briej?reuieu/ oi 
FOOD AND NUTRITION 
IN FIVE COUNTRIES 
FIVE LECTURES BY ' 
DELEGATES TO THE UNITED NATIONS FOOD CONFERENCE 
DELIVERED IN THE AUDITORIUM OF 
THE UNITED STATES DEPARTMENT OF AGRICULTURE 
JUNE 7-18, 1943 
SPONSORED BY 
THE INTERDEPARTMENTAL NUTRITION COORDINATING COMMITTEE 
and 
FOOD DISTRIBUTION ADMINISTRATION 
WAR FOOD ADMINISTRATION • WASHINGTON. D. C. 
WAR FOOD ADMINISTRATION 
U. S. DEPARTMENT OF AGRICULTURE NFC-1 1 
Lriej? review oj? 
FOOD AND NUTRITION 
IN FIVE COUNTRIES 
CONTENTS 
Page 
Introduction n 
The Economics of Mexican Nutrition I 
By Dr. Francisco DeP. Miranda 
Nutritional Problems op Egypt 6 
By Prof. Ali Hassan 
Page 
Influence of the Belgian Agricultural Pattern 
Upon the Nutrition Habits op the Country 11 
By Prof. E. J. Bigwood 
Dietary Habits of the Chinese 18 
By Dr. J. Heng Liu 
Public Health and Nutrition in India 23 
By Dr. W. R. Aykroyd 
UNITED STATES 
GOVERNMENT PRINTING OFFICE 
WASHINGTON • 1944 
Washington, D. O. 
Issued January 1944 INTRODUCTION 
In 1942, to focus attention upon the necessity for a coordinated 
approach to food and nutrition problems, a series of eleven lectures 
was delivered at the United States Department of Agriculture, and 
later published as "The Food Front.” 
Immediately after the United Nations Conference on Food and 
Agriculture at Hot Springs, Va., in May and June 1943, we were 
fortunate to have six of the delegates from other countries speak to 
us in a continuation of "The Food Front” series of lectures. Their 
talks provide comparison between the nutritional problems of our 
own country and the countries from which these delegates came. They 
are particularly interesting as further evidence of the interdependence 
between the agricultural production of a country and the health of 
its people. 
This series of lectures was opened by Prof. J, C. Drummond, the 
British representative to the National Food Conference, who spoke 
briefly about the wartime nutrition problems in England as an intro- 
duction to the British film "A World of Plenty” which featured Sir 
John Orr, one off the world pioneers in nutrition education. 
M, L. Wilson, Chief, 
W. H. Sebreijl, Associate Chief, 
Nutrition Programs Branch, 
Food Distribution Administration,. THE ECONOMICS OF MEXICAN NUTRITION 
Dr. Francisco DeP. Miranda 
Miranda, Francisco DeP., physician; b. Mexico; graduate of the National University of 
Mexico City. Member of the Directing Council of the Pan American Sanitary Bureau; has 
occupied important positions in the National Department of Health of Mexico. Director 
of the National Institute of Nutrition of Mexico. Well known in the United States, where 
he has attended many medical meetings. 
It gives me great pleasure to address you in the 
capital of your country. I did not think I would be 
so privileged as to speak to you at this time. I was 
prepared only for the Conference on Food and Agri- 
culture. But this occasion gives me an opportunity 
to meet in person those who have been working here 
along the same lines that we work in Mexico, as well 
as those who are the leaders of the nutrition move- 
ment in the world. 
You must understand what are and have been the 
conditions in my country, and you must understand 
that your work in the United States has been the in- 
spiring thought that has led us in our work. We are 
grateful for this inspiration and we came here more 
to learn than to teach. We haven’t anything to teach 
you. We only have to show you that we have ac- 
cepted your teachings; that we are working very 
hard because the conditions that prevail in my 
country are so different from those that prevail here 
that an adaptation must be made in order to meet 
those conditions. 
Mexico is a large country. It has a territory of 
nearly 2 million square kilometers and a population 
of nearly 20 million inhabitants, that is, 10 inhabit- 
ants per square kilometer. The number of inhabit- 
ants at the production and reproduction age (15 to 
45 years) is 478 per thousand. The number of per- 
sons beyond the age of 45 is only 146 per thousand. 
