Professional Documents
Culture Documents
Medical Testament
County Palatine of Chester
/FT 3 more than a ?uarter of a century of medical $enefit under the National Health @nsurance /ct )e, the Local Medical and Panel Committee of Cheshire, feel that )e are in a #osition to re,ie) our e9#erience of the system( Constituted $y the statute to re#resent the #anel of an area, such a committee is in touch )ith all the family doctors '' in the case of Cheshire some *++ '' )ithin and on its $orders( Ho) far has the /ct fulfilled the o$Aect announced in its title '' %the Pre,ention and Cure of Sic4ness%B Cf the second item )e can s#ea4 )ith confidence( @f %#ost#onement of the e,ent of death% $e e,idence of cure that o$Aect has $een achie,ed5 the &reater e9#ectation of life )hich is sho)n $y the fi&ures of the 3e&istrar'Deneral is attri$uta$le to se,eral factors5 $ut certainly not least to the ser,ices of the #anel( The fall in fatality is all the more nota$le in ,ie) of the rise in sic4ness( Eear $y year doctors ha,e $een consulted $y their #atients more and more often, and the claims on the $enefit funds of societies ha,e tended to rise( Cf the first item, %the #re,ention ((( of sic4ness,% it is not #ossi$le to say that the #romise of the =ill has $een fulfilled( Thou&h to the sic4 man the doctor may #oint out the causes of his sic4ness, his #resent necessity is #aramount, and the moment is seldom o##ortune, e,en if not altoðer too late for any essay in #re,enti,e medicine( Cn that first and maAor count the /ct has done nothin&( <e feel that the fact should $e faced( Cur daily )or4 $rin&s us re#eatedly to the same #oint5 %This illness results from a lifetime of )ron& nutritionF% The )ron& nutrition $e&ins $efore life $e&ins( %.nfit to $e a mother% '' from under'nutrition or nutritional anaemia '' is an occasional ,erdict u#on a
maternal death( For one such fatal case there are hundreds of less se,erity )here the frail mothers and sic4ly infants sur,i,e( An Indictment The re#roach of the $ad teeth of n&lish children is an old story( @n 193* out of 3,:*3,9:G school children e9amined, 2,:2>,299 needed dental treatment( !1" Seein& that the #ermanent teeth de,elo# from the se,enteenth )ee4 of #re&nancy, and that certain foods, accurately 4no)n since 191G, !2" are the condition of their #ro#er &ro)th, that is a re#roach )hich should $e remo,ed( <ith it )ould &o the ,aried host of maladies that s#rin& from diseased teeth( That its remo,al is #ractica$le is sho)n $y Tristan da Cunha( Most of the #o#ulation of the little island, #eo#le of our race, li,in& on the #roduct of sea and soil, ha,e #erfect teeth )hich last them their li,es( 3ic4ets, for )hich n&land )as a $y')ord )hen Dlisson descri$ed it in 1*>+, is still )ith us( Dross deformities are rarer, $ut the $i& heads, tumid a$domens, flaccid s4ins, $ul&ed Aoints, and #inched chests are a common#lace of infancy8 and e,en at school a&e 3,:>H cases of ric4ets )ith *,:1> others of s#inal cur,ature )ere found in 193* $y the school medical officers in 1,HHH,+31 ins#ections( !3" Eet its #re,ention $y ri&ht feedin& is so easy that e,ery do& $reeder 4no)s the means( !:" 3ic4ets is a hea,y contri$utor to the C3 #o#ulation( The maternal mortality committee found that there is much less in Holland, )here $utter, mil4, and cheese are #lentiful, and the )omen, $y ,irtue of their &enerally healthy s4eletal de,elo#ment, are #rotected a&ainst the ris4s that are commonly faced $y )omen in the industrial areas of n&land( !>" Nutritional anaemia is of t)o 4inds, one su$tle and a#t to ha##en durin& #re&nancy, the other sim#le and due to too little iron in the food( !