Soil Fertility and National Health
IN the last chapter the retreat of the crop and the animal before the parasite was discussed. Disease was regarded as Nature's verdict on systems of agriculture in which the soil is deprived of its manurial rights. When the store of humus is used up and not replenished, both crops and animals first cease to thrive and then often fall a prey to disease. In other words, one of the chief causes of disease on the farm is bad soil management.
How does the produce of an impoverished soil affect the men and women who have to consume it? This is the theme of the present chapter. It is discussed, not on the basis of complete results, but from the point of view of a very promising hypothesis for future work. No other presentation is possible because of the paucity, for the moment, of direct evidence and the natural difficulties of the subject.
In the case of crops and live stock, experiments are easy. The investigator is not hampered in any way; he has full control of his material and freedom in experimentation. He cannot experiment on human beings in the same way. The only subjects that might conceivably be used for nutrition experiments on conventional lines are to be found in concentration camps, in convict prisons, and in asylums. Objections to using them for such purposes would almost certainly be raised. Even if they were not, the investigator would be dealing with life in captivity and with abnormal conditions. Any results obtained would not necessarily apply to the population as a whole.
Perhaps the chief difficulty at the moment in following up the possible connexion between the produce of a fertile soil and the health of the people who have to consume it, is to obtain from well-farmed land regular supplies of such produce in a perfectly fresh condition. Except in a few cases, food is not marketed according to the way it is grown. The buyer knows nothing of how it was manured. The only way to obtain suitable material would be for the investigator to take up a piece of land and grow the food itself. This, so far as my knowledge goes, has not been done. This omission explains the scarcity of direct results and why so little real progress has been made in human nutrition. Most of the work of the past has been founded on the use of food material very indifferently grown. Moreover, no particular care has been taken to see that the food has been eaten fresh from its source. Such investigations therefore can have no solid foundation.
Apart from the evidence that can be gathered from nutrition experiments, is there anything to be learnt about health from agriculture itself? Can the East which, long before the Roman Empire began or America was discovered, had already developed the systems of good farming which are in full swing to-day, throw any light on the relation between a fertile soil and a healthy population? It is well known that both China and India can show large areas of well-farmed land, which for centuries have carried very large populations. Unfortunately two factors -- overpopulation and periodic crop failures due to irregular rainfall -- make it almost impossible to draw any general lessons from these countries. The population, looked at in the mass, is always recovering from one catastrophe after another. Over-population introduces a disturbing factor -- long-continued semi- starvation -- so powerful in its effects on the race and on the individual that any benefits arising from a fertile soil are entirely obscured.
When, however, the population of the various parts of India is examined, very suggestive differences between the races which make up its 350 million inhabitants are disclosed. The physique seen in the northern area is strikingly superior to that of the southern, eastern, and western tracts. We owe the investigation of the causes of these differences to McCarrison, who found that they corresponded with the food consumed. There is a gradually diminishing value in the food from the north to the east, south and west in respect of the amount and quality of the proteins, the quality of the cereal grains forming the staple article of diet, the quantity and quality of the fats, the mineral and vitamin content, as well as in the balance of the food as a whole.
Generally speaking the people of northern India, which include some of the finest races of mankind, are wheat eaters, the wheat being consumed in the form of thin, flat cakes made from flour, coarse but fresh-ground in a quern. All the proteins, vitamins, and mineral salts in the grain are consumed. The second most important article of diet is fresh milk and milk products -- clarified butter, curds, and buttermilk; the third item is the seed of pulse crops; the fourth vegetables and fruit. Meat, as a rule, is very sparingly eaten except by the Pathans.
Turn now to the other parts of India, east, west, and south, in which the rice tracts provide the staple food. This cereal -- a relatively poor grain at best -- is parboiled, milled or polished, washed in many changes of water, and finally boiled. It is thereby deprived of much of its protein and mineral salts and of almost all its vitamins. In addition, very little milk or milk products are consumed, while the protein content of the diet is low both in amount and quality. Vegetables and fruit are only sparingly eaten. It is these shortcomings in their food that explain the poor physique of the peoples of the rice areas.
In order to prove that these bodily differences were due to food, McCarrison carried out experiments on young growing rats. When young growing rats of healthy stock were fed on diets similar to those of the races of northern India, the health and physique of the rats were good; when they were fed on the diets in vogue in the rice areas, the health and physique of the rats were bad; when they were fed on the diets of races with middling physique, the health and physique of the rats were middling. Other things being equal, good or bad diet led to good or bad health and physique.
