THE conception presented in this work, based on evolutionary, epidemiological and other scientific considerations, recalls the conclusions that many have arrived at instinctively in the past, without any scientific aid at all. Thus Horace, some 2000 years ago, as stated at the very beginning of this book, warned that 'you may drive out Nature with a pitchfork, but she will ever hurry back, to triumph in stealth over your foolish contempt'.
In much more recent times eminent members of our profession, such as Sir Robert McCarrison, have pursued a similar approach, based on natural considerations, and the thirty-two practising physicians and surgeons  in the county of Cheshire -- who played no small part in founding the present Soil Association in this country, dedicated to natural principles in nutrition and in agriculture -- have laboured tirelessly in the same vein, and in particular have blamed the spate of modem degenerative diseases on alterations in our food, and urged the medical profession to return to the Hippocratic view -- that the physician should also be a naturalist and should take cognizance of the cycle of Nature as well as of man. These beliefs were carried further forwards in 1957 by over 400 doctors and dentists. 
The dental profession has always been the most aware of the impact of refined carbohydrates, the effects of which on the teeth smite the eye, and a member of that profession, Mr. Weston Price,  made one of the most revealing of all personal epidemiological studies. He travelled purposefully in different parts of the world and found that wherever a civilized, refined diet overtook an erstwhile healthy race, dental decay became rampant. He also showed that from a very early age the skull itself sometimes shared in these effects, and from this observation made penetrating suggestions concerning delinquency.
It is pertinent here to observe that it is the Medical Officers of Health in this country who, more than any other group, hold in their hands the practical application of the dietetic principles set out in this work. From this fraternity the author has received no greater support or more information than from Dr. Kenneth Vickery, who since the mid-1950's has written repeatedly of the dangers of refined carbohydrate foods in human nutrition, especially in connexion with the giving of cane-sugar in milk feeds to babies, and the ever-earlier introduction of refined farinaceous foods into the diet of infants. He has considered that such additions not only are the direct cause of dental decay and ever-more-frequent obesity in young children, but also probably lay the foundation for other conditions in later life, such as coronary thrombosis.
While lending sustained and influential support to the conception of the saccharine disease, Dr. Vickery has criticized the author for not including more prominently in this disease the vitamin deficiencies that stem from refined carbohydrates, to which some allusion has been made. This criticism is only too valid, especially since, as Dr. Vickery has pointed out, such deficiencies must be accentuated in many sufferers from the saccharine disease who are obese, since in them the vitamin claims of much non-vital tissue (fat) are in conflict with the claims of tissues that are very vital indeed. In old age, too, as stated earlier, Dr. Geoffrey Taylor and others have shown how serious these deficiencies can be, partly through ignorance of the foods needed, partly through lack of money to buy such foods, and partly through lack of energy to forage for them even if there is the money to buy them.
These vitamin deficiencies, however, though a formidable public health problem, are relatively well understood, and in a skeletal work of this sort the author has preferred to devote the space to conditions where he may have something to contribute. But Dr. Vickery's points are very real ones. One thing that seems to be very clear is that vitamins should always be taken, if that is remotely possible, in their natural setting, i.e., in the natural foods containing them. By this means not only are there taken any vitamins that have not yet been isolated, but also there is avoided the risk of overdosage, which can at times be just as dangerous as underdosage.
Meanwhile, in a recent personal communication (January, 1973), which the author is privileged to quote, Dr. Vickery states that he is entirely certain that 'if the present conception becomes applied to public health, it will not only result in a dramatic reduction in the degenerative diseases of today and in the personal suffering caused by them, but will also bring a corresponding relief to the overburdened resources of the National Health Service'.