*" @t is 4no)n that anaemia, es#ecially of the latter 4ind, is common, es#ecially amon& children and )omen, )ho need much more iron in their food than men( /n in?uiry into the food of 1,1>2 families sho)ed that 1+ #er cent s#ent :s( a )ee4 #er head on food, 1+ #er cent( s#ent o,er 1:s(, )hile four more &rou#s of 2+ #er cent( each, s#ent *s(, Gs(, 1+s(, and 12s( res#ecti,ely( The food of the three lo)er &rou#s )as definitely deficient in iron( !H" @t is certain from this that nutritional anaemia amon& the #oorer classes is far commoner than is reco∋ed( Here is an e9am#le5 the $lood colour )as tested in t)o &rou#s of
school children, one a %routine sam#le% of children, the other s#ecially selected on account of #o,erty( Cnly half the #oor children and only three'?uarters of the su##osedly normal children had a $lood colour of H+ #er cent( of normal( !G" The final item of our indictment is consti#ation( /d,ertised a#erients are a measure of its #re,alence, and the host of di&esti,e disorders )hich result from it are a su$stantial #ro#ortion of the conditions for )hich our aid, as doctors, is sou&ht( Eet the cause in e,ery case '' a#art from rare a$normalities '' is the ill choice or ill #re#aration of food( @t is true that )e are consulted on these conditions )hen they are esta$lished and ha,e to deal )ith the effects '' &all' stones, a##endicitis, &astric ulcer, duodenal ulcer, colitis, and di,erticulitis '' of years in )hich the $ody has $een denied its due of this constituent of food or $urdened )ith an e9cess of that( Cther means of cure than #ro#er feedin& are called for at this late sta&e8 $ut the #rimary cause none the less )as )ron& nutrition( Convincing Research Those four items '' $ad teeth, ric4ets, anaemia, and consti#ation '' )ill ser,e as the heads of our indictment8 $ut in truth they are only a fra&ment of the )hole $ody of 4no)led&e on food deficiencies )hich different in,esti&ators from Lind !9" and Ca#tain Coo4 !1+" to Ho#4ins !11" and the Mellan$ys !2, :" ha,e unloc4ed( =ut it seems to us that the master 4ey )hich admits to the #ractical a##lication of this 4no)led&e as a )hole has $een su##lied $y Sir 3o$ert McCarrison( !12" His e9#eriments afford con,incin& #roof of the effects of food and &uidance in the a##lication of the 4no)led&e ac?uired( @n descri$in& his e9#eriments, )hich )ere made in @ndia, he mentions first the many different races of )hich the #o#ulation, 3>+ millions, is com#osed( % ach race has its o)n national diet( No) the most stri4in& thin& a$out these races is the )ay in )hich their #hysi?ue differs( Some are of s#lendid #hysi?ue, some are of #oor #hysi?ue, and some are of middlin& #hysi?ue( <hy is there this difference $et)een themB There are, of course, a num$er of #ossi$le causes5 heredity, climate, #eculiar reli&ious and other customs, and endemic diseases( =ut in studyin& the matter it $ecame e,ident that these )ere not #rinci#al causes( The #rinci#al cause a##eared to $e food( For instance, there
)ere races of )hich different sections came under all these influences $ut )hose food differed( Their #hysi?ue differed, and the only thin& that could ha,e caused it to differ a##eared to $e food( The ?uestion then )as ho) to #ro,e that the difference in #hysi?ue of different @ndian races )as due to food( %@n order to ans)er it @ carried out an e9#eriment on )hite rats to see )hat effect the diets of these different races )ould ha,e u#on them )hen all other thin&s necessary for their #ro#er nutrition )ere #ro,ided( The reasons for usin& rats in e9#eriments of this 4ind are that they eat anythin& a man eats, they are easy to 4ee# clean, they can $e used in lar&e num$ers, their ca&es can $e #ut out in the sun, the round of chemical chan&es on )hich their nutrition