From MEDICINE TODAY & TOMORROW October 1937

By F Le Gros Clark

IT is well at times to survey the course of events.   Few will suppose that all this contemporary talk  about malnutrition is due to the fact that we are as a com­munity less adequately fed than were our immediate forefathers.

Indeed, even our remoter ancestors, while possibly better supplied with certain vitamins (B1; for example, and D), must frequently have come near the edge of scurvy as their long winters closed.

But three or four social elements have suddenly combined in recent years, and a catalyst, so to speak, has been thrown into the midst of them; the result is a profound public interest in the problems of nutrition.

For one thing, we can now produce in abundance the food we require; for another thing, we can now transport it and preserve it. We possess, too, the necessary experience of social organization to make it a relatively simple task to ensure that the various foodstuffs are available for the consuming public. Finally, the researches of the last thirty years have now assured us that correct nutrition is the basis of sound health in most individuals and that correct nutrition is dependent on a number of factors in the diet.

That some of the factors are present in very small quantities and appear to act on the organism much as do the hormones only adds emphasis to the recent discoveries. No medical man would now dream of ignoring the vitamins, any more than he ventures to ignore the function of internal secretions in the body’s economy.

Moreover, we have in the last five years or so reached the stage where we are exploring the nature of various forms of minor and complex deficiency, such as are presumably prevalent—if they exist at all—among our own population; and of their existence there can now be little doubt.

The catalyst that turned this compound into a social explosive was the depression of 1930 onwards. Millions of families in this country and in America were thrust closer than ever before in their experience to the margin of destitution; and the new gospel of nutrition began to acquire a meaning for them. Conversely, the scientific workers, some of whom were gratified enough to find an audience, supplied in survey and demonstra­tion the necessary fuel for the agitation.

The character of “destitution” and of the “poverty line” was widely debated; and it was generally agreed in liberal circles that, whatever might be said in regard to housing, fuel, clothes, and other necessities of life, an income which left the family deficient in its dietetic needs was a social iniquity. Surveys carried out from 1929 to 1935 in such areas as Sheffield, Southampton,

Newcastle, and the Merseyside appeared to demonstrate that not less than 20 per cent, of the country’s children (possibly 30 per cent, was nearer the mark) were in families upon or below the poverty line. The essays published by Orr and M’Gonigle in 1936 emphasized both the inadequacy of many diets considered in themselves and the insufficiency of many incomes for the purchase of a balanced diet when other demands had been met.

It was inevitable that the medical societies should respond to the popular interest in the subject. A certain debate on the problem of “minimum scales on diet” was brought to its climax and its conclusion by the publication in November 1933 of the report of the Dietetic Committee of the British Medical Association.

Whatever criticism this report may have received on the score that its pricing was in the main too low, it was clear even from a cursory study of facts that a very large number of families were quite unable to purchase the diets recommended. The scales proposed were “un­official,” if authoritative; and rumour has it that several of the dieticians responsible for the report were only too happy to initiate the public controversy that actually resulted from their efforts. But the “unofficial” character of the scales made it inevitable that neither the national nor the local authorities recognized them as basic unless they wished to do so.

Meanwhile, the informed public found need for specially-established committees which might provide it with the data it required and might voice its opinions as to policy.

In the winter of 1933-1934 the Children’s Minimum Committee and the Committee Against Malnutrition made their appearance, and have since developed their harmonized campaigns. Under pressure from such bodies and from the political parties of the Opposition, the Government was compelled to modify its scales of benefit and to pay some lip service to the idea of “scales of human maintenance” when designing its unemploy­ment assistance scheme.

Unfortunately, the scales of assistance, when finally made public, were based on no known estimate of family requirements; for it must be emphasized that at no time has the Government—even though possessed of an authoritative advisory committee on nutrition— admitted the possibility of making a scientific estimate of family requirements. In fact it has done so; under pressure it raised the scale of benefit slightly and modified its unemployment assistance scales; and the local authority certainly admits some scale, however vague, when assessing applicants for relief. But in phrase the Government seems never to have agreed that such scales are medically and scientifically determinable.

No mention has yet been made of the part played by the League of Nations in 1935-1936 in raising the whole controversy to an international level.

The reports issued from the League are of varying significance. But they have at least succeeded in persuading us to dismiss the concept of “minimum diets” as unscientific and to replace it by that of the “optimum ” as medically the only sure criterion.

It were perhaps best in this brief survey to confine ourselves to the problem in our own country. Here discussion on the subject is likely to change its,form as time goes on. At present the movement for national fitness and the rise in the retail prices of food and other necessities are giving the established facts a fresh value in the public mind.

The question of a solution grows more and more prominent.

Can we conceive of a rational food policy for the nation?

Shall the distribution of certain essential food­stuffs be made a public service?

It is probable that during the next few months increasing attention will be paid to precisely this aspect of the matter. The time for gathering facts has not passed and never can pass; but the time for a reasoned application of them has certainly come.

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