When the health and physique of the various northern Indian races were studied in detail the best were those of the Hunzas, a hardy, agile, and vigorous people, living in one of the high mountain valleys of the Gilgit Agency, where an ancient system of irrigated terraces has been maintained for thousands of years in a high state of fertility. There is little or no difference between the kinds of food eaten by these hillmen and by the rest of northern India. There is, however, a great difference in the way these foods are grown. The total area of the irrigated terraces of the Hunzas is small; ample soil aeration results from their construction; the irrigation water brings annual additions of fine silt produced by the neighbouring glacier; the very greatest care is taken to return to the soil ail human, animal, and vegetable wastes after being first composted together. Land is limited: upon the way it is looked after life depends. A perfect agriculture, in which all the factors that combine to produce high quality in food, naturally results.
What of the people who live upon this produce? In The Wheel of Health, Wrench has gathered together all the information available and has laid stress on their marvellous agility and endurance, good temper and cheerfulness. These men think nothing of covering the 60 miles to Gilgit on foot in one stretch, doing their business and then returning.
There is one point about the Hunza agriculture which needs further investigation. The staircase cultivation of these hillmen receives annual dressings of fresh rock-powder, produced by the grinding effect of the glacier ice on the rocks and carried to the fields in the irrigation water. Is there any benefit conferred on the soil and on the plant by these annual additions of finely divided materials? We do not know the composition of this silt. If it contains finely divided limestone its value is obvious. If it is made up for the most part of crushed silicates, its possible significance awaits investigation. Do the mineral residues in the soil need renewal as humus does? If so, then Nature has provided us with an Experiment Station ready-made and with results that cannot be neglected. Perhaps in the years to come, some heaven-sent investigator of the Charles Darwin type will go thoroughly into this Hunza question on the spot, and will set out clearly all the factors on which their agriculture and their marvellous health depend.
A study of the races of India and of their diet, coupled with the experimental work on rats carried out by McCarrison, leaves no doubt that the greatest single factor in the production of good health is the right kind of food and the greatest single factor in the production of bad health is the wrong kind of food. Further, the very remarkable health and physique enjoyed by the Hunza hillmen appears to be due to the efficiency of their ancient system of farming.
These results suggest that the population of Great Britain should be studied and the efficiency of our food supply investigated. If the physique and health of a nation ultimately depend on the fresh produce of well-farmed land, if bad farming is a factor in the production of poor physique and bad health, we must set about improving our agriculture without delay.
Two very different methods have recently been employed for testing the efficiency of the food supply of this country. In the first case (Cheshire) the population of a whole county, which includes both rural and urban areas, has been studied in the mass for a period of twenty-five years and the general results have been recorded. In the second case (Peckham) a number of families have been periodically examined with a view to throwing light on the general health and efficiency of a group of comparatively well-to-do workers in a city like London.
The methods adopted in the study of the population of Cheshire and in the publication of the results are highly original. About twenty-five years ago, the National Health Insurance Act for the Prevention and Cure of Sickness came into force. This measure has brought the population under close medical observation for a quarter of a century. If the experience of the Panel and family doctors of the county could be synthesized, valuable information as to the general health of the community would be available. This has been accomplished. The local Medical and Panel Committee of Cheshire, which is in touch with the 600 family doctors of the county, has recorded its experience in the form of a Medical Testament. They find it possible to report definite progress in the 'Cure of Sickness' -- the second part of the objective framed by the National Health Insurance Act. There is no doubt that we have learnt to 'postpone the event of death' and this is the more remarkable in view of the rise in sickness, in short the failure of the first part of the Act's objective. On this latter count there is no room for complacency.
'Our daily work brings us repeatedly to the same point -- this illness results from a life-time of wrong nutrition.' They then examine the consequences of wrong nutrition under four heads -- bad teeth, rickets, anaemia, and constipation -- and indicate how all this and much other trouble can be prevented by right feeding. For example, in dealing with the bad teeth of English children some striking facts are emphasized. In 1936 out of 3,463,948 schoolchildren examined, no less than 2,425,299 needed dental treatment. That this reproach can be removed has been shown by Tristan da Cunha, where the population is fed on the fresh produce of sea and soil -- fish, potatoes, and seabirds' eggs are the staple diet with sufficient milk and butter, meat occasionally and some vegetables -- all raised naturally without the help of artificial manures and poison sprays. In 1932, 156 persons examined had 3,181 permanent teeth of which 74 were carious. Imported flour and sugar have been brought in to a greater extent of late, which may account for the tendency of the teeth to deteriorate observed in 1937.
