cane refiners from U. S. Department of Agriculture figures. Short tons raw value converted to refined by factor of 1.0596295 for U. S. cane refiners (Average of 1938-9 government figures), and 1.07 for all others. iindustrydocuments.ucskedu/docsxqgl0226

What is the balance in the end?

zjcf0227

zjcf0227_p3, zjcf0227_p4, zjcf0227_p5, zjcf0227_p6, zjcf0227_p7, zjcf0227_p8

$ 3,214, $ 3,214

VNA OF GREATER ST. LOUIS STATEMENT OF RECEIPTS & DISBURSEMENTS FOR THE MONTH OF SEPTEMBER, 1982 Beginning Balance August 31, 1982 $ 21,448 September Receipts: PIP $777,694 United Way 35,551 Medicaid 47,557 Other 47,556 Miscellaneous 1,143 909,501 September Disbursements: Payroll, Taxes and Benefits $632,459 Accounts Payable 274,727 Rent 15,725 Lindell Trust - North Office 854 Lindell Trust - South L.H.I. 1,912 Lindell Trust - Computer 1,925 Bridgeton Investment 529 Capital Equipment Purchases 2,704 930,835 Total Operating Fund Checking Acct. -Lindell Trust $ 114 Payroll Checking Account-Bal. Centerre Bank $ 2,500 Petty Cash 600 3,100 Ending Balance September 30, 1982 $ 3,214 Source: https://wwww.industrydocuments.ucsf.edu/docs/zjcf022 VNA OF GREATER ST. LOUIS ACTUAL VS PROJECTED CASH FLOW STATEMENT YEAR TO DATE SEPTEMBER 30, 1982 ACTUAL PROJECTED VARIANCE Beginning Balance January 1, 1982 $ 29,361 $ 29,361 $ - RECEIPTS PIP $7,214,564 $7,444,622 $ (230,058) Medicare Cost Report Settlement 120,000 - 120,000 United Way 312,599 319,961 ( 7,362) Medicaid 185,233 226,865 ( 41,632) Others 395,533 392,234 3,299 Miscellaneous 46,828 10,500 36,328 Designated Cash 200,000 200,000 - Loan-Line of Credit 100,000 100,000 - TOTAL RECEIPTS $8,574,757 $8,694,182 $ (119,425) DISBURSEMENTS Payroll, Taxes and Benefits $6,053,864 $5,934,522 $ 119,342 Accounts Payable 2,237,482 2,294,066 ( 56,584) Pension - 110,000 (110,000) Rent 109,940 104,574 5,366 Lindell Trust - North Ofc. 7,686 7,686 - Lindell Trust - South L.H.I. 17,208 17,208 - Lindell Trust - Computer 17,325 17,325 - Bridgeton Investment Co. 4,761 4,761 - Designated Cash 100,000 100,000 - Capital Equipment Purchases 55,738 61,500 ( 5,762) $8,604,004 $8,651,642 $(47,638) ENDING BALANCE SEPTEMBER 30, 1982 $ 114 $ 71,901 $( 71,787) Source: https://www.industrydocuments.ucsf.edu/docs/zicf227 VNA OF GREATER ST. LOUIS CAPITAL BUDGET 1 9 8 2 Balance Capital Equipment, January 1, 1982 $720,744 Additions: Furniture & Fixtures - See Attached $30,954 Leasehold Improvements 24,784 $55,738 Reductions: Sale of 3 CRT's (3,450) 52,288 Balance Capital Equipment, September 30, 1982 $773,032 Source: https://www.industrydocuments.ucsf.edu/docsiz)cf0227 VNA OF GREATER ST. LOUIS CAPITAL EQUIPMENT BUDGET 1 9 8 2 No. of Unita Cost Purchased Executive Videocassette 1 $ - $ 390 Bookcase Credenza 1 - 313 Durable Medical Equipasnt Card Cabinets with Bases 15 700 Plant Operations Paper Shredder 1 1,290 Shelf Unita 12 600 1,200 Snow Blowar 1 - 550 Illuminatad aign 1 - 608 Communications Refrigerator 1 - 665 Planning Office Deak and Chair 1 600 Central Admissione Carousel and Chair 1 1,500 Secretary Chair 3 300 Lateral File Cabinet 1 360 Table 1 350 CRT Work Station 1 - 432 Human Resources Desk and Chair, Bookshelf 1 750 297 Table and Chairs 1 - 421 Education Food Model 1 300 Recording Anne 1 1,000 35MM Camera 1 400 497 Selectric Typewriter 1 1,100 Office and Clasaroom Furnitura 6,450 7,914 Consultanta Daska and Chairs 5 3,850 1,028 Lateral File Cabinat 1 520 358 Bookcase 2 - 361 North Office Dextrometer with Accessories 3 1,000 3,481 Deak and Chair 1 550 1,895 Selectric Typewriter 5 5,500 Refrigerator with Icemaker 1 - 599 Imprinter 1 - 309 Lateral File Cabinet 2 - 718 Calculatore 6 - 426 Bookcase 3 - 542 South Office Copier with Stand 1 3,000 Dextrometer with Accessorias 5 1,700 1,880 Selectric Typewriter 1 1,100 Imprinter 1 - 309 Desk and Chair 3 - 1,871 Lateral File Cabinet 1 - 533 Draperies 1 - 340 Social Service Selectric Typewriter 1 1,100 Rehabilitation Office Selectric Typewriter 1 1,100 Desk and Chair 1 600 Imprinter 1 300 312 Medical Records Shelving 1 - 2,136 Fiscal Office File Cabinet 2 1,100 Selectric Typewriter 1 1,500 Deak 1 - 569 Accounting Selectric Typewriter 2 1,800 Desk 1 360 Calculator 1 300 Billing Selectric Typewriter 8 7,200 Lateral File Cabinet 1 720 Total $49,000 $30,954 Source: https://www.industrydocuments.ucst.edu/docs/z)cf0227 VNA OF GREATER ST. LOUIS VENDOR ACCOUNTS PAYABLE ANALYSIS FOR THE MONTH OF SEPTEMBER, 1982 Vendor Accounts Payable Vouchering: August $256,113 September 288,190 $544,303 Total Vendor Accounts Payable at 61 days. $544,303 = $ 61 8,923 Vendor Accounts Payable per day. Vendor Accounts Payable per September 30, 1982 Balance Sheet divided by Vendor Accounts Payable per day = Number of outstanding accounts payable days. $601,570 = $ 8,923 67 Outstanding Accounts Payable days as of September 30, 1982. The above analysis show that Vendor Accounts Payable are being maintained at a level higher than 60 days as of September 30, 1982. 1981 1982 January 69 60 February 70 74 March 73 69 April 68 60 May 66 66 June 76 73 July 70 65 August 77 68 September 59 67 October 53 November 61 December 59 Source: https:llwww.industrydocuments.ucst.edu/docsizjcf0227 VNA OF GREATER ST. LOUIS PRODUCTIVITY REPORT FOR THE MONTH OF SEPTEMBER, 1982 1981 1982 1982 VISIT BREAKDOWN PER ACTUAL ACTUAL BUDGET FULL TIME EQUIVALENT FTE FTE FTE 1. TOTAL VISITS RN/LPN 12,065 13,251 11,739 HHA 6,413 7,131 6,908 Rehab 3,358 3,393 2,953 Social Service 555 677 492 Consultant 332 379 268 Total Service 22,723 24,831 22,360 2. FTE STAFF RN/LPN 104.5 115.8 110.1 HHA 95.6 104.0 106.0 Rehab 26.9 29.5 35.0 Social Service 10.0 10.0 10.0 Consultant 9.0 11.0 11.0 Visiting Staff 246.0 270.3 272.1 Support Staff 130.5 141.0 144.7 Total Staff 376.5 411.3 416.8 3. VISIT PER FWD/FTE RN/LPN 5.5 5.4 5.1 HHA 3.2 3.3 3.1 Rehab 5.9 5.5 4.0 Social Service 2.6 3.2 2.3 Consultant 1.8 1.6 1.2 Visiting Staff 4.4 4.4 3.9 Support Staff 8.3 8.4 7.4 Total Staff 2.9 2.9 2.6 4. AVG. MONTHLY VISITS PER FTE RN/LPN 115.5 114.4 106.6 HHA 67.1 68.6 65.2 Rehab 124.8 115.0 84.4 Social Service 55.5 67.7 49.2 Consultant 36.9 34.5 24.4 Visiting Staff 92.4 91.9 82.2 Support Staff 174.1 176.1 154.5 Total Staff 60.4 60.4 53.6 Source 1. General Revenue Report - September, 1981 and 1982 2. Human Resources Report - August, 1982 Source: https:/lwww.industrydocuments.ucsf.edu/docs/zjcf0227

