HOME LONGEVITY
LIBRARY CATALOG
[Original pamphlet]
After more than a quarter of a century of medical benefit under the National Health Insurance Act we, the Local Medical and Panel Committee of Cheshire, feel that we are in a position to review our experience of the system. Constituted by the statute to represent the panel of an area, such a committee is in touch with all the family doctors--in the case of Cheshire some 600--within and on its borders.
How far has the Act fulfilled the object announced in its title--"the Prevention and Cure of Sickness"?
Of the second item we can speak with confidence. If "postponement of the event of death" be evidence of cure that object has been achieved: the greater expectation of life which is shown by the figures of the Registrar-General is attributable to several factors: but certainly not least to the services of the panel.
The fall in fatality is all the more notable in view of the rise in sickness. Year by year doctors have been consulted by their patients more and more often, and the claims on the benefit funds of societies have tended to rise.
Of the first item, "the prevention . . . of sickness," it is not possible to say that the promise of the Bill has been fulfilled.
Though to the sick man the doctor may point out the causes of his sickness, his present necessity is paramount, and the moment is seldom opportune, even if not altogether too late for any essay in preventive medicine. On that first and major count the Act has done nothing.
We feel that the fact should be faced.
Our daily work brings us repeatedly to the same point: "This illness results from a lifetime of wrong nutrition!"
The wrong nutrition begins before life begins. "Unfit to be a mother"--from under-nutrition or nutritional anaemia--is an occasional verdict upon a maternal death. For one such fatal case there are hundreds of less severity where the frail mothers and sickly infants survive.
The reproach of the bad teeth of English children is an old story. In 1936 out of 3,463,948 school children examined, 2,425,299 needed dental treatment. [1] Seeing that the permanent teeth develop from the seventeenth week of pregnancy, and that certain foods, accurately known since 1918, [2] are the condition of their proper growth, that is a reproach which should be removed. With it would go the varied host of maladies that spring from diseased teeth. That its removal is practicable is shown by Tristan da Cunha. Most of the population of the little island, people of our race, living on the product of sea and soil, have perfect teeth which last them their lives.
Rickets, for which England was a by-word when Glisson described it in 1650, is still with us. Gross deformities are rarer, but the big heads, tumid abdomens, flaccid skins, bulged joints, and pinched chests are a commonplace of infancy; and even at school age 3,457 cases of rickets with 6,415 others of spinal curvature were found in 1936 by the school medical officers in 1,777,031 inspections. [3]
Yet its prevention by right feeding is so easy that every dog breeder knows the means. [4]
Rickets is a heavy contributor to the C3 population. The maternal mortality committee found that there is much less in Holland, where butter, milk, and cheese are plentiful, and the women, by virtue of their generally healthy skeletal development, are protected against the risks that are commonly faced by women in the industrial areas of England. [5]
Nutritional anaemia is of two kinds, one subtle and apt to happen during pregnancy, the other simple and due to too little iron in the food. [6] It is known that anaemia, especially of the latter kind, is common, especially among children and women, who need much more iron in their food than men. An inquiry into the food of 1,152 families showed that 10 per cent spent 4s. a week per head on food, 10 per cent. spent over 14s., while four more groups of 20 per cent. each, spent 6s., 8s, 10s, and 12s. respectively. The food of the three lower groups was definitely deficient in iron. [7] It is certain from this that nutritional anaemia among the poorer classes is far commoner than is recognized. Here is an example: the blood colour was tested in two groups of school children, one a "routine sample" of children, the other specially selected on account of poverty. Only half the poor children and only three-quarters of the supposedly normal children had a blood colour of 70 per cent. of normal. [8]
The final item of our indictment is constipation. Advertised aperients are a measure of its prevalence, and the host of digestive disorders which result from it are a substantial proportion of the conditions for which our aid, as doctors, is sought. Yet the cause in every case--apart from rare abnormalities--is the ill choice or ill preparation of food. It is true that we are consulted on these conditions when they are established and have to deal with the effects--gall-stones, appendicitis, gastric ulcer, duodenal ulcer, colitis, and diverticulitis--of years in which the body has been denied its due of this constituent of food or burdened with an excess of that. Other means of cure than proper feeding are called for at this late stage; but the primary cause none the less was wrong nutrition.
Those four items--bad teeth, rickets, anaemia, and constipation--will serve as the heads of our indictment; but in truth they are only a fragment of the whole body of knowledge on food deficiencies which different investigators from Lind [9] and Captain Cook [10] to Hopkins [11] and the Mellanbys [2, 4] have unlocked.
But it seems to us that the master key which admits to the practical application of this knowledge as a whole has been supplied by Sir Robert McCarrison. [12]
His experiments afford convincing proof of the effects of food and guidance in the application of the knowledge acquired.
In describing his experiments, which were made in India, he mentions first the many different races of which the population, 350 millions, is composed.
"Each race has its own national diet. Now the most striking thing about these races is the way in which their physique differs. Some are of splendid physique, some are of poor physique, and some are of middling physique. Why is there this difference between them? There are, of course, a number of possible causes: heredity, climate, peculiar religious and other customs, and endemic diseases. But in studying the matter it became evident that these were not principal causes. The principal cause appeared to be food. For instance, there were races of which different sections came under all these influences but whose food differed. Their physique differed, and the only thing that could have caused it to differ appeared to be food. The question then was how to prove that the difference in physique of different Indian races was due to food. In order to answer it I carried out an experiment on white rats to see what effect the diets of these different races would have upon them when all other things necessary for their proper nutrition were provided. The reasons for using rats in experiments of this kind are that they eat anything a man eats, they are easy to keep clean, they can be used in large numbers, their cages can be put out in the sun, the round of chemical changes on which their nutrition depends is similar to that in man, and a year in the life of a rat is equivalent to about twenty-five years in the life of a human being. So that by using rats one gets results in a few months which it would take years to get in man. What I found in this experiment was that when young growing rats of healthy stock were fed on diets similar to those of people whose physique was good the physique and health of the rats were good, when they were fed on the diets similar to those of people whose physique was bad the physique and health of the rats were bad, and when they were fed on diets similar to those of people whose physique was middling the physique and health of the rats were middling." [12]
A special group which he fed on the food of Travancore, in which there is a considerable proportion of tapioca, disclosed a far higher percentage of gastric and duodenal ulcer cases than the other groups. This was informing, as the people of Travancore suffer with peptic ulcer very much more commonly than the other peoples of India.
"Good or bad physique as the case might be was, therefore, due to good or bad diet, all other things being equal. Further, the best diet was one used by certain hardy, agile, vigorous, and healthy races of Northern India." (Note: The Hunza, [13] Sikh, and Pathan.) "It was composed of freshly ground whole-wheat flour made into cakes of unleavened bread, milk and the products of milk (butter, curds, buttermilk), pulses (peas, beans, lentils, fresh green leaf vegetables, root vegetables (potatoes, carrots, and fruit, with meat occasionally.
"Now in my laboratory I kept a stock of several hundred rats for breeding purposes. They lived under perfect conditions: cleanliness, roomy cages, good bedding, abundant fresh water, fresh air, and sunlight--all these things they had; and they were fed on a diet similar to that of a race whose physique was very good. They were kept in stock from birth up to the age of 2 years--a period equivalent to the first fifty years in the life of human beings. During this period no case of illness occurred among them, no death from natural causes. no maternal mortality, no infantile mortality except for an occasional accidental death. In this sheltered stock good health was secured and disease prevented by the combination of six things: fresh air, pure water, cleanliness, sunlight, comfort, and good food. Human beings cannot, of course, be so sheltered as these rats were, but the experiment shows how important these things are in maintaining health.
DIET AND DISEASE
"The next step was to find out how much of this remarkably good health and freedom from disease was due to the good food: food consisting of whole-wheat flour cakes, butter, milk, fresh green vegetables, sprouted pulses, carrots, and occasionally meat with bone to keep the teeth in order. So I cut out the milk and milk products from their diet, or reduced them to a minimum, as well as reducing the consumption of fresh vegetable foods, while leaving all other conditions the same. What was the result? Lung diseases, stomach diseases, bowel diseases, kidney and bladder diseases, made their appearance. It was apparent, therefore, that the good health depended on the good diet more than on anything else, and that the diet was only health-promoting so long as it was consumed in its entirety; so long, in fact, as it contained enough milk, butter, and fresh vegetables.
"Many more experiments were done which showed that, when rats or other animals were fed on improperly constituted diets, such as are habitually used by some human beings, they developed many of the diseases from which these human beings tend to suffer: diseases of the bony framework of the body, of the skin covering it, and of the membranes lining its cavities and passages; diseases of the glands whose products control its growth, regulate its processes, and enable it to reproduce itself--diseases of those highly specialized mechanisms--the gastro-intestinal tract and lungs--designed for its nourishment; diseases of the nerves. All these were produced in animals under experimental conditions by feeding them on faulty human diets. Here is an example of such an experiment. Two groups of young rats of the same-age were confined in two large cages of the same size. Everything was the same for each group except food. One group was fed on a good diet, similar to that of a Northern Indian race whose physique and health were good, and of which the composition is given above. The other was fed on a diet in common use by many people in this country, a diet consisting of white bread and margarine, tinned meat, vegetables boiled with soda, cheap tinned jam, tea, sugar, and a little milk: a diet which does not contain enough milk, milk products, green leaf vegetables, and whole-meal bread for proper nutrition. This; is what happened. The rats fed on the good diet grew well; there was little disease among them, and they lived happily together. Those fed on the bad diet did not grow well; many became ill and they lived unhappily together, so much so that by the sixtieth day of the experiment the stronger ones among them began to kill and eat the weaker, so that I had to separate them. The diseases from which they suffered were of three chief kinds: diseases of the lungs, diseases of the stomach and intestines, and diseases of the nerves--diseases from which one in every three sick persons among the insured classes, in England and Wales, suffers." [12]
These researches were minutely made on a large scale, and but for the food the conditions of each group were identical and ideal. Their results to our minds carry complete conviction--especially as those of us who have been able to profit by their lesson have been amazed at the benefit conferred upon patients who have adopted the revised dietary to which that lesson points. [14]
It is far from the purpose of this statement to advocate a particular diet. The Esquimaux on flesh, liver, blubber, and fish; the Hunza or Sikh on wheaten chappattis, fruit, milk, sprouted legumes, and a little meat; the islander of Tristan on his potatoes, seabirds' eggs, fish, and cabbage, are equally healthy and free from disease. But there is some principle or quality in these diets which is absent from, or deficient in, the food of our people today. Our purpose is to point to this fact and to suggest the necessity for remedying the defect.
To descry some factors common to all these diets is difficult, and an attempt to do so may be misleading, since knowledge of what those factors are is still far from complete; but this at least may be said, that the food is, for the most part, fresh from its source, little altered by preparation, and complete; [22] and that, in the case of those based on agriculture, the natural cycle:
Animal & Vegetable Waste--> Soil--> Plant--> Food {Animal-->} Man
is complete. No chemical or substitution stage intervenes. [23]
Sir Albert Howard's work on the nutrition of plants, initiated at Indore and carried from India to many parts of the world, seems to constitute a natural link in this cycle. [16]
He has shown that the ancient Chinese method [17] of returning to the soil, after treatment, the whole of the animal and vegetable refuse which is produced in the activities of a community results in the health and productivity of crops and of the animals and men who feed thereon.
He has discovered the principles of the treatment of that refuse. These principles are complex, but the treatment is simple though precise. The following quotation from his writings embodies in practical form this factor of inestimable value to human health and economy.
