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Typos p. 82: sucessfully [= successfully]; p. 91: elswhere [= elsewhere]; p. 95: carboydrates [= carbohydrates]; p. 97: degress [= degrees]; p. 102: distention [= distension]; p. 108, n. 1: Lahman [= Lahmann]; p. 110: referrred [= referred]; p. 114: Christendon [= Christendom]; p. 117: scurvey [= scurvy]; p. 117: resistent [= resistant]
Chapter III Good Diet Habits It is often supposed that because, in a high percentage of cases, the pristine vigour of youth deals sucessfully with the ordinary diet of modern England it is, as far as they are concerned, all right and demands no modification. It is here submitted that this is a mistaken notion. Functional troubles which occur in the thirties are, as a rule, not spontaneous phenomena fallen from the Thus it is untrue to say that children and adolescents thrive on the ordinary, traditional diet of a country like England. The number who succumb i.e., whose primitive vigour was not even equal to the trial of strength imposed by the errors in this diet, should suffice to show that escape from trouble is secured, not because of, but in spite of this diet. This, however, does not mean that the seeds of trouble have not been sown and will not germinate and develop in later life. The enormously high percentage of people in the thirties and forties who, in this country, develop some kind of digestive trouble, or a trouble resulting from the steady poisoning of their systems by a faulty or inadequate diet, should suffice to demonstrate that it is very difficult to draw the line, and to say that, from this or that stage of adolescence a rational diet shall henceforward be insisted upon. If it can be shown that the modern traditional diet is wrong, it cannot be desirable to give it to anyone, child or adult. And to stake on the vigorous health of the young by forcing this diet upon them, or to use their survival in spite of it as an argument in its favour, is to overlook the gradual process of deterioration which must take place in the majority of modern people before a serious dysfunction in the thirties can develop out of the smooth functioning of a healthy child. Even in youth, therefore, vicious habits of feeding are to be condemned, and cannot be adopted with impunity. The second fact to be appreciated about the ordinary diet of modern England is the insincerity and ignorance of those who, in resisting recommended modifications in their dietetic habits, argue that all such recom- If the people who advance this plea were known to be in the habit of departing in their every day meals conspicuously from the ordinary and traditional diet of England, if they belonged to a nation every individual of which had his own peculiar diet, differentiated from the rest, and if, moreover, they were notoriously unable to put up at any hotel or inn in the land for fear of being offered precisely that standardized kind of diet which most conflicts with the moral of their adage, there might be something in their plea. Seeing, however, that the very people who usually advance this plea are always wedded to the very kind of diet which is served at every hotel, restaurant and private table in the country, from Land's End to John o' Groats; seeing, above all, that the very uniformity of our patent drug advertisements, and of our national ailments, points to a common and identical, and not an individual and differentiated source in diet, those who, in resisting the recommendation of the food reformer, plead that "one man's meat is another man's poison," are really only trying to defend their devotion to the conventional and Standardized diet of their country, and their plea, with its ring of individual differentiation, is just a piece of transparent bluff. As a matter of fact, so rigorous is the standardization throughout the country, so complete is the contempt everywhere shown for the adage "one man's meat is another man's poison," that, allowing for differences in quality and charges, the same bill of fare might easily serve the purpose of all restaurants, hotels, boarding-houses, private houses and even hospitals and other institutions, all over Great Britain. Nor is the individualist plea upheld even by Nature's practice. For, within the species, Nature sets the example of prescribing a certain optimal diet, irrespective of slight constitutional differences, for all in- So much for the greatly abused adage which is neither true nor particularly witty. There are, of course, notable constitutional differences between human beings, especially nowadays when all standardization of type and everything in the nature of a rigorous approximation to a norm of health and stamina have long ceased to exist. Nor should we forget that with the prevailing differentiation of type and temperament, even among people of the same village or hamlet, the unique individual endowment in endocrine glands may play an important part in particularizing habits and tastes. But to argue from these well-known facts that an unwise diet i.e., a diet deficient or grossly redundant in regard to one or several ingredients can ever be wise, would be foolish to the point of peril, and yet it should not be forgotten that the ordinary and traditional diet of England is both defective and redundant in quite a number of ingredients, although it is often maintained that it is ideally suited to certain individuals. As an instance of how rigidly specific Nature has made the first food of all mammalian species, let us consider milk. It is often thought by laymen and for a long while was even thought by scientists that the milk of the mammalia is an inter-changeable product which may at will be taken from the female of any species and fed to the young of any other. A priori the idea would seem to be wrong, because it is difficult to see how, for instance, the milk of a grass-feeder can have the same qualities as that of a meat-eater. But modern science rules out so rigidly any appeal to a priori reasoning that again and again the Put your child of six months to the dug of a goat, an ass, or a cow, and immediately your vision tells you that the thing is monstrously wrong, offensively unnatural! If however, every morning you receive the milk of a goat, an ass, or a cow, in a clean, neatly-labelled bottle, the connexion between your infant and the lower animal is not so obvious in fact, it is so successfully disguised that it has to be deliberately pondered over in order to be appreciated. And yet Nature does, of course, provide for differences between the milk of distinct species, and to mix them up, or distribute them indiscriminately as man once thought he could do, is as monstrous as the spectacle of your child at the animal's dug. In human milk, for instance, three substances tryptophan, lecithin and calcium (to mention only the most obvious) are present in very different proportions from those known to exist in the milk of the cow. And if we compare the tasks which have to be performed by human and cow's milk respectively, this will not seem strange. Cow's milk has, in a few months, to rear an animal relatively big of bone, small of brain and not too highly or delicately organized. In a few months also, human milk has to rear a creature relatively small of bone, large of brain, and so highly organized that the perfection of its senses and bodily controls has made it the master of the world. Unless, in this matter alone, Nature has departed singularly from her customary method of suiting her provisions to the requirements, how could cow's and human milk be interchangeable? As a matter of fact, cow's milk contains more calcium than is needed by the young human being; it contains too little lecithin, Think of the consequences of these three differences alone if the human breast be denied to infants as it is to-day in England in about 66% of cases! If there can be little doubt about Progress in so far as it relates to stupidity, and if disturbances of the endocrine glands, causing not merely endocrine imbalance, but also such disorders as cretinism, diabetes, virilism (in girls), pituitary deficiency, etc., are increasing by leaps and bounds, are we not justified in ascribing much of this abnormality to the unwarranted belief that specific mammalian secretions are interchangeable? Are we not, moreover, justified in condemning all those influences, political, sociological and sentimental, which have led women to believe that they can be mothers and at the same time fail to perform an important maternal function? At the present moment in this country, as Dr. A. F. G. Spinks has said: "bottle-feeding of infants was rampant and unless the craze was checked, England would become a bottle-fed nation." 1 This remark was made sixteen years ago. But let no one suppose that conditions have improved since. The indications point rather to the conclusion that they have grown worse. Eight years after Dr. Spinks' remarks, for instance, The Lancet estimated that in England probably only 27.6% of middle-class and 38.8% of working-class women suckled their children for six months or longer. 2 And yet it is well-established that breast-feeding, as anyone with a spark of intelligence might have guessed, is the best possible form of nourishment for infants, 1 Lancet. 19.2.27. 2 Ibid. 23.2.35. If current trends remain unaltered, there can be little doubt that the present low rate of breast-fed babies in this country is likely to decline yet further, and this despite the fact that such unnatural treatment of their offspring by modern mothers is recoiling on the mothers themselves. As might have been expected, the denial of this function to the female breast could not possibly lead to a healthy condition of that organ, and although it would be impossible here to give statistics of the minor disorders due to this denial alone, in the major disorders the records are alarming enough. For instance, carcinoma of the breast is nine times more common in this country, in which bottle-feeding is rife, than in Japan where breast-feeding is almost universal. And the death-rate from breast-cancer is rapidly rising. 2 In 1920 it was only 4,488, and in 1936 it was 7,079. Dr. Bogen who compared the birth-rate in the separate States of the U.S.A. with the mortality from breast-cancer, in women over forty-five, found that they show an inverse correlation. "States with a high birth-rate having a low mortality from breast-cancer." And such data as are available from other parts of the world confirm these findings. Among fifteen countries, England and Wales head the list with the highest mortality from breast cancer and the lowest birthrate. 3 1 See a small section of these statistics given in the author's Future of Woman, Chap. III. See also the Final Report of the League of Nations on the Relation of Nutrition and Health, etc. p. 69: "The mortality rate among the artificially-fed infants is 56 times greater than that among those completely breast-fed;" and, according to a recent investigation, "whereas only about 4 out of 91,749 of the breast-fed infants died of respiratory infections, 82 out of the 1,707 artificially-fed infants died from this cause." 2 See Annual Reports of the Registrar General for years 1920 to the present day. Most of the statistics will be found quoted in The Future of Woman. Chap. II. 3 British Medical Journal. 