Mention "AVERAGAE 1938-9 DELIVERIES, SHORT TONS, RAW VALUE" of "Puerto Rico"?

xqgl0226

xqgl0226_p6, xqgl0226_p7

798,782

B REFINERS' RECEIPTS BY SOURCES OF SUPPLY (SHORT TONS) Figures from U.S.D.A. (RAW VALUE) PUERTO PHILIPPINE ALL CUBA RICO U.S. HAWAII ISLANDS OTHERS TOTAL 1937 1,769,443 771,465 301,214 959,936 924,958 127,780 4,854,707 1938 1,576,693 779,864 352,027 899,340 911,255 128,361 4,647,540 1939 1,553,765 817,699 442,214 890,178 902,510 78,086 4,684,452 1940 1,586,917 690,140 272,416 980,641 931,636 52,459 4,514,209 1941 2,521,039 805,389 319,262 906,284 786,321 247,711 5,586,006 Average of 3 best years 1,959,133 800,984 371,168 948,954 922,616 167,951 5,170,800 % 37.8 15.7 7.2 18.4 17.7 3.2 100.0 1938-9 Average 1,565,229 798,782 397,121 894,759 906,883 103,224 4,665,998 % 33.5 17.2 8.5 19.2 19.4 2.2 100.0 edu/d 02 C ESTIMATED ANNUAL REVENUE OF SUGAR RESEARCH FOUNDATION, INC., BASED ON MAXIMUM ASSESSMENT SET FORTH IN TENTATIVE PLAN*, ASSUMING 100% PARTICIPATION FOR EACH GROUP THEREIN AVERAGE 1938-9 DELIVERIES, SHORT TONS, RAW VALUE Beet Processors 1,629,660 $ 152,304.60 Offshores 567,730 53,058.85 U. S. Cane Refiners 4,441,345 251,484.50 Raw Sugar Producers: Cuba 1,565,229 $ 59,085.83 Puerto Rico 798,782 30,153.22 Hawaii 894,759 33,776.26 123,015.31 $ 579,863.26 .5€ per bag, refined, for beet processors and producers of refined from their own cane. .30 per bag, refined, for refiners .26 per bag, refined, for raw producers Additional Revenue Which Would Be Available From Other Groups Not Included Above, If All Participate. Mainland D/C Cane 116,650 $ 10,901.96 La. - Fla. Raw Producers 470,783 17,771.59 All Other Raw Producers 119,916 4,526.71 $ 33,200.16 1938-9 Deliveries for domestic consumption and receipts of raws from various areas by U. s. cane refiners from U. S. Department of Agriculture figures. Short tons raw value converted to refined by factor of 1.0596295 for U. S. cane refiners (Average of 1938-9 government figures), and 1.07 for all others. iindustrydocuments.ucskedu/docsxqgl0226

Mention "AVERAGAE 1938-9 DELIVERIES, SHORT TONS, RAW VALUE" of "Hawaii"?

xqgl0226

xqgl0226_p6, xqgl0226_p7

894,759

B REFINERS' RECEIPTS BY SOURCES OF SUPPLY (SHORT TONS) Figures from U.S.D.A. (RAW VALUE) PUERTO PHILIPPINE ALL CUBA RICO U.S. HAWAII ISLANDS OTHERS TOTAL 1937 1,769,443 771,465 301,214 959,936 924,958 127,780 4,854,707 1938 1,576,693 779,864 352,027 899,340 911,255 128,361 4,647,540 1939 1,553,765 817,699 442,214 890,178 902,510 78,086 4,684,452 1940 1,586,917 690,140 272,416 980,641 931,636 52,459 4,514,209 1941 2,521,039 805,389 319,262 906,284 786,321 247,711 5,586,006 Average of 3 best years 1,959,133 800,984 371,168 948,954 922,616 167,951 5,170,800 % 37.8 15.7 7.2 18.4 17.7 3.2 100.0 1938-9 Average 1,565,229 798,782 397,121 894,759 906,883 103,224 4,665,998 % 33.5 17.2 8.5 19.2 19.4 2.2 100.0 edu/d 02 C ESTIMATED ANNUAL REVENUE OF SUGAR RESEARCH FOUNDATION, INC., BASED ON MAXIMUM ASSESSMENT SET FORTH IN TENTATIVE PLAN*, ASSUMING 100% PARTICIPATION FOR EACH GROUP THEREIN AVERAGE 1938-9 DELIVERIES, SHORT TONS, RAW VALUE Beet Processors 1,629,660 $ 152,304.60 Offshores 567,730 53,058.85 U. S. Cane Refiners 4,441,345 251,484.50 Raw Sugar Producers: Cuba 1,565,229 $ 59,085.83 Puerto Rico 798,782 30,153.22 Hawaii 894,759 33,776.26 123,015.31 $ 579,863.26 .5€ per bag, refined, for beet processors and producers of refined from their own cane. .30 per bag, refined, for refiners .26 per bag, refined, for raw producers Additional Revenue Which Would Be Available From Other Groups Not Included Above, If All Participate. Mainland D/C Cane 116,650 $ 10,901.96 La. - Fla. Raw Producers 470,783 17,771.59 All Other Raw Producers 119,916 4,526.71 $ 33,200.16 1938-9 Deliveries for domestic consumption and receipts of raws from various areas by U. s. cane refiners from U. S. Department of Agriculture figures. Short tons raw value converted to refined by factor of 1.0596295 for U. S. cane refiners (Average of 1938-9 government figures), and 1.07 for all others. iindustrydocuments.ucskedu/docsxqgl0226

What is the balance in the beginning?