"The Indore process is simple. A layer about 6 in. deep of mixed vegetable wastes is lightly covered with about 2 in. of farmyard manure followed by a good sprinkling of earth. If any wood ashes are available these are added with the soil. The proportion of mixed wastes to farmyard manure must not exceed 3:1 by volume. The sandwich process is repeated until the material in the heap or pit is after fermentation 3 ft. thick. The layers must be kept moist, but not wet, lest the air supply be interrupted. The moistened heap should resemble as far as possible a pressed-out sponge. The temperature rapidly rises to about 150° F. and the whole mass becomes covered with greyish-white mycelium. After two or three weeks the heaps or pits are turned and watered if necessary. A second turn and watering follows at the end of six weeks from the start, by which time the mass has crumbled and turned black. In three months from the beginning the carbon-nitrogen ratio falls from 33:1 in the original mixture to about 12:1, when the humus, which resembles old leaf-mould, is ready for the land.
"Over-acidity, faulty aeration, too much moisture, or an unsuitable site--any of these may present a passing problem in this country. Such problems must be tackled bearing in mind the special circumstances giving rise to them. In no case yet have they proved insoluble.
"The process is a partial reversal of the work of the green leaf. In the cells of the leaf simple substances obtained from the soil and the atmosphere are synthesized by means of the energy of sunlight into carbohydrates and proteids. The fungi and bacteria in the compost heap practically undo this synthesis until a comparatively stable condition of organic matter is reached in the shape of humus. This is the real food of the soil and of the crop. The second stage in breaking down the materials made by the leaf is only reached when the soil organisms oxidize humus into simple substances once more which can be absorbed by the roots of plants. The wheel of life has then completed a single revolution.
"It is not difficult to understand that the use of artificials in feeding the crop direct side-tracks a portion of Nature's essential round; artificial stimulus applied year after year and at the same times must inevitably breed evils, the full extent of which are as yet but dimly seen. The relation between quality and yield, for example, does not lend itself to scientific formulae. The time may come when yield will depend entirely upon quality, but quality can never under any circumstances depend upon yield. Factory-made manure is the weak link in the chain of agricultural economics."
It seems obvious to us that the new knowledge of nutrition compels our profession to return to the Hippocratic view--in so far as it has abandoned it--that a physician is a naturalist (phusikos) and to take cognizance of the other links of the cycle of Nature as well as of man, his patient. For only so can he understand his patient. Without pretension to agricultural knowledge we can appreciate the bearing of Sir Albert Howard's discovery on our work.
Whether his discovery can be harnessed to the problems of public health, to the sanitary disposal of municipal and village waste has, we understand, been investigated. That side of the matter does not closely concern us; but we understand that the disposal of town wastes on a large scale at Nairobi [18] on these principles has succeeded, and that Mr. E. F. Watson, superintendent of the Governor's Estates, Bengal, has applied the Indore method to the house refuse and night soil of smaller municipalities. [19] Whether the heat, 150° F., will kill the ankylostomum is a question to be answered.
Turning to England, we learn that at Bodiam in Sussex, at the large hop garden of Messrs. Arthur Guinness, Son and Co., Ltd., [20] the system disposes of many tons of the crushed refuse of Southwark with results satisfactory in all respects: and Captain R. G. M. Wilson's Iceni Estate in Lincolnshire [21] provides another illustration of this method of turning waste to wealth.
Though we bear no direct responsibility for such problems, yet the better manuring of the home land so as to bring an ample succession of fresh [23] food crops to the tables of our people, the arrest of the present exhaustion of the soil, and the restoration and permanent maintenance of its fertility concern us very closely. For nutrition and the quality [23] of food are the paramount factors in fitness. No health campaign can succeed unless the materials of which the bodies are built are sound. At present they are not.
Probably half our work is wasted since our patients are so fed from the cradle, indeed before the cradle, that they are certain contributions to a C3 nation. Even our country people share the white bread, tinned salmon, dried milk regime. Against this the efforts of the doctor resemble those of Sisyphus.
This is our medical testament, given to all whom it may concern--and whom does it not concern?
We are not specialists, or scientists, or agriculturists. We represent the family doctors of a great county--the county, said Michael Drayton, of "such as soundly feed"; a county which gives its name to a cheese than which there is none better, though to most Englishmen alas! only a name; a county where the best farming is still possible, which should minister to the needs of its own industrial areas and of a far wider circle.
We cannot do more than point to the means of health. Their production and supply are not our function. We are called upon to cure sickness. We conceive it to be our duty in the present state of knowledge to point out that much, perhaps most, of this sickness is preventable and would be prevented by the right feeding of our people. We consider this opinion so important that this document is drawn up in an endeavour to express it and to make it public; and the occasion on which it is to be announced has been organized in the hope of ventilating it; and we are happy indeed that Major-General Sir Robert McCarrison and Sir Albert Howard have agreed to be present and to address the meeting.
We wish to say finally that the interest taken in the matter by the Lord-Lieutenant of Cheshire, Brigadier General Sir William Bromley Davenport, K.C.B., C.M.G., C.B.E., D.S.O., who will be present, is sincerely appreciated.
(Signed by the Members of the Local Medical and Panel Committees)
John Kerr (Chairman)
N. A. Boswell (Vice-Chairman)
J. Barry Bennett (Hon. Treasurer)
F. G. Allan
H. Jaffe
G. Binns
J. H. Kerr
O. H. Blacklay
R. E. Loney
Harry E. Bower
W. S. Lynd
H. D. Brice
James Murphy
J. W. Chadwick
J B. Murphy
J. D. Chisholm
M. Parkes
R. B. Davidson
J. Noble Platt
W. W. Dickson
L. T Pollard
M. Dwyer
J. R Robertson
H. English
W. J. A. Russell
F. M. Fellows
W. E. C. Thomas
J B. Fulton
F. Wraith
R. F. Gerrard
Lionel Jas. Picton (Hon. Secretary)
Notes 1-24 are found at the very end of this
collection of documents:
---------------------------
[From Supplement to "The New English Weekly," April 6th, 1939.]
Nutrition & Soil Fertility
A Report of the Speeches of Sir Robert McCarrison, C.I.E., M.D., F.R.C.P. and Sir Albert Howard, C.I.E., M.A., Fellow of the Imperial College, at a Meeting at the Town Hall, Crewe, on March 22nd, 1939, in support of the Medical Testament of the Local Medical and Panel Committees of the County Palatine of Chester.
Sir Robert McCarrison, then spoke as follows:
In a book entitled "Studies in Deficiency Disease," which I published 19 years ago, I postulated, as a result of epidemiological, experimental and histopathological researches, that a large proportion of the common ailments of mankind were the direct or indirect consequences of faulty food: food deficient in certain essential substances--suitable protein, mineral salts and vitamins--and excessively rich in carbohydrates. I concluded an exhortation, contained in the introductory chapter to that book with a statement which I venture here to repeat:
With increasing knowledge of nutritional problems, it has become apparent that our dietetic habits need remodelling, and that education of the people as to what to eat and why they eat it is urgently necessary. It is clear that green vegetables, milk and eggs should form a far higher proportion of the food of the nation than is now customary. Municipalities and other public bodies should concentrate on the provision of an abundance of milk and vegetables, for there is no measure that could be devised for improving the health and well-being of the people at the present time that surpasses this either in excellence or in urgency.
Those of you who are familiar with the progress of research, on the relation of food to health and disease, during the past 19 years, will be aware of the great mass of evidence that has accumulated from all over the world, demonstrating beyond all possibility of doubt the truth of these statements.
You can imagine, then, with what pleasure I received last Christmas morning notice of the intention of the doctors of Cheshire to prepare a "Medical Testament" in which they would affirm--as a result of their experiences during the last few years--that a large part of the illness they are called upon to treat is the consequence of faulty nutrition, and this faulty nutrition the consequence of faulty food. You can imagine, too, with what gladness I read the passage in their "Medical Testament" in which amazement was expressed at the benefits accruing to their patients from the simple expedient of correcting defects in their diets; and with what whole-heartedness I would support their plea for the prevention of disease by these means. You can imagine, also, with what feelings of thankfulness I found the statement made in their 'Testament' that my own work had helped them, in some measure, to arrive at the conclusions set out in this remarkable document. It is with such feelings as these that I find myself on this platform to-day, glad of the opportunity, and of the privilege, to lend support to their movement, and impressed by the zeal and public spirit which have impelled them to make their convictions known....
The science of nutrition tends, day by day, to be- come more and more complex. Biochemical and other facts accumulate with such rapidity and cover so wide a field that for some amongst us there is the risk of failing to see the wood for the trees. It is well, therefore, to have certain guiding principles constantly in mind. The first of these is an understanding of the nature of nutrition; the second is awareness of the factors that disturb nutrition; the third is the knowledge that food--a chief, but not the only, instrument of nutrition--is the dominant factor in determining man's general physical endowment, powers of endurance and resistance to disease; the fourth is that a well constituted diet made up of fresh natural foodstuffs, largely lacto-vegetarian in character, contains all elements and complexes, known and unknown, needed for normal nutrition, so far as food can supply them, always provided that the fruits of the earth are produced on soils that are not impoverished. For me these four principles are the essence of the whole matter and their right application provides the means of preventing and alleviating a vast amount of human suffering no matter what future research has to reveal in regard to the factors in food responsible for this prevention and alleviation of disease.
The Nature of Nutrition.
"Nutrition" is one of the most misused words in the English language. Some people seem to think that it merely means "food"; others that it is a condition of body depending on food--a condition which may be good, bad or indifferent as the case may be. Actually it is a fundamental function on which the condition of the body depends. Food is the instrument, nutrition is the act of using it: the series of coordinated processes concerned in the growth, maintenance and repair of the living body as a whole or of its constituent parts. A primary purpose of the function of nutrition is, therefore, to establish and sustain the structure and function of all organs and parts of the body; to keep, in short the mechanism of the body in good repair and running order. Nutrition does for our bodies what we or our chauffeurs must do for our cars, in the way of constant attention to oiling, greasing, adjustment and fuel-supply, if they are to remain functionally efficient. Now health is that condition of body in which all organs and parts are sound and perform their functions duly, easily and satisfactorily. It follows, therefore, that the primary purpose of the function of nutrition is to maintain health; to prevent that disturbance of structure or function of organs or parts of the body which is disease. In these days, when the words 'nutrition' and 'malnutrition' are so loosely used, it is necessary to have this conception of the nature of nutrition as a fundamental function of the body, and of malnutrition as disorder of that function, constantly before us.
The acts and processes involved in nutrition are, many. They include respiration, the acceptance of food and water, mastication, deglutition, digestion, circulation, assimilation, and excretion--pulmonary, urinary, cutaneous and intestinal. Such, then, is 'nutrition': the most important of all functions of the body since upon it all other functions depend. I doubt whether in thinking of it we always think of all these processes as part of it: of 'excretion,' for instance, or of the efficient action of the bowels, the lungs or the skin. Yet they are as much a part of nutrition as is digestion. Nor do we, I venture to say, always remember that the efficiency of the processes involved in nutrition depends on the adequate nourishment of the organs and tissues responsible for them; of the nourishment of the gastrointestinal tract and endocrine organs, for instance. Nor do we always remember that proper exercise of the body not only aids the operation of the processes involved in nutrition but is actually essential to their fullest efficiency. Indeed, such exercise is part and parcel of nutrition.
Adaptation.
There is another aspect of "nutrition" which is often forgotten. I refer to adaptation: that peculiar property of the body and its constituent parts by virtue of which they adapt themselves to all sorts of conditions.