The Testament then goes on to the work of McCarrison (referred to above) 'whose experiments afford convincing proof of the effects of food and guidance in the application of the knowledge acquired'. This has been applied in local practice in Cheshire and the results have been amazing. Two examples will suffice.
1. In a Cheshire village the nutrition of expectant mothers is supervised by the local doctor once a month. The food of the mother is whole-meal bread, raw milk, butter, Cheshire cheese, oatmeal porridge, eggs, broth, salads in abundance, green leaf vegetables, liver and fish weekly, fruit in abundance and a little meat. The whole-meal bread is made from a mixture of two parts locally grown wheat, pulverized by a steel fan revolving 2,500 times a minute, and one part of raw wheat-germ (fresh off the rollers of a Liverpool mill). The flour is baked within thirty-six hours at most -- a point to be rigidly insisted upon -- and a rather close but very palatable bread is obtained. With rare exceptions the mothers feed their infants at the breast -- nine months is advised and then very slow weaning finishing at about a year. The nursing mother's food continues as in pregnancy; the infants are fed five times a day with four-hour intervals beginning at 6 a.m. The children are splendid; perfect sets of teeth are now more common; they sleep well; pulmonary diseases are almost unknown; one of their most striking features is their good humour and happiness. They are sturdy-limbed, beautifully skinned, normal children. This was not a scientific experiment. It was part of the work of family practice. The human material was entirely unselected and the food was not specially grown; but that, in spite of these imperfections, the practical application of McCarrison's work should yield recognizable results shows that in a single generation improvement of the race can be achieved.
2. A young Irishman aged 23, with a physique and an alertness of mind and body it was a delight to behold, was found to be suffering from catarrhal jaundice after two months' residence in England, where he had been living on a diet mostly composed of bacon, white bread, meat sandwiches and tea, with a little meat and an occasional egg. In Ireland his food had consisted of the fresh natural products of the soil -- potatoes, porridge, milk and milk products, broth (made from vegetables) and occasional meat, eggs, and fish. The change over to a diet of white bread and sophisticated food was at once followed by disease. This case shows how quickly good health can be lost by improper feeding.
The Testament then leaves the purely medical domain and deals with that principle or quality in the varied diets which produces the same result -- health and freedom from disease (such as the Esquimaux on flesh, liver, blubber, and fish; the Hunzas and Sikhs on wheaten chappattis, fruit, milk, sprouted legumes and a little meat; the islanders of Tristan on potatoes, seabirds' eggs, fish, and cabbage). In all these cases the diets have one thing in common -- the food is fresh and little altered by preparation. The harvest of the sea is a natural product. When the foods are based on agriculture, the natural cycle from soil to plant, animal and man is complete without the intervention of any chemical or substitution phase. In other words, when the natural produce of sea and soil has escaped the attention of agricultural science and the various food preservation processes, it would seem that health results and that there is a marked absence of disease.
The last part of the Medical Testament deals with my own work on the connexion between a fertile soil and healthy plants and animals; with the means by which soil fertility can be restored and maintained; with a number of examples in which this has been done. These have already been described and need not be repeated.
This remarkable document concludes with the following words:
'The better manuring of the home land so as to bring an ample succession of fresh food crops to the tables of our people, the arrest of the present exhaustion of the soil and the restoration and permanent maintenance of its fertility concern us very closely. For nutrition and the quality of food are the paramount factors in fitness. No health campaign can succeed unless the materials of which the bodies are built are sound. At present they are not.
'Probably hall our work is wasted' since our patients are so fed from the cradle, indeed before the cradle, that they are certain contributions to a C3 nation. Even our country people share the white bread, tinned salmon, dried milk regime. Against this the efforts of the doctor resemble those of Sisiphus.
'This is our medical testament, given to all whom may concern -- and whom does it not concern?'
The Testament was put to a public meeting held at Crewe on March 22nd, 1939, by the Lord Lieutenant of Cheshire, Sir William Bromley-Davenport, and carried by a unanimous vote. More than five hundred persons representing the activities of the County of Cheshire were present. The Medical Testament was published in full in the issue of the British Medical Journal of April 15th, 1939. It has been widely noticed in the press all over the Empire.