zjcf0227

zjcf0227_p3, zjcf0227_p4, zjcf0227_p5, zjcf0227_p6, zjcf0227_p7, zjcf0227_p8

$ 21,448, $ 21,448

VNA OF GREATER ST. LOUIS STATEMENT OF RECEIPTS & DISBURSEMENTS FOR THE MONTH OF SEPTEMBER, 1982 Beginning Balance August 31, 1982 $ 21,448 September Receipts: PIP $777,694 United Way 35,551 Medicaid 47,557 Other 47,556 Miscellaneous 1,143 909,501 September Disbursements: Payroll, Taxes and Benefits $632,459 Accounts Payable 274,727 Rent 15,725 Lindell Trust - North Office 854 Lindell Trust - South L.H.I. 1,912 Lindell Trust - Computer 1,925 Bridgeton Investment 529 Capital Equipment Purchases 2,704 930,835 Total Operating Fund Checking Acct. -Lindell Trust $ 114 Payroll Checking Account-Bal. Centerre Bank $ 2,500 Petty Cash 600 3,100 Ending Balance September 30, 1982 $ 3,214 Source: https://wwww.industrydocuments.ucsf.edu/docs/zjcf022 VNA OF GREATER ST. LOUIS ACTUAL VS PROJECTED CASH FLOW STATEMENT YEAR TO DATE SEPTEMBER 30, 1982 ACTUAL PROJECTED VARIANCE Beginning Balance January 1, 1982 $ 29,361 $ 29,361 $ - RECEIPTS PIP $7,214,564 $7,444,622 $ (230,058) Medicare Cost Report Settlement 120,000 - 120,000 United Way 312,599 319,961 ( 7,362) Medicaid 185,233 226,865 ( 41,632) Others 395,533 392,234 3,299 Miscellaneous 46,828 10,500 36,328 Designated Cash 200,000 200,000 - Loan-Line of Credit 100,000 100,000 - TOTAL RECEIPTS $8,574,757 $8,694,182 $ (119,425) DISBURSEMENTS Payroll, Taxes and Benefits $6,053,864 $5,934,522 $ 119,342 Accounts Payable 2,237,482 2,294,066 ( 56,584) Pension - 110,000 (110,000) Rent 109,940 104,574 5,366 Lindell Trust - North Ofc. 7,686 7,686 - Lindell Trust - South L.H.I. 17,208 17,208 - Lindell Trust - Computer 17,325 17,325 - Bridgeton Investment Co. 4,761 4,761 - Designated Cash 100,000 100,000 - Capital Equipment Purchases 55,738 61,500 ( 5,762) $8,604,004 $8,651,642 $(47,638) ENDING BALANCE SEPTEMBER 30, 1982 $ 114 $ 71,901 $( 71,787) Source: https://www.industrydocuments.ucsf.edu/docs/zicf227 VNA OF GREATER ST. LOUIS CAPITAL BUDGET 1 9 8 2 Balance Capital Equipment, January 1, 1982 $720,744 Additions: Furniture & Fixtures - See Attached $30,954 Leasehold Improvements 24,784 $55,738 Reductions: Sale of 3 CRT's (3,450) 52,288 Balance Capital Equipment, September 30, 1982 $773,032 Source: https://www.industrydocuments.ucsf.edu/docsiz)cf0227 VNA OF GREATER ST. LOUIS CAPITAL EQUIPMENT BUDGET 1 9 8 2 No. of Unita Cost Purchased Executive Videocassette 1 $ - $ 390 Bookcase Credenza 1 - 313 Durable Medical Equipasnt Card Cabinets with Bases 15 700 Plant Operations Paper Shredder 1 1,290 Shelf Unita 12 600 1,200 Snow Blowar 1 - 550 Illuminatad aign 1 - 608 Communications Refrigerator 1 - 665 Planning Office Deak and Chair 1 600 Central Admissione Carousel and Chair 1 1,500 Secretary Chair 3 300 Lateral File Cabinet 1 360 Table 1 350 CRT Work Station 1 - 432 Human Resources Desk and Chair, Bookshelf 1 750 297 Table and Chairs 1 - 421 Education Food Model 1 300 Recording Anne 1 1,000 35MM Camera 1 400 497 Selectric Typewriter 1 1,100 Office and Clasaroom Furnitura 6,450 7,914 Consultanta Daska and Chairs 5 3,850 1,028 Lateral File Cabinat 1 520 358 Bookcase 2 - 361 North Office Dextrometer with Accessories 3 1,000 3,481 Deak and Chair 1 550 1,895 Selectric Typewriter 5 5,500 Refrigerator with Icemaker 1 - 599 Imprinter 1 - 309 Lateral File Cabinet 2 - 718 Calculatore 6 - 426 Bookcase 3 - 542 South Office Copier with Stand 1 3,000 Dextrometer with Accessorias 5 1,700 1,880 Selectric Typewriter 1 1,100 Imprinter 1 - 309 Desk and Chair 3 - 1,871 Lateral File Cabinet 1 - 533 Draperies 1 - 340 Social Service Selectric Typewriter 1 1,100 Rehabilitation Office Selectric Typewriter 1 1,100 Desk and Chair 1 600 Imprinter 1 300 312 Medical Records Shelving 1 - 2,136 Fiscal Office File Cabinet 2 1,100 Selectric Typewriter 1 1,500 Deak 1 - 569 Accounting Selectric Typewriter 2 1,800 Desk 1 360 Calculator 1 300 Billing Selectric Typewriter 8 7,200 Lateral File Cabinet 1 720 Total $49,000 $30,954 Source: https://www.industrydocuments.ucst.edu/docs/z)cf0227 VNA OF GREATER ST. LOUIS VENDOR ACCOUNTS PAYABLE ANALYSIS FOR THE MONTH OF SEPTEMBER, 1982 Vendor Accounts Payable Vouchering: August $256,113 September 288,190 $544,303 Total Vendor Accounts Payable at 61 days. $544,303 = $ 61 8,923 Vendor Accounts Payable per day. Vendor Accounts Payable per September 30, 1982 Balance Sheet divided by Vendor Accounts Payable per day = Number of outstanding accounts payable days. $601,570 = $ 8,923 67 Outstanding Accounts Payable days as of September 30, 1982. The above analysis show that Vendor Accounts Payable are being maintained at a level higher than 60 days as of September 30, 1982. 1981 1982 January 69 60 February 70 74 March 73 69 April 68 60 May 66 66 June 76 73 July 70 65 August 77 68 September 59 67 October 53 November 61 December 59 Source: https:llwww.industrydocuments.ucst.edu/docsizjcf0227 VNA OF GREATER ST. LOUIS PRODUCTIVITY REPORT FOR THE MONTH OF SEPTEMBER, 1982 1981 1982 1982 VISIT BREAKDOWN PER ACTUAL ACTUAL BUDGET FULL TIME EQUIVALENT FTE FTE FTE 1. TOTAL VISITS RN/LPN 12,065 13,251 11,739 HHA 6,413 7,131 6,908 Rehab 3,358 3,393 2,953 Social Service 555 677 492 Consultant 332 379 268 Total Service 22,723 24,831 22,360 2. FTE STAFF RN/LPN 104.5 115.8 110.1 HHA 95.6 104.0 106.0 Rehab 26.9 29.5 35.0 Social Service 10.0 10.0 10.0 Consultant 9.0 11.0 11.0 Visiting Staff 246.0 270.3 272.1 Support Staff 130.5 141.0 144.7 Total Staff 376.5 411.3 416.8 3. VISIT PER FWD/FTE RN/LPN 5.5 5.4 5.1 HHA 3.2 3.3 3.1 Rehab 5.9 5.5 4.0 Social Service 2.6 3.2 2.3 Consultant 1.8 1.6 1.2 Visiting Staff 4.4 4.4 3.9 Support Staff 8.3 8.4 7.4 Total Staff 2.9 2.9 2.6 4. AVG. MONTHLY VISITS PER FTE RN/LPN 115.5 114.4 106.6 HHA 67.1 68.6 65.2 Rehab 124.8 115.0 84.4 Social Service 55.5 67.7 49.2 Consultant 36.9 34.5 24.4 Visiting Staff 92.4 91.9 82.2 Support Staff 174.1 176.1 154.5 Total Staff 60.4 60.4 53.6 Source 1. General Revenue Report - September, 1981 and 1982 2. Human Resources Report - August, 1982 Source: https:/lwww.industrydocuments.ucsf.edu/docs/zjcf0227

What is the total number of persons examined?

snyc0227

snyc0227_p218, snyc0227_p219, snyc0227_p220, snyc0227_p221, snyc0227_p222, snyc0227_p223, snyc0227_p224, snyc0227_p225, snyc0227_p226, snyc0227_p227, snyc0227_p228, snyc0227_p229, snyc0227_p230, snyc0227_p231, snyc0227_p232, snyc0227_p233, snyc0227_p234, snyc0227_p235, snyc0227_p236, snyc0227_p237, snyc0227_p238, snyc0227_p239