Let me give you a few examples of it: examples for which I am indebted to Alex Carrel's book, "Man the Unknown. "The body adapts itself to heat and cold, to wind and rain, to sun and soil, to altitude and sea-level, to sudden changes of climate, to the most varied kinds of diet. The exercise of its powers of adaptation to these environmental conditions stimulates all organic functions; and this exercise, this stimulation, is essential to well-being and to the acquisition of stamina, vigour, powers of endurance and resistance to fatigue. Thus "we resist cold as we resist heat, by nervous, circulatory, and nutritive changes of our whole body. All the organs as well as the skin are maintained in constant activity by exposure to heat, cold, wind, rain and sun. But when we spend our lives sheltered from the inclemencies of the weather our adaptive functions atrophy from disuse." (Carrel). We become "soft" and lack hardiness.
The same is true of different organs of the body. Thus, the stomach is designed by nature to digest all sorts of natural foods. But when we constantly present it with sloppy, disintegrated, highly sweetened, easily digested food it is relieved of half its work. It is deprived of the stimulus of effort and the less it has to do the less it does. So it becomes functionally inefficient. Quite recently an extensive inquiry was carried out in Sweden into the cause of the high incidence of achylia and its attendant gastro-intestinal ailments (colitis, constipation, etc.). One factor in its causation was found to be this very thing acting in association with vitamin-deficiency.
Factors influencing Nutrition.
The efficiency of the function of nutrition may be said, then, to depend on four things:
First, the adequate provision of the materials with which the nourishment of the body is effected; oxygen, water, food and a substance or substances produced in the skin by the action of sunlight.
Secondly, the efficient performance of each one of the acts or processes involved in nutrition.
Thirdly, the efficient exercise of the body and of its adaptive functions.
Fourthly, the avoidance of all influences which adversely affect nutrition: such, for instance, as over-eating, imbalance of the food, insufficient rest and sleep, smoke-laden atmosphere which cuts off the beneficient rays of sunlight, worry, emotional excitement, alcohol and infection. I often think that we fail to get the fullest benefits from properly constituted food owing to neglect of one or other or several of these things: such, for instance, as the sufficient consumption of water, proper action of the bowels, physical exercise, or adequate rest and sleep, especially in growing children.
So far I have spoken of the first two of the four guiding principles enumerated in my opening remarks.. The other two may be grouped together under the single heading:
Food, the foundation of Health
Food, as I have said, is the dominant factor in determining man's general physical endowment and powers of resistance to disease. The "Medical Testament" refers to certain experiments, carried out by me in India, which are amongst those the results of which led to this conclusion. Some of you may have read the account of them which the "Testament" gives, and those of you who have not will, I hope, do so, and be as convinced by their results as the authors of the "Testament" have been. It had been my purpose to refer to them myself in some detail but inasmuch as this document does so I shall content myself by summarizing their results in a few words. Some races of India are of fine physique and enjoy good health, others are of poor physique and subject to much disease. The dominant factor in the production of these differences is food. Those races whose diets are made up for the most part of whole cereal grains, legumes, milk and its products, green leaf and root vegetables, fruit and meat in moderation--"the protective foods," now so-called--are of fine physique and healthy, provided the foodstuffs are fresh and produced on soils that are not impoverished. Those whose diets are made up for the most part of denatured foodstuffs, such as polished rice, with little or no milk, milk products, fresh vegetables, legumes, fruit and meat, are of poor physique and subject to disease in great variety of form. Animals (white rats) fed on these diets respond to them in the same way: on the former diet they remain healthy; on the latter they become diseased. This is understandable when we remember what the functions of food are.
Food has two functions: the first, to provide materials--carbohydrates, fats, and, to a lesser extent, proteins--from which energy is generated for the vital activities; and the second, to provide materials--proteins, mineral elements, and vitamins - needed for the growth, maintenance and repair of the body as a whole and of its constituent parts, and for, the regula- tion of its processes. In accordance with these two functions, the food-stuffs available for our use are divisible into two classes: "the fuel foods" and "the protective foods."
The fuel foods are those rich in energy-bearing substances. They include the cereal grains, bread, potatoes, sugar and animal and vegetable fats. They may be likened to the petrol with which we provide our cars. Their combustion produces the energy needed for the work; of the body, as the combustion of petrol produces the energy needed for the work; of the car. And just as the engine of the car needs a suitable fuel-mixture, so does the engine of the body. The protective foods are those rich in protective substances--proteins, mineral elements calcium, phosphorus,, iron, iodine, etc., and vitamins. They are so-called because these substances protect the body against deterioration of its structure and functions. 'They may be likened to the oil, grease, adjustments and other attentions needed to maintain the efficiency of our cars. Without their adequate provision structure and function will assuredly suffer: disease will result, for disease is disturbance of structure or of function of organs or parts of the body. The protective foods protect us, therefore, against disease: disease most likely to arise while the body is growing. 'The chief protective foods are milk and its products, green leaf and root vegetables, fruit, legumes, eggs, fish oils, and meat--particularly glandular organs. Some of these are rich in one or more kinds of protective substances; some are rich in others. Their proper combination ensures the presence of all.
In this country everyone gets enough fuel foods, chiefly in the form of white bread, potatoes, margarine or butter; and nearly everyone gets enough protein in the form of meat of one kind or another. But many millions do not get enough of the protective foods. Consequently, they are prone to suffer from disturbances of structure or of function of organs or parts of the body, just as a car will when adequate oil, grease and attention are denied it.
Let our rule be, therefore, to select our foodstuffs, from the unsophisticated materials that nature provides. Let the energy-bearing foods be chosen not only because they are energy-bearing but because they are also protective: whole wheat flour, for instance, which is rich in mineral elements and vitamins of the B class, rather than white flour which is not. We are often told that provided the diet be varied enough there is no need for this; but the diet of millions of people is not varied enough. This "varied diet" string is one on which many are wont to harp, but it is a string that is often out of tune with modern conditions of life. So let us follow the example of the races of Northern India and consume the energy-yielding foods together with the protective substances that are linked to them by nature. Let us not divorce the one from the other; otherwise in balancing the constituents of the diet we will have to do for ourselves what nature does much better. There are four chief faults in the diets. of a great mass of the people in this country. First, the use of denatured white flour and of the bread, cakes, etc., made from it, in preference to the whole wheat flour, whole meal bread and whole cereal grains. Secondly, there is the excessive use of carbohydrate foods and the inordinate use of sugar, sweets and sweet cakes which is one of the outstanding dietetic vices of the day. This inordinate use of sugar disturbs the balance of the diet, causing it to be excessively rich in carbohydrate relative to vitamin B1--producing, in short, a relative deficiency of this very important vitamin--and, it impairs the appetite, especially in children, for more nutritious foods. Thirdly, there is the insufficient use of fresh, green vegetable foodstuffs in the form of salads. And fourthly, there is the insufficient use of safe milk; and the large consumption, by many people, of meat and other animal foods--a practice as unnecessary as it is uneconomical. This is not to decry meat, which is an excellent foodstuff, but to decry the excessive and wasteful use of it.
Before leaving the subject of the faults of British diets, let me read you an extract from a recent review article on the subject of wholemeal flour and bread versus white flour and bread. It was published in January of this year and may be taken as the latest, if not the last, word on the subject: Extract from a review article on " The Nutritive Value of Wheaten Flour and Bread," by ALICE MARY COPPING, Lister Institute, London, published in Nutrition Abstracts and Reviews, January, 1939. Vol. VIII No. 3. pp. 555.
If one sums up the evidence which has been collected in the course of this review it is quite clear that the change over from wholemeal to white flour, that took place when steel roller mills were introduced nearly 10 years ago, has resulted in reduction of the nutritional value of the protein, in serious lowering of the content of calcium phosphorus and iron, in reduction of the Vitamin B, and vitamin B2 complex content, and carotene content and probably in complete removal of the vitamin E, all representing dead loss nutritionally. In order to change back to wholemeal it is necessary to alter the tastes of the people and to overcome the vested interests in the existing milling industry, and to find means of using wholemeal flour more quickly and of storing it more satisfactorily. The advantages to be gained in national health would make it well worth while to overcome these difficulties.
Dietetic Malnutrition.
Malnutrition due to faulty food--dietetic malnutrition--is widespread. Poverty, ignorance, indifference and prejudice are responsible for it. While not attempting in any way to minimize the baneful influence of poverty it may be remarked that much call be done to ensure an adequate diet by the right choice of food, and that at relatively little cost. Much can be done with little to ensure a properly constituted diet if people set about it the right way and get rid of the idea that they are starving unless continually fortified with 'baked meats,' 'sugar and spice and all that's nice.' In regard to ignorance all that I need say is that our educational system is deplorably lacking in facilities for the acquisition of knowledge of food values. "We spend millions on feeding the minds of the youth of the nation. Is it not time that we spent a little (as an essential part of all school curricula) on showing those young people how rationally to feed their bodies and those of their prospective progeny?" (Lord Bledisloe).
Faulty nutrition, due usually to faulty food, is as you yourselves have found, responsible for a large proportion of human ailments. It is responsible for them because it gives rise to disturbances in structure and in functions of different organs and parts of the body--disturbances varying according to the nature of the food-faults--and because it lowers the resistance of the body to infection. Malnutrition and infection: these two, acting singly or more often in consort, are the chief causes of much of the disease to which man is erroneously supposed to be heir--erroneously because it is preventable. "Millions of people in all parts of the globe are either suffering from inadequate physical development or from disease due to malnutrition or are living in a state of sub-normal health which could be improved if they consumed more or different food. That this situation can exist in a world in which agricultural resources are so abundant and the arts of agriculture have been so improved that supply frequently tends to outstrip effective demand remains an outstanding challenge to constructive statesmanship and international cooperation." Such is the conclusion to which the Committee of the League of Nations on "The Problem of Nutrition" has arrived (1937).
Degenerative Diseases.
Within the lifetime of many of us, great progress has been made in the prevention of one of the two great classes of disease: the infectious diseases. But so far relatively little progress has been made in the prevention of the other great class: the degenerative diseases, such as rheumatism, heart disease, diabetes, nervous disease, kidney disease, gastro-intestinal disease, cancer and mental disease, to which under modern conditions of life man seems to have become more subject.
The degenerative diseases are due to physiological decay of the organs or parts of the body concerned, and of this decay malnutrition is a chief cause. It is preventable only by so adjusting our ways of life-- social, economic, agricultural and international--as to ensure for everyone a diet that will satisfy physiological needs. No expenditure, however vast, on health services, housing or physical training can ensure national fitness unless and until these needs be satisfied. Their satisfaction is the primary essential for national health. Their satisfaction is the first principle of good government.
[Sir Albert Howard said:]
For the last forty years I have devoted a large amount of my time to the study of the health of crops, to the health of the live stock which live thereon and to the discovery of the conditions necessary for both crops and stock to resist disease.