15.6.35. Nor is the malnutrition corrected when the infant grows into childhood, because, owing to the lack of any sound tradition handed down from mother to daughter, the feeding of the toddler, i.e., the child who has comparatively recently been weaned, is in an even more deplorable state in this country than that of the infant up to twelve months. Thus in the Final Report of the mixed committee of the League of Nations on the Relation of Nutrition to Health, Agriculture and Economic Policy, 1 we read: "In a recent enquiry in London schools it was revealed that, among children of five years of age, there were 67 per cent to 88 per cent of cases of abnormalities of the bones, 67 per cent to 82 per cent of cases of adenoids, enlarged septic tonsils, and other diseases of the pharynx, and 88 per cent to 93 per cent having badly formed or decayed teeth." And the compilers of the Report leave us in no doubt that these conditions might "have been avoided by the inclusion in their [the infants'] diet of large quantities of protective foods." Now these children are just at the age when they have emerged from the so-called "toddler" period a period which, as I have stated, is in England most beset by errors of dieting caused through ignorance and the lack of sound traditions among the women of the country; 2 and many of them have also had the seeds of their ill-health sown in infancy by being denied the breast. Thus, it may fairly be assumed that not only are those 1 Issued in August, 1937. pp. 7273. 2 The author has had some experience in the feeding of the weaned child and the toddler, and has prescribed a diet for the former which has proved most successful. Its details can be obtained on application. When, therefore, we find that recent authoritative doctrines of diet also point to the fact that there are sound rules of universal application, which cannot be departed from, even in adult and mature life, without injury to the organism, we cannot too heartily deplore the common tendency so stubbornly adhered to by the majority of English people to-day to remain faithful to dietetic customs which ante-date the period of enlightenment in food. As there is overwhelming evidence to show, these old-time dietetic customs not only cannot maintain a human being in health, but are also manifestly causing a large amount of national debility, illness, disease and degeneration. (a) The amount to eat. Etymologies are often more picturesque than sound, and probably the derivation of the French word menu, which I once heard suggested by a prominent chef in France, is of the picturesque order. It was as follows: At the time of the Thirty Years' War, when the French and German armies were in close touch and some German blood was introduced into the French Royal Family by the marriage of the King's brother to a Bavarian Princess, certain German words also found their way into the French language, among them such army terms as "bivouac", and such tavern terms as the word "menu". The latter was really no more than the arbitrary creation of indolence, for it represents the initial If the story is true, it speaks highly for the wisdom of the Germans of that time, for no better advice could be given to all, rich and poor alike, than to eat moderately. There is not the slightest doubt that a very large proportion of the illness and dysfunction which now brings millions of all classes to the doctor's surgery, is due chiefly to sitomania, or the habit of over-indulging in food, and in this respect the working classes are now just as blameworthy as their economic superiors. Even the high incidence of childbed casualties in Western Europe and America, as I have shown convincingly elswhere, 1 can be ascribed to a large extent, to the present gross over-feeding of expectant mothers who, in the erroneous belief that a pregnancy justifies any amount of greed, habitually over-indulge, and are even encouraged to do so. The result is that grossly over sized babies are habitually produced and, to the shame of all concerned, are regarded as a credit to the parents and particularly to the mother, although she may have been gravely injured in the birth, and a fatigue party from Harley Street may have been employed to bring it about. "That most people eat too much," says Lord Horder, "will scarcely be gainsaid," 2 and Dame Louise McIlroy, 1 The Truth About Childbirth. 2 Lancet. 16.7.27. But whereas among men and unmarried or non-reproductive women, over-eating leads merely to diabetes, every variety of dyspeptic disorder and kidney disease, circulatory troubles and probably cancer too according to a recent investigator, 4 in bearing mothers it may punish a second and innocent party the child, either by making the birth so difficult as to be the cause of death to the foetus in transit, or else by leading (through the effects of instrumental traction) to such injuries to the child's head as to make it permanently imbecile, or paralysed, or both. My own view, however, is that over-eating, universal though it is in Europe, is generally due not so much to the actual ingestion of too much food as bulk, but of too much food of the concentrated kind. It is natural and normal to desire a sense of repletion after eating, and it is in the practice of securing this sensation, not by food of low nutritive value, but to an excessive extent by high class proteins, that habitual sitomania or over-eating consists. If people habitually obtained the sense of repletion by bulk of the right sort, i.e., less highly concentrated food-stuffs, they would satisfy their natural craving for repletion at meals, and at the same time not be excessive eaters. Nor, in that case, would they whether males, 1 Lancet. 25.5.35. 2 Obstetrics (New York, 1930). 3 Ingleby Lectures. 1934. p. 9. 4 Dr. Frederick L. Hoffmann: Cancer and Diet (Baltimore, 1937). See especially pp. 656, 661, 662665. For another possible contributory cause of cancer, see my Choice of a Mate, pp. 143144. There, on the basis of the principle of reversion through random breeding, I point out that the recent increase in cancer all over the civilized world may not be unrelated to the persistent crossing and recrossing of different types and stocks, which has been rife since improved means of transport made communications easy, rapid and therefore frequent. As, like most Western people, I am the outcome of wanton random breeding cancer from this cause may well nullify all my health disciplines. Thus, the need of securing a healthy sense of repletion at a meal, which has already been referred to in another section, becomes, through ignorance and unwise convention, a means of establishing a habit of over nourishment. In other words, the common error of modern traditional diet is to eat as if the human body were, in its daily activities, run on its own structure of tissue or fleshy parts, which required to be replaced while running, instead of eating as if it were run on its fuel. Meat, for instance, has become much more easily accessible to all classes, through imports of foreign mutton and beef, and the sense of repletion, instead of being secured largely by foods of low nutritional value, is now secured by eating a too large amount of this food so rich in protein. The fact that in the last seventy years the consumption of meat has been doubled and now stands at 130 lbs. per head of the population per annum, i.e., over 1/4 lb. per head per day, is a proof of the deleterious changes that have been taking place. As this 1/4 lb. per head per day is calculated for the whole population, of which an appreciable proportion are, of course, babies and infants who either do not touch meat at all or eat only a small fraction of 4 oz., the adult population are really eating much more than an average 1/4 lb. per day. Attempts to deal with this question, as anyone acquainted with the literature on diet published in the last fifty years will know, have taken two forms. On the one hand, dietists and popular writers on diet have recommended the practice of always rising from a meal with the appetite not completely cloyed, i.e., without the sense of repletion. And on the other, there have been those the wiser of the two groups of teachers who have recommended the inclusion in the daily diet at each meal of a great deal of mere "roughage", or food of low nutritional value, in The first recommendation is, I submit, psychologically and physiologically wrong. In the first place, because it seems to rule out as pernicious the very natural and healthy craving to obtain repletion at a meal, and secondly because it appears to leave the more important consideration of securing bulk by foods of lower nutritional value than say, meat or cheese, or eggs, or fish, altogether out of account. Meat is not harmful in itself, neither is cheese, nor fish, nor any of the foods known as sources of first-class proteins. What is harmful is to try to secure the sense of repletion at a meal chiefly by means of them. Along the line of human descent, one of the closest collateral branches to that of man consists of the monkeys, and an investigation carried out on these animals two or three years ago at the Zoological Gardens has a strong bearing on the present discussion. It was found that the monkeys at the Zoo which on arrival were fed on equal quantities of cereals and other concentrated foodstuffs acquired fatty degeneration of the heart. The attempt to correct this by giving them small meals only caused them to suffer from inadequate peristalsis. It was found, however, that, in its natural state, the monkey's alimentary canal is adapted to "a large amount of leaves, shoots, and roots which provide little nourishment in large bulk," and when the Zoo monkeys were fed on this principle they remained healthy. 1 When reporting the results of the above investigation, Sir Peter Chalmers Mitchell said that "the necessity for indigestible bulk was too often forgotten", even in humans. The history of the reforms which have gradually been 1 Sir Peter Chalmers Mitchell, in his Cavendish Lecture to the West London Medico-Chirurgical Sec. London. 5.7.33. As we have hinted above, it was long thought that the human body was run on the substances of which its muscles and viscera are composed, i.e., protein. Thus over seventy years ago, on the authority of Liebig, it was supposed that albumins or proteins were needed in direct proportion to a man's or woman's activity. And since such foods as butcher's meat, fish, poultry, eggs, and cheese were known to be vehicles of protein, a meal was not considered a meal if it did not contain large quantities of one or another of these articles of diet. But it must not be supposed that Liebig, by lending his authority to this dangerous belief, caused a revolution in English diet habits, which before his time had been sound. Nothing of the sort! He merely confirmed the bad eating habits of the nation, and added the seal of scientific authority to popular error. The strange part of it is, however, that despite many authoritative refutations of Liebig since his time, the bad habits of the nation still persist, and one can only conclude that this is so because one of the fundamental and most prevalent of human vices is possibly greed. True, there were many further scientific findings which seemed to confirm Liebig before enlightenment ultimately came. For instance, in 1881, Voit declared that a man required 20 per cent of his daily diet to consist of protein. Atwater, a little later, made it 25 per cent, and Moleschott and Vierordt 20 per cent. That is to say, for an adult who had ceased growing, 7 per cent to 12 per cent more tissue building material was being recommended than Nature herself allows to an infant which doubles its weight in six and trebles it in twelve months! But it was not until Dr. Lahmann in 1892 appreciated this discrepancy and conceived the brilliant idea of finding out the proportion of protein, carboydrates, fats and salts in mother's milk, in order to use this as a basis of Taking only the ingredients other than water in milk, we find that they consist of: Fat, sugar and mineral salts to the amount of 85.5 per cent and Protein to the amount of 13.5 per cent. Thus, for a creature like a human baby, which doubles its weight in the first six months, and trebles it in the first twelve months after birth, Nature provides a diet which, apart from water, contains only 13.5 per cent of the tissue-building and maintaining substance known as protein. But relative to the total bulk of breast milk taken by an infant, the protein is really only 1.6 per cent, because 88 per cent is water. Only in relation to the ingredients other than water is the amount of protein 13.5 per cent. Even this, however, is not a wholly reliable basis of calculation; because, unless we know the adult's activity as compared with the infant's, we cannot accurately assess the adult's needs. After Lahmann, Chittenden in 1904 also protested against the massive dosage of proteins in the ordinary diet prevalent in his day. But it was not until it was shown that the amount of urea excreted was by no means proportionate to the activity indulged in that Liebig and his school, together with the whole of the dietetic conventions which have prevailed until this day, were ultimately shown to be grossly at fault. Dr. Drinkwater, whose view I have already elaborated above, put the case graphically as follows: "If," he says, "muscles were worn away by the exercise of their normal function, according to the old view, it would be like a locomotive having to have its wheels and machinery renewed at the end of each journey, instead of needing simply water and fuel." 1 Nowhere is Nature as prodigal as that! 1 Food in Health and Disease (London. 