1,359

TABLE X-27. PREVALENCE OF INTESTINAL PARASITES IN 573 MILITARY MEN BY LOCATION, FEDERATION OF MALAYA, 1962 Location Total Number examined 115 63 87 15 39 163 39 52 573 Helminths 1/ Ascaris (13.0) (33.3) (24.1) (33.3) (46. 2) (24.5) (51.3) (15.4) (25.8) lumbricoides 15 21 21 5 18 40 20 8 148 Trichuris (75.6) (74.6) (64.4) (73.3) (76.9) (76.1) (84.6) (67.3) (73.8) trichiura 87 47 56 11 30 124 33 35 423 Hookworm (47.0) (57.1) (39.1) (33.3) (46.2) (53.4) (46.2) (53.8) (48.9) species 54 36 34 5 18 87 18 28 280 Trichostrongylus (0.9) -- -- (0.2) species 1 -- - -- - -- - -- 1 Diphyllobothrium -- -- -- -- (2.6) -- -- -- (0.2) latum -- -- -- 1 -- -- 1 Enterobius (1.7) -- (1.1) -- -- (1.8) -- -- (1.0) vermicularis 2 -- 1 - - 3 -- -- 6 Unknown -- -- -- -- -- -- -- -- -- trematode -- -- - -- -- - Heterodera -- -- -- -- -- -- marioni -- -- -- -- Protozoa Endamoeba (6.1) (4.8) (2.3) -- (12.8) (1.2) (5.1) (5.8) (4.2) histolytica 7 3 2 -- 5 2 2 3 24 Endamoeba coli (8.7) (7.9) (5.7) - (15.4) (9.2) (30.8) (9.6) (10.1) 10 5 5 -- 6 15 12 5 58 Giardia lamblia (7.0) (1.6) -- (2.6) (0.6) (7.7) - (2.4) 8 1 -- 1 1 3 -- 14 Iodamoeba (1.7) (1.6) - -- -- -- -- -- (0.5) butschlii 2 1 -- -010 - -- - 3 Endolimax nana -- (1.6) (5.1) -- (5.1) (1.9) (1.0) -- 1 -- 2 -- 2 1 6 Trichomonas - -- -- -- -- -- -- -- species - - -- -- -- No parasites (10.4) (4.8) (18.4) (26.7) (15.4) (9.8) (2.6) (17.3) (11.7) observed 12 3 16 4 6 16 1 9 67 1/ Figures in parentheses are percentages. 219 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 TABLE X-28. PREVALENCE OF INTESTINAL PARASITES IN 573 MILITARY MEN BY AREA OF ORIGIN, FEDERATION OF MALAYA, 1962 Area of Origin Total Number examined 33 40 24 76 173 125 45 14 27 16 573 Helminths Ascaris lumbricoides (36.4 (32.5) (16.7) (36.8) (16.8) (26.4) (20.0) (84.3) (25.9) (25.0) 1/ (25.8) 12 13 4 28 29 33 9 9 7 4 148 Trichuris trichiura (78.8) (87.5) (66.7) (86.8) (64.7) (73.6) (73.3) (92.8) (70.4) (68.8) (73.8) 24 35 16 66 112 92 33 13 19 11 423 Hookworm species (42.4) (57.5) (54.2) (44..7) (52.0) (42.4) (53.3) (35.7) (55.6) (56.2) (48.9) 14 23 13 34 90 53 24 5 15 9 280 Trichostrongylus species -- -- (0.6) -- -- -- (0.2) -- -- -- -- 1 -- -- -- -- -- 1 Diphyllobothrium latum -- -- -- -- -- -- -- (7.1) -- -- (0.2) -- -- -- -- -- -- -- 1 -- -- 1 Enterobius vermicularis -- -- (4.2) -- (1.2) -- (6.7) -- -- -- (1.0) -- -- 1 2 -- 3 -- -- -- 6 Protozoa Endamoeba histolytica (3.0) (2.5) (12.5) (1.3) (5.8) (5.6) (2.2) -- -- -- (4.2) 1 1 3 1 10 7 1 -- -- -- 24 Endamoeba coli (9.1) (2.5) (25.0) (13.2) (6.9) (16.8) (11.1) -- -- -- (10.1) 3 1 6 10 12 21 5 -- -- -- 58 Giardia lamblia -- (7.5) -- (3.9) (2.3) (2.4) -- (7.1) -- -- (2.4) -- 3 -- 3 4 3 -- 1 -- -- 14 Iodamoeba butschlii -- -- (4.2) (1.3) (0.8) -- -- -- -- (0.5) -- -- 1 1 1 -- -- -- -- 3 Endolimax nana (3.0) -- (1.3) (1.2) (1.6) -- -- -- -- -- (1.0) 1 -- -- 1 2 2 -- -- 6 -- No parasites observed (12.1) (5.0) (8.3) (7.9) (15.6) (11.2) (13.3) (14.8) (12.5) (11.7) 4 2 2 6 27 14 6 -- 4 2 67 1/ Figures in parentheses are percentages. Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 TABLE X-29. PREVALENCE OF INTESTINAL PARASITES IN 1,359 CIVILIANS AND MILITARY DEPENDENTS BY AREA OF ORIGIN, FEDERATION OF MALAYA, 1962 Area of Origin Total Number examined 197 213 147 205 102 203 153 54 85 1,359 Helminths (66. 1/ Ascaris lumbricoides (80.8) (60.5) (55.6) (79.4) (72.9) (71.9) (20.4) (82.4) (68.1) 130 172 89 114 81 148 110 11 70 925 Trichuris trichiura (91.4) (96.7) (81.0) (89.3) (92.2) (92.1) (90.8) (38.9) (90.6) (88.7) 180 206 119 183 94 187 139 21 77 1,206 Hookworm species (60.9) (61.0) (62.6) (42.0) (72.5) (36.4) (45.8) (35.2) (29.4) (50.8) 120 130 92 86 74 74 70 19 25 690 Trichostrongylus species -- (1.4) (0.7) -- -- (0.6) (1.8) (1.2) (0.5) 3 1 -- -- -- 1 1 1 7 -- Diphyllobothrium latum (0.5) -- -- -- -- -- -- -- -- (0.1) 1 -- -- 1 -- -- -- -- -- -- Enterobius vermicularis (6.6) (5.2) (5.4) (7.3) (2.0) (2.0) (6.5) -- (8.3) (5.2) 13 11 8 15 2 4 10 -- 7 70 (2.0) -- -- (0.5) -- -- -- Unknown trematode -- -- (0.4) 4 -- -- -- -- 1 -- -- -- 5 -- -- -- (0.5) -- -- -- Heterodera marioni (0.1) -- -- -- -- 1 -- -- -- 1 -- -- -- Protozoa Endamoeba histolytica (3.6) (2.3) (2.0) (4.9) (4.9) (2.4) (13.1) (3.7) (8.3) (4.7) 7 5 3 10 5 5 20 2 7 64 Endamoeba coli (23.4) (22.1) (15.6) (20.5) (17.6) (8.4) (32.7) (9.2) (18.8) (19.4) 46 47 23 42 18 17 50 5 16 264 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 TABLE X-29 (Continued) Giardia lamblia (1.5) (0.9) (4.8) (5.8) (6.9) (4.4) (5.9) -- (9.4) (4.2) 3 2 7 12 7 9 9 -- 8 57 Iodamoeba butschlii (2.5) (0.5) (1.4) (0.5) (2.0) -- (4.6) -- (1.2) (1.4) 5 1 2 1 2 -- 7 -- 1 19 Endolimax nana (0.5) -- -- (1.0) (1.0) -- (2.0) -- -- (0.5) 1 -- -- 2 1 -- 3 -- - 7 Trichomonas species -- -- -- -- -- -- -- (1.8) -- (0.1) -- -- -- -- -- -- -- 1 -- 1 No parasites observed (4.6) (0.9) (10.2) (5.4) (2.9) (5.4) (1.3) (31.5) (1.2) (5.2) 9 2 15 11 3 11 2 17 1 71 1/ Figures in parentheses are percentages. Source: https:/lwww.industrydocuments.ucsf.edu/docssnyc0227 TABLE X-30. PREVALENCE OF INTESTINAL PARASITES IN 1,359 CIVILIANS AND MILITARY DEPENDENTS BY RACE AND BY RURAL VS. URBAN, FEDERATION OF MALAYA, 1962 Race Chinese Malay Indian Unknown Total Rural Urban Number examined 377 795 181 6 1,359 1,067 292 Helminths Ascaris lumbricoides (56.8)1/ (74.0) (66.3) (50.0) (68.1) (72.2) (52.7) 214 588 120 3 925 771 154 Trichuris trichiura (76.1) (94.8) (88.4) (83.3) (88.7) (92.1) (76.4) 287 754 160 5 1,206 983 223 Hookworm species (32.6) (60.1) (47.5) (50.0) (50.8) (57.1) (27.7) 