In this connexion Dr. Vickery, together with the author himself, would single out one step which appears to be eminently feasible right away -- a campaign to persuade people to change to a true wholemeal bread, coupled with the elimination of white bread and refined farinaceous products from the dietary of hospitals and other public institutions. The provision of unprocessed bran on a large scale, for the millions of sufferers here from ordinary constipation, would appear to be the thin end of the wedge in this respect. Another feasible step -- but much less feasible, alas! -- would be a modification of the contents of school tuckshops, so that sweets were replaced by such things as raw fruits, dried fruits, and nuts, in order that some inroads were made on the present dreadful commitment to sweets by the young people in this country. Such a step would have to make up any financial loss to the shops concerned -- the cost of which would come back many times over in the accounts of the National Health Service. A very similar step would be desirable in hospital canteens, too, where at the moment are available only the foods that are responsible, if this volume counts for anything, for so many of the patients being where they are.
A Note on Treatments
The present work is essentially one on aetiology, but since the first step in the treatment of a disease lies in removal of the cause, where this is possible, the work also becomes implicated in treatment. And here a note of caution is necessary. For the natural approach in the quest for causation, as discussed above, does not always lead to a natural approach in treatment, too.
Thus, as suggested earlier,  it is possible to divide all diseases into, as it were, unnatural and natural groups. The members of the unnatural group, confined to civilized man and some domestic animals, include the degenerative conditions dealt with in this book; per contra, the chief members of the natural group, seen in all living creatures, include the infections and infestations, where one organism preys upon another in the struggle for existence -- good examples of which in humanity are attacks by viruses, by bacteria, and by multicellular organisms like a tapeworm or, for that matter, a tiger.
Sometimes the distinction between unnatural and natural diseases becomes blurred, but, as a rule, the absence or presence of infectiousness (either direct or, as in the case of malaria, indirect) decides the issue, for only by infectiousness can the natural diseases continue occurring from generation to generation. This test readily reveals the difference between an unnatural disease like appendicitis and a natural one like typhoid fever.
Here the following extract from the author's original paper  is relevant:
'At this stage one might refer to the light thrown on this classification of diseases by some consideration of the diseases that occur in animals. A perusal of some of the textbooks of veterinary surgery is not only a very interesting experience, but it confers added perspective on the nature of disease that is most valuable.
'In surveying such a panorama of disease it becomes very clear that the dog assumes a position in relation to other animals very similar to that occupied by civilized man in relation to other, primitive races.
'In modern conditions the dog, which in Nature is almost a pure carnivore, has largely been turned into a herbivore. In Nature, as in an English countryside, it would spend its time catching rabbits, rats, and other similar mammals, and would never turn aside to eat the ears of the wheat ripening in the field. 'The nearest it would get to that would be occasionally to make itself sick by eating a few blades of grass. Yet in civilized conditions, especially in those of poverty, the dog lives on wheat, in the form of bread, dog biscuits, and related foods, to a much greater extent than it does on flesh. Meat and fat are expensive foods; bread is a cheap food; it is not surprising, therefore, that most dogs in English homes live on a preponderance of farinaceous, as opposed to protein, materials.
'This results in the dog being exposed to all the unfortunate consequences of an over-consumption of carbohydrates that have been mentioned earlier in the case of civilized man. Thus the dog suffers from dental caries, diabetes, chronic interstitial nephritis and so on; and no doubt if dogs were more carefully examined in the last stages of their lives, these conditions would be found still more frequently.
'Although tumours will not be dealt with in these pages, it is interesting to quote from Hamilton Kirk:  "Tumours in dogs are very commonly found, but in cats much less so. 'The malignant variety is, unfortunately, very prevalent; in fact, cancer may be said to be quite common." (This subject has recently been elaborated in The Lancet. )
'But all the above diseases are rarer in the cat. Why? Because the cat, also a pure carnivore, differs in its food habits from the dog, under domestic conditions. Although it lives with humanity, "it walks alone", and avoids most of the food eaten by the dog. It lives on milk, fish, mice, birds, and so on, rather than on biscuits. The carnivorous cat, in short, under civilized conditions, largely stays carnivorous. And that is the obvious explanation why the diseases of civilization are more rarely seen in it.
'Consideration of such facts as these from the case of animals makes the classification of diseases into two main groups, the natural and the unnatural, even more easily appreciated, perhaps, in the sister science of veterinary surgery than in that of medicine itself.'