1906). p. 10. So that we must not think of the adult's activity as involving chiefly the expenditure of his protein elements, or tissues, but as the expenditure of his fuel. Compared, therefore, with the protein needs of a growing infant, who is making new tissue daily, those of an adult are very small indeed. Of course, we know that men grow thin when they starve. And this leads people to think that tissue-building materials, or proteins, are really the one important kind of "solid" food. But when a man grows thin if he starves, it only means that his body, which has the capacity of converting its own tissues into fuel if necessary, has been forced to this extreme measure. This does not mean that in the full-grown, active man, protein is not required at all; it is required for the purpose of tissue repair. But to make it 13.5 per cent of the solid elements of his diet the amount provided by Nature to the growing infant is madness, and yet, as we have seen, this was a madness regarded as sanity until quite recently. Nay more, this insane provision of protein was, as we know, often very much exceeded by the scientific dietists and, of course, grossly exceeded by the world at large. Lahmann was in favour of conforming to the proportions of milk. Chittenden declared that "body weight, health, strength, mental and physical vigour and endurance can be maintained with at least one-half of the proteid food ordinarily consumed." 2 He placed the proportion of protein for the adult 3.5 per cent lower than for the infant, and thought 1 Drinkwater. Op. cit. p. 10. 2 Physiological Economy in Nutrition (London. 1904). p. 475. Both these estimates, however, have now been found to be very much in excess of the actual needs of the grown active man. Boyd, for instance, taking meat as the source of protein, estimates the minimal daily ration of protein requisite to maintain body-weight at 30 grammes, i.e., only about 4.65 per cent in a total amount of 650 grammes of food. 2 Ragnar Berg, after making a more accurate investigation, found it to be only 26 grammes, or 4 per cent of the total; 3 and Rose, after providing a better supply of alkalis, found it to be 24 grammes, or only 3.7 per cent. 4 Sherman, after surveying all previous estimates, and after conscientious experimentation, came to the conclusion that the adult body's need of protein should be calculated on a basis of .58 grammes per kilogramme of the body-weight. 5 And Ragnar Berg concludes that "a supply equivalent to 1 gramme of protein per kilogramme of body-weight, when a mixed diet is taken . . . provides a margin of safety of from 50 per cent to 100 per cent." 6 Thus a fully grown adult, of say 10 stone, should consume not more than 2.2 ounces of protein per day i.e., if he is taking his protein in the form of meat or cheese, he should not take more than half a pound of beef or curd cheese altogether; or if he is taking it in the form of cod-fish, not more than 7/8 of a pound. It is obvious that the average full-grown man, even of moderate habits, habitually allows himself a much larger proportion of protein. If he has eggs and bacon 1 Op. cit. p. 475. 2 Vitamins (London, 1923. p. 61.) 3 Ibid. 4 Ibid. 5 Ibid. 6 Ibid. Now the dangers of exceeding a moderate and adequate ration of protein are many and serious. In the first place, the excess tends to produce uric acid, and thus to cause all the ailments associated with this bye-product of protein-surfeit. Secondly, owing to the menace to the body of any excess of protein, the metabolic agencies of the organism attack the excess of protein before anything else, and try to dispose of it by combustion, thus neglecting the fats and carbohydrates, which are left to be deposited as superfluous adipose tissue all over the body, and to impede its functions and harass its organs. Thirdly, the excreting organs, particularly the kidneys, owing to the abnormal strain put upon them, in disposing of the nitrogenous waste products, tend to become exhausted and diseased, and to give rise to all the ailments associated with renal inadequacy. And fourthly, owing to the constitution of the human gut, not evolved like that of the carnivora to deal quickly with highly concentrated food-stuffs, there is a tendency to putrefaction of the badly digested material in the intestine, and hence, to stasis and all the secondary results of stubborn costiveness, i.e., the aperient habit, inflammation, piles, so-called biliousness, flatulence, etc. True, Ragnar Berg allows a small increase of protein for reproduction, and in this case proteins of high biological value are essential. But even when reproduction is allowed for, it is obvious from the above figures that the average man who has ceased growing Taking a young married man's total daily bulk of solid food as 600 grams, this means that 16.6 per cent according to Dr. Nixon should consist of protein. And this, as a non-vegetarian be it noted, he considers a generous and adequate allowance for all needs including fertility. Thus even a modern medical authority, quite unbiassed in favour of a vegetarian diet, but rather the other way, regards 3.527 ounces of protein as the maximum daily requirement for a young man in his prime and when the reproductive powers are at their zenith. And yet, there can be no doubt that to this day, in spite of all that has been discovered and and established in this department of knowledge, the majority of people still adhere to the mid-Victorian, Liebig, fallacy of making at least 19 per cent to 25 per cent of their total intake of food consist of protein. It means a harvest for doctors and owners of proprietary drugs, but little else. So much for the leading dietetic question the problem of proteins. (c) The next preliminary question concerns the matter of bulk. The reader may ask if so much protein, and so much fat, and so much carbohydrate are required every day, why not swallow a concentrated bolus consisting of adequate rations of all these in- 1 B.M.J. 6.1.34. p. 2. This would answer very well if we had been evolved that way. But our evolution has, been different. A comparison of man with other animals close to him in constitution reveals the fact that he is a creature who has been accustomed for millions of years to extract his quotas of the various food products he requires from a large heterogeneous mass of material, in which the essential ingredients he requires are not too highly concentrated. His dentition and his bowel differentiate him sharply from the carnivora, whose pointed cutting back teeth and short bowels adapt them admirably to the eating of meat, which is a highly concentrated form of food. Both man's teeth and his bowel bear a marked resemblance to those of the animals nearest to him in the evolutionary ladder the anthropoid or higher apes; and their dietetic habits, which have been studied, answer exactly to what has been stated above as being man's ideal requirements. By this is meant the need of consuming a mass of heterogeneous food, chiefly vegetable, in which the protein content is proportionately small and therefore not too highly concentrated. The investigation carried out on the monkeys at the Zoological Gardens, mentioned above, showed that they appear to secure the sense of repletion, essential to health and the feeling of satisfaction after a meal, by a good deal of so-called "roughage" (i.e., material with a very low concentration of nutritive elements), while evidently mixing it with a certain percentage of some highly concentrated food. Now man is remotely in time, but closely in type, related to these animals. As we have seen, however, the mistake that most civilized people in the last two or three millenniums have made is to secure the sense of repletion on a kind of food-stuff of highly nutritive value. Nature, providing for the desire of repletion in the There are various reasons why the sense of repletion after a meal is both necessary and comforting. In the first place, because the stomach itself is a distensible organ, consisting on its inner surface, when it is at rest, of pleats or so-called "rugae" which become flattened out when a good meal is taken, but which most probably remain as pleats after an inadequate meal. This seems to point to two conclusions: (a) that when an inadequate meal is taken a normal stimulus is not given to the organ and (b) that, in view of this natural pleating of the inner coat, and the probable retention between the rugae of detritus from a previous meal, the distention of the stomach by an adequate meal, giving a sense of repletion, acts incidentally as a sanitary measure, cleansing the complicated structure of the organ, and keeping it in a healthy condition. Secondly, owing to the fact that the peristaltic action of the intestines is stimulated more completely by an adequate than by an inadequate meal, the sense of repletion probably also gratifies an instinct concerned with the well-being of the lower reaches of the alimentary canal; for it was certainly found in the experiments on monkeys that when, in the hope of reducing the evil effects of their consistently excessive ingestion of highly nourishing foods, smaller meals were given them, they suffered from inadequate peristalsis. This fact may shed light on a good deal of the costiveness of dyspeptics, because, since dyspepsia leads to sitophobia, smaller and smaller meals tend to be taken, and increasing constipation ensues. If, instead of taking smaller meals, the dyspeptic took large meals consisting chiefly of foods of low nutritive value, he would probably find I have certainly found that his dyspepsia would vanish, and with it his tendency to constipation. From another point of view, therefore, we have So that the reply to the question with which this section opened is that it would be quite impossible to maintain life by small concentrated boluses of the required food ingredients, and thus to obviate all the trouble of elaborate meals. Bulk must be taken, and it is best for us humans to make up our bulk, as far as possible, out of the foods of low nutritive value. The next question is, can an active and strenuous life be led on such a diet? Most certainly! A much more active and productive life can be led on a diet suited to our needs than on a diet not suited to our needs; because with the latter it is impossible to ward off the illness, lethargy and indolence that result from a poisoned and exhausted state of the body. The enormous strength and endurance of Indian and Chinese coolies who live chiefly on rice, with a minimal addition of meat juice or meat, are proverbial. Indian coolies, as thin as laths, will carry a piano up the side of a hill in the time that it will take the burly, muscular furniture remover of London to carry one into a house from a pantechnicon standing at the door. The strength and endurance of the Greek wrestlers of antiquity are also a matter of history, and yet they were trained on a diet consisting of figs, nuts, cheese and As Dr. Dodds points out: "It is much easier to take in calories in the form of food than to get rid of them by exercise." And speaking of squash rackets which he describes as a game requiring the greatest output of energy, he says: "A person playing for roughly half an hour will have utilized some 300 calories, equivalent in terms of food, to say, 2 slices of bread and butter, or alternatively, to 2 dry Martini cocktails." Speaking of public dinners, Dr. Dodds says: "Those who assemble at public dinners have usually already consumed their essential 2,800 calories at breakfast, luncheon and tea, and therefore the dinner is not necessary from an energy standpoint. I have estimated that the total number of calories to be offered to each host or guest at the Middlesex Hospital annual old students' dinner is 2,500." Assuming that a few of those present would drink beverages other than water, and estimating these drinks modestly at 725 calories per head. Dr. Dodds continues: "In order to overcome the effects of this it will be necessary to play squash for 5 1/2 hours, or alternatively, to climb a mountain of the height of Ben Nevis 5 times, to walk 60 miles or to run 30 miles. As another alternative 50 hours submersion in a cold bath would be effective." 