123 478 86 3 690 609 81 Trichostrongylus species (0.3) (0.6) (0.6) -- (0.5) (0.6) (0.3) 1 5 1 -- 7 6 1 Diphyllobothrium latum -- (0.1) -- - (0.1) (0.1) -- -- 1 -- -- 1 1 - Enterobius vermicularis (3.2) (5.5) (7.7) -- (5.2) (4.9) (6.2) 12 44 14 -- 70 52 18 Unknown trematode (0.3) (0.2) (1.1) -- (0.4) (0.3) (0.7) 1 2 2 -- 5 3 2 Heterodera marioni (0.3) -- -- -- (0.1) (0.1) -- 1 -- -- -- 1 1 -- Protozoa Endamoeba histolytica (1.6) (5.9) (6.1) -- (4.7) (5.2) (2.7) 6 47 11 -- 64 56 8 Endamoeba coli (5.6) (25.0) (23.8) (16.7) (19.4) (21.5) (12.0) 21 199 43 1 264 229 35 Source: https:/lwww.industrydocuments.ucsf.edu/docs/snyc0227 (2:) (6-2) : : ante dn 225 TABLE X-31. PREVALENCE OF INTESTINAL PARASITES IN 1,359 CIVILIANS AND MILITARY DEPENDENTS BY RACE AND RURAL VS. URBAN, FEDERATION OF MALAYA, 1962 Rural Urban Race Malay Indian Chinese Unknown Total Malay Indian Chinese Unknown Total Number examined 756 66 240 5 1,067 39 115 137 1 292 Helminths 1/ Ascaris lumbricoides (75.9) (54.5) (65.8) (60.0) (72.2) (35.9) (73.0) (40.9) -- (52.7) 574 36 158 3 771 14 84 56 -- 154 Trichuris trichiura (95.1) (89.4) (83.8) (80.0) (92.1) (89.7) (87.8) (62.8) (100.0) (76.4) 719 59 201 4 983 35 101 86 1 223 Hookworm species (62.3) (65.2) (38.3) (60.0) (57.1) (17.9) (37.4) (22.6) -- (27.7) 471 43 92 3 609 7 43 31 -- 81 Trichostrongylus species (0.7) -- (0.4) -- (0.6) -- (0.9) -- -- (0.3) 5 -- 1 -- 6 -- 1 -- -- 1 Diphyllobothrium latum (0.1) -- (0.1) -- -- -- -- - -- -- 1 -- -- -- 1 -- -- -- -- -- Enterobius vermicularis (5.6) (7.6) (2.1) -- (4.9) (5.1) (7.8) (5.1) -- (6.2) 42 5 5 -- 52 2 9 7 -- 18 Unknown trematode (0.3) (0.4) -- (0.3) -- (1.7) -- -- -- (0.7) 2 -- 1 -- 3 -- 2 -- -- 2 (0.4) (0.1) -- -- -- -- Heterodera marioni -- -- -- -- -- -- 1 -- 1 -- -- -- -- -- Protozoa Endamoeba histolytica (6.2) (4.5) (2.5) -- (5.2) -- (7.0) -- -- (2.7) 47 3 6 -- 56 -- 8 -- -- 8 Endamoeba coli (25.4) (28.8) (7.1) (20.0) (21.5) (17.9) (20.9) (2.9) -- (12.0) 192 19 17 1 229 7 24 4 -- 35 Source: https://www.industrydocuments.ucst.edu/docs/snyc0227 TABLE X-30 (Continued) Giardia lamblia (4.6) (4.5) (4.2) -- (4.5) -- (7.0) (0.7) -- (3.1) 35 3 10 -- 48 -- 8 1 -- 9 Iodamoeba butschlii (2.4) -- -- -- (1.7) -- (0.9) -- -- (0.3) 18 -- -- -- 18 -- 1 -- -- 1 Endolimax nana (0.5) (3.0) (0.4) -- (0.6) -- (0.9) -- -- (0.3) 4 2 1 -- 6 -- 1 -- -- 1 Trichomonas species -- -- -- -- -- -- (0.9) -- -- (0.3) -- -- -- -- -- -- 1 -- -- 1 No parasites observed (1.0) (1.5) (8.8) -- (2.8) (5.1) (4.3) (24.8) -- (14.0) 8 1 21 -- 30 2 5 34 -- 41 1/ Figures in parentheses are percentages. Source: https://www.industrydocuments.ucst.edu/docsisnyc0227 Tables X-32 and 33 summarize hematocrit-hemoglobin values by prev" alence of hookworm versus nonhookworm in the civilian and military populations. The numbers of persons on whom both hematology and parasitologic data were available were very small. All rates were consistent with a lower hematologic index in those individuals with hookworm although data were only "statistically significant" for civilian males. Table X-34 summarizes the multiple infes- - tation rate of parasite species at each location. Diphyllobothrium latum was rare. No Schistosome, Clonorchis, Paragonimus, or Taenia species were found. Summary The prevalence of intestinal protozoa and helminths from more than 2,000 persons of different ages, ethnic groups and localities in the Federation of Malaya was determined by examination of a single stool specimen by the MIF and MIFC technics. Over=all prevalence of intestinal parasites ranged from 50 to 100 percent by location. Of the people surveyed 92.5 percent harbored one or more parasites. The military prevalence rates were considerably lower than those of the civilians and military dependents. Of the 13 parasites found, Trichuris trichiura (81-100 percent prevalence) was the most common helminth followed by Ascaris lumbricoides (15=97 percent) and hookworm (34-91 percent). Prevalence of Endamoeba histolytica ranged from 0-13 percent and Endamoeba coli from 7.4a33 percent by location. Enterobius vermicularis averaged 5.2 percent by location. Diphyllobothrium latum was rare. Schistosome, Clonorchis, Paragonimus and Taenia species were not found. Other Studies Results of studies on blood levels of folic acid, vitamin B 12, magnesium and vitamin B6 will be presented in the final report. References 1. Sapero, J.J., and Lawless, D.K. The MIF stain-preservation technic for the identification of intestinal protozoa. Am. J. Trop. Med. and Hyg. . , 2, 613-619, 1953 2. Blagg, W., Schloegel, E.L., Mansour, W.S., and Khalaf, O.I. A new concentration technic for the demonstration of protozoa and helminth ova in feces. Am. J. Trop. Med. and Hyg., 4; 23-28, 1955 3. Interdepartmental Committee on Nutrition for National Defense. Manual for Nutrition Surveys, revised edition, in press, 1964 229 Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 TABLE X-32. DISTRIBUTION OF HEMATOCRIT AND HEMOGLOBIN VALUES IN 573 MILITARY MEN IN PRESENCE OR ABSENCE OF HOOKWORM, FEDERATION OF MALAYA, 1962 Hemoglobin With Without Hematocrit With Without gm/100 ml hookworm hookworm Total hookworm hookworm Total Number 29 29 58 Number 27 29 56 Mean 15.62 16.04 15.83 Mean 44.3 44.5 44.4 S.E. 0.24 0.36 0.22 S.E. 0.61 0.74 0.48 12.0 2 2 34 1 1 13.0 3 1 4 39 1 3 4 14.0 5 5 10 40 1 3 4 15.0 11 5 16 41 1 2 3 16.0 4 7 11 42 2 2 4 17.0 5 7 12 43 1 4 5 18.0 1 1 2 44 5 2 7 19.0 -- 45 3 1 4 22.0 1 1 46 5 2 7 47 6 2 8 48 3 3 49 1 1 50 3 3 51 1 1 52 1 1 1/ S.E. - standard error. TABLE X-33. DISTRIBUTION OF HEMOGLOBIN AND HEMATOCRIT VALUES IN 1,359 CIVILIANS AND MILITARY DEPENDENTS IN PRESENCE OR ABSENCE OF HOOKWORM, FEDERATION OF MALAYA, 1962 No. males No. females Hemoglobin With Without With Without gm/100 ml hookworm hookworm Total hookworm hookworm Total Number 31 19 50 18 27 45 Mean 12.69 14.07 13.22 12.66 13.53 13.18 S.E.1/ 0.37 0.43 0.29 0.42 0.32 0.26 8.0 3 3 -- 9.0 1 1 2 2 4 10.0 1 1 3 3 11.0 6 6 1 1 12.0 5 4 9 3 7 10 13.0 7 5 12 4 8 12 14.0 6 5 11 5 5 10 15.0 2 1 3 3 3 16.0 1 1 2 2 2 17.0 1 1 18.0 1 1 -- 1/ S.E. = standard error. 