A pioneer dietitian: Audrey Cahn (a). (Retrospective).

This article provides an overview of the work and achievements of Audrey Josephine Cahn, one of Australia's pioneer dietitians. Her career commenced in the late 1920s when she was the first female student to complete a Bachelor of Agricultural Science at the University of Melbourne. Today, at age 96, Audrey maintains a lifelong interest in developments in nutritional research and education. She believes there has been a 'gradual but too slow understanding of nutrition and dietetics' in this country.

Audrey Cahn's work as an early dietitian--like all pioneers--involved tackling obstacles that have been cleared for those today working in the same field. In her case, these included male chauvinism, public ignorance and a degree of antagonism from the medical profession.

Today, the role of food in maintaining good health and high nutritional status is widely believed to be one of great importance. Several decades ago this concept was virtually non-existent, and a great deal of education, effort and enlightenment has been necessary to bring this idea to widespread acceptance. Audrey said recently that 'unfortunately the medical, university and health professions shared the general public perception that dietetics is a profession or trade suited only for women as a branch of cookery'.

The circles in which Audrey grew up encouraged all young people--both male and female--to pursue study at university. She was born and raised in the grounds of the University of Melbourne, and both her parents were instrumental in the introduction of dietetic subjects into courses there.

Audrey's father, Professor WA Osborne, was appointed to the Chair of Physiology in 1903. Her mother, Dr Ethel Osborne, had visited America and investigated hospital dietary departments with the aim of applying similar principles back in Australia. Together Audrey's parents instigated dietetic training leading to a postgraduate diploma at the University of Melbourne in the 1930s. They also collaborated in producing 'A Primer of Dietetics', the first textbook of its kind published in Australia. Later, Audrey made her own contributions to the inclusion of nutrition courses in tertiary education. She also visited the USA in 1957 where she said it was 'encouraging to see the considerable number of dietitians employed, not only in hospitals but in restaurants and other fields'. However, she was 'horrified' when she went on to the UK where dietitians were regarded as 'specialised cooks without professional status'.

Audrey's Bachelor of Science degree was in agriculture, because she 'liked animals and wanted to work in the great outdoors'. Following this, she was one of two students to first complete the new Postgraduate Diploma of Dietetics, introduced to the University of Melbourne in 1937. The next three decades were filled with appointments, ranging from cheese analysis to assessing the adequacy of diets in mental asylums to lecturing in nutrition and dietetics at the university where she was born.

Throughout her long career, Audrey Cahn pursued many directions in the fields of dietetics, food technology and catering. Her first appointment after graduation was as a microbiologist and food analyst in the dairy industry. Two scholarships of [pounds sterling]100 each enabled Audrey to conduct research into the physical properties of fat particles in milk.

This work was followed by many years' employment as a senior dietitian in a range of hospitals: St Vincents (Melbourne); Royal Perth Hospital; and, during the second world war, the Heidelberg Military Hospital. The Mental Hygiene Department also employed Audrey for one year to assess the adequacy of food provided to patients in mental wards across Victoria. Patients at that time were referred to as 'lunatics' in asylums. Audrey's overall findings concluded that the food given to lunatics was 'quite nutritionally adequate'.

Simultaneously with her hospital dietetic work Audrey carried out as much extra work in the field as possible. One major involvement in research outside normal duties was in the Melbourne Child Growth Study. The first of its kind in Australia, this longitudinal study commenced in 1954 and initially involved 60 boys and 60 girls. Its aim was to investigate patterns of growth and development in normal Australian children, especially skeletal growth and rate of maturation.

Food intake records and questionnaires were completed for each child, and the data analysed to assess the intake of selected nutrients. While the majority of children were found to be consuming diets that provided approximate nutrient levels as suggested in recommended allowances, a major discovery was that Australian children were relatively inactive and overweight. A number of published papers resulted from this study, related to nutrient intakes, meal patterns and physical activity of the children assessed. This research contributed to the revision of Dietary Allowances for Australians, and Food Composition Tables used in Australia.

Another early Australian dietitian, Nancy Hitchcock, spoke of the influence that learning of this study had on her future career path. She recalls Audrey Cahn as being one of the few dietitians who 40 years ago undertook research and published the results. Nancy considered the Melbourne growth study a significant and unique project in Australia because it was longitudinal and because it included nutritional assessment (1).

'To me, then a young recent graduate, this research, publication and presentation was a clear indication that there was more to dietetics than the clinical work that was our usual employment,' said Nancy.

Throughout her career Audrey wrote articles on many topics related to food and nutrition research. These included: vitamin C content of jams and canned juice; food intake and activity of urban adolescents; digestive dysfunction and orange juice; the composition of milk, and its nutritive importance; comparative nutritive values of meat pies and sandwiches; and chemical analysis of meat cuts before and after cooking by different methods.

As one of Australia's first dietitians Audrey faced some major difficulties. Unlike today, there was little public interest in nutrition. Some sectors of the health field did recognise the value of early dietetic work, such as the dental profession and those working outside the hospital environment. However, many of the medical professionals regarded dietitians as 'cooks without scientific knowledge', and there was little support or interest from nursing staff in the hospitals. This led to a sense of isolation for dietetic staff within the working hospital environment.