1 There is, therefore, as we see, no foundation whatsoever for the belief, extensively rife at present, that three meals a day, consisting of meat and highly nutritious foods, are essential to strength and health. Owing, however, to the deplorable influence of Christianity which has persistently associated foodstuffs other than meat with holy and fast days, a conviction has become firmly rooted in modern mankind, particularly among the poorer and more ignorant classes, that only steaks, chops and cuts from the joint are food at all. All the rest, including, if you please, even fish, by having been consistently rele- 1 Lancet. 7.10.33. (d) The next preliminary question concerns the matter of mineral salts. Lahmann made a great point of this, and very rightly, because mineral salts constitute the most neglected element in ordinary modern diet. To balance the amount of acid created by the excessive protein ration of most modern people, and their abuse of food of high nutritional value like meat, the diet of the civilized man ought really to contain a large quantity of mineral or food salts. And yet, as a matter of fact, except for Sodium chloride (salt), very little is taken. Lahmann declares that it is useless to take these salts in their inorganic form, that in this form they are not stable in the body, and that they only become stable when absorbed in their organic form, i.e., in the tissue of vegetables, in milk, in bone, etc. But, seeing that modern man does not trouble about these salts in any form, the distinction is not likely to interest him. Basing his estimates on the food salts in cow's milk, Lahmann argued that .71 per cent at least of all human food should consist of food salts in an organic form. A modern estimate sets the amount of food salts in human milk at .31 per cent. In Lahmann's time this was set at .45 per cent. But Lahmann did not trust the figure, and preferred to base his calculations on cow's milk. He said: "I choose as a makeshift cow's milk, as I cannot consider most of the analyses of human milk normal, on account of the unhealthiness of mankind generally." 1 If, however, we take a modern estimate of the food salts in cow's milk, which is roughly .66 per cent, and reckon what proportion this bears to the other ingredi- 1 Op. cit. p. 4. Ragnar Berg maintains that an excess of bases (alkaline elements) in the food "is desirable were it only to ensure optimal conditions for the utilisation of the proteins in the diet, and to reduce the liability to the formation of noxious products of metabolism." 1 These elements, consisting of the food salts, of which the most popularly known is calcium, are to be obtained chiefly from roots, salads, green vegetables, radishes, etc. But it is important that the vegetables should not be cooked, or at least boiled, if the full mineral-salt value is to be extracted from them; for Ragnar Berg actually found "the water in which potatoes, greens, etc., have been boiled . . . is speedy and effective" (in supplying the organism with a food rich in bases). 2 This implies that boiling must involve a corresponding loss of bases in the vegetables thus treated. Apart from balancing the acid-generating elements in the diet, enabling the blood to clot, and providing the necessary constituents for maintaining the teeth and bones in repair; apart, too, from facilitating the utilisation of proteins, and preserving the alkaline elements in the body from attack when hyper-acidity has been neutralized thus a badly fed woman loses her teeth in pregnancy the bases of food salts derived from organic sources also have the virtue of enabling the organism to profit from the value of certain vitamins. The vitamins, in fact, cannot do their work in the absence of the necessary inorganic salts, and vitamin D, of which more anon, cannot be effective unless the organism is adequately supplied with calcium. 1 Op. cit. p. 73. 2 Ibid. p. 90. He then adds: "Civilized man runs the risk of not securing from his food all the needful mineral elements," and he enumerates the following sources of these essential food salts: "The peel of fruit and hull of cereal grains," supply calcium, phosphorus and iron. Iron is also found in "red, yellow and green foods yolk of egg and carrots, and in vegetables and fruits." Calcium "is found primarily in milk; fruits and vegetables . . . while meat and milled cereals are poor in calcium." Phosphorus, needed for cell multiplication, for the glands, the bones, and the sexual elements, "is found abundantly in eggs and milk, also in wheat (entire grain, but not white flour), oatmeal, dried beans, and many nuts." 1 Before leaving the question of food salts, it is important to clear up certain matters relating to table-salt or sodium chloride. Many people imagine that table-salt produces bone, and they therefore put it into the milk given to children. Others, not quite so foolish, nevertheless take an abundance of it themselves, and frequently cover an already condimented meal with table-salt. In doing this they are probably following an instinct which impels them, in the absence or deficiency of food salts in their food, to obtain at least some sort of inorganic salt as a substitute. As a matter of fact, however, table-salt is a wholly artificial adjunct to a well regulated diet, which appears to have been adopted when cooking became general. 1 B.M.J. 6.1.34. p. 1. The injury done to the body by table-salt has been emphasized by the leading German dietician, Ragnar Berg, who has called attention to the effect of the various ions on the urinary apparatus. "For more than thirty years," he says, "we have known that the sodium ion has a paralysing affect upon the activities of the kidneys and of the ureters, according to the more recent . . . researches of American physiologists this is equally true of the chlorine ion." 2 He also maintains that it disturbs the osmotic balance of the body, and paralyses the endothelial activity, a secretory process "on the part of the vascular endothelium which, both from the blood and from the tissues, incorporates substances in solution, and then selectively passes them on to one side or the other." 3 In this Ragnar Berg is really only following and amplifying the teaching of his great master. Dr. Lahmann, who forty years ago warned his countrymen concerning the disturbance caused by salt in the 1 Lahman. Op. cit. p. 43. 2 Op. cit. pp. 275276. 3 Ibid. p. 287. "The salt dissolved in the blood," says Dr. Lahmann, "passes into all the tissues, and a process of osmosis takes place, that is an exchange of the dissolved constituents between the blood corpuscles and tissue-cells on the one side, and the plasma of the blood containing too much salt on the other. Through the cell membranes the salt enters the cells, and the cell contents pass out. "Dr. Lahmann also adds: "Now is it not probable that, owing to the constant action of the unnatural process of osmosis [he should have said, "owing to the constant destruction of the body's osmotic balance"] set up by the abuse of common salt, some of the tissues may have become abnormally permeable?" 2 He then goes on to refer to scurvy and hæmophilia as possible consequences; but there are many others. From a different standpoint. Dr. Lenz declares that salt is bad owing to its tendency to eliminate iodine. After arguing that "iodine is essential to the tissue changes of the human organism," he says: "I am inclined to suspect that the sodium-chloride [ordinary 1 The various organs, blood-vessels and glands of the body, it should be remembered, consist of tissue, more or less permeable, in contact with vessels also consisting of tissue, more or less permeable. They are not like zinc or iron vessels sealing the liquids or semi-liquids they hold completely from contiguous vessels. It must be assumed, therefore, that these hollow organs have an optimal degree of impermeability adapted to the kind of liquid each has to hold, and it is this optimal impermeability which may be called the "osmotic balance". Since, however, salt increases osmosis i.e., the oozing capacity of liquids through membranes it may upset the original normal impermeability of the organs (osmotic balance) and thus occasion undesirable oozings from one organ into another. 2 Op cit. pp. 4547. When we remember that the authorities to whom I have referrred concern themselves only with the acute results of excess, or the cumulative consequences of habitual salt-taking, and that there are probably, if not certainly, numerous sub-acute consequences associated with a moderate use of salt, which probably debilitate the system in some way, it seems clear that wisdom indicates caution where table-salt is concerned more especially if we bear in mind that it seems to have become a necessity only since the cooking of food became universal. My own experience is that, when a sufficiency of food salts is taken by means of a wise and well-selected diet, the yearning for sodium chloride steadily declines, and with it any pleasure that may be felt in eating food condimented with table-salt. (e) The next preliminary question to be considered is that of sugar. It should be borne in mind that sugar, as we know it, that is, as a concentrated extract of the sugar-cane juices, or of beet, or of a synthetic chemical product, is a comparatively recent commodity of civilization. 2 "There is a very widespread idea that sugar, being a natural food, there is little danger in taking it in a l Human Heredity (London, 1931). p. 339. 2 Cane sugar was obtainable as early as the 13th and 14th centuries; but it was very expensive. Loaf sugar, for instance, cost the then exorbitant sum of 1s. to 2s. a pound. As Dr. Nixon says: "Sugar offers in a concentrated form the most readily available carbohydrates, and it possesses a high satiety value. Unfortunately it has also disadvantages." One of these is that "it is easily eaten in excess." 