231 Source: https:/lwww.industrydocuments.ucsf.edu/docsisnyc0227 TABLE X-33 (Continued) DISTRIBUTION OF HEMOGLOBIN AND HEMATOCRIT VALUES IN 1,359 CIVILIANS AND MILITARY DEPENDENTS IN PRESENCE OR ABSENCE OF HOOKWORM, FEDERATION OF MALAYA, 1962 No. males No. females Hematocrit With Without With Without percent hookworm hookworm Total hookworm hookworm Total Number 31 18 49 18 25 43 Mean 39.7 41.0 40.2 39.0 39.2 39.1 S.E. 0.99 1.10 0.74 0.95 0.51 0.49 23 1 1 -- 25 1 1 -- 32 -- 1 1 33 1 1 1 1 2 34 -- 35 1 1 3 1 4 36 2 1 3 3 3 37 4 2 6 1 2 3 38 2 2 4 2 1 3 39 2 2 4 1 3 4 40 4 2 6 4 5 9 41 3 1 4 5 5 42 1 1 2 1 3 4 43 4 2 6 1 1 2 44 2 2 1 1 45 1 1 2 1 1 46 1 1 1 1 47 -- 48 1 1 2 -- 49 1 1 -- 50 1 1 2 -- 232 Source: https:/lwww.industrydocuments.ucsf.edu/docs/snyc0227 TABLE X-34. NUMBER OF PARASITE SPECIES PER PERSON BY LOCATION, FEDERATION OF MALAYA, 1962 Species No Total Location #1 #2 #3 #4 #5 #6 finding 1/ positive Fort Escandar 2 1 20 3 1 0 0 27 (7.4)2/ (3.7) (74) (11.11) (3.7) (100) Batu Garrison 4 6 3 -- -- -- 4 13 (23.5) (35.3) (17.6) (23.5) (76.5) Sentul 8 40 23 11 -- 2 1 84 (9.4) (47) (27) (12.9) (2.35) (1.17) (99) Sulerman Courts 5 7 9 3 3 4 27 (16.1) (22.3) (29) (9.67) (9.67) (12.9) (87) Kampong Bheru 4 - 3 -- -- 7 7 (28.5) (21.4) (50) (50) Surgei Merap Sekalah 7 11 4 2 -- -- 2 24 (26.9) (42.2) (15.3) (7.68) (7.68) (92.3) 2d Battn, R M R3/ 9 40 57 28 4 -- 1 138 (6.4) (28.8) (41) (20) (2.87) (0.72) (99.2) Tg. Tinggi 37 24 9 2 -- 17 72 (41.5) (26.9) (1.01) (2.25) (19.1) (80.8) 12 1 2 -- -- -- 3 15 (66.7) (5.55) (11.1) (16.6) (83.3) Ching Chan School 3 19 43 10 1 -- 0 76 (3.92) (25) (56.5) (13.1) (1.3) (100) Kampong Melor 6 25 10 1 -- -- 1 42 (13.9) (58) (23.2) (2.32) (2.32) (97.6) Mulong 1 5 6 1 -- -- 13 (7.7) (38.4) (46) (7.69) (100) 4th Battn, R M R 1 24 42 15 4 -- 1 86 (1.16) (27.8) (49.0) (17.4) (4.65) (1.16) (98.7) Lubok Terua (Malaya school) 52 70 20 5 -- 16 147 (31.0) (42.9) (12.6) (3.1) (9.9) (90.1) 3 1 3 1 -- -- 2 8 (30) (10) (30) (10) (20) (80) Tg. Kerayong 4 13 31 20 4 -- -- 72 (5.55) (18) (43) (27.7) (5.55) (100) Chung Hwa 4 13 14 1 -- - 2 32 (11.7) (38.2) (41) (2.94) (5.86) (94) Source: https:/llwww.industrydocuments.ucsf.edu/docs/snyc0227 TABLE X-34 (Continued) NUMBER OF PARASITE SPECIES PER PERSON BY LOCATION, FEDERATION OF MALAYA, 1962 Species No Total Location #1 #2 #3 #4 #5 #6 finding 1/ positive Kampong Melagu (school) 19 8 7 -- -- -- 14 34 (39.5) (16.7) (14.6) (29.1) (70.9) Mengkibol 22 40 35 10 -- 1 2 108 (20) (36.3) (31.8) (9.1) (0.91) (1.83) (98.1) 6th Battn, R M R 9 17 20 11 2 1 1 60 (14.7) (27.8) (32.7) (18) (3.27) (1.67) (1.67) (98.2) Kluang town 48 40 13 5 1 14 107 (39.8) (33.1) (10.8) (4.1) (0.8) (11.6) (88.5) Sri Lanlong 7 4 -- -- - -- 9 11 (35) (20) (45) (55) 1st Rec. Battn, R M R 13 8 5 -- -- -- 8 26 (38.2) (23.6) (14.7) (23.4) (76.5) Kesangtha 16 18 8 1 -- -- 9 43 (30.7) (34.6) (15.3) (1.92) (17.3) (82.7) Tg. Keling (Malaya school) -- 7 15 4 2 2 -- 30 (23.3) (50) (13.3) (6.65) (6.65) (100) Military Induction Center 2 9 13 5 1 -- -- 30 (6.65) (30) (43.3) (16.6) (3.33) (100) 5th Battn, R M R 7 13 16 3 -- -- 1 39 (17.9) (33.3) (40.0) (7.69) (2.56) (97.4) Batu Gajah 6 11 11 5 -- -- 6 33 (15.3) (28.1) (28.1) (12.8) (15.3) (81.6) Ben Ban School, Ben Ban 5 37 18 -- 1 -- - 61 Community Center (81.9) (60.6) (29.5) (1.63) (100) Fusing Village 11 18 16 4 1 -- 3 50 (20.7) (33.9) (30.9) (7.54) (1.87) (5.66) (94.4) 3 4 1 -- -- -- 1 8 (33.3) (44.4) (11.1) (11.1) (88.8) Ampeng Bahru 8 19 16 2 -- -- 3 45 (16.6) (39.6) (33.3) (4.16) (6.24) (93.6) Kampong Berchan (Chinese 9 5 4 2 -- -- 6 20 school) (34.5) (19.2) (15.3) (76.9) (23) (77) 1 6 13 2 -- -- - 22 (4.54) (27.2) (59.1) (9.09) (100) Source: https://www.industrydocuments.ucsf.edu/docs/snyc0227 TABLE X-34 (Continued) NUMBER OF PARASITE SPECIES PER PERSON BY LOCATION, FEDERATION OF MALAYA, 1962 Species No Total Location #1 #2 #3 #4 #5 #6 finding 1/ positive Alor Star High School 18 16 11 4 -- -- 5 49 (33.3) (29.6) (20.3) (74.2) (9.25) (90.7) Kampong Cumong (Malaya school) 4 25 42 24 9 4 0 108 (3.8) (23.1) (40) (22.8) (8.3) (3.8) (100) 3d Battn, R M R 21 27 9 2 1 3 60 (33.3) (42.8) (14.2) (3.17) (1.58) (4.76) (95.2) Total 391 632 572 187 35 10 146 1,827 (19.8) (31.7) (28.9) (9.5) (1.8) (0.5) (7.4) (93.3) 1/ Ten vials were broken. 2/ Figures in parentheses are percentages. 