The area of cultivated land in 1934 was 14,517,699 
hectares, approximately 36 million acres, or 2.16 acres 
per inhabitant, which ought to place Mexico among 
the nations with an abundant food supply. Notwith- 
standing, our figures for production, with some ex- 
ceptions, are those of a low yield, owing to (1) prim- 
itive systems of land exploitation, (2) the fact that 
we have yet to develop our irrigation projects, and 
(3) the state of health of the rural laborer. His low 
capacity for work is the result of bad nutrition. 
In order to have a picture of individual food con- 
sumption, it must be realized that national consump- 
tion figures are very unequally divided among the 
population, chiefly according to the economic status. 
Roughly speaking, the population of Mexico could 
be divided, from this point of view, into four groups: 
Percent 
Very poor economic status 25 to 30 
Poor economic status 22 to 26 
Adequate economic status 32 to 86 
Ample economic status 14 to 18 
This economic situation is the result of the history 
of the country. It can be said that now all our na- 
tional policy has been directed toward bettering the 
standards of life of the population, which have been 
very low since the Aztec and Maya period, through 
the colonial and the economic liberalism eras, 
A great part of the population passed from a sys- 
tem of slavery to one of “peonage” (which systems 
were very much alike)—from the Spanish “encomi- 
enda” to the massing of great fortunes, which in our 
country chiefly meant the monopolization of lands 
by a capitalist minority. There was really no great 
change. 
But today the aim of all branches of the Govern- 
ment is to give all the people an opportunity to 
satisfy at least the necessities of life. 
A great part of the population of Mexico is com- 
posed of pure Indians. We have 4 to 6 million pure 
Indians in Mexico, mostly employed in agriculture. 
We have a large mixed population (white and In- 
dian). From 16 to 20 percent of the population is 
white. For a long time the Indians were in a state 
of slavery or peonage, with very little for the neces- 
sities of life. They were exploited by existing con- 
ditions—producing only raw materials—and the 
country was without any industrialization. 
This year is considered to be one of importance to 
Mexico because the curve of our agricultural produc- 
tion—even though it has gone up every year—has 
been met by the upward movement of the industrial- 
ization curve; this year, 1943, gives us larger income 
figures from industrial than from agricultural re- 
sources. Our agricultural resources and our indus- 
trial resources are now equally divided. There is 
a greater tendency to develop industry than agri- 
culture. But agriculture still needs development, 
and the Government has made great effort in this 
direction. 
A little more than 50 percent of the inhabitants 
have incomes insufficient for the necessities of life. 
The total yearly income of the population has been 
estimated at 7 billion pesos, an average of 350 pesos 
per inhabitant. It would not give a correct picture 
of the situation to translate 350 pesos by the rate of 
exchange to $70 a year, because the cost of living in 
Mexico is much lower than in the United States. 
If we are to compare the cost of living in Mexico 
City with the cost of living in the United States, the 
1 rate of exchange would be considered as 2 pesos for 
$1. Then we could translate 350 pesos a year to 
$175. 
Examining the consumption figures we have the 
average daily per capita consumption for vegetable 
foods as follows: 
inson, of the Rockefeller Foundation, collaborating 
with our organizations. These families are inhabit- 
ants of a marginal zone of Mexico City and are 
representative of 2 percent of the population of this 
zone. The data are on a 7-day basis. The values are 
presented in the following tabulations as edible por- 
tions of foods and are calculated as consumption per 
adult man per day, by using Bigwood’s consumption 
coefficients. 
Grams 
Corn 279 
Wheat 70 
Beans 22 
Potatoes — 13 (10 grams, net) 
Sweetpotatoes 8.6 (6.6 grams, net) 
Chickpeas 7 
Faba 2. 7 (1.7 grams, net) 
Sugar 56 
Meat, fish and fowl 
Eggs, per week 
Grams 
Mean consumption, 80. 
Median, 72. 
Mean, 2.1. 
Median, 1.6. 
Cubic centimeters 
This gives a total of 330 grams of carbohydrates, 
38.4 grams of proteins, and 15.5 grams of fats—1,651 
calories per day per person, from vegetable foods. 
Corn is chiefly eaten by low-income groups, where- 
as wheat is chiefly eaten by high-income groups, 
beans by all groups, and potatoes and rice chiefly 
by high-income groups. 
Animal foods have a very low consumption in 
Mexico. The average per capita consumption of 
meat, for 1934 was: 
Milk, per day 
Mean, 395. 
Median, 359. 
There is a definite relation between the quantity 
of the above-mentioned products and the economic 
status of the family. 
Butter 
(Mean, 1.6. 
[Median, too low to be considered. 
Grams 
Grams 
Other fats, such as bacon and Vegetable 
fats 
(Mean, 28. 