de#ends is similar to that in man, and a year in the life of a rat is e?ui,alent to a$out t)enty'fi,e years in the life of a human $ein&( So that $y usin& rats one &ets results in a fed months )hich it )ould ta4e years to &et in man( %<hat @ found in this e9#eriment )as that )hen youn& &ro)in& rats of healthy stoc4 )ere fed on diets similar to those of #eo#le )hose #hysi?ue )as &ood the #hysi?ue and health of the rats )ere &ood, )hen they )ere fed on the diets similar to those of #eo#le )hose #hysi?ue )as $ad the #hysi?ue and health of the rats )ere $ad, and )hen they )ere fed on diets similar to those of #eo#le )hose #hysi?ue )as middlin& the #hysi?ue and health of the rats )ere middlin&(% !12" / s#ecial &rou# )hich he fed on the food of Tra,ancore, in )hich there is a considera$le #ro#ortion of ta#ioca, disclosed a far hi&her #ercenta&e of &astric and duodenal ulcer cases than the other &rou#s( This )as informin&, as the #eo#le of Tra,ancore suffer )ith #e#tic ulcer ,ery much more commonly than the other #eo#les of @ndia( %Dood or $ad #hysi?ue as the case mi&ht $e )as, therefore, due to &ood or $ad diet, all other thin&s $ein& e?ual( Further, the $est diet )as one used $y certain hardy, a&ile, ,i&orous, and healthy races of Northern @ndia(% !Note5 The Hun;a, !13" Si4h, and Pathan(" %@t )as com#osed of freshly &round )hole')heat flour made into ca4es of unlea,ened $read, mil4 and the #roducts of mil4 6$utter, curds, $uttermil47, #ulses 6#eas, $eans, lentils, fresh &reen leaf ,e&eta$les, root ,e&eta$les 6#otatoes, carrots, and fruit, )ith meat occasionally( %No) in my la$oratory @ 4e#t a stoc4 of se,eral hundred rats for $reedin& #ur#oses( They li,ed under #erfect conditions5 cleanliness, roomy ca&es, &ood $eddin&, a$undant fresh )ater, fresh air, and sunli&ht '' all these thin&s they had8 and they )ere fed on a diet similar to that of a race )hose #hysi?ue )as
$##ustration fro" (Nutrition an% )ea#th( b' *ir Robert +c,arrison -.aber an% .aber, 1/001 -- rats fe% on the Eng#ish %iet took to canniba#is". ,#ick )EREfor fu##-si2e% i"age.
,ery &ood( They )ere 4e#t in stoc4 from $irth u# to the a&e of 2 years '' a #eriod e?ui,alent to the first fifty years in the life of human $ein&s( 0urin& this #eriod no case of illness occurred amon& them, no death from natural causes( no maternal mortality, no infantile mortality e9ce#t for an occasional accidental death( @n this sheltered stoc4 &ood health )as secured and disease #re,ented $y the com$ination of si9 thin&s5 fresh air, #ure )ater, cleanliness, sunli&ht, comfort, and &ood food( Human $ein&s cannot, of course, $e so sheltered as these rats )ere, $ut the e9#eriment sho)s ho) im#ortant these thin&s are in maintainin& health(
Diet and disease
%The ne9t ste# )as to find out ho) much of this remar4a$ly &ood health and freedom from disease )as due to the &ood food5 food consistin& of )hole' )heat flour ca4es, $utter, mil4, fresh &reen ,e&eta$les, s#routed #ulses, carrots, and occasionally meat )ith $one to 4ee# the teeth in order( So @ cut out the mil4 and mil4 #roducts from their diet, or reduced them to a minimum, as )ell as reducin& the consum#tion of fresh ,e&eta$le foods, )hile lea,in& all other conditions the same( <hat )as the resultB Lun& diseases, stomach diseases,