2 The fact that many thousands of people to-day, and millions of children, must be eating too much sugar is shown by statistics of sugar consumption alone. In 1819 the amount consumed per head of the population per annum in Great Britain was 17 pounds. In 1928 it was 90 pounds. £55,000,000 are now being spent a year in the United Kingdom on sugar confections and chocolate alone, apart from the sugar consumed in beverages, puddings, etc. If all this heavy expenditure on sugar and this high consumption, amounting to 90 pounds per head per annum is a necessity now, why was it not a necessity in 1819? One thing is certain that health has not improved in the interval. Among children sugar has largely replaced fat as a source of energy, and there is little doubt that a correlation has been established between the present high consumption of sugar and disease. "There is a widely prevailing opinion in the [medical] profession," says Dr. Chalmers Watson, "that the modern excessive use of highly refined artificial sugar is definitely detrimental to the health of the community, lowering the resistance to disease, predisposing 1 Medical Press and Circular. 9.11.32. 2 B.M.J. 6.1.34. Dr. Nixon points out that it promotes obesity, that in concentrated form it may irritate the gastric mucosa, that as it is slow to leave the stomach it may set up fermentation, and that it may be the cause of a reduction in the consumption of other foodstuffs and lead to dietary deficiency. 2 Certainly in modern children, who eat sweets continuously, I have often noticed a feeble or fitful appetite, and an unnatural capriciousness with their food. Dr. J. H. P. Paton of the James Mackenzie Institute of Clinical Research, St. Andrews, has also drawn attention to the disquieting increase in the consumption of sugar in Great Britain in recent times. Tolerance for sugar, he maintains, is not unlimited, and the physiologist Macleod found that when only as much as about .190 of an ounce of sucrose per kilo, of body weight is consumed by a healthy person, sucrose appears in the urine. That is to say, in a healthy person weighing ten stone who consumes 12 ounces of sugar a day, sucrose appears in the urine. Dr. Paton found sucrose in half the specimens of urine in healthy school girls. Dr. Paton has suggested that the reduction of catarrhal illness in a boarding-school during the war years (19141918) was associated with the rationing of sugar. Both the physiologist M'Clendon and Dr. C. H. Cameron, believe that the over-ingestion of carbohydrates leads to an increase of the lymph content of the. body, which in its turn induces catarrh. Maitland Ramsay has also found the rationing of sugar beneficial to the eyes. Dr. Paton further stated that he found in a girls' 1 Medical Press and Circular. 9.11.32. 2 B.M.J. 6.1.34. An interesting observation also made by Dr. Paton is that the graphs of sugar consumption and the cancer death rate since 1850 run nearly parallel. There may be no connexion between the two, but the coincidence is disquieting. 1 All this does not mean that sugar is to be entirely eschewed, or that carbohydrates are not a necessary part of human food. For the contrary is true, and if the body is stinted in carbohydrates it simply manufactures them at the expense of the tissues or other types of food, by converting proteins into carbohydrates. Thus Dr. Nixon calls carbohydrates "protein sparers." 2 But all people who wish to maintain their health should bear in mind that much less sugar is really required than most moderns consume, and that, in any case, the body which receives no sugar except that which it extracts from the fresh or dried fruit taken, is also constantly manufacturing sugar from the starchy substances consumed in the diet. Such starchy substances are all the cereals; but in this country, chiefly wheat (taken in the form of bread) or potatoes, honey or beetroot. The Royal Society Food (War) Committee estimated that the normal diet of an average man should consist of 500 grammes of carbohydrates daily i.e., roughly about 1 lb. 2 oz. This should include all bread, all potatoes, all cakes, jams, sweets, sweet puddings, etc. eaten during the day. To eat an enormous amount of sugar in addition to such a ration of carbohydrates would, of course, be a 1 Journal American Medical Association. 29.10.32. 2 B.M.J. 6.1.34. Thus, for the adult, a golden rule would be to take sweet things only with a meal, and to take them sparingly, because of the other carbohydrates that are, in any case, being absorbed in the form of bread, potatoes, etc. (f) The next preliminary question to be considered is that of the accessory foodstuffs, or vitamins. Until the year 1910, only 33 years ago, mankind knew only about four classes of nutritive substances proteins, fats, carbohydrates and mineral salts. And the chemists told you that provided the amount of each of these substances you absorbed sufficed to make up an adequate number of calories per day, you were all right and need not bother about anything else. Thus, we used to be told by the chemists that it did not matter two pins whether you ate butter or margarine, because in ultimate analysis, each yielded the same number of calories to the body. In vain did the layman protest that in spite of all the calories in Christendon, margarine was quite unlike butter. In vain did the housewife protest that when mice attacked her stores it was the butter they ate and Such was the position until about the year 1910, when a number of mysterious diseases, such as beri-beri, rickets, scurvy, and the general susceptibility to infection and the lack of a capacity for repair in the body, induced investigators very reluctantly to conclude that there must be some other quality in food which hitherto chemistry had failed to trace and which, if absent, led to certain diseases. For instance, after exhaustive researches, it was found that it was the natives living on polished rice who contracted beri-beri, 1 while those living on unpolished rice remained immune. It was also found that it was those babies who were fed for long periods on pasteurised milk, and those sailors who had for long periods been deprived of orange or lemon juice, or fresh fruits, or fresh vegetables, who suffered from scurvy, while those (babies or sailors) who, with tendencies to scurvy, were given orange juice, or fresh fruit, or fresh vegetables, rapidly became normal again. 2 It was further discovered that it was infants fed on certain kinds of scientifically treated milk, or on milk from cows deprived of sunshine, who contracted rickets, or who became easily infected with disease, while those who had good milk, or mother's milk, did not, provided, of course, the mothers were healthy. Thus gradually was the attention of scientists directed to certain minute accessories to ordinary food-stuffs, which became known as vitamins, or completins, and 1 An Eastern disease marked by anæmia, paralysis, and dropsical symptoms. 2 The fact as to sailors had of course long been known, and the cure, consisting in a raw fruit or fresh vegetable, or fruit juice therapy, had been successfully applied for generations. But the rationale of the cure had remained a mystery. These vitamins might be described as certain properties of food-stuffs, or of particular parts of foodstuffs, which are essential to health, growth and well-being, which may be removed by stripping a food-stuff of certain of its parts, or by boiling it, or otherwise cooking it, or by producing from that food-stuff a commercial extract, in the manufacture of which, the essential property has been lost. There are a number of such vitamins, but I shall deal only with five vitamins A. B. C. D. E. referred to thus because these letters are the names by which they are actually known in science. Vitamin A is necessary for growth and for the maintenance of resistance to disease. Vitamin B is one of the factors on which normal growth is dependent. It is not a simple substance, but consists of a group of vitamins which are necessary for the maintenance of health. Vitamin C is the anti-scurvy vitamin. Vitamin D is the anti-rickets vitamin, and the vitamin essential to proper calcium metabolism, and Vitamin E is the vitamin necessary for reproduction and the sexual functions. Now it is most important to appreciate that it is quite fantastic to hope to keep in health, no matter how much you may eat, unless your food contains, if possible every day, but certainly once or twice a week, adequate allowances of all these vitamins. Their distribution among our common food-stuffs is as follows: Vitamin A is present in fish-oils and fats, butter, egg-yolk, milk, cheese, liver, green vegetables and carrots. It is also present in kidney fat, beef fat and mutton fat. But in green vegetables and carrots the supply is less plentiful than in the other food-stuffs. Vitamin B group is present in whole cereals, beans, peas, Vitamin C is present in fresh fruits and green vegetables, potatoes and carrots. (Cattle and dogs can manufacture their own Vitamin C, but guinea pigs, monkeys and men must obtain it from their food). Vitamin D is present in fish-oils and fats, egg-yolk, milk, butter and liver. Vitamin E is abundantly present in wheat germ, in lettuce, watercress and alfalfa. An obvious inference from the above is that cod liver oil is a first class source of Vitamins A and D. Various important facts concerning the food-sources of vitamins must now be dealt with. The first is that they are not equally resistant to heat; The consequence is that whereas some of them, like vitamins B, C and E, survive quite a fair amount of cooking or baking, A and D cannot, and it is, therefore, important to see to it that your sources of Vitamins A and D are not over cooked, or, if possible, not cooked at all. The fact that infants fed on pasteurized milk over a long period develop scurvey, also shows that vehicles of C cannot be cooked with impunity. But, seeing that G is largely obtained from potatoes by the populations of Western Europe, and that it has been established that cooked potatoes do still contain enough of this Vitamin to ward off scurvy, we are justified in inferring that, at least as regards this Vitamin and its need in adults, cooked potatoes are an adequate source. If, however, in addition to potatoes, fruit and raw green vegetables are eaten, there cannot possibly be a deficiency of vitamin C in the diet. Although Vitamin A has been found to be more resistent to destruction than was originally supposed, it is better and safer if possible to obtain and consume the foods which are sources of this Vitamin uncooked if possible. Or, as in the case of liver, egg-yolk, beef Vitamin B survives heat more satisfactorily than A, but one of our principal sources of it bread which is baked in an oven, depends for its content of this Vitamin upon the milling product used in the making of the particular loaf we eat. Since the Vitamin B content of the amount of yeast added in the baking of bread is too small to be responsible for a significant addition to the Vitamin B content of bread, we must be careful to choose that bread which contains the B Vitamin from the wheat grain. Now in wheat, it is the germ that is richest in Vitamin B, next comes the bran, while the white flour derived from the rest of the grain is so poor in Vitamin B that, by itself, it has been found incapable of protecting birds against polyneuritis or man against beri-beri. Cereals represent one of the main supplies of Vitamin B in the human dietary, and before the introduction of the roller mills about fifty years ago, the stone-milled flour did represent an important source of supply of this Vitamin. White bread which contains no germ or bran has, however, now ceased to fulfil this function. On a varied diet, including milk, butter, eggs, porridge, potatoes and other vegetables, the absence of Vitamin B from bread may not be seriously felt. But those who can afford such a diet do not depend much on bread. It is among the poor, and especially the children of the poor, that bread represents the bulk of the daily diet, and where among them margarine replaces butter the absence of Vitamin B from white bread is a serious dietetic defect. 