[Median, 25. 
Mexico (entire country) : Kilograms 
Beef 7. 5 
Mutton . 2 
Pork 2. 5 
Goat . 4 
The consumption of significant quantities of butter 
is limited to higher economic levels. There is a ten- 
dency for the consumption of “other fats” to be 
higher among higher economic levels. 
Total 1 10.6 
Grams 
The Federal District: 
Beef 27.4 
Mutton 1.1 
Pork 10.4 
Goat . 9 
Total cereals • 
Corn products ■ 
Wheat products 
Other cereals1 
Mean, 599. 
.Median, 562. 
Mean, 318. 
.Median, 286. 
Mean, 318. 
.Median, 217. 
Mean, 21. 
.Median, 17. 
Total 39.8 
The per capita consumption has increased. In 
1933 it was 10.1 kilograms per capita; in 1934, 10.6; 
in 1935, 11; and in 1936, 11.4. 
We have no data on fish and fowl consumption, 
but we kno-fr it also is very low. 
Milk is consumed in the Federal District at the 
rate of 250 grams a day per capita. Outside the 
Federal District the consumption is lower, but it 
has not been determined. 
The higher consumption of milk and meat in the 
Federal District is explained because the Federal 
District with 1,700,000 inhabitants, of whom 1,600,000 
dwell in cities, has from 18 to 22 percent of the “more 
than sufficient” income group and from 38 to 42 per- 
cent of the “adequate income” group. 
The consumption of fats is very low. Butter is 
only used by the high-income groups. The same is 
true of eggs. Though Mexico is a producer of fruits, 
the consumption of them is not high. Part of the 
crop is exported, a part goes to industry, and a part 
is lost because of lack of transportation facilities. 
In cities, prices at retail are high and only high- or 
medium-income families can afford to buy fruit. 
A summary of more recent data on the consump- 
tion levels of 80 families (565 persons) is taken from 
a survey made under the direction of Dr. W. D. Rob- 
1 “Other cereals” are rice and, occasionally, oats. 
Dry leguminous grains (mostly beans and oc- 
casionally chickpeas, lentils, and dry peas) are pre- 
ferred by all income groups; there is no immediate 
apparent relation between the consumption of these 
foods and economic level. Their daily per capita 
consumption is: 
Dry leguminous grains < 
Green and yellow vegetables - 
Tomatoes. - 
Potatoes (white) - 
Other vegetables ■ 
Grams 
(Mean, 53. 
[Median, 49. 
(Mean, 48. 
[Median, 46. 
[Mean, 64. 
[Median, 59. 
[Mean, 35. 
[Median, 28. 
(Mean, 17. 
[Median, 14. 
There is a tendency toward increased consumption of 
vegetables at high economic levels. 
Consumption of citrus fruits and bananas follows: 
Citrus fruits 
Bananas • 
Grams 
Mean, 24. 
(Mean, 38. 
[Median, 18. 
There are other significant fruits like the pepper 
(chile). Consumption of chile is as follows 
on the contrary, more common among low-income 
groups. Undoubtedly not only food is important 
in this respect; psychological factors are also im- 
portant in modern life. As Dr. Chavez has said: 
“The Mexican Indian is an impassive spectator of 
civilization.” 
Ignorance is common in all walks of life, if all 
meanings of the word are considered. 
Poverty is the predominant reason for malnutri- 
tion. Some of the causes of poverty among the rural 
workers are: Low yield of harvests because of primi- 
tive methods of agriculture, scarce irrigation, few 
routes of communication, temporary or itinerant oc- 
cupation, and low selling prices for crude agricul- 
tural products for exportation. 
Among city dwellers the reasons for poverty are: 
Underdevelopment in industry, low salaries escaping 
Government control, predominance of unskilled la- 
borers, great development of petty commerce, unre- 
munerative arts and crafts. Added to these are social 
conditions such as disorganization of family life, a 
high proportion of illegitimate unions and temporal 
unions, diminished sense of responsibility, and, among 
city dwellers, dissipation of money for nonessentials. 
Alcoholism is a very important factor. Alcoholics 
exhibit the most advanced picture of malnutrition. 
Miserable conditions of life frequently result. 
The number of victims of,malnutrition easily rec- 
ognized as such is not very high in Mexico, except in 
certain regions where special conditions of produc- 
tion prevail. As in other countries, most cases can 
only be detected by special diagnostic methods which 
have been introduced recently. 
Among the most common types of malnutrition 