In an interview with Dr Leann Tilley, Audrey said, 'as far as nutrition and dietetics were concerned, the main problems have been the utter lack of understanding of nutrition as a science'. Nutrition was often regarded as a 'soft, or womens' field of science, and because dietetics was considered a female profession conditions of employment were relatively poor. In her first hospital appointment work contracts were informal and verbal, and the salary for early dietitians was meagre. Audrey observes that when men became involved in nutrition and dietetics, recognition of these professions improved as it helped to alter the prevailing chauvinistic attitudes. She also believes, compared with many other countries, it is a sad fact that few men and women have chosen to study nutrition in Australia.

At the outbreak of the second world war dietetics was a new profession in Australia. While the integration of women employed in the services (beyond nursing) was a slow process, the army was forced to reconsider old restrictions. This included the expanding fields of medicine, physiotherapy and dietetics in which women were increasingly employed (2). During the war Audrey Cahn joined the Australian Army as a dietitian, based at the Heidelberg Military Hospital in Melbourne. As senior dietitian she was responsible for the diet of the entire hospital population, both staff and patients. She also oversaw the cooks and kitchenhands, and a significant portion of the hospital's budget.

As in other hospitals in Australia at the time, the recognition of the value of dietetic work was very low at Heidelberg Military Hospital. Female officers were also less valued than the male officers. Women in the army were then classified as 'temporary gentlemen' and received two thirds of the amount men were paid.

Initially, women employed with the army as health professionals were members of the Voluntary Aid Detachment, and were not given officer status. However, with the formation of the Australian Army Medical Women's Service, Mrs Audrey Cahn overnight became Major Cahn. This made her the highest ranking woman at the hospital. She spent four years with the army and was responsible for general catering of the military hospital, while another dietitian was responsible for diet therapy.

Following this role, from 1947 until her retirement in 1968, Audrey worked back at the University of Melbourne. There, she lectured in nutrition, food service administration and food preparation in the Russell Grimwade School of Biochemistry. This lecturing role extended beyond the university to other educational institutions, and also continued after retirement.

Apart from lecturing, she organised and ran the practical classes leading to the Diploma of Dietetics. This involved food analysis through animal experiments and cooking classes. Audrey wanted her students to view nutrition from a wholistic perspective, and as preventative rather than therapeutic medicine. Her belief was in well-balanced diets, with real food rather than supplements in pill form. She has also said that the nutrition field suffered from the fact it evolved as a hospital-based discipline involving therapeutic intervention. She now believes a good advance is the employment of dietitians in fields other than hospitals.

Audrey Cahn's important contribution to the now highly regarded fields of nutrition and dietetics is reflected in her wide membership of relevant organisations. In the late 1940s she was a prime mover in negotiations leading to the formation of the Australian Dietetic Council in 1950, now known as the Dietitians Association of Australia (3). As a dietitian in Victoria, she was involved in the formation of the Victorian Dietetics Association in the mid 1930s.

She said, 'our main aim was to establish satisfactory training and registration. We were able to persuade the Victorian Government to form a Dietitians' Registration Board, in 1942. Sadly, in the mid 1990s, the Board was terminated'.

Also a founding member of National Dietetic Associations, and the Catering Institute of Australia, she belonged to a wide range of boards and committees concerned with nutrition and dietetics. Fellow dietitians at some of those national meetings today recall Audrey's 'very sensible and sound' and 'unflappable' manner, and the fact she was 'always ready to speak her mind'.

The high regard in which Audrey was held by staff and colleagues is reflected in this poem, written by two of her employees upon her departure from the Heidelberg Military Hospital in 1946:

Ode to the High Priestess of Kitchens Pay and M.S.

by two sadly disillusioned clerks

Oh, Commissioner of Catering, Exponent of the Culinary Arts,

Shall the peas, blue boiler still boil when your presence now departs

From this particular stew-brewing vale of tears

Where you've superintended the uses of left-over meats for
nigh on five years.

The cooks in the swimming pool will no longer valiantly swim --

The lemon essence will suffer at the hands of Banjo and Jim

The perfume will leave the cabbage, the stew will be lacking
in grease --

The inspirations that accompanied your presence will give a last
dying kick, and cease.

The office that's been your head-quarters will lose its
individual touch...

No more will your starving clerks want to raid the WAAAFery, MUCH.

The old bottom cupboard will be tidy, the requisitions will lose
their charms

When we don't spy you rushing from kitchen to office with the
roster clutched in your arms.

The QM will no longer function -- how could they without us to fight --

And Matron's stinging remarks will lose that particular brand of spite

That seems to be directed at us whenever there's battle in view

In spite of the fact that you've done your best to camouflage
the inevitable stew.

Oh, think of us, we beg of you, in nineteen ninety four,

Still battling against terrific odds to keep Repat. from the door...

Spare a thought in 'Civvie Street' for we who serve and stand and wait

Destined to a life of torture and pain by an unjust
military-minded fate.

WOE IS US

(a.) Merran Laver, a writer specialising in food and nutrition, is also Audrey Cahn's granddaughter. The information was obtained from interviews with Audrey Cahn, Win Garran and Nancy Hitchcock (all retired dietitians) in 2002 and an interview by Dr Leann Tilley of the School of Biochemistry, La Trobe University with Audrey Cahn in 1993.

References

(1.) Cahn A, Steel J. A review of the Melbourne child growth study. Proceedings of the Nutrition Society of Australia 1980;5.

(2.) Hunter-Payne G. On the Duckboards: experiences of the other side of war. Sydney: Allen & Unwin; 1995.

(3.) Nash H. The history of dietetics in Australia. Canberra: Dietitians Association of Australia; 1989.