My qualifications for such an undertaking are these. I belong to an old agricultural family and was brought up on a farm. After a long training in science--three years devoted mostly to chemistry and physics at the Royal College of Science, London, and three years to biological subjects at Cambridge--I began research in agriculture in 1899 in the West Indies as a mycologist, where I specialised in the diseases of the sugar cane and cacao, and also began a study of tropical agriculture. My next post was Botanist at Wye College, where I was in charge of the hop experiments and where I had ample opportunities for the study of this interesting crop and its diseases. In 1905 I was appointed Imperial Economic Botanist to the Government of India at Pusa and for the first time was provided with real facilities for work--land, money, and freedom to grow crops in my own way and to observe among other thing, the reaction to insect and fungous pests of suitable varieties when properly grown. My real education as an investigator then began--six years after taking my degree and after obtaining all the paper qualifications then needed for research. My duties at the Pusa Research Institute, fortunately for me, had not been clearly defined and I escaped the fate of many of our agricultural investigators--a life devoted to a research organisation already becoming obsolete. It was possible, therefore, to attempt to break new ground and to try out an idea which had occurred to me in the West Indies, namely, to see what happened when insect and fungous diseases were left alone and allowed to develop unchecked and where indirect methods only, such as a combination of better varieties and improved methods of agriculture, were employed to prevent attack.
I took up all the land that was still available fit Pusa, some 75 acres, and spent my first five years in India ascertaining by practical experience the principles underlying health in crops. I rapidly discovered that my best teachers were the peasants of India themselves and Nature's own Professors of Agriculture, the insects and fungi which attack crops. By 1910 I had learnt a great deal from my new instructors--how to grow healthy crops practically free from disease without any help from mycologists, entomologists, bacteriologists, agricultural chemists, statisticians, clearing-houses of information, artificial manures, spraying machines, insecticides, fungicides, germicides and all the other expensive paraphernalia of the modern Experiment Station.
I then posed to myself the principles which appeared to underlie the diseases of plants:--
1. Insects and fungi are not the real cause of plant diseases and only attack; unsuitable varieties or crops improperly grown. Their true role is that of censors for pointing out the crops which are imperfectly nourished and so keeping our agriculture up to the mark.
2. The policy of protecting crops from pests by means of sprays, powders and so forth is unscientific and unsound as, even when successful, such procedure merely preserves the unfit and obscures the real problem--how to grow healthy crops.
I then took steps to have my own oxen and to ascertain, from first-hand experience, the reaction of well-chosen and well-fed animals to diseases like rinderpest, Johne's disease, septicaemia, foot and mouth disease and so forth which are so common in India. After a short time my animals duly came in contact with other oxen suffering, among other things, from foot and mouth disease. I have myself seen my oxen rubbing noses with foot and mouth cascs. Nothing happened. The healthy, well-fed animal reacted towards this disease exactly as improved and properly cultivated crops did to insects and fungi--no infection occurred.
These preliminary results suggested that the birth right of every crop and of every animal is health and that the correct method of dealing with disease is not to destroy the parasite but to make use of it for keeping agricultural practice up to the mark--in other words to regard the diseases of crops and livestock as Nature's Professors of Agriculture. These ideas were put to the test during the next 21 years at three centres in India, at all of which I had to manage large areas of land and look after numerous oxen: Pusa (1910-1924); Quetta (summers of 1910 to 1918); Indore (1924-1931). Everything possible was done to grow crops properly: everything possible was done for the livestock as regards food, hygiene and general management. The result was freedom from disease.
In the course of this work it was soon discovered that the thing that matters most in soil management is a regular supply of freshly made humus, prepared from animal and vegetable wastes, and that the maintenance of soil fertility is the real basis of health.
It was then necessary to study how best to convert vegetable and animal wastes into humus so that every holding and every farm could become self-supporting as regards manure. Eventually a simple method of composting these wastes was devised, tested and tried out on the 300 acres of land at the disposal of the Institute of Plant Industry, Indore. This area was manured with the humus made from the vegetable and animal wastes produced on the farm only. In a few years production more than doubled: disease to all intents and purposes disappeared. The results were published in book form in 1931 under the title "The Waste Products of Agriculture," by the Oxford University Press, just when I became due for retirement from tropical service.
Had it been possible to foresee the future, I should have added another item to my research programme--the raising on fertile soil of all the food needed by a section of the labour force and their families, so as to demonstrate the connection, which I am convinced exists, between humus and the health of mankind.
I hope some at any rate of the Experiment Stations of the world will rectify this omission at the earliest possible moment. It could also be done by any institution or any large estate in this country which controls sufficient land to feed the resident population. The contrast between the health of such a community and that of the countryside around would soon lead to "Medical Testament" No. 2.
Since 1931 steps have been taken to [act?] the Indore Process taken up all over the world and particularly by the plantation industries directed from London, including coffee, tea, sugar, sisal, maize, cotton, tobacco and rubber. In tea, for example, in 1938 not less than 1,000,000 tons of compost were being made every year: this was five years after the first trial had been completed. In coffee the progress has been even more spectacular. An account of the position at the end of 1935 has been published by the Royal Society of Arts in a pamphlet entitled "The Manufacture of Humus by the Indore Process." In all these trials the results have been the same: the conversion of vegetable and animal wastes into humus has been followed by a definite improvement in soil fertility, in the health of the crops and of the livestock. My own experience in India has, therefore, been repeated all over the world.
In 1935 it was decided to make a beginning in Great Britain at a few centres, so that the results could be written on the land itself--a method which tends to reduce discussion and argument to a minimum. The first large-scale trial was carried out on a market garden at Surfleet in South Lincs. by Captain R. G. M. Wilson, who in 1937 summed up his results as follows:--
"The method of humus making which has been employed is the Indore Process and it has proved remarkably successful. The output in the current year (1937) will be about 1,000 tons. As a result of this utilisation of humus, the land under intensive cultivation has already reached a state of independence and for the last two years no chemicals have been used in the gardens either as fertilisers or as sprays for disease and pest control."
A little later a much larger trial of the Indore Process was started at Bodiam in Sussex on the largest hop garden in Great Britain, the property of Messrs. Arthur Guinness, Son & Co. Here the old hop bine, hop string and the miscellaneous wastes of the garden have been composted with pulverised dustbin refuse from Southwark, about 10,000 tons of finished humus a year being manufactured. The results have been satisfactory in every way. Humus has proved considerably cheaper than artificials I have never seen healthier or finer hops than those grown on humus in this garden.
Another large-scale trial of humus has been carried out by Sir Bernard Greenwell on 13,000 acres of land in Surrey and Suffolk. Sir Bernard has composted the pulverised town wastes from Southwark with farm yard manure and vegetable wastes and has applied thousands of tons of humus to his land. He summed up his experiences in a paper read at the Farmers' Club on January 30th last, in the following words: "A fertile soil means healthy crops, healthy animals and last but not least healthy human beings." In the discussion which took place on this paper it was suggested that these words should be adopted as the motto of the Ministry of Agriculture and of the Ministry of Health.
I am convinced that it will be only a few years before this motto is put into practice all over the country: Quality and taste in food is all-important as every owner of live stock ill this country fully realises. What is true for animals is surely true for ourselves.
How does humus affect the health of plants? The mycorrhizal association provides the clue. Living threads of fungous tissue pass from the humus in the soil into the active roots and are digested there.
This happens in practically all crops and particularly in the grasses and clovers of our best pastures. This explains why a really good pasture will feed a bullock and yield high quality meat, milk and cheese. Humus, of course, will feed a plant in another way, by providing indirectly the small quantities of nutrients needed by the green leaf for growth. Artificials only supply salts for the leaf and cannot, therefore, influence quality. For this reason the use of sulphate of ammonia on some of the celebrated pastures of Europe has led to loss of taste and quality in the meat and in the cheese. A fertile soil on the other hand influences both quality and yield and therefore health.
The view that soil fertility is the basis of the public health system of the future is incorporated in the "Medical Testament" which is before this Meeting. I am convinced that the adoption of this document will help to place medicine on a new plane. That portion of the National Health Insurance Act dealing with the prevention of sickness will be developed. Agriculture will fall into its proper place as the real foundation of preventive medicine. The medical profession will come into its own as the guardian of the greatest of our national possessions--a healthy, virile, sturdy population. This will give the country real security. A Great Britain properly nourished can face the world in arms.
The Lord Lieutenant of Cheshire, Brig.-General Sir William Bromley-Davenport, K.C.B., C.M.G., C.B.E., D.S.O., in moving a vote of thanks to the speakers, paid tribute to the care with which the "Medical Testament" had been drawn up by Dr. Picton, Secretary of the Cheshire Panel Committee.
"The Testament" was unanimously adopted by tile audience of over 600 persons, representing the County of Cheshire, the County Council, the Medical profession and the National Farmers' Union.
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[The Cheshire Medical Testament Was then published in the British Medical Journal, London, Saturday, April 15, 1939, entitled "Nutrition, Soil Fertility, and the National Health."]
MAY 27, 1939
SIR,--MY attention has been drawn to Dr. R. R. Bomford's letter in your issue of May 13, in which he asks for evidence for the view that the nutritive value of vegetables and other crops depends on humus prepared from vegetable and animal wastes. This is set out in two documents--(1) the references appended to the Medical Testament, a closely printed pamphlet of 28 pages, and (2) the proceedings of the public meeting held at Crewe on March 22 last at which the Testament was unanimously adopted. This latter paper appeared in the New English Weekly of April 6, the reprints of which ran to another 25 pages of print. Had Dr. Bomford been able to study these documents I feel sure his letter would not have been written.
No mysticism is needed to prove that crops grown in soil manured with humus contain a factor or factors necessary for animal nutrition which are often absent when artificial manures are used. It is only necessary. to feed such crops to animals or human beings end to observe the results. Two recent examples of such experiments will suffice.
At Marden PARK in Surrey, Sir Bernard Greenwell has found that a change over to a ration of fresh home-grown food (raised on soil manured with humus) fed to poultry and pigs has been followed by three important results: (1) the infantile mortality has to all intents and purposes disappeared, (2) the general health and well-being of the livestock has markedly improved; (3) a reduction of about 10 per cent. in the ration has been obtained because such home-grown produce possesses an extra satisfying power.
At a large preparatory school near London, at which both boarders and day boys are educated, the change over from vegetables grown with artificial manures to produce grown on the same land with Indore compost has been accompanied by results of considerable interest to parents and to the medical profession. Formerly, in the days when artificials were used, cases of colds, measles, and scarlet fever used to run through the school. Now they tend to be confined to the single case imported from outside. Further, the taste and quality of the vegetables have definitely improved since they were raised with humus.
How does humus affect the quality and nutritive power of a crop? The mycorrhizal association in the active roots provides the clue. Living threads of fungous tissue pass from the humus in the soil into the active roots and are digested there. This happens in practically all crops and explains why a fertile soil produces crops resistant to disease and of high nutritive value. The plant feeds in two ways: (1) by means of the carbohydrates and proteins synthesized in the green leaf by the energy of sunlight, in which process the salts, absorbed in dilute solution from the soil, play an essential part, and (2) by the direct digestion of fungous tissue in the cells of the active portion of the surface roots. Artificial manures only influence the work of the leaf, and therefore only partially feed the plant. Humus influences both the leaf and-the mycorrhizal association, and is therefore a complete and balanced plant food. This explains why crops raised with artificials are so liable to disease and so deficient in quality and satisfying power, and why crops raised on humus resist disease and provide real nourishment for the animal.
A great deal of work on the effect of humus on the crop, on the animal and on mankind has been in progress all over the world since the Waste Products of Agriculture--in which the scientific principles underlying the Indore process are set out--was published by the Oxford University Press in 1931. The results are everywhere the same. A fertile soil leads to healthy crops, healthy animals, and last, but not least, to healthy human beings. Each centre which adopts the Indore process becomes a focus for the revolution in agriculture which is now proceeding. The results are being written, not in the transactions of the learned societies but on the land itself. The rapid progress that is being made depends not on mysticism or on special pleading, but on the one unanswerable argument --success.--I am, etc.,
Blackheath, S.E., May 17.