3/ R M R = Royal Malayan Regiment. Source: https://www.industrydocuments.ucst.edu/docs/snyc0227 APPENDIX II-1 SUGGESTED ENRICHMENT PROCEDURES FOR INCREASING INTAKES OF THIAMINE AND RIBOFLAVIN The low level of intake of thiamine and riboflavin by the civilians studied and the generally low levels of these vitamins found by the bio- chemical studies suggest that riboflavin and thiamine deficiencies exist in Malaya. On the other hand, the absence of firm clinical evidence of widespread avitaminosis would seem to indicate that there was generally adequate vitamin nutrition. If the population were examined in the latter part of the monsoon season, a period of nutritional stress, clinical signs of vitamin deficiency might be more apparent. The urgency of the need for vitamin supplementation should be decided on after a careful examination of the findings of this and other surveys. Increased vitamin intake can be most conveniently achieved by the enrichment of normally consumed foods. Various methods of enrichment with riboflavin and thiamine are presented below, followed by a discussion of the sectors of the population that would benefit from particular types of enrichment. Enriched Rice Rice enrichment can be attained by the addition of a highly enriched rice grain (premix) to regular rice so that the final product contains the desired level of vitamins. Amounts of premix are used to obtain 4.4-8.8 ppm (parts per million) of thiamine, 2.6-5.3 ppm of riboflavin, 37-70 ppm of niacin, and 28-57 ppm of iron in the final mixture. Premix grains should be coated with a layer of protective material such as confectioner's shellac to prevent loss of vitamins during any washing that precedes cook- ing of the rice. The use of riboflavin in a premix produces a yellow color in the enriched grains. This may reduce the acceptability of the product since a uniform white color is considered by many South Asians to denote high quality in rice. To obtain widespread use of premixed enriched rice it may be advisable to reduce the level of riboflavin in the vitamin mix- ture, or to exclude it entirely, in order to have a product with acceptable color characteristics. Premix, with or without riboflavin, is available from Thai Rice Company 691 Sathorn Road, River Bank, Bangkok Thailand Food Enrichment Enterprise 2219 Singalong Manila, Philippines 236 Source: https:/lwww.industrydocuments.ucsf.edu/docs/snyc227 Addition of premix to regular rice can be accomplished with machinery (Draver Feeders) available from B. F. Gump & Company 431 S. Clinton Street Chicago, Illinois U.S.A. The cost of the vitamins will be about $ M 1 per 1,000 pounds of final en riched product. Vitamin Wafers The addition of vitamins directly to the rice during preparation is the least expensive form of supplementation. It can be readily accomplish ed through the use of wafers designed for addition to stated quantities of rice. The desired concentration of thiamine and riboflavin in the wafer should be determined on the basis of the number of persons fed out of a single cooking vessel. Current sources of such wafers include Merk & Company, Rahway, New Jersey, U.S.A., and Hoffmann=LaRoche, Nutley, New Jersey, U.S.A. Fortified Condensed Milk Vitamins may be added to canned sweetened condensed milk. Riboflavin and thiamine should be added at the rate of 2 mg per 100 gm of canned milk or 8 mg per 14 ounce can. The cost would be about $ M 0.10 per 100 cans. Fortified Wheat Flour Wheat flour is an ideal carrier for supplemental vitamins. Enrich ment of flour to obtain riboflavin and thiamine levels of 10 ppm would make flour a good source of these vitamins. Virtually all the wheat flour is imported in bags; therefore the enrichment should be done at the flour mill before bagging. Flour is imported largely from Australia, although about a dozen other countries also export flour to Malaya. The protein content of Australian wheat is about 10 to 11 percent. Importation of wheat flour of higher prow tein content (14 percent) from the U.S. and Canada might be a means of in- creasing protein intakes generally. Diversification of the Food Supply Larger intakes of riboflavin and thiamine would result from larger consumption of green and leafy vegetables and legumes, which are easy to raise. Other foods that are good sources of riboflavin are durian, mush rooms, bullock's heart fruit and granidilla. Thiamine is high in grains, durian, bamboo shoots, garlic and pork. (The Second Five=Year Plan calls for a 50 percent increase in pork production.) 237 Source: https://www.industrydocuments.ucsf.edu/docsisnyc0227 The use of enriched rice would be of the greatest benefit to the urban population. This is a group which is quite particular about the quality or color of their rice and it is very doubtful that a riboflavineenriched rice would be popular. The enrichment of the rice milled in the innumerable small gasoline=driven mills of the countryside would be a difficult task, perhaps impossible to achieve unless the farmers themselves demanded the enrichment. These small mills supply the bulk of the rice consumed in the rural areas. The rural population would not benefit from an enrichment program unless a massive program were made to reach the small rice mills. The use of vitamin wafers is adapted to institutional programs such as military messes, hospitals and orphanages where supervision of cooking tech= nics is possible. Fortified condensed milk would be of benefit to that part of the popu lation normally consuming condensed milk. Since such fortification is simple and direct it should be put into practice even though it affects only a part of the population. Fortified wheat flour would be of principal benefit to the Indians and to the urban population. Use of wheat products by some rural Malays in the kampongs indicates that some enrichment of the rural diet could also be achieved in this way. 238 Source: https://www.industrydocuments.ucsf.edu/docsisnyco227 APPENDIX TABLE III-1. EMPLOYMENT IN SELECTED INDUSTRIES IN THE FEDERATION OF MALAYA, 19591/ 1000's of employees Estates - Rubber 282 Coconut 7.9 Oil palm 14.6 Tea 4.0 Pineapple 2.4 Mining os Tin 