Another example, also of recent date, is still more disturbing: Not long ago the Pioneer Health Centre in Peckham carried out a survey of families of the artisan class, for whom the centre is intended. This survey revealed that 90 per cent. of those over 25 years of age had some physical defect.
From another source I glean the following statement: “Among the insured population there were lost in 1933 a total of 29,000,000 weeks of work. To this staggering loss must be added the cost of replacement of labour and the expense entailed in the care of the sick during the period of incapacity. These figures represent a heavy burden upon the community which is largely unnecessary.”
It is a burden, however, that the community must continue to bear until it has learned that to be physically efficient the individuals comprising it must not only be taught to practice the principles of nutrition, but be provided with the means to practice them. It is to be noted in connection with this enormous amount of certified sickness that it was not of the killing kind — “the people were sick but not mortally sick”. [ Spectator, October 19th, 1934, p.586.].
There is, too, the very high incidence of anaemia, due to deficiency of iron, in working-class women, to which attention has recently been drawn by Professor Davidson, of Aberdeen, “If,” he says, “the percentage of anaemic women found in Aberdeen is present in the industrial areas of the South (and we believe that anaemia may be even more serious there, since economic conditions are worse and the cost of living higher), then the loss of economic efficiency of the working-class mothers in this country must be enormous.”.
The still very high incidence of tuberculosis, especially in adolescence, is another outstanding evidence of national ill- health: “During the last completed decade, 1921-30, there were, roughly speaking, forty-five thousand deaths of males and an equal number of females at ages 15-30. Amongst the males very nearly one-third of this mortality was due to tuberculosis while amongst the females the proportion was as high as one-half.” [+ Report of the Chief Medical Officer of Health, 1933.]
It seems probable that a principal, if not a paramount, cause of this high incidence of, and mortality from, tuberculosis at this particular period of life is faulty food deficient in vitamin A, involving a low content of this vitamin in lung tissue and consequent susceptibility of the lung to infection.
As a final example of the prevalence of physical inefficiency, malnutrition in childhood may be cited. “In his Annual Report for the year 1934, the Chief Medical Officer of the Board of Education repeats the emphasis of former reports on the necessity for satisfactory nutrition. During the routine medical examination 12 children per 1,000 were found to be malnourished and 14 per 1,000 under-nourished” (I quote from the British Medical Journal).
It may be taken as certain that a major proportion of this faulty nutrition was due to food of improper quality or to insufficient food or to both. Believing, as I do, that sickness is more often the result of malnutrition than malnutrition the result of sickness. I venture to think that the evidences of malnutrition in school children are likely to be more widespread than these figures indicate.
For it is not only that children suffering from malnutrition are under-weight or undergrown; that there is a disproportion between their weight and height; that their posture is poor; that they are often round-shouldered and have protruding bellies, winged scapulae and lordosis; that they are of poor muscular development and easily fatigued; that they are irritable, haggard, anxious and, perhaps, mentally slow if not precocious; that they are wakeful, restless, and often troubled with unpleasant dreams; that they have headache and fleeting pains, sometimes in one part of the body, sometimes in another; although all these are signs of malnutrition. But there are others, indicating disturbances in structure or in function of organs or parts of the body: the circulation is poor; the skin in mottled or dry and hot, or moist, cold and clammy; there is usually anaemia; the digestive system is quite commonly unstable or disordered, constipation is frequent or may alternate with diarrhoea, the appetite is capricious — the desire for “sweats” is often inordinate — dental caries is the rule — and susceptibility to infection is very marked, especially infection of the upper respiratory passages.
It is well enough to say that malnutrition may be brought about by faulty health habits or by physical defects, such as dental decay or gastro- intestinal disorder; it may. But these physical defects, this bad or capricious appetite, this constipation or digestive disturbance, this anaemia, this poor circulation,. this faulty function of the skin — these are themselves consequences of faulty nutrition and, as a rule, it is this that gives rise to them, not they that give rise to the faulty nutrition.
If we take this view of “malnutrition” in school children — and for my own part I believe it to be the correct one– then it will be found that there are in this country not 12 per 1,000 who are suffering from it, but several times that number; nor will it be found to be confined exclusively to the poorer classes. Indeed, the widespread incidence of dental caries and of minor rickets is, in itself, sufficient evidence that this is so.
There is one certain means of detecting dietetic malnutrition and that is by the assessment of the nutritive value of the diet that is actually being consumed; and in making this assessment attention must be paid as much to such essentials as calcium, phosphorus, iron and iodine as to vitamins, proteins and energy-bearing foods. If the diet does not contain in adequate amounts all elements and complexes needed for normal nutrition, then the user of it is suffering from, or will suffer from, malnutrition.
It seems probable that a cause of malnutrition which may be overlooked is the non- provision of sufficient energy-bearing foods to meet the enormous expenditure of energy by growing children consequent on their bodily activities in sports and games.
I was assured recently by one who labours in the East End of London that such “fresh” vegetable foods as ultimately penetrate into that locality are usually many days old; and I am reminded, in this connection, of certain interesting observations made some time ago by one of my Indian assistants. He found that within seventy-two hours of gathering green vegetables from my well- tended kitchen garden in Coonoor, they lost the major part of their vitamin C content.
I do not know whether the rapidity of this loss would be as great in England, where climatic conditions are so different; but it seems safe to assume that by the time their sparse supply of leafy vegetables reaches the dwellers in the East End of London the vitamin C content is considerably reduced.
PREVENTION OF DISEASE BY DIET.
Concerning the matter of disease prevention and of the part which properly-constituted food may play therein, I need give only three examples: the first provided by Miss Margaret McMillan, in her book: The Nursery School– which should be an obligatory text-book for every student of medicine; the second by the Papworth Village Settlement for sufferers from tuberculosis; and the third by the anti-natal work now being done in Dublin. Many others could, of course, be given.
Hear what Miss McMillan had to say of the weakly and ill-conditioned children who came from the slums of Deptford to her nursery school; children, rickety and bronchitic; children with adenoids and dental caries; children with inflammatory states of eyes, nose, ear and throat. After they have been nutured and properly fed for three or four years they are, she tells us, almost all cured of any ailments they may have had: “they are all straight and well grown, the average child is a well-made child, with clean skin, alert, sociable, eager for life and new experiences.” He does not need, she says, to see the doctor or the dentist, and he has none of the minor ailments that affect the children of the slums.
Surely this is an achievement of the highest order, an answer to the question how best to deal with “the minor ailments that affect the children of the slums”, and a cogent reason for the establishment throughout the length and breadth of the land of nursery schools of the McMillan type. It is a heartening sign of the times that the present Government intends actively to encourage their establishment.
And at the Papworth Village Settlement for the subjects of tuberculosis, what do we find? That in this village of 400 persons no child born there during the twenty years of its existence has, while a member of the community, contracted tuberculosis of the lungs, bones, joints, cerebral membranes, nor indeed any clinical form of the disease. Yet these children are the offspring of parents who suffer from tuberculosis and are in constant contact with them.
EDUCATION.
In this matter of education in the principles of nutrition two of the great professions — the medical and the scholastic — are in a position greatly to aid the endeavours of Government in “the building of an AI nation”. In regard to my own profession I may repeat what I wrote fifteen years ago: ” It is for us so to instruct ourselves that we may . . . use our newer knowledge to the end that customs and prejudices may be broken and a more adequate dietary secured for those under our care.”