ALBERT HOWARD
SIR,--After the unanimity of acceptance with which the Cheshire Testament has been received the criticism of our views in the courteous letter from Dr Richard Bomford of New York was stimulating. The question is whether the cycle
Animal & Vegetable Waste--> Soil--> Plant--> Food {Animal-->} Man
is essential to health or whether, as Dr. Bomford suggests, a solution of chemicals might be substituted for the first two items. To grow food crops in nutrient solutions might, he thinks, be of the utmost importance in rapid expansion of food production in an emergency; but that if, as Sir Albert Howard holds--and we who accept his teaching--organic manure of both animal and vegetable origin be an essential link in the cycle, this hope is illusory. But, he continues, it is for the committee to bring forward more evidence for their views than is contained in the Cheshire Testament. Well, Sir, we have done so.
With the Testament, as issued in Cheshire, a body of references was circulated, a twenty-eight-page document substantiating all our statements. "Out of the earth," says Sir Robert McCarrison, "are we and the plants and animals that feed us created and made, and to the earth we must return the things whereof we are made if it is to yield again foods of a quality suited to our needs." We quoted that wonderful book by Dr. Bomford's countryman, Professor King, published incomplete and posthumously, Farmers of Forty Centuries, which is a mass of information on the way the Chinese for 4,000 years have organized the composting of all vegetable, animal, and human wastes, and after their most skilful preparation the return a the soil at the optimum momen of the resultant fertiliser. It is this system which alone has made possible their 500 million self-supported'population. And we quoted Viscount Lymington's remark that the book "should have made all Western doctors and biological scientists re-think and re-value everything they ever thought or dreamt." We quoted Sir Albert Howard's note on the effect of the composted town wastes of Nairobi--"the results obtained on controlled experimental plots of flowers, vegetables, maize, grassland, and coffee have been amazing." The sales of the compost already in 1934 were 3,400 tons at 14s. We quoted Mr. Haynes, the manager of the Bodiam hop garden of Messrs. Arthur Guinness and Son, that on their 500 acres he uses 10,000 tons a year of a compost of ashbin refuse, hop bines, string, etc. We quoted Captain Wilson of Surfleet as giving up chemical manure for compost, and saying that formerly his potato crop was sprayed four or five times and now it is only sprayed once, and this, it is hoped, will also be dispensed with before many years, when the land has become healthy end in a proper state of fertility."
A day or two ago I said to a farmer, "Tom, what about this--manure for the potatoes?" [The dash is not an expletive, but the name of a firm of chemical manufacturers.] "Oh," he said, "we mun use it. Our customers won't look at little uns and we've got to have the weight; but"--here he smiled slyly--"we allus set two drills for ourselves wi'out it"
To return to our references, one of many would alone carry conviction--about Sir Albert Howard's oxen at Indore. Fed on the product of his 300-acre farm, entirely manured with compost, they never took the foot-and mouth disease or the rinderpest, "which frequently devastated the countryside." Sir Albert told me he had seen his animals rubbing noses with his neighbours' cattle, which at the time were streaming with foot-and mouth disease. Yet nothing happened: his beasts were immune! Finally we pointed to the explanation given by Sir Albert Howard of the effect of the compost: not only does it recreate the crumb structure of the soil and furnish the soil population with food--that population includes earthworms which aerate the soil, and which chemical fertilizers drive away--but it (compost) "is essential for the full activity of the mycorrhiza." It is because of that, to answer Dr. Bomford, that you can not beneficially interfere with the natural cycle by chemical means. In the presence of "inorganics" the mycorrhiza (the root-investing fungi which act as the intermediary between the humus and the plant, their mycelial threads actually entering the root-hairs and being therein digested) disappear!
"When plants like French beans are grown on poor soil by means of artificial manure the produce is tasteless and of poor quality. For real taste and quality it is necessary to use humus made from vegetable and animal wastes or farmyard manure. A supply of combined nitrogen appears to reach the plant by way of the nodules [the nitrifying nodules on the root-hairs of the Leguminosae] and root-hairs; and materials which are needed for quality appear to be absorbed by the mycorrhiza. . . . The mycorrhizal association occurs in most if not all our crops--cereals, fruit trees, grasses and clovers, hops, strawberries, vines, bulbs, and so forth--and it at once explains why farmyard manure gives better results than artificials . . ."
Dr. Bomford invites us to refrain from taking sides in this matter. We cannot refrain. It is a primary concern of preventive medicine. The water-culture of tomatoes--and tomatoes are one of the few food crops in which the mycorrhizal association has not so far been found, I am told--may, as Templeman and Watson say, "always be of academic interest"; but that should not deflect attention from the great national problem of dwindling soil fertility and of the present ignorance--terrible in view of the need--of the means of restoring it by town wastes. Southwark alone seems to be alive to their value, and sold last year £2,715 worth of ashbin rubbish for composting. Should any still feel that the value of humus-grown food for human beings is in doubt a perusal of Dr. Wrench's Wheel of Health would be convincing.--I am, etc.,
LIONEL JAS. PICTON.
Holmes Chapel, May 14.
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A FEW years ago the Cheshire Panel Committee issued their "Medical Testament," in which they said that the first of the two objects of the National Health Insurance Act had not been attempted. That object was "the prevention of sickness." The authorities had contented themselves with the second, "the cure of sickness."
The Panel Committee, consisting of thirty-one family doctors, saw that the prevention of sickness depends on right feeding. In this matter, as a nation, "we have left undone the things that we ought to have done and done the things we ought not to have done, and there is no health in us."
An extreme statement, to attribute all illness to wrong food? Yes, I agree that it is seldom possible to trace a particular illness to the food the patient had been eating. But the Panel Committee was looking at lifelong conditions and at the nutrition of the mothers of the race. Here, in quotations from their own words, is their argument:
"Of the first item, the Prevention . . . of Sickness, it is not possible to say that the promise of the Bill has been fulfilled.
"Though to the sick man the doctor may point out the causes of his sickness, his present necessity is paramount, and the moment is seldom opportune, even if not altogether too late, for any essay in preventive medicine. On that first and major count the Act has done nothing.
"We feel that the fact should be faced.
"Our daily work brings us repeatedly to the same point: this illness results from a lifetime of wrong nutrition!
"The wrong nutrition begins before life begins. "Unfit to be a mother"--from under-nutrition or nutritional anaemia--is an occasional verdict upon a maternal death. For one such fatal case there are hundreds of less severity where the frail mothers and sickly infants survive.
"The reproach of the bad teeth of English children is an old story. In 1936 out of 3,463,948 school-children examined 2,425,299 needed dental treatment. Seeing that the permanent teeth develop from the seventeenth week of pregnancy and that certain foods, accurately known since 1918, are the condition of their proper growth, that is a technical reproach which should be removed. That its removal is practicable is shown by Tristan da Cunha. Most of the population of the little island, people of our race, living on the product of sea and soil, have perfect teeth which last them their lives."
Here is another illustration of the Panel Committee's contention about this matter of teeth: a thousand Indian and a thousand Chinese labour recruits on the Singapore base (1923 onward) were examined, and their dental condition was compared with that of our men. "The teeth were larger and stronger, apparently more fully developed; the arches were wide, making room for full development; uniformity and white ivory aroused one's wonder and envy." "Eighty-seven per cent. of Indians and 67 per cent. of Chinese exhibited this standard of complete and perfect teeth, free from defect, every tooth doing its duty. A similar examination of the active service personnel of one of H.M. ships in 1921, representing a highly select and well-cared-for part of the general population, revealed only 75 per cent. of the standard of perfection, but even these lacked the uniformity and ivory-like whiteness of the Asiatic teeth" (Surgeon-Captain Given, R.N., in The British Medical Journal, December 27, 1941.) The explanation is not race: the Tristan islanders are of our own race.
The Panel Committee pass from teeth to rickets, the prevention of which by right feeding "is so easy that every dogbreeder knows the means "; and to nutritional anaemia which Sir John Orr has shown is only too common at the lower income levels of the population; and to constipation:
"Advertised aperients are a measure of its prevalence, and the host of digestive disorders which result from it are a substantial proportion of the conditions for which our aid, as doctors, is sought. Yet the cause in every case--apart from rare abnormalities--is the ill choice or ill preparation of food. It is true that we are consulted on these conditions when they are established and have to deal with their effects--gallstones, appendicitis, gastric ulcer, duodenal ulcer, colitis, and diverticulitis--of years in which the body has been denied its due of this constituent of food or burdened with an excess of that. Other means of cure than proper feeding are called for at this late stage; but the primary cause none the less was wrong nutrition.
"Those four items--bad teeth, rickets, anaemia, and constipation--will serve as the heads of our indictment, but in truth they are only a fragment of the whole body of knowledge on food deficiencies which different investigators from Lind and Captain Cook to Hopkins and the Mellanbys have unlocked.
"But it seems to us that the master key which admits to the practical application of this knowledge as a whole has been supplied by Sir Robert McCarrison."
The Panel Committee go on to describe his experiments and studies of the diets of the many races and myriad people of India. The results of those experiments and studies carried to their minds complete conviction, "especially as those of us who have been able to profit by their lesson have been amazed at the benefit conferred upon patients who have adopted the revised dietary to which that lesson points."
It is the purpose of this volume to hand on that lesson, to disclose it to the public in a form readily understandable, and to do one other thing--to establish quality, quality dependent upon the way in which the food is grown and produced, as of the essence of the matter.
"It is far from the purpose of this statement [I again quote from the "Medical Testament"] to advocate a particular diet. The Esquimaux, on flesh, liver, blubber, and fish; the Hunza or Sikh, on wheaten chupatis, fruit, milk, sprouted legumes, and a little meat; the islander of Tristan on his potatoes, seabirds' eggs, fish, and cabbage, are equally healthy and free from disease.
"But there is some principle or quality in these diets which is absent from, or deficient in, the food of our people to-day. Our purpose is to point to this fact and to suggest the necessity of remedying the defect.
"To descry some factors common to all these diets is difficult and an attempt to do so may be misleading, since knowledge of what those factors are is still far from complete*; but this at least may be said, that the food is, for the most part, fresh from its source, little altered by preparation, and complete; and that the natural cycle,
Animal & Vegetable Waste--> Soil--> Plant--> Food {Animal-->} Man, is complete."
[* Sir Robert McCarrison, in a letter to the writer, says, "There is 'something' in freshness and quality of food which is not accounted for by the known chemical ingredients of food: proteins, fats, carbohydrates, minerals, and vitamins."]
This is as true of the harvest of the sea as of the land. An interesting sidelight is that artificial sea-water, chemically identical with the analysis of ocean water, wil1 not maintain the life of fish from the ocean.
In the natural cycle no chemical or substitution stage intervenes. How well our peasantry know this! I said to one "Tom, do you use chemical manure for potatoes?" He replied, "Oh, yes, we must; we want the size and the weight." He saw my dubious look: "Well, yes; we want the fat cheques--but--we always set two rows for ourselves without it." The loss of quality, of taste, and of 'using' condition, of the product of side-tracking nature by the use of chemical manures, is perfectly well known to the sons of the soil.
The attempt to short-circuit the natural cycle, which began with Liebig in the eighteen forties, and which has obsessed agriculturists ever since, was innocent enough at its inception.
"The accidental discovery of concentrated manure, which serves all the purpose of horse or town manure, is also a great help to the farmer. So long as guano lasts the tenant may augment his crop in proportion to the quantity he can purchase, and a ton of boiled bones upon an acre of grassland, and at a cost of from £3 10S. to £4 10S., will double its value."