1 I refer here to liver cut into slices about i inch thick. If thinner slices are prepared, the cooking should be reduced proportionately. With regard to D, this is chiefly a matter of the amount of sunshine enjoyed by the pastures on which the cows, providing our milk and butter, graze; because the chief source of this Vitamin, so important for calcium metabolism and, therefore, for teeth and bones, is dairy produce. It has been found, for instance, that in New Zealand butter the vitamin D content is distinctly lower in winter, owing to the greater distance of the sun from the zenith at that season and the fact that the period of unclouded sunshine is on the average six hours a day in winter against nine hours a day in summer. Thus the butter derived from English cows, even when they are given cod liver oil, never reaches the standard of New Zealand summer butter as regards Vitamin D content. Owing to the relatively poor supply of sunshine in England, even in summer, English butter is always much nearer in Vitamin D content to New Zealand winter butter. As to the Vitamin A content of butter, milk and cream, this appears to remain more or less constant. For although an excess of Vitamin A, so important for natural immunity to all infections, may be stored in the liver of a lactating animal, apparently this excess is not transferred to the milk, which has a maximal Vitamin A value that is never exceeded. Only milk that has been left untampered with, however, will preserve its Vitamin content unimpaired. And if we are to be certain of obtaining our Vitamin A and D through milk, butter and cream, it is important that the milk should not have been over-heated. As to vitamin E, which is essential to reproduction and to normal vigour of the sexual organs, this, as I have stated, is to be found abundantly in wheat germ and in lettuce. In white bread, however, it is deficient, and eaters of white bread would be well advised either to eat lettuce or watercress at some of their meals during the week, or else to make wholemeal bread part of their bread ration. In cases of avitaminosis, or vitamin deficiency, the symptoms are so varied that it is impossible to deal with even a fraction of them. A person, for instance, may find himself constantly afflicted with influenza during the winter, and yet never appreciate the fact that perhaps all that he is suffering from is a deficiency of Vitamin A, (the protective and immunising Vitamin) which he can immediately correct by taking cod liver oil. Another person may suffer but this is a little more rare from the familiar symptoms of threatening scurvy, before he finds out that all he needs is raw salad, or an orange. While yet another may suffer from defective teeth the ailment par excellence of the British people, with their lack of sunshine without understanding that what he needs is Vitamin D, which he can obtain from cream, good butter, fish oils, or simply milk, in order to improve his calcium metabolism. Though Vitamin D can do little unless the sufferer is providing himself with calcium in his food, by taking plenty of root vegetables, if possible raw with his salad. There are grounds for supposing that Vitamin D is synthetised in the human body itself, by exposure to sunlight, so that in a warm bright summer it is not so very important to make sure of taking adequate supplies of Vitamin-D-containing food. But in the Before leaving the question of heating and cooking, and their effect on food, it is important to bear in mind that the salts of foods, like their vitamin content, are to some extent destroyed or removed by the cooking process. Boiling in water, for instance, removes some of the most valuable salts from many vegetables; the heating of milk to a temperature of 140� to 150� F. very materially alters the chemical character of the citric acid of milk in its relationship to the calcium and potash content of the nutrient, and the process is not suffered without loss. Even with meat, boiling for a comparatively brief period transforms the organic phosphates into inorganic, so that they are of greatly diminished value to the body.
We are now prepared for the problem of actual dieting, and the four aspects in which it has to be considered are: 1. The supply of calories, or units of energy required. 2. The quantity of first-class protein. 3. The supply of mineral matter, and 4. The Vitamin content. Two expert bodies, consisting of the most authoritative dietists in Great Britain have carefully-considered this problem. They are, the Ministry of Health's Advisory Committee on Nutrition, who published their report in 1932, and the British Medical Association's Committee on Nutrition, who published theirs in 1933. As there was slight disagreement between their findings, on February 6th and 27th, 1934, three doctors from the Health Ministry's Advisory Committee and three doctors from the B.M.A.'s Nutrition Committee held a conference and duly issued an Agreed Report.
This agrees so completely with the findings of physiologists and dietists thirty years ago, that the three intervening decades seem to have added nothing to expert knowledge on this point. As regards the amount of protein of which the daily diet should consist, the Agreed Report, issued by the Joint Committee, stated that, "Accumulated evidence indicates that the total daily need for protein per man unit probably lies between 80 and 100 grammes, i.e., from 2 4/5 to 3 1/2 ounces." This allowance of protein is so close to that arrived at for the young man in his prime, in the section (b) on proteins above, that it confirms all my findings; and the confirmation is of more particular interest seeing that it comes from a body of selected experts, representing two independent groups of investigators totally unbiassed in favour of a vegetarian or fruitarian diet. We may take it, then, that for the average urban dweller of sedentary habits, 2 4/5 ounces of protein is the optimum allowance, about 2/5 of which should consist of first class protein, i.e., that of cheese, eggs, fish or meat. So that if we take 1 1/8 ounces of first class protein as the optimum allowance, the rest to be made up of proteins of lower grade, such as cereal and vegetable proteins, we find that an average man of sedentary habits has consumed enough first class protein in one This would leave about 1 3/4 ounces to be made up in lower grade proteins. If, then, he took half a pound of white bread, half a pound of potatoes, 4 ounces of rice pudding, half a pint of milk, 2 ounces of prunes, 2 cups of cocoa, and 2 ounces of peas, he would complete his protein ration for the day. These 2 4/5 ounces of protein would account for 1,660 calories, leaving 1,340 calories to be made up of fats and carbohydrates. If, then, he took 4 ounces of butter on his bread, 3 ounces of jam, an apple weighing 4 ounces, or an orange weighing 6 ounces and 2 ounces of dates, he would complete his need of calories for the day. Personally, however, I regard such a diet for a sedentary man as too concentrated. I would reduce the first class protein by about one third, leave more proteins to be made up at haphazard by bulkier food than meat, eggs, cheese, or fish, and increase the ration of carbohydrates with fruit and vegetables. As to the choice of first class proteins, I would endeavour whenever possible, i.e., about five or six days a week, to make this fish, and for the following reasons: (a) Fish has to be eaten fresh. It is never eaten as stale as meat with putrefaction already set in. (b) It is more easily digested; therefore more easily assimilable than meat. This means that, again, during digestion, the products of putrefaction will be less than with meat, for, with accelerated digestion, there is diminished chance of both the generation and absorption of such products. One reason why fish is more easily digested is that it has much less connective tissue than meat. The easy pulping of fish with a fork is a simple mechanical demonstration of this. (c) There is also more of such valuable elements as The total ration of fish, consisting of a herring, or 1/4 pound of cod, turbot, sole, plaice, skate, haddock, kipper or what not, should be taken at one meal. Or if it is desired to reduce the ration of fish, and to take two eggs as part of the first class protein, these could be taken at breakfast, and only half the ration of fish at night, while a little cream can be taken with lunch, with salad, roots, fruit and brown bread. If a rule is made, however, never to have any meal without fruit, or any large meal, lunch or dinner, without salad; if, moreover, satiety is secured at each meal while a ration of not more than 3/8 of a pound of fish and one egg is distributed over the day, the rest of each meal being made up with fruit, cereals, cream, roots, lettuce, brown bread, a little cheese (just a relish), butter and honey, the feeling of repletion will be obtained without the evils of a too concentrated diet; the intestine will be stimulated to regular action by the fruit juices and the bulk; no concentration of uric acid will occur, no indigestion or furred tongue. 1 On such a diet six days in a week, a meat meal once a week may be enjoyed as a pleasant change, and on the same day a little extra of everything may also be taken without harm. It is in the sense of these recommendations that I advise all people seriously to consider Bircher-Benner's work, and his breakfast and lunch dishes; because, if his system be strictly adhered to for these first meals, and fish is taken in the evening, little harm can come. In case of illness whether temporary indigestion, biliousness, rheumatism, catarrh, furunculosis, headache, constipation, etc. turn over to Bircher-Benner altogether, exclude the fish ration and the eggs and cheese and in a week you will be all right again. 1 As this is neither a cookery book nor a volume of recipes for dishes, the reader is referred to Bircher-Benner's own pamphlets and book for description of dishes. It should, however, always be borne in mind that the kind of health secured nowadays by a diet consisting largely of fruit and vegetables depends, as regards the latter especially, on the kind of soil on which the produce is grown. As Bircher-Benner himself points out, "The very soil on which food is now grown is poisoned," 1 and we cannot expect perfect health to be maintained even on a sound and balanced diet so long as the wholesomeness and health of the soil remain doubtful factors in the process of food production. Thus, although it is of the utmost importance that sound food values should be more generally known than they are to-day, particularly among our urban populations, too high hopes regarding the ultimate results of this dissemination of the new knowledge in dietetics should not be entertained until the fundamental question of the health of the soil has been satisfactorily solved and the resulting principles properly applied. It now only remains to say a word or two on drink, and we can turn to the next section. The question of drink may conveniently be considered under three aspects: (a) The time to drink. (b) The quantity to drink. (c) The kind of liquor to drink. (a) The time to drink in normal conditions should be determined by the impulses of the body. To drink when no thirst is felt, or to drink to order, is, I submit, justifiable on no grounds whatsoever. In health manuals it is not unusual to find even great 1 New Health Magazine: Report of Dr. Bircher-Benner's Lecture at University College, London. February, 1933. p. 17. The idea is probably to relieve a condition, very common nowadays, in which quantities of dehydrated fæcal matter tend to accumulate in a congested intestine, and in which the kidneys are also overworked in their effort to eliminate the bye-products of excessive protein ingestion. And when, in