$o)el diseases, 4idney and $ladder diseases, made their a##earance( @t )as a##arent, therefore, that the &ood health de#ended on the &ood diet more than on anythin& else, and that the diet )as only health'#romotin& so lon& as it )as consumed in its entirety8 so lon&, in fact, as it contained enou&h mil4, $utter, and fresh ,e&eta$les( %Many more e9#eriments )ere done )hich sho)ed that, )hen rats or other animals )ere fed on im#ro#erly constituted diets, such as are ha$itually used $y some human $ein&s, they de,elo#ed many of the diseases from )hich these human $ein&s tend to suffer5 diseases of the $ony frame)or4 of the $ody, of the s4in co,erin& it, and of the mem$ranes linin& its ca,ities and #assa&es8 diseases of the &lands )hose #roducts control its &ro)th, re&ulate its #rocesses, and ena$le it to re#roduce itself' diseases of those hi&hly s#eciali;ed mechanisms '' the &astro'intestinal tract and lun&s '' desi&ned for its nourishment8 diseases of the ner,es( /ll these )ere #roduced in animals under e9#erimental conditions $y feedin& them on faulty human diets( %Here is an e9am#le of such an e9#eriment( T)o &rou#s of youn& rats of the same a&e )ere confined in t)o lar&e ca&es of the same si;e( ,erythin& )as the same for each &rou# e9ce#t food( Cne &rou# )as fed on a &ood diet, similar to that of a Northern @ndian race )hose #hysi?ue and health )ere &ood, and of )hich the com#osition is &i,en a$o,e( The other )as fed on a diet in common use $y many #eo#le in this country, a diet consistin& of )hite $read and mar&arine, tinned meat, ,e&eta$les $oiled )ith soda, chea# tinned Aam, tea, su&ar, and a little mil45 a diet )hich does not contain enou&h mil4, mil4 #roducts, &reen leaf ,e&eta$les, and )hole'meal $read for #ro#er nutrition( %This is )hat ha##ened( The rats fed on the &ood diet &re) )ell8 there )as little disease amon& them, and they li,ed ha##ily toðer( Those fed on the $ad diet did not &ro) )ell8 many $ecame ill and they li,ed unha##ily toðer, so much so that $y the si9tieth day of the e9#eriment the stron&er ones amon& them $e&an to 4ill and eat the )ea4er, so that @ had to se#arate them( The diseases from )hich they suffered )ere of three chief 4inds5 diseases of the lun&s, diseases of the stomach and intestines, and diseases of the ner,es '' diseases from )hich one in e,ery three sic4 #ersons amon& the insured classes, in n&land and <ales, suffers(% !12" These researches )ere minutely made on a lar&e scale, and $ut for the food the conditions of each &rou# )ere identical and ideal( Their results to our minds carry com#lete con,iction '' es#ecially as those of us )ho ha,e $een a$le to
#rofit $y their lesson ha,e $een ama;ed at the $enefit conferred u#on #atients )ho ha,e ado#ted the re,ised dietary to )hich that lesson #oints( !1:" The Defect and the Remedy @t is far from the #ur#ose of this statement to ad,ocate a #articular diet( The s?uimau9 on flesh, li,er, $lu$$er, and fish8 the Hun;a or Si4h on )heaten cha##attis, fruit, mil4, s#routed le&umes, and a little meat8 the islander of Tristan on his #otatoes, sea$irds- e&&s, fish, and ca$$a&e, are e?ually healthy and free from disease( =ut there is some #rinci#le or ?uality in these diets )hich is a$sent from, or deficient in, the food of our #eo#le today( Cur #ur#ose is to #oint to this fact and to su&&est the necessity for remedyin& the defect( To descry some factors common to all these diets is difficult, and an attem#t to do so may $e misleadin&, since 4no)led&e of )hat those factors are is still far from com#lete8 $ut this at least may $e said, that the food is, for the most #art, fresh from its source, little altered $y #re#aration, and com#lete8 !22" and that, in the case of those $ased on a&riculture, the natural cycle5 3ni"a# 4 5egetab#e --6 *oi# --6 7#ant --6 .oo% 83ni"a# --69 +an :aste is com#lete( !1>" No chemical or su$stitution sta&e inter,enes( !23" Sir /l$ert Ho)ard-s )or4 on the nutrition of #lants, initiated at @ndore and carried from @ndia to many #arts of the )orld, seems to constitute a natural lin4 in this cycle( !1*" He has sho)n that the ancient Chinese method !1H" of returnin& to the