So says "Law Rawstorne, Esquire," in The New Husbandry (1849). Unhappily, he and his successors failed to realize two vital factors that the intervening years were to teach: (1) that concentrated manure renders available the reserves stored in the soil by, I had almost said, 'early agricultural piety,' for so I think of the reverent return to the soil of all that has ever come from it; and (2) that guano and bone-dust are all very well, but all dusts are not the same dust; the chemical dusts which this new husbandry led up to are like a money-lender's loan to the spendthrift heir of an old estate.
At all costs the natural cycle must be preserved, and for two reasons, one of which, the robbery of the soil-fertility by artificials, has just been mentioned; the other of which is thus:
"The ancient Chinese method of returning to the soil, after treatment, the whole of the animal and vegetable refuse which is produced in the activities of a community results in the health and productivity of crops and of the animals and men who feed thereon."
That, indeed, is the conclusion of the whole matter. The principle or quality in the diets of those peoples whose health is outstanding is that the food comes fresh and from a soil rendered fertile by Nature's round, the circulation of organic matter.
We owe to Sir Albert Howard the revelation of the way this circulation works. It is at its best in the forest, where Nature slowly but surely maintains perennial fertility without our aid. It is at its second best in peat, which is sour and close. He has disclosed the secrets of the fungus and microbic processes the Chinese have used, and made them easy of understanding. By his lifetime of labour the intimite complexities of soil management, both in farm and garden, are sweetened and made broad and plain for anyone of goodwill to grasp and employ. His work at Indore disclosed methods whichwe can all use. Soil so handled, even if in poor condition, improves the first year, becomes fully fertile in three or four, and yields crops--corn, apples, bush fruits, roots, potatoes, tomatoes, greens, and salads which, besides being well grown, are of unrivalled quality and which are to an astonishing extent disease-resistant. A head gardener recently showed me a bed of strawberries. "All mine had 'yellow-edge.' There is no cure but to grub them up and burn them--say the experts. I replanted mine in compost, and just look at them--not a trace of disease!"
Evidence in great volume exists that the health of people living on compost-grown food is exceptional; but as the evidence is necessarily derived from what we are pleased to call 'primitive races,' such as the Burusho of Hunza, who preserve in this modern world an ancient civilization, it is difficult to gather and table. But active work is being done at home, and in the now countless places throughout the world where Indore composting is carried out this work is yielding indications of rich promise of better human health.
To be healthy, children must be born of mothers who eat well-chosen food. To be fully healthy, with full joy of life and stamina, the food must be grown by the simple but supreme agriculture which has now been disclosed. And the same is true of the children in infancy and adolescence. And the same is true of man and woman. If you build a house of defective materials, however good the plan or even the workmanship, the house will be defective. The plan on which a baby is built is his heredity; the materials are the food his mother ate--there is none other. Those given him by the milk of the breast in his first year are from the same source. I do not think it irreverent to say that the primary means of grace in the early stage of life are right choice and right quality of food; both must be employed if you would have the hope of glory.
— From "Feeding the Family in War-time, Based on the New Knowledge of Nutrition" by Doris Grant, Harrap, London, 1942.
Sir Robert McCarrsion on Diet for Health:
There is, therefore, no longer any doubt as to what the right kind of diet is. It is one made up of the following eight classes of foodstuffs:--
And it is on diets made up for the most part of these that you must live if you wish to be vigorous, hardy and healthy and to remain healthy.
The Teeth.
"Of great practical iimportance was the observation that the feeding of the mother during pregnancy and lactation might have an even greater effect on the development and structure of the permanent, than of the deciduous teeth of the offspring." --[Sp. Rep. Ser. Med. Res. Coun., London. "Vitamins: A survey." p. 91]
Also:--
(b) (1934) Drs. Wilfrid Fish and Leslie Harris, D. Sc., in 1934 drew attention to shortage of Vitamin C causing poor dental enamal and cement.
(c) (1937) Dr. Evelyn Sprawson. London Hospital. Stated that children in the institution in which he worked who were fed on raw milk had perfect teeth whereas others in circumstances identical in all respects except that their milk was pasturized had defective teeth.
(a) J. Wilkinson: Views summarised under "Anaemia," Rolleston's Encyclopaedia of Medicine.
(b) C.C. Ungley: Gouldstonian Lectures for 1938. 'Lancet': 23rd April, 1938, p. 925.
'Some deficiencies of Nutrition': II 'Nutritional Deficiency in relation to Anaemia.'
He refers, inter alia, to the observation by Lucy Wills, [B.M.J. 1931, vol I. p. 1059] that deficiency of "a substance associated with the Vitamin B complex" might play a part in the causation of pernicious anaemia. In certain tropical anaemias, often arising in pregnancy, and always associated with poor diets, Wills observed that Marmite, that is autolysed yeast, was as effective as liver extract. Large doses are given, a drachm 2 to 4 times a day, and the complicating oedema rapidly disappears.
Scurvy.
Lind recognised the value of green salads:--"Salads of any kind are beneficial; but especially the mild saponaceous herbs, dandelion, sorrel, endive, lettuce, fumitory, and purslain. To which may be added scurvy-grass, cresses . . . " For medicines in scurvy, he continues, "there is no great occasion, provided the green herbage and fresh broth keep the belly lax. . . "
"Sour Krout, of which we had a large quantity, is not only a wholesome vegetable food, but in my judgement highly antiscorbutic, and it spoils not by keeping. . . By this means the disease was prevented getting a foothold on the ship." At first the sailors would not eat it, but "the moment they see their superiors set a value upon it, it becomes the finest stuff in the world and the inventor an honest fellow. . . "
"Rob* of lemon and orange is an antiscorbutic which we were not without. The surgeon made use of it in many cases with great success." *['Rob' means "the inspissated juice of ripe fruit, obtained by evaporation of the juice over a fire till it acquires the consistence of a syrup, which will prevent its fermentation." (Webster) For Zilva's present day metnod of concentrating lemon juice see "Vitamins: A survey" (Med. Res. Council) 1932, p. 255. The juce thus concentrated 4-1/2 times was used in 1930-31 by the Brit. Arctic Air Route Expedition. A dessertspoonful a day kept Augustine Courtauld entirely free from all symptoms of scurvy from 26th October, 1930, to 5th May, 1931.
Of the termination of Cook's second voyage Raymond Beazley writes [Traill's Social England, vol. 5, p. 303] "On 29th-30th July (1755) he landed at Plymouth, after three years' absence and with the loss of only four men--a decisive victory over the scurvy."
The regular use of lemon juice was made compulsory in the Navy in 1804. In the middle of the century West Indian lime juice was unfortunately substituted. In 1876 H.M.S. "Alert" and H.M.S. "Discovery," Captain Nares plentifully supplied with lime juice, and had much serious scurvy. Miss A. Henderson Smith, 'Lancet' 1918, ii 813 and R.A.M.C. Jl. 1929, 32, 93, 188, reviews this important blunder.
Modern recognition of accessory food factors:
Of his experiments on rats upon a purified synthetic diet which included fat, protein, carbohydrate, salts and water--all the ingredients of food then known to be necessary--he wrote that:--
"The total energy consumption of the animals was carefully determined, and it was shown that the rats upon the highly purified diet ceased to grow at a time when their intake was more than sufficient quantitatively to maintain growth."
"On a less pure basil dietary the food consumption necessary for a given weight increment was reduced to one half or less compared with that necessary on a pure basal dietary."
"Cessation of growth on a pure dietary took place before any failure of appetite." Half a teaspoonful of milk added ade all the difference: the rats began to grow.
Leslie Harris, D.Sc. ["Vitamins in theory and practice" 1931, Cambridge Univ. Press] points to this work by Hopkins as providing the convincing quantitative evidence for the accessory food factors. It was substantially the beginning of a new dietetic era.
Sir Robert McCarrsion's work:--
Perhaps no passage in his writings better summarises his doctrine than that which is quoted in our Testament. For his Gabrielle Howard Memorial Lecture, Food and Nutrition, see below.
McCarrison (Sir R.) Lloyd Roberts lecture; adventures in research, Tr. M. Soc., London. 60: 46-71, 1937
----------. Nutritional needs in pregnancy.--Brit. M.J. 2: 256-257. August 7, 1937.
----------. Nutrition in health and disease.--Brit. M.J. 2: 611-615. Sept. 26, 1936.
----------. Diet and nutrition.--M. Officer. 56: 185, Oct. 31, 1936
---------- & Krishnan (B.G.). Lathyrism in rat. Indian J.M. Research. 22: 65-66, July, 1934.
---------- & Sankaran (G.) Effect on thyroid cellsin vitro of "goitre-noxa" associated with certain conditions of insanitation.--Indian J.M. Research. 22: 53-57.
----------. Effect of plasma from polyneuritic fowls on growth in vitro of embryo-chick intestine.--Indian J. M. Research. 22: 67-70, July 1934.
----------, Krishnan (B.G.) & Madhava (K.B.). Effect of caging on thyroid gland of albino rats with stastical note.--Indian J. M. Research 22: 59-64, July, 1934.
----------, Sankaran (G.) & Beer (W.A.). Electrophoresis experiments with virus of rabies.--Indian J.M. Research. 21: 917-934, April, 1934.
----------. Interaction of food and sanitary conditions in causation and prevention of thyroid disease.--Indian J. M. Research 20: 957-969, April, 1933.
----------. Goitrogenic action of soya-bean and ground-nut.--Indian J.M. Research 21: 179-181, July, 1933.
----------. Paper on food and goitre.--Brit. J.J. 2: 671-675, October 14, 1933.
---------- & Sankran (G.) Hydrogen-ion concentration in organis and body fluids of sorbutic guinea-pigs.--Indian J. M. Research, 20: 971-974, April, 1933.
---------- & Sankran (G.) Effect of iodine on growth and metabolism of thyroid tissue in vitro.--Indian J. M. Research. 21: 183-186, July, 1933.
---------- & Sankran (G.) Effect of plasma from case of poly-neuritis gallinarum on growth of tissues in vitro; preliminary note.--Indian J. M. Research. 21: 187-189, July, 1933.
---------- & Madhava (K.B.) Effect of insanitary conditions on thyroid gland and other organs of body.--Indian J. Med. Research. 20: 697-722, Jan., 1933.
----------, Sankaran (G.) and Madhava (K.B.) Effect of exclusive diet of cabbage on internal organs of rabbits, with statistical examination of data.--Indian J.Med.Research. 20: 723-738, Jan., 1933.
----------, Sankaran (G.) and Madhava (K.B.) Hydrogen ion concentration in organs of pigeons fed on polyneuritis-producing diets.--Indian J. Med. Research. 20: 739-756, Jan, 1933.
----------. Problems of nutrition in India.--Nutrition Abstr. & Rev. 2: 1-8, July, 1932.
----------. Effect of sunlight and darkness on thryoid gland.--Indian J.Med. Research. 20: 633-635, Oct., 1932.
---------- & Madhava (K.B.). Effect of insanitary conditions on thyroid gland and other organs of body.--Indian J. Med. Research. 20: 637-649, Oct., 1932.
----------. Aetiology and epidemiology of endemic goitre.--Rep. Internat. Conf. Goiter (1927), pp. 280-310, 1929.
---------- & Medhava (K.B.). Life line of thyroid gland: contribution to study of goitre.--Indian J.M. Research. (Memoir No. 23) pp. 3-378. March, 1932.
----------. Some surgical aspects of faulty nutrition.--Brit. M.J. 1: 966-971, June 6, 1931.