conversation with Sir Robert McCarrison, I drew his attention to the passage in a pamphlet of his on diet, where he recommended the drinking of water between meals, he explained to me that this was intended only for the modern man living on the conventional diet of England, and that it was not supposed to apply to one like myself who lived chiefly on Bircher-Benner lines. I took this to mean that, owing to the large amount of moisture and roughage which is naturally ingested on the Bircher-Benner regimen, my condition would be such as not to require any additional liquid administered at odd moments of the day without the impulse of thirst, and, indeed, I may say that, ever since living on the Bircher-Benner diet, I have noticed that my thirst has in any case diminished conspicuously. It is, however, one thing to drink, no matter how much, when one is thirsty, and another to drink when one is not thirsty, and with all due respect to Sir Robert McCarrison and the other authorities who recommend the drinking of water at odd times during the day (usually between meals), whether thirst is felt or not, I cannot see that it can do any good, even if one is in the state usually brought about by the observance of the conventional diet. I would go further and suggest that the practice may be exceedingly harmful, a matter already discussed under (e) in Chapter II. The next question under the present head is, should one drink at meals? When, however, such a man sits down to his weekly meal of meat, based on the conventional fare of England to-day, or even if he daily concentrates all his high-class protein ration into one meal, and sits down in the evening to a dinner consisting chiefly of fish, or eggs, or cheese, or a mixture of all these, there is nothing whatsoever against his drinking with that meal if he feels the need. Nor need he fear to drink some light alcoholic preparation, such as wine or cider or ale. In fact, if he does concentrate all his high-class protein ration in this one meal, a little wine is all to the good, provided it is not too heavy. Let such a man ask himself two questions: What has been the tradition of his race almost for millennia? and what does Nature herself prescribe? The tradition of his race and the best of his race for almost millennia has been to drink with meals. Presumably, however, in healthy conditions, only when thirst demanded it. And Nature prescribes 88 per cent of water in the normal food of the growing infant! To say that one should not drink with meals or to put it more accurately so as to include the Bircher-Benner regime in the generalization, to say that one should not have with one's meal sufficient liquid to slake normal thirst is, therefore, nonsense. And whether one achieves the result by eating foods with a high water content, or by drinking extra liquid is a matter of indifference, except that the former alternative is known to be associated with a more wholesome regimen. (b) Regarding the quantity to drink, if this cannot safely be left to the feelings of the person concerned, there is clearly something wrong with him. It need hardly be said that all drinking for drinking's sake, as it is sometimes carried on by student clubs in Germany and by "pub-crawling" groups in England, is thoroughly to be condemned, as is also the practice of cock-tail drinking and any form of bibulous pastime not imposed by a natural impulse. The practice of drinking beverages of relatively high alcoholic potency, however, when thirst does not demand it, is even more to be deprecated than the mere drinking of water in similar circumstances, for, as we have seen above, alcohol is a food, and a couple of cocktails may need a lot of working or walking off. To sit down to a big meal after taking a few is, therefore, simply barbarous, and those who habitually do this must, in the end, suffer from their frivolous disregard of their body's needs and functions. It is not a bad plan to remember that Puritanism and Luxurious Living are really but different aspects of the same medal. Both imply a contempt of the body and its needs, and both, therefore, take their root in negativism. (c) Regarding the kind of liquor to drink, this depends largely on the diet to which one is accustomed. I can imagine nothing more unpleasant than the drinking of alcoholic liquor of any kind, especially the more concentrated, when eating Bircher-Benner's breakfast or luncheon dishes. On the other hand, when I am eating a meal of the kind served at dinner by a conventional restaurant, As I have shown in my Man's Descent from the Gods, there are good reasons for supposing that the drinking of alcoholic liquors has been traditionally associated with the sophisticated diet that became prevalent after cooking utensils and fire were discovered. At any rate, Dionysus is a later mythological figure than Prometheus, and I have collected much evidence to show that the former, with his, gift of wines, distillations and fermented liquors, probably arose as a necessity and as a corrective, when the havoc caused in health from the first cooking of food began to alarm mankind. I did not find a culture where alcoholic drinks were used, in which fire had not long been discovered and employed in the preparation of food. We therefore seem to possess some colourable warrant for assuming that, for incalculable centuries, mankind, particularly in those nations which are now most highly civilized, has been in the habit of drinking some kind of fermented or alcoholized liquor with its cooked food. On the other hand, a fact my investigations brought very plainly to light was this that where health and civilization have been most flourishing and enduring, fermented liquors with a relatively low alcoholic content (ales, cider, perry, and native fermented decoctions unknown to Europe) have always prevailed over liquors with a high alcoholic content. As to spirits a comparatively recent innovation, with sometimes 40 per cent to 60 per cent of alcohol, they seemed to be associated chiefly with decadent civilizations. Wines, with their 8 per cent to 12 per cent of alcohol were, on the other hand, compatible with a high level of civilization and with its duration, and were not conspicuously different from the old ale of various cultures (Egypt, England, China, Africa, etc.) with their 5 per cent to 9 per cent of alcohol. Drinks of a higher alcoholic content, such as mead, for On the conventional cooked diet, therefore, no one need refrain from drinking the old ale of such cultures as those of Mediæval, Tudor, and Stuart England, and of ancient Egypt, if he can get anything at all like it, or from drinking the natural light wines of France, Italy and Germany. It should, however, be remembered that the latter cannot now be popular drinks, and that it behoves all, therefore, who have the welfare of the nation as a whole at heart, to restore to England, so long as she remains a country subsisting mainly on cooked food, a good sound drink such as the Ale of pre-Puritan days, which can be made accessible to all. With the eating of raw fruit and vegetables i.e., the diet prescribed by Bircher-Benner, the question of an alcoholic beverage does not arise, because the need is not felt. And I submit that it is the best proof of my thesis, as expounded in Man's Descent from the Gods, that the need for fermented beverages is actually not experienced on a diet resembling that which was probably universal before fire was discovered and before the Promethean pall of smoke began to settle over man's world. To sum up, therefore, let it be stated as a general principle that, except medicinally, 1 drinks containing about the average of alcohol represented by such fermented liquors as light wines, ales, ciders and perries 1 There is much evidence to suggest that alcoholic drinks in general were at first regarded only as medicine hence the very root of the word mead. The Persian word for wine, daru, also meant medicine originally. See Chap. VI. Man's Descent from the Gods. The directions outlined above and the particular attention given to such separate aspects of food as its caloric value, contents of organic salts, vitamins, etc., may be and, indeed, have been criticized on the ground that they amount to a "fragmentation" of what should be something whole and sound, accessible to us without our having to take thought, i.e., our whole food supply should be healthy by tradition, and even its ingredients should be accepted as a matter of course by each fresh generation growing up in a nation soundly based on a healthy soil and its wise cultivation. There should be no individual concern about its components as revealed by analysis. Dr. Wrench is among those who have argued in this way, and now all the writers in the Agricultural Revival Movement repeat the criticism as if it contained the wisest policy for every unfortunate member of civilized society. At the present moment, however, with civilized man wholly bereft of a sound tradition in diet, becoming ever more urbanized and more widely separated from his sources of food, and with his rural population no longer observing even that minimum care of the soil which prevailed up to thirty years ago, it is not too helpful and is actually romantic to hold up before him, in a country like England, a diet like the Hunza's and to say: "Eat as they eat, and what they eat, and ye shall flourish!" Having utterly lost our way in the matter of healthy food and the soil from which it derives, not to mention Long ago I pointed out our present dependence on intellectual methods of recovery in the absence of sure guiding instincts. 1 But where food is concerned, the position is actually worse than this; for even if we possessed the instincts required for dieting ourselves healthily, the difficulty of obtaining food all the ingredients of which are healthy, would still be insuperable in our modern world. So that the position is really this we are reduced to avoiding the grosser errors of the customary diet, and for the nonce i.e., until the sources of our food are regenerated making the best of picking our way with what help science can supply. It is far from ideal, but it is all we can hope to do hence the detailed discussion above about the various components of our diet and the conditions to observe if an approximately healthy diet is to be our rule in present circumstances. We have examined the alternative course. It is to be found in such counsels of perfection as are summarized in the works of the Healthy-Soil-Evangelists, although, as we now know, they have grossly overstated their case in presenting it to us. Even if we could assume, however, that their claims were not exaggerated, how could the modern man of our urbanized civilization begin to put them into practice? He and his like represent roughly about 82 per cent of the population of England and Wales. 2 1 See my little work Recovery. (London, 1935). 