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tent of 340 I.U. per pound and a maximum ash limit of 0.595 per cent. The adoption of these new standards did not materially increase its acceptance. The quantities of enriching ingredients per pound are: Minimum Maximum mg. mg. Thiamine 2.0 2.5 Riboflavin 1.2 1.5 Niacin 16.0 20.0 Iron 13.0 16.5 Calcium (from bone meal) 500.0 650.0 In 1944 enrichment of all flour imported into Newfoundland was made compulsory by the Government of Newfoundland. When Newfoundland entered confedera- tion with Canada in 1949, it was agreed that compulsory enrichment of flour would continue in Newfoundland, although en- richment was illegal under the Food and Drug Act of Canada. In 1953 the Food and Drug Act was modified to permit flour enrichment in any part of Canada. PUBLIC HEALTH BENEFITS OF ENRICHMENT The Newfoundland Report Having reviewed the history of enrich- ment, its factual basis and the means whereby it has been introduced, it remains to evaluate the success achieved in terms of public health and what remains to be done. Experience in Newfoundland still affords the most tangible evidence of the effect of enrichment on public health. The Newfoundland Survey39 showed broad aspects of improvement in public health following enrichment of all bread and flour for four years. Total mortality fell from 12.1 to 10.5 per 1000 population, and infant mortality fell from 102 to 61 per 1000 births. Deaths from tuberculosis dropped 25 per cent. Although other fac- tors also contributed to the improvement in health, there was a selective decrease in those signs of malnutrition which enrich- ment of bread and flour would be likely to correct. In spite of educational efforts to correct ascorbic acid deficiency by increas- ing the amount of vitamin C in the diet, the incidence of ascorbic acid deficiency had not improved. Fortification of margarine with vitamin A and enrichment of flour with thiamine, riboflavin, niacin, iron, and calcium were introduced in Newfoundland in 1944. By 1948 the signs of malnutrition had become less prevalent, and much of the apathy and listlessness which characterized the popula- tion in 1944 was no longer evident. There were also favorable changes in mortality statistics. In view of the results reported by Moore, and the studies on Newfoundland reported by Wilder et al40, one is led to the view that the Newfoundland diet must have had deficiencies which were definitely corrected by the addition of thiamine, riboflavin, nia- cin, and iron. Benefits in the United States A 1943 publication of the Food and Nu- trition Board41 contained the statement that "all the evidence from numerous surveys over the past ten years to the present among persons of all ages in many localities is without exception in complete agreement that inadequate diets were widespread in the nation." This view was based on find- ings in clinics of the nation and confirmed by dietary surveys made during the decade 1930-1940. The purpose of this review is " W. R. Aykroyd, N. Jolliffe, O. H. Lowry, P. E. Moore, W. H. Sebrell R. E. Shank, F. F. Tisdall, R. M. Wilder, and P. C. Zamecnik. Medical resurvey of nutrition in Newfoundland, 1948. Can. Med. Assoc. J. 60: 1 (1949) Grace A. Goldsmith, W. J. Darby, Ruth C. Steincamp, Anne S. Beam, and Ellen McDevitt. Resurvey of nutritional status in Norris Point, Newfoundland. J. Nutrition 40: 41 (1950) 40 R. M. Wilder. Recent nutrition survey in Newfoundland; significance of the findings. Presented at the Conference on Nutrition in Newfoundland, sponsored by The Nutrition Foundation, Inc., April 4, 1949. 11 National Research Council Bulletin 109. Inadequate diets and nutritional deficiencies in the United States. Washington, 1943. 16