----------. Causation of stone in India.--Brit. M.J. 1: 1009-1015. June 13, 1931; also Lancet. 1: 1413-1417, June 27, 1931; also Vet. J 87: 411-430, Sept., 1931.
----------. Researches on "stone": on effect of milk in preventing formation of calcium stones in urinary tract of albino rats.--Indian J. M. Research. 19: 51-53, July, 1931.
----------. Experimental production of gastric ulcer in albino rats: preliminary report.--Indian J. Med. Research. 19: 61-66, July, 1931.
---------- & Ranganathan (S.). Researches on "stone"; on relative importance of Vitamin A, radiostoleum, cod-liver oil and sodium phosphate in preventing formation of calcium stones in urnary tract of albino rats.--Indian J. Med. Research. 19: 55-60, July, 1931.
---------- & Sankaran (G.). Urinary excretion of iodine by goitrous and non-goitrous persons in Gilgit.--Indian J. Med. Research. 19: 67-70, July, 1931.
----------. Further researches on stone. Indian J. M. Research 18: 903-934, Jan, 1931.
----------. Studies on goitre produced by cabbage.--Indian J. Med. Research. 18: 1311-1334, April, 1931.
----------. Some surgical aspects of faulty nutrition.--Lancet: 1: 1151-1154, May 23, 1931.
---------- & Singh (M.). Note on Bartonella muris anaemia.--Indian J. Med. Research. 18: 945-949, Jan. 1931.
---------- & Sankaran (G.) & Madhava (K.B.). Urinary excretion of iodine by goitrous and non-goitrous persons in Gilgit, with statistical examination of experimental data.--Indian J. Med. Research, 18: 1336-1345, April, 1931.
----------. Note on size of thyroid gland of albino rats (Coonoor).-- Indian J. Med. Research. 18: 553-555, October, 1930.
----------. Further researches on lymph-adenoid goitre in rats.--Indian J. Med. Research. 18: 577-598, Oct., 1930.
-------- & Madhava (K.B.). Effects of high protein diets on thyroid gland, with statistical note.--Indian J. Med. Research. 18: 619-661, October, 1930.
----------. Whole wheat and white bread; comparative study.--Indian J. Med. Research. 17: 667-691, Jan., 1930.
----------. Diseases of faulty nutrition. Far East. A. Trop. Med., Tr. Seventy Cong. (1927). 3: 311-320, 1930.
----------. Relative values of national diets of certain Indian races. Far East. A. Trop. Med., Tr. Seventy Cong. (1927) 3: 322, 1930.
----------. Effects of faulty food deficient in vitamins on gastro-intestinal tract.--Far East. A. Trop. Med., Tr. Seventy Cong. (1927) 3: 324-328, 1930.
----------. Effect of manganese on growth.--Far East A. Trop. Med., Tr. Seventy Cong. (1927) 3: 343, 1930.
----------. Collected Papers on Goitre and Cretinism, 1915.
----------. The Etilology of Endemic Goitre: being the Milroy Lecture delivered at the Royal College of Physicians of London, January, 1913.
----------. The Thyroid Gland in Health and Diseases, 1917.
----------. Studies of Deficiency Disease. 1921.
----------. The Simple Goitres. 1926.
----------. Food: a primer for use in schools, colleges, welfare centres, boy scout and girl guide organisations, etc., in India. 1931.
----------. Nutrition and National Health. 1936. Cantor Lectures: Royal Society of Arts.
----------. Nutrition and Health. Gabrielle Howard Memorial Lecture, Royal Institution. May 25th, 26th, 1937.
---------- , Sundararjan (E.R.) & Gloster (T.H.), Beri-beri-Columbarum. 1928.
----------. Influence of manganese chloride in preventing lympy-adenoid goitre in rats.--Indian J. Med. Research. 17: 442-452, Oct., 1929.
----------. White and Brown bread. Brit. M.J. 2: 913-914, Nov. 16, 1929.
----------. Beri-beri columbarum.--Indian J. Med. Research. (Memoir No. 10) pp. 1-146, March, 1928.
----------. Experimentally produced lympy-adenoid goitre.--Indian J. Med. Research. 15: 909-914, April, 1928.
----------. Influence of irrigation on nutritive value of rice.--Indian J. Med. Research. 15: 915-920, April, 1928.
----------. Note on expermental production of lymphnadenoid goitre in rats.Brit. M.J. 1: 5-6, Jan 5, 1929.
----------. Remarks on diseases of faulty nutrition.--Brit. M.J. 1: 92-93, Jan 21, 1928.
----------. Studies on lathrism.--Indian J. Med. Research. 15: 797-800, Jan., 1928.
----------. Experimental production of stone-in-bladder.--Indian J. Med. Research. 15: 801-806, Jan., 1928.
----------. Experimental production of stone-in-bladder with note on pernicious anaemia and epidemic dropsy: preliminary note.--Indian J. Med. Research. 14: 895-899, April, 1927.
----------. Experimental production of stone-in-bladder.--Indian J. Med. Research. 15: 197-205, July, 1927.
----------. Experimental production of new type of goitre unrelated in its origin to iodine.--Indian J. Med. Research. 15: 247-263, July, 1927.
----------. Experimental prevention of stone in bladder in rats.--Brit. M. J. 2: 159-160, July 30, 1927; also Indian J. Med. Research. 15: 485-488. Oct., 1927.
---------- et al. Relation of endemic goitre to iodine-content of soil and drinking water.--Indian J. Med. Research. 15: 207-246, July, 1927.
----------. Expermient in goitre prevention: further history of goitre at Lawrence Royal Military School, Sannwar, Junjab, India.--Indian J. Med. Research. 14: 655-658, Jan., 1927; also Brit. M.J. 1: 94-95, Jan. 15, 1927.
----------. Nutritive value of wheat, paddy and certain other food-grains.--Indian J. Med. Research. 14: 631-639, Jan., 1927.
----------. Effect of manganese on growth.--Indian J. Med. Research. 14: 641-648, Jan., 1927.
----------. Good diet and bad ones: expermiental contrast.--Indian J. Med. Research. 14: 649-654, Jan., 1927.
----------. Experimental production of stone in bladder.--Brit. M.J. 1: 717-718, April 16, 1927.
----------. Experimental production of new type of goitre unrelated in its origin to iodine.--Lancet. 1: 916-920, April 30, 1927.
----------. Effect of manurial conditions on nutritive and vitamin values of millet and wheat.--Indian J. M. Research. 14: 351-378, October, 1926.
----------. Lathyrism in Gilgit Agency.--Indian J. M. Research. 14: 379-381, Oct., 1926.
----------. Good diet and bad one: experimental contrast.--Brit. M.J 2: 730-732, Oct. 23, 1926.
----------. Effects of excessive ingestion of lime on thyroid gland and influence of iodine in countracting them.--Indian J. M. Research. 13: 817-821, April, 1926.
----------. Relationship of diet to physical efficiency of Indian races.--Practitioner. 114: 90-100, Jan., 1925.
----------. Thyroid disease.--Brit. M. J. 1: 1065-1069, June 13, 1925.
---------- & Norris (R.V.). Relationship of rice to beri-beri in India.--Indian J.M. Research. (Memoir No. 2) 1-87, Oct., 1924.
----------. Pathogenesis of deficiency disease: effect of asphyxia on action of adrenalin; effect of carbon dioxide on action of adrenalin.--Indian J. M. Research. 11: 749-769, Jan., 1924.
----------. Rice in relation to beri-beri in India. Brit. M.J. 1: 414-420, March 8, 1924; also in Proc. Roy. Soc. Med. (Sect. Trop.Dis. & Parasit.) 17: 65-82, June, 1924.
----------. Relation of manure to nutritive and vitamin value of certain grain.--Brit.M.J. 1: 567-569, March 29, 1928.
----------. Pathogenesis of deficiency disease; relation of faulty nutrition to development of epithelioma contagiosum.--Indian J. M. Research. 11: 1119-1129, April, 1924.
----------. Effects of excess ingestion of certain amino acids on growth, metamorphosis and thyroid gland of tadpoles.--Indian J. M. Research. 11: 1131-1136, April, 1924.
----------. Effects of long continued ingenstion of tyramine and histamine.--Indian J. M. Research. 11: 1137-1156, April, 1924.
----------. Goitre.--Brit. M. J. 1: 989-994, June 7, 1924.
----------. Function of adrenal glands and its relation to concentration of hydrogen ions.--Brit. M. J. 1: 101-102, Jan 20, 1923.
----------. Relation of faulty nutrition to development of epithelioma contagiosum of fowls.--Brit. M. J. 2: 172-174, Aug. 4, 1923.
----------. Pathogenesis of deficiency disease: concerning the function of adrenal gland and its relation to concentration of hydrogen ions.--Indian J. M. Research. 10: 861-899, April, 1923.
----------. Pathogenesis of deficiency disease; effects of heat, cold serum and sunlight on the action of epinephrin and adrenalin hydrochloride.--Indian J. M. Research. 10: 900-907, April, 1923.
----------. Pathogenesisof deficiency disease: observations on fat excess in relation to iodine requirements and to thyroid gland.--Indian J. M. Research. 11: 1-51, July, 1923.
----------. Faulty food in relation to gastro-intestinal disorder.--J.A.M.A. 78:1-8, Jan. 7, 1922.
----------. Goitre--Eye, Ear, Nose and Throat, Mouth. 3: 396-402, 1924-5.
----------, Williams (L.), et al. Discussion on non-specific disturbances of health due to vitamin deficiency.--Proc. Roy. Soc. Med. 18: 1924-25, Sect. Roy Soc. Med. 15-24.
----------. Observations on the effects of fat excess on the growth and metamorphosis of tadpoles.--Proc. Roy.Soc. Med. 92: 295-303, S.B. 1920-21.
----------. Fats in relation to the genesis of goitre.--Brit. M.J. 1: 179-181, 1922.
----------. Effect of faulty foods on endocrine glands.--N. York M.J. 115: 309-314, 1922.
----------. Endocrine gland studies, including goitre in India.--Proc. N. York. Path. Soc. 21: 154-174, 1921.
----------. The influence of deficient and ill-balanced dietaries in favouiring the development of gastro-intestinal infections.--Indian J. M. Research. Calcutta, 1920, Cong. No. 38-43.
----------. The pathogenesis of deficiency disease. III. The influence of deficiencies in accessory food factors on the intestine.--Indian J. M. Research. 7: 269-278, 1919-1920.
----------. The effects of deficient dietaries on monkeys.--Brit. M.J. (Abstract). 1: 249-253, 1920.
----------. The pathogenesis of deficiency disease. No. V. Histo-pathology.--Indian J. M. Research. 7: 269-278, 1919-1920.
----------. No. VIII. The general effects of deficient dietaries on monkeys.--Indian J. M. Research. 308-341, 1919-1920.
----------. The pathogenesis of deficiency disease. No. IX. On the occurrence of recently developed cancer of the stomach in a monkey fed on food deficient in vitamins.--Indian J. M. Research. 7: 633-647, 1919-1920.
----------. Dietetic deficiency and endocrine activity: with special reference to deficiency oedemas.--Brit. M. J. 2: 1920. Sect. Trop. Med. 236-239.
----------. The pathogenesis of deficiency disease.--Brit. M. J. 1: 177, 1919.
----------. The pathogenesis of deficiency disease.--Indian J. M. Research, 6: 275-355, 1918, 1919.
----------. The influence of deficiency of accessory food factors on the intestine.--Brit. M. J. 2: 37-39, 1919.