2 According to the 1931 Census, 73% of our population lived in cities of 10,000 inhabitants and upwards. But of those elements in our urban masses who might wax enthusiastic over the prospect of adopting agriculture as a career, how many know any more about the country and its occupations than the view from a railway-carriage window may have given them? How many of them would really like it or endure it, when once they had tried to live as the rural worker lives? Even to retain the existing rural population on the land in the near future will, in my opinion, be difficult enough. For not only does the work itself consist very largely of drudgery often performed in trying circumstances of weather and dirt, but the home life and conditions also of the worker are in most cases so indescribably uncomfortable and trying that no townsman or townswoman would believe them possible. I am intimately acquainted with the domestic life of farm labourers only in East Anglia, but from what I have seen in the form of hardship, lack of ordinary kitchen and scullery appointments, and generally Spartan conditions among them, I should say that, unless a vast programme of rebuilding and reconditioning of village dwellings, including the extension of public utilities to rural areas, can be undertaken immediately after the war, the probability is that few of the younger generation who have, in the various male and female services, had opportunities of experiencing the more comfortable conditions even of the 1 See, for instance. Lord Northbourne's Look to the Land, Chap. V. where, discussing the prospect of a more "devoted care of the soil", the author says, "An obvious corollary to this is that far more people would be wanted on the land." See also, Lady Eve Balfour's The Living Soil, pp. 178179 in particular. It is too easily forgotten, both by the authorities and those townspeople who like to dream about an agricultural revival, that it is precisely the mediæval conditions of rural life which make it seem at once so fascinating and picturesque to them, and so grim to the rustic. But how and when is the necessary vast programme of reconstruction and reconstitution to be carried out, with its inevitable corollary, the supply of urban amenities to the country areas? For it would be a mistake to suppose that elaborate plumbing in cottage and farm-house is going to suffice. The work of reappointing the homes of our agricultural workers and multiplying them will have to be accompanied by a comprehensive scheme of reconstitution applied to all farm outhouses, barns, and sheds. Whether this work is carried out sooner or later, it is useless to contemplate a revival of agriculture and of rural life on the lines so attractively sketched by our latter-day Healthy-Soil Evangelists, until it has been conscientiously accomplished. Moreover, if the authorities are contemplating anything similar to that recruitment of urban workers for settlement on the land, which was organized by the National Socialists of Germany in the last decade before the war, it should be borne in mind that the middle-aged townsman (for he is the kind of citizen most prone to cherish illusions about a rural life) cannot be expected, when once his profound ignorance of real rural work and conditions have been corrected, to suffer anything but disillusionment, and ultimately nostalgia for his former urban existence. And if this is true of him who turns to the land in his maturity, after half a lifetime spent in an office, a surgery, professional chambers, a factory, or a warehouse, how much more true must it be of the younger generation of the towns, not yet nauseated by the city and its occupations? Besides, as I have already hinted, the very work of rural areas compares badly with the more comfortable, generally cleaner and drier work of cities. Those who can talk inspiringly of the ennobling effect of work on the soil and of the unbroken link between the earthly and the heavenly fields, ought not only to make a closer study of the rustic of a purely agricultural area like East Anglia and Lincolnshire, but should also be invited to do a whole year of farm labourer's work, and live a whole year in the average farm labourer's cottage. But this recalls the woman's aspect of the question. It was my belief twenty years ago in Dorset that it was the womenfolk of rural areas who, owing to the extremely primitive conditions with which they daily have to wrestle, had done most to help in modifying farming in a regrettable direction (the development of "milk factories" for instance!) and to swell the exodus to the towns. 1 But in East Anglia I have been convinced that the almost impossible conditions of their lives in the mediæval cottages placed at their disposal are having precisely the same effect. Indeed, I have difficulty in believing that any young female rustic of East Anglia is likely to show a desire to return to the countryside if her life in any of the services has given her the opportunity of comparing town with country life. 2 In fact, I should go so far as to argue with Lord Northbourne that even marriage with a rural worker would now in many cases be refused. 3 So that, here again, we are brought face to face with the delays and difficulties that are likely to confront us in any programme of rural renaissance on which a revival of agriculture must depend. But without it, 1 See my Taming of Don Juan (London, 1924). 2 The authors of Living in the Country (London 1940) bear me out here, for they are "inclined to think that women have sought the town more than men". 3 Look to the Land (London, 1940). p. 38. Finally, there is this point to consider in connexion with the chances of our ever acquiring that modicum of health capable of being secured without taking thought and merely by eating the traditional food of our homeland, grown on healthy soil What about self-sufficiency? Even in order to realize but approximately the ideal held before us by arm-chair agricultural reformers of the new school, we should, as we have seen, have to carry out a vast programme which might take decades to complete, and this a programme not aiming at more than 70 per cent of self sufficiency. But what about the 30 per cent which would still have to be imported from abroad? Can we reasonably expect ever to succeed in making our foreign producers of food come up to the standard of the Hunza? And this question is all the more pertinent seeing that there appears to be no serious intention of maintaining even the 70 per cent of home supplies reached during the War. Speaking before the United Nations Relief and Rehabilitation Administration in Atlantic City on November 12th, 1943, Colonel Llewellin, our Food Minister said: "If world trade barriers are barred, Britain will not have to maintain the intensified food cultivation made necessary by the war." 1 This goes some way towards supplying the official reply to a question about the Atlantic Charter put to me by a correspondent in the wholesale meat trade. His question was: "How can we ensure a prosperous condition for British agriculture and at the same time put into operation what seems to be visualized in the 1 Daily Press. November 13th, 1943. The answer is we cannot without making such changes in our mode of life, our outlook and general organization as may take decades to effect. Besides, it does not seem likely that we shall ever achieve self support or self-sufficiency, at least as regards wheat, for, apart from the fact that self-sufficiency is associated politically with a doctrine of nationalism, which is now anathema to prevailing thought on the side of the United Nations, it does not seem practical as a working programme. According to Mr. C. Henry Warren, for instance, "Corn, especially wheat, can never be grown in Britain in sufficient quantities to support the population, or even substantially to supplement supplies, from abroad; and subsidies ought never to be canvassed by means of appeals slyly based on the supposition that it can." 1 The utmost he regards as possible in the production of corn in this country is that "It should be grown as an integral part of the traditional rotation of arable, whereby the land may be maintained at a maximum of fertility." 2 So that, at best, we must expect much of our bread, probably 75 per cent, 3 to come from abroad. 4 What becomes, then, of the much-noised Hunza ideal? In what sense is it a practical programme for this country? At best, as we have seen, it is an ideal which, even if wholly realized, would yield results far short of what its most sanguine advocates expect, unless other important biological reforms preceded that part of its realisation which consists in a healthy food supply derived from healthy soil. 1 England and the Farmer (London, 1942). p. 63. 2 Ibid, p. 67. 3 Ibid. p. 59. 4 The Earl of Portsmouth in Alternative to Death declares it possible to feed 40,000,000 people in these islands. But apparently this would involve a mixture of potato flour in our bread and probably the import of "a little cereal." (p. 166). For all practical purposes, therefore, and as a policy capable of immediate application, the advice to imitate the Hunza is quite valueless to the Englishman of to-day who wishes to improve that contribution to his general health which consists in a sound diet. At what date in the future the inhabitants of the British Isles will be in a position to follow this advice and benefit from it, no one can now tell. But, if there is any validity whatsoever in the above sketch of the preliminary steps which will necessarily have to precede both a reform of our methods of husbandry, and the production of healthy foodstuffs (both vegetable and animal) from a healthy soil in these islands and in those parts of the world from which we shall probably continue to derive at least some of our nutriment, it seems not unlikely that the present generation will long have passed away before the ultimate aim is achieved. Moreover, it should be borne in mind that it is not merely a matter of time i.e., of the time necessary to introduce and establish the necessary changes, as if the whole population were on tip-toe, only awaiting the requisite reforms, in order to step into their places and set to work. Besides those already enumerated, many difficult problems will have to be solved before such a moment arrives, and not the least of these will be the means, in a democratic country, of "directing" the necessary labour to the land, of transforming the present sewage and town waste disposal plants, of increasing our livestock without penalising those vested interests already committed to a continued policy of meat imports, and possibly too of scrapping our chemical fertilizer industry. With all this in view, I decided that modern man required, at least in regard to that contribution to his health which consists in sound food, more practical and less romantic counsels than to be told to imitate the Hunza. It is for this reason that, in the teeth of the One last word before I dismiss for good these romantics of the healthy-soil-healthy-food path to "perfect health and physique", who naively hurl the charge of "fragmentation" at the scientific dietists of the day. I should like to ask them all from Dr. Wrench to Lady Eve Balfour what is their own romantic doctrine but "fragmentation"? They repeatedly use the word "whole" the necessity of a "whole" diet in order to be a "whole" or healthy man and imply thereby that their doctrine is a "whole" doctrine of health. Nay, they not only imply but actually declare that it is so. And yet have we not seen that, in order to complete Dr. Wrench's alleged "whole" doctrine of health, we have had to make three major additions to it? And is Lord Northbourne, or Lady Eve Balfour, or, in fact, any other writer on health, based solely on McCarrison, in any better case? 1 They are all fragmentationists! Let anyone who doubts this consider the title of this work and the manner in which it has been illustrated in these pages. To all of them, therefore, I suggest that they should try to perceive the beam that is in their own eye before attempting to remove the mote in their brother's. 1 The Earl of Portsmouth is the one happy exception. He evidently suspects that in the attainment of perfect health and physique there are other factors besides healthy food derived from a healthy soil. See, for instance, his speech on the subject in the House of Lords on October 26th., 1943. After stressing the admittedly important factor of healthy food, he said, "It may be that other things have also something to do with the matter." In the spate of verbiage that threatens daily to engulf us, these important words have probably been overlooked; but at least they save him who spoke them from the charge of fragmentation. |
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