The experience of the Cheshire doctors is supported by the work of Doctors Williamson and Pearse at the Peckham Health Centre in South London. In connexion with the study of families whose average wage is between £3. 15s. and £4. 10s. a week, about 20,000 medical examinations have been recorded. The results have recently been published in book form under the title Biologists in Search of Material (Faber & Faber). It was found that no less than 83 per cent. of apparently normal people had something the matter with them, ranging from some minor maladjustment to incipient disease. One of the most important contributions of these Peckham pioneers has been to unearth the beginnings of a C3 population. The next step will be to see how far these early symptoms of trouble can be removed by fresh food grown on fertile soil. For this the Centre must have: (1) a large area of land of its own on which vegetables, milk, and meat can be raised, and (2) a mill and bakehouse in which whole-meal bread, produced on Cheshire lines from English wheat grown on fertile soil, can be prepared. In this way a large amount of food resembling that of the Hunza hillmen can be obtained. The medical records of the families which consume this produce, after the change over from the canned stuff of the shops and the semi-carrion of the cold stores has been made, will form interesting reading.
The health of our population has been studied by these two very different methods. Both lead to the same conclusion, namely, that all is not well: that there is an enormous amount of indisposition, inefficiency, and actual disease. The Medical Testament boldly suggests that want of freshness in the food and improper methods of agriculture are at the root of the mischief. This provides a stimulating hypothesis for future work. A case for action has been established. The basis of the public health system of the future has been foreshadowed.
A certain amount of supporting evidence is already available. Two recent examples can be quoted, the first dealing with live stock, the second with schoolboys.
At Marden Park in Surrey, Sir Bernard Greenwell has found that a change over to a ration of fresh home-grown food (raised on soil manured with humus) fed to poultry and pigs has been followed by three important results: (1) the infantile mortality has to all intents and purposes disappeared; (2) the general health and well-being of the live stock has markedly improved; (3) a reduction of about 10 per cent. in the ration has been obtained because such home-grown produce possesses an extra-satisfying power.
At a large preparatory school near London, at which both boarders and day-boys are educated, the change over from vegetables, grown with artificial manures, to produce grown on the same land with Indore compost has been accompanied by results of considerable interest to parents and to the medical profession. Formerly, in the days when artificials were used, cases of colds, measles, and scarlet fever used to run through the school. Now they tend to be confined to the single case imported from outside. Further, the taste and quality of the vegetables have definitely improved since they were raised with humus.
Much more work on these lines is needed. A search will have to be made throughout Great Britain and Northern Ireland for resident communities such as boarding-schools, training centres, the resident staff of hospitals and convalescent homes which satisfy the following four conditions: (1) the control of sufficient fertile and well-farmed land for growing the vegetables, fruit, milk and milk products, and meat required by the residents; (2) a mill and bakehouse for producing wholemeal bread with the new Cambridge wheats grown on fertile soil without the assistance of artificial manures; (3) the medical supervision of the community by a carefully chosen disciple of preventive medicine; (4) a man or woman in control who is keenly interested in putting the findings of the Medical Testament to the test and who is prepared to surmount any difficulties that may arise. In a very few years it is more than probable that islands of health will arise in an ocean of indisposition. No controls will be necessary -- these will be provided by the country-side round about. Elaborate statistics will be superfluous as the improved health of these communities will speak for itself and will need no support from numbers, tables, curves, and the higher mathematics. Mother earth in the appearance of her children will provide all that is necessary. The materials for Medical Testament No. 2 will then be available. Cheshire no doubt will again take the lead and provide a second milestone on the long road which must be traversed before this earth can be made ready to receive her children.
In this work research can assist. Medical investigations should be deflected from the sterile desert of disease to the study of health -- to mankind in relation to his environment. Agricultural search, after reorganization on the lines suggested in the next chapter, should start afresh from a new base-line -- soil fertility -- and so provide the raw material for the nutritional studies of the future -- fresh produce from fertile soil. The agricultural colleges with their farms should devote some of their resources to feeding themselves, and so demonstrating what the products of well-farmed land can accomplish. They should strive to equal and then to surpass what a tribe of northern India has already achieved.
Scott Williamson, G., and Innes Pearse, H. Biologists in Search of Material, Faber & Faber, London, 1938.
Howard, Sir Albert. 'Medical Testament on Nutrition', British Medical Journal, May 27th, 1939, p. 1106.
McCarrison, Sir Robert. 'Nutrition and National Health' (Cantor Lectures), Journal of the Royal Society of Arts, lxxxiv, 1936, pp. 1047, 1067, and 1087.
-- 'Medical Testament on Nutrition', Supplement to the British Medical Journal, April 15th, 1939, p. 157; Supplement to the New English Weekly, April 6th, 1939.
Wrench, G. T. The Wheel of Health, London, 1938.
Next: 13. A Criticism of Present-day Agricultural Research
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