----------. The effects of a sorbutic diet on the adrenal glands.--Brit. M. J. 2: 200, 1919.
----------. The pathogenesis of deficiency disease. II. Thke effects of deprivation of B accessory food factors.--Indian J. M. Research. 6: 550-556, 1918, 1919.
----------. The life history of the thyroid apparatus.--Med. Press & Circ. 154: 307-309, 1917.
----------. India and medical progress.--Brit. M. J. 2: 109-112, 1917.
----------. The experimental production of congenital goitre.--Indian J. M. Research. 4: 183-189, 1916, 1917.
----------. Nervous cretinism.--Proc. Roy. Soc. Med. 7: 157-164, 1913, 1914.
----------. Endemic goitre.--Practicioner. 94: 70-93, 1915.
----------. The distribution of goitre in India.--Indian J. M. Research. 2: 778-790, 1914-15.
----------. Experimental researches on the etiology of endemic cretinism, congenital goitre and parathyroid disease.--Indian J. M. Research. 1: 505-522, 1913-14.
----------. An enquiry into the causation of goitre atthe Lawrence Military Asylum, Sanawar.--Indian J. M. Research. 1: 536-588, 1913-14.
----------. The ductless glands.--Lancet. 1: 931, 1914.
----------. Etiology of endemic cretinism, congenital goitre, and congenital parathyroid disease: abstract of experimental researches.--Lancet. 1: 817-819, 1914.
----------. The pathogenesis of experimentally produced goitre.--Indian J. M. Research. 2: 183-213, 1914.
----------. Experimental researches on the etiology of endemic goitre.--Indian J. M. Research. 2: 214; 226, 1914.
----------. A contribution to the study of experimental beri-beri.--Indian J. M. Research. 2: 369, 374, 1914.
----------. A second series of expermients dealingwith the transmission of goitre from man to animals.--Ann. Trop. M. & Parastol. 5: 453-470, 1911,1912.
----------. The vaccine treatment for simple goitre.--Lancet. 1: 337-360, 1912.
----------. The vaccine treatment of simple goitre.--Proc. Roy. Soc. Med. 5: Med. Sect. 37-52, 1911, 1912.
----------. The expermental transmission of goitre from man to animals.--Ann. Trop. M. & Parasitol. 5: 187-198, 1911.
----------. The expermental transmission of goitre from man to animals.--Proc. Roy. Soc. S.B. 84; 155, 1911.
----------. A resume of researches on endemic goitre.--Indian M. Gaz. 46: 253-260, 1911.
----------. Further expermental researches on the etiology of endemic goitre.--Ann. Trop. M. & Parisitol. 5; 1-14, 1911.
----------. Observations on the amoebae in the intestines of persons suffering from goitre in Giltit.--Quart. J. Micr. Sc. 43: 723-736, 1908, 1909.
----------. A summary of further researches on the eitology of endemic goitre.--Proc. Roy. Soc. S.B. 81: 31, 1909.
----------. A critical analyhsis of the eitology and sympatomatology of the three-day fever of Chitral; and an analogyk between this condition and dengue fever.--Indian M. Gaz. 43: 5-12, 1908.
----------. Observations of endemic cretinism in the Chitral and Gilgit Valleys.--Lancet 2: 1275-1280, 1908.
----------. The three days' fever of Chitral: a contribution to the study of unclassed fevers of India.--Indian M. Gaz. 41: 7-14, 1906.
----------. Enteric fever in Goorkhas with a few remarks as to its propagation and differential diagnosis in the early stage.--Indian M. Gaz. 38: 98-100, 1903.
----------. A case of blastomycetic dermatitis in the Chitral.--Indian M. Gaz. 38: 138-140, 1903.
Dr. Wrench in "The Wheel of Health" [C.W. Daniel and Co., Ltd., 40 Great Russell Street, W.C. 1--1938] has gathered together all the information available about this people. It is an easy read volume of fascinating interest an dthe culture of the food which is the basis of their marvellous health--and be it added good humour--is related.
That there are some suggestive evidences in a high mountain district of Peru of a closely comparable civilisation, long extinct, is a fact of interest. In view of the range of green vegetables the Hunza cultivate, the detail that some sixty salad plants have been discovered in this Peruvian region is noteworthy, especially as no such flora is found elsewhere in that country.
These have no pretentions to be scientific research but are submitted as examples of the effects of diet noted over and over again in ordinary family practice.
A
The reality of the value of using fresh, well chosen food is shewn in a practice in a Cheshire village. The County ante-natal scheme makes provision for a woman's own family doctor to supervise her in pregnancy. Her nutrition is his first concern. In the village referred to the local Mothers' organisation conducts a 'child-welfare' each month to which the local doctor is honorary M.O. A fair percentage of all his patients attend and thus receive his advice upon the nurture of the children some 8 to 12 times a year; and a thorough mutual understanding has grown up. The food of the mother, during her pregnancy, is wholemeal bread, 1 to 2 pints of milk (raw), generally including 1/2 a pint at breakfast taken with porridge (medium oatmeal scattered into boiling water and stirred till it thickens); eggs are used freely; salads in abundance, including celery and dandelion leaves; green leaf vegetables plunged into boiling water for 5 minutes and eaten with butter or poached eggs--or with meat, but the amount of meat taken is very moderate; liver weekly; herrings twice or once a week and a little cod liver oil except on herring days; fruit in abundance--such is an outline of their food. The eveningmeal is often begun with soup of the Scots broth type, but carrots, unpeeled, are grated into it just before serving. Apples are eaten in their skins or baked in their skins, and otehr fruit is used freely. Potatoes are baked in their skins or boiled in their skins [dropped into boiling water and boiled till they "smile," then the water is poured off and a crumpled cloth put in the pot whilst it is drawn to the side of the fire.] Cheshire cheese, grated into a salad, with a hard egg, is advised and popular.
The wholemeal bread in question is fertility bread, that is, locally grown wheat, ground or rather dashed to pieces by a steel fan revolving 2,500 times a minute in a local mill, mixed with half its weight of raw wheat germ fresh off the rollers of a Liverpool mill and--a point to be rigidly insisted upon--baked at once, within 36 hours at most--a rather close but very palatable bread, requiring no little skill in baking, though a number of bakers in the neighbourhood have acquired it.
If her haemoglobin be 80 per cent, or under, the mother receives iron, ferrous sulphate, or other.
With rare exceptions, and those almost always "strangers," the mothers feed their infants at the breast 9 months and then wean them by a year or a little more. The nursing mother's food continues as in pregnancy, including the greens and salads. The feeding times are 6 a.m., 10 a.m., 2 p.m., 6 p.m., and 10 p.m.--and very seldom in the small hours.
The children begin to bite the wholemeal crusts at from 7 to 9 months and then often get a little raw turnip juice made by putting Barbadoes sugar [Muscovado] into hollowed out swede or other turnip.
Except custard (egs and also "beast milk") and junket, no milk puddings are used, except when occasionally reice which still has its germ and silver skin, can be obtained. Ordinary rice is discouraged.
Furmity, [Frumenty] is not yet forgotten by the indigenouis people and its use is encouraged.
No patent or "processed" food of any kind whatever is employed, with the exception of Marmite and dried yeast.
Broth, red gravy, brains and marrow bones are used for the children from 9 months onwards.
The children are encouraged to go barefoot, which suits them very well, but only a very few of the mothers so far, are entirely cordial about this.
When the regime grew up little by little, many years ago, there were a thousand minor difficulties; fruition was slow. But it has now been established long enough for the generation it has fostered to be studied.
The teeth are a good index of the fidelity of the mother in carrying out the regimen, both before and after the baby was born; and it may be said that perfect sets are becoming more common.
The children are spendid. As infants they sleep as well as could be wished, grow well, and are not over fat, but weigh well and very seldom "ail anything." Broncho-pneumonia, for instance, is almost unknown amongst them. One fo their most striking features is their good humour and happiness. They are sturdy limbed, beautifully skinned normal children.
It is not desired to give the impression that the child population of this village is perfect or that complete compliance with the dietary advised is secured even amongst all who attend the centre; but it is a fact that the mothers follow it substantially and with good results, which those concerned think they recognise.
The benefits are visible in the households. "We have all taken to brown bread now; and I'm sure we're the better for it."--"No white berad comes in this house: it's all wholemeal and there's no trouble with constipation."--"We've got that fond of the meal bread that when we went to the seaside and they gave us white we all looked at each other!:--And a number of families seriously cultivate their gardens for growing a succession of saladings.
B
A young woman, town bred, resident in a large public institution where she was a technical instructress, married a farmer. That is to say she passed from a menage where white bread and contract butter were the invariable rule whilst green vegetables were the rare exception, and subjected to prolonged cooking in steam jacketed pans at that,--to one where good fresh food was available if trouble were taken. It was taken; but it was too late. Anaemic and constipated as she was, her pregnancy confirmed the fear that she was in no fit state to become a mother. Despite all efforts she passed through th ekind of experience which seems to justify the notion that to be gravid is to be ill. All forms of toxemias of pregnancy, anorexia, hyperemesis, albuminuria and oedemia were exhibited by turns; and a foul otorrhoea of old standing awoke to virulent activity. Despite all this she arrived at term and underwent an anxious, lingering and difficult confinement. The infant, resuscitated by prolonged artificial respiration, was sickly and emaciated. His respirations were intermittent and after some 60 hours he breathed his last. The mother hung on to life and almost inperceptably her condition drifted--or rather was led, for she was surrounded by the utmost solicitude--into slow convalescence.
All this detail has been related as a contrast to the sequel. Being actively minded she began to take quickened interest in her surroundings, the farm. Little by little she came to do a real share of the normal work of a country-bred farmer's wife. Strength and the look of health came to her. The improvement was not fortuitous. It was decided from the start that a real attempt should be made to rebuild her physique. Her food waws the fertility bread, farm or Empire butter, salads in variety and abundance, with grated carrots, soup and barley, potatoes in their jackets and unlimited fruit. Marmite and dried yeast were used. She took about a quart of milk a day fresh from their own cows, and she gradually came to take as many eggs as she wished, heerings freely and occasionally liver. She enjoyed life, and it was obvious in about a year that she was in abounding health.
Then she announced that she was again pregnant. A time of excellent health followed, no drawback. The confinement was normal, birth being spontaneous. The baby was in first rate condition. Lactation was established and maintained fully and easilyi for over 9 months, finished finally in about a year. With the exception of a mild influenzal attack, the mother's health has been good. Furthermore the chronic otorrhoea of many years' standing has at last dried up.
The baby is as good, physically and in morale, as could be wished.
C
In May, 1938, I was consulted by a young Isishman. His age was about 23. He complained that he was "very poorly and had been sick and vomiting for three days." I found he was suffering from catarrhal jaundice. He ad come over from the West of Irreland two months previously and was employed on a road construction scheme in Cheshire.
I questioned him about his diet. I fouind that his breakfast consisted of bacon, white bread and tea. His dinner he took to his work and was mainly sandwiches of white bread and ham or beef with tea, and his evening meal was white bread and butter, sometimes an egg, and sometimes a bit of meat and tea.
My examination revealed to me, despite his illness, a physique and an alertness of mind and body which it was a delight to behold. He was well over six feet in height with jet black hair and a ruddy complexion, and in his jaws there were 32 healthy and symmetrical teeth. He possessed a supple body and limbs of good proportion, and apart from his gastric condition was of sound constitution.
I thought him to be as fine a specimen of humanity as I had ever seen. He aroused my interest and I wondered how such a body had