Now, the treatments in these two groups of diseases are diametrically opposite to each other. For in the unnatural diseases the natural approach in treatment is correct, mainly consisting as it does in the removal of unnatural causes. It is here that the diet card at the end of this work comes into its own. But how relatively ineffective is this approach in the natural diseases! Of what avail are the hands in an attack by a tiger? A revolver is more to the point. And, indeed, in the natural diseases generally, such as the infections and infestations, highly unnatural treatments are indicated, including the use of drugs, antibiotics, and surgical operations.
Such steps are also needed even in the unnatural diseases for any damage already sustained. For example, the natural diet will certainly prevent and arrest dental decay, but for any decay already present normal dental treatment will be imperative. Similarly, in diabetes the natural diet will prevent and may well arrest the disease, but it can never replace the use of insulin where the damage already sustained indicates the need for this material; and likewise over operative treatment in appendicitis.
It is seen that controlled and co-ordinated naturopathy, especially in the reverence it betokens for the human body, is a very valuable approach in therapeutics, but its blanket application to disease generally would be totally unjustified.
Since this is mainly a work on the causation of disease, it is not really implicated in what civilized man in general, and Westernized man in particular, will do about such causation, if it becomes generally accepted as true. This is an entirely different subject, just as the discovery of smoking as the main cause of lung cancer, and what the public does about it, are two subjects that are entirely different from each other. If the author were asked what he thought the public will do in the present case, over the consumption of refined carbohydrates, he would hazard the guess: in prevention, very little; in treatment, quite a lot; in short, people will go on enjoying themselves till they get hurt. This would follow the smoking and lung cancer precedent, though in the present case a drug habit is not involved, and so the outlook may be brighter.
But at this point the question of economics comes into the picture. For if it were just a question of substituting unrefined carbohydrates for refined ones, little loss of pleasure would be involved and therefore little opposition would be expected. But such a step involves some extra expense, and the more people who attempt such substitution, the greater the expense becomes, owing to the ensuing rise in prices, especially of raw fruit. This is why the author singled out the eating of wholemeal bread as the first and most feasible step, and even here there could eventually be considerable repercussions in the animal-feed industry.
It may well be, in fact, that the struggle for existence, in the shape of simple economics, will compel humanity to adapt itself to the consumption of these refined foods. But this adaptation will take many thousands of years and will be accompanied by immense personal suffering. For those not wishing themselves to participate in this grim evolutionary event, and who are prepared to spend a little more money, the diet card, already mentioned, will, if the author's experience is any guide, prove to be valuable. It is in a form suitable for the lay public and saves a great deal of talking and explaining on the part of medical practitioners.
In conclusion, the author hopes that the lack of academic detail in this work will not be construed as a weakness. Were it so construed, he would try to defend himself with the following: In many of the conditions set out here as parts of a single master-disease, mostly erupting within the past 100 years, particularly such conditions as colonic stasis (with its diverticular and venous complications) and extending through the Escherichia coli infections, peptic ulcer and diabetes right up to the dreaded coronary thrombosis, what have the thousands of highly academic papers published on these conditions so far achieved? They have produced miraculous surgical and pharmacological antidotes to the ravages produced by these conditions on the human body, but the conditions have not been stopped from occurring; on the contrary they are commoner now than they ever were, and most of them are still getting commoner. Nor have members of our own profession been in any way absent from the sufferers in this remorseless advance. May not the author therefore plead, with all humility, that there may be room for a different type of work, embodying a much greater reverence for Nature herself? -- a work where academic details that do not seem vital are deliberately omitted in the interests of greater perspective and simpler conclusions. And with this reference to simplicity he ends his book on the same note as that on which he began it.
1. Cheshire Panel Committee (1939), Brit. Med. J., 1, suppl., 157.
2. Lancet (1957), 1, 152.
3. Price, W. A. (1950), Nutrition and Physical Degeneration. Los Angeles: American Academy of Applied Nutrition.
4. Cleave, T. L. (1956), J. R. Nav. Med. Serv., 40, No. 2, 55.
5. Kirk, Hamilton (1945), Index of Diagnosis, 42, 449-50. London: Baillière, Tindall & Cox.
6. Leader (1968), Lancet, 2, 618.
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