21.4 Coal 0.3 Iron 4.0 Manufacturing - Pineapple canning 1.5 Soft drinks 1.9 Tobacco 3.7 Engineering 6.1 Saw milling 6.5 Oil milling 1.2 Rice milling 1.9 Printing 3.7 Rubber milling 5.3 Transport - 27 Government - 182.3 1 See reference (1), Chapt. V. APPENDIX TABLE III-2. EDUCATION IN THE FEDERATION OF MALAYA, 1961¹/ Total schools 5,409 Total pupils 1,322,256 Total teachers 49,177 University of Malaya Students Agriculture 53 Arts 556 Science 203 Engineering 198 Total 1,010 1/ See references (1), (2) and (8), Chapt. V. 239 Source: https:/l/www.industrydocuments.ucst.edu/docs/snyc0227 APPENDIX TABLE IV-1. FOOD COMPOSITION VALUES USED IN CALCULATING MALAYAN INTAKES (in 100 gm portions) Carbo- Food Item Calories Protein hydrate Fat Calcium gm gm gm mg Cereals, bread, etc. Rice (home pounded) 359 7.1 78.0 1.1 14 Rice (fully milled) 360 6.7 79.0 0.7 10 Glutinous rice 362 6.7 79.0 0.7 12 Rice flour 363 7.4 79.0 0.5 (6) Wheat flour2/ 350 11.7 75.0 1.5 24 Sago flour 338 1.5 86.0 0.6 12 White bread, unenriched 276 8.2 52.3 3.3 65 White bread, enriched 276 8.2 52.3 3.3 65 Biscuits 364 7.5 79.4 0.8 17 Biscuits, Army specifi- cation 413 9.6 74.0 9.6 23 Protein foods (meat, fish, eggs, pulses, nuts, etc.) Beef, boneless 275 17.0 0 21.6 10 Beef, tinned 296 15.5 2.8 26.1 13 Stew beef, tinned (5/8 boneless) 171 11.0 0 13.5 5 Mutton, medium fat, E.P.37 317 15.7 0 27.7 9 Chicken, E.P. 200 20.2 0 12.6 14 Liver, beef 136 19.7 6.0 3.2 7.0 Liver, buffalo (see Liver, beef) Venison 146 15.1 0 9 9 Fresh fish 62 8.8 -- 2.7 15 Salted dry fish 125 25 -- 2 38 Fresh prawns 38 6.6 2 0.8 41 Cockles 20 3.2 3 0.4 36 Ikan bilis (anchovies) 310 62 -- 5 2,480 Dry prawns 295 62.4 1.8 2.3 247 Belachan (shrimp paste) 242 29.6 4.2 2.5 1,552 Squid, tinned 111 20.7 5.2 0.1 -- Egg (duck) 164 11.3 0.8 12.6 50 Egg (hen) 144 11.0 0.7 10.4 44 Dhall (pigeon peas) 343 20.9 59.5 1.7 29 Bean curd 58 6.3 3.1 3.1 46 1/ Names of the sources, in full, are presented at the end of this table. Numbers following the source are item numbers in source. Sources followed by (L.T.) are those recommended by Lady Thomson, Institute for Medical Re- search, Kuala Lumpur. Values in parentheses are imputed values. 2/ For military specifications wheat flour must contain per 100 gm of flour not less than: iron 1.65 mg, thiamine 0.24 mg, nicotinic acid 1.60 mg and creta praeparata 235-390 mg. Wheat flour from United Kingdom is so enriched. 3/ E.P. = edible portion. 240 Source: https://www.industrydocuments.ucsf.edu/docsisnyc0227 APPENDIX TABLE IV-1 (Continued) FOOD COMPOSITION VALUES USED IN CALCULATING MALAYAN INTAKES (in 100 gm portions) Thia- Ribo- Iron Vitamin A mine flavin Niacin Vitamin C Source 1/ mg IU mg mg mg mg 1.0 (0) 0.16 0.04 2.5 (0) F.A.O., 11 (L.T.) 0.9 (0) 0.08 0.03 1.6 (0) F.A.O., 12 (L.T.) 0.8 (0) 0.16 -- -- (0) U.S.D.A. No. 34, 20 (0.8) (0) (0.12) (0.03) (1.5) (0) U.S.D.A. No. 34, 19 2.4 (0) 0.32 0.07 1.7 (0) F.A.O., 2 1.0 -- (0) (0) (1.0) (0) F.A.O., 38 0.6 -- 0.05 0.08 0.9 0 U.S.D.A. No. 8, 134 1.8 -- 0.24 0.15 2.2 0 U.S.D.A. No. 8, 138 0.5 (0) 0.03 0.03 0.7 (0) U.S.D.A. No. 34, 38 (L.T.) 1.5 -- 0.07 0.05 0.7 0 Army specifications 2.6 44 0.07 0.15 4.1 -- U.S.D.A. , Armed Forces 2.6 30 0.03 0.13 1.8 -- Army specifications 1.6 27 0.05 0.10 2.7 -- Army specifications 2.4 -- 0.14 0.20 4.5 0 U.S.D.A. No. 34, 246a 1.5 410 0.08 0.16 8.0 (0) U.S.D.A. No. 34, 266a 6.6 43,900 0.26 3.33 13.7 31 U.S.D.A. No. 34, 240 1.8 (20) 0.11 0.20 5.0 0 F.A.O.S 184 0.5 20 0.03 0.07 1.2 -- F.A.O., 227 (L.T.) 1.0 ... 0.05 0.10 2.5 0 F.A.O., 240 (L.T.) 1.6 370 0.03 0.03 1.0 - F.A.O., 228; M.R.( C. 184 17.0 250 0.02 0.04 1.3 -- F.A.O., 229; M.R. C. 185 2.5 -- 0.12 0.25 6.1 -- F.A.O., 243 (L.T.) 6.3 (210) (0.14) (0.43) (6.5) (0) U.S.D.A No. 34, 314 14.8 -- 0.09 -- -- 0 Singapore tables -- -- -- -- -- -- Analyzed values 2.4 1,040 0.13 0.26 0.1 0 F.A.O., 217; U.S.D.A. No. 34, 319a 2.2 890 0.09 0.27 0.1 0 F.A.O., 215 (L.T.) ; U.S.D.A. No. 34, 321a 5.8 130 0.50 0.14 2.3 4 F.A.O. 63 1 (L.T.): Singapore tables 1.1 20 0.05 0.04 0.4 (0) F.A.O., 57 241 Source: https://www.industrydocuments.ucst.edu/docs/snyco227 APPENDIX TABLE IV-1 (Continued) FOOD COMPOSITION VALUES USED IN CALCULATING MALAYAN INTAKES (in 100 gm portions) Carbo- Food Item Calories Protein hydrate Fat Calcium gm gm gm mg Soya curd 71 7.0 3.0 4.1 100 Ground nuts 548 26.2 27.0 42.8 73 Green gram 340 23.9 58.0 1.3 145 Four-angled bean 27 1.9 3.1 0.2 63 Gelingua 340. 23.9 60.0 1.3 145 Jering nut 340 23.0 60.0 1.3 145 Vegetables Onions (small, red) 37 1.3 6.5 0.2 30 Lady fingers 31 1.6 7.8 0.3 66 Brinjal (eggplant) 20 1.0 5.5 0.2 12 Cucumber 10 0.6 3.2 0.1 7 Bean sprouts 32 4.2 4.5 0.7 38 Cabbage 17 1.1 5.3 0.1 35 Kankong (dark leaves) 22 2.4 4.9 0.3 131 Bayam (Amaranth, dark leaves) 22 2.4 4.9 0.3 131 Sawi (light) (mustard greens) 18 1.5 5.1 0.1 41 Fern shoots 18 1.5 3.5 0.1 41 Long green beans 32 2.2 6.9 0.2 52 String beans, tinned 18 1.0 4.2 0.1 27 Bamboo shoots 27 2.6 5.2 0.3 13 Tapioca shoots 18 1.5 5.1 0.1 41 Sweet potato tops 18 1.5 5.1 0.1 41 Lobak (dark green leaves) 22 2.4 4.9 0.3 131 Tomato, green, red 20 1.0 4.0 0.3 11 Red chillies (fresh) 28 1.2 6.0 0.2 7 Green chillies (fresh) 19 1.0 6.0 0.2 5 Dry chillies 246 12.6 37.7 4.5 159 Bitter gourd 29 1.1 6.6 0.3 45 Tapioca 131 0.9 32.7 0.2 25 White potato 70 1.7 17.0 0.1 7 Potato, tinned 58 1.7 13.0 -- 8 Sweet potato 97 1.1 23.7 0.3 28 Fruits Rambutan 63 0.8 14.5 0.1 25 Papaya 39 0.6 10.0 0.1 20 Banana 71 0.8 23.0 0.3 6 1/ Insufficient data. 242 Source: https:/lwww.industrydocuments.ucsf.edu/docs/snyc0227