soil, after treatment, the )hole of the animal and ,e&eta$le refuse )hich is #roduced in the acti,ities of a community results in the health and #roducti,ity of cro#s and of the animals and men )ho feed thereon( He has disco,ered the #rinci#les of the treatment of that refuse( These #rinci#les are com#le9, $ut the treatment is sim#le thou&h #recise( The follo)in& ?uotation from his )ritin&s em$odies in #ractical form this factor of inestima$le ,alue to human health and economy( %The @ndore #rocess is sim#le( / layer a$out * in( dee# of mi9ed ,e&eta$le )astes is li&htly co,ered )ith a$out 2 in( of farmyard manure follo)ed $y a
&ood s#rin4lin& of earth( @f any )ood ashes are a,aila$le these are added )ith the soil( The #ro#ortion of mi9ed )astes to farmyard manure must not e9ceed 351 $y ,olume( The sand)ich #rocess is re#eated until the material in the hea# or #it is after fermentation 3 ft( thic4( The layers must $e 4e#t moist, $ut not )et, lest the air su##ly $e interru#ted( The moistened hea# should resem$le as far as #ossi$le a #ressed'out s#on&e( The tem#erature ra#idly rises to a$out 1>+ de& F( and the )hole mass $ecomes co,ered )ith &reyish')hite mycelium( /fter t)o or three )ee4s the hea#s or #its are turned and )atered if necessary( / second turn and )aterin& follo)s at the end of si9 )ee4s from the start, $y )hich time the mass has crum$led and turned $lac4( @n three months from the $e&innin& the car$on'nitro&en ratio falls from 3351 in the ori&inal mi9ture to a$out 1251, )hen the humus, )hich resem$les old leaf'mould, is ready for the land( %C,er'acidity, faulty aeration, too much moisture, or an unsuita$le site '' any of these may #resent a #assin& #ro$lem in this country( Such #ro$lems must $e tac4led $earin& in mind the s#ecial circumstances &i,in& rise to them( @n no case yet ha,e they #ro,ed insolu$le( %The #rocess is a #artial re,ersal of the )or4 of the &reen leaf( @n the cells of the leaf sim#le su$stances o$tained from the soil and the atmos#here are synthesi;ed $y means of the ener&y of sunli&ht into car$ohydrates and #roteids( The fun&i and $acteria in the com#ost hea# #ractically undo this synthesis until a com#arati,ely sta$le condition of or&anic matter is reached in the sha#e of humus( This is the real food of the soil and of the cro#( The second sta&e in $rea4in& do)n the materials made $y the leaf is only reached )hen the soil or&anisms o9idi;e humus into sim#le su$stances once more )hich can $e a$sor$ed $y the roots of #lants( The )heel of life has then com#leted a sin&le re,olution( %@t is not difficult to understand that the use of artificials in feedin& the cro# direct side'trac4s a #ortion of Nature-s essential round8 artificial stimulus a##lied year after year and at the same times must ine,ita$ly $reed e,ils, the full e9tent of )hich are as yet $ut dimly seen( The relation $et)een ?uality and yield, for e9am#le, does not lend itself to scientific formulae( The time may come )hen yield )ill de#end entirely u#on ?uality, $ut ?uality can ne,er under any circumstances de#end u#on yield( Factory'made manure is the )ea4 lin4 in the chain of a&ricultural economics(% @t seems o$,ious to us that the ne) 4no)led&e of nutrition com#els our #rofession to return to the Hi##ocratic ,ie) '' in so far as it has a$andoned it ''
that a #hysician is a naturalist 6phusikos7 and to ta4e co∋ance of the other lin4s of the cycle of Nature as )ell as of man, his #atient( For only so can he understand his #atient( <ithout #retension to a&ricultural 4no)led&e )e can a##reciate the $earin& of Sir /l$ert Ho)ard-s disco,ery on our )or4( Agriculture's Contribution <hether his disco,ery can $e harnessed to the #ro$lems of #u$lic health, to the sanitary dis#osal of munici#al and ,illa&e )aste has, )e understand, $een in,esti&ated( That side of the matter does not closely concern us8 $ut )e understand that the dis#osal of to)n )astes on a lar&e scale at Nairo$i !1G" on these #rinci#les has succeeded, and that Mr( ( F( <atson, su#erintendent of the Do,ernor-s states, =en&al, has a##lied the @ndore method to the house refuse and ni&ht soil of smaller munici#alities( !19" <hether the heat, 1>+ de& F(, )ill 4ill the an4ylostomum is a ?uestion to $e ans)ered( Turnin& to n&land, )e learn that at =odiam in Susse9, at the lar&e ho# &arden of Messrs( /rthur Duinness, Son and Co(, Ltd(, !2+" the system dis#oses of many tons of the crushed refuse of South)ar4 )ith results satisfactory in all res#ects5 and Ca#tain 3( D( M( <ilson-s @ceni state in Lincolnshire !21" #ro,ides another illustration of this method of turnin& )aste to )ealth( Thou&h )e $ear no direct res#onsi$ility for such #ro$lems, yet the $etter manurin& of the home land so as to $rin& an am#le succession of fresh !23" food cro#s to the ta$les of our #eo#le, the arrest of the #resent e9haustion of the soil, and the restoration and #ermanent maintenance of its fertility concern us ,ery closely( For nutrition and the ?uality !23" of food are the #aramount factors in fitness( No health cam#ai&n can succeed unless the materials of )hich the $odies are $uilt are sound( /t #resent they are not( Pro$a$ly half our )or4 is )asted since our #atients are so fed from the cradle, indeed $efore the cradle, that they are certain contri$utions to a C3 nation( ,en our country #eo#le share the )hite $read, tinned salmon, dried mil4 re&ime( /&ainst this the efforts of the doctor resem$le those of Sisy#hus( This is our medical testament, &i,en to all )hom it may concern '' and )hom does it not concernB <e are not s#ecialists, or scientists, or a&riculturists( <e re#resent the family doctors of a &reat county '' the county, said Michael 0rayton, of %such as soundly feed%8 a county )hich &i,es its name to a cheese than )hich there is
none $etter, thou&h to most n&lishmen alasF only a name8 a county )here the $est farmin& is still #ossi$le, )hich should minister to the needs of its o)n industrial areas and of a far )ider circle( <e cannot do more than #oint to the means of health( Their #roduction and su##ly are not our function( <e are called u#on to cure sic4ness( <e concei,e it to $e our duty in the #resent state of 4no)led&e to #oint out that much, #erha#s most, of this sic4ness is #re,enta$le and )ould $e #re,ented $y the ri&ht feedin& of our #eo#le( <e consider this o#inion so im#ortant that this document is dra)n u# in an endea,our to e9#ress it and to ma4e it #u$lic8 and the occasion on )hich it is to $e announced has $een or&ani;ed in the ho#e of ,entilatin& it8 and )e are ha##y indeed that MaAor'Deneral Sir 3o$ert McCarrison and Sir /l$ert Ho)ard ha,e a&reed to $e #resent and to address the meetin&( <e )ish to say finally that the interest ta4en in the matter $y the Lord' Lieutenant of Cheshire, =ri&adier Deneral Sir <illiam =romley 0a,en#ort, 2(C(=(, C(M(D(, C(=( (, 0(S(C(, )ho )ill $e #resent, is sincerely a##reciated( 6Si&ned $y the Mem$ers of the Local Medical and Panel Committees7 1ohn 2err 6Chairman7 N( /( =os)ell 6Iice'Chairman7 1( =arry =ennett 6Hon( Treasurer7 F( D( /llan H( 1affe D( =inns 1( H( 2err C( H( =lac4lay 3( ( Loney Harry ( =o)er <( S( Lynd H( 0( =rice 1ames Mur#hy 1( <( Chad)ic4 1 =( Mur#hy 1( 0( Chisholm M( Par4es 3( =( 0a,idson 1( No$le Platt <( <( 0ic4son
L( T Pollard M( 0)yer 1( 3 3o$ertson H( n&lish <( 1( /( 3ussell F( M( Fello)s <( ( C( Thomas 1 =( Fulton F( <raith 3( F( Derrard Lionel 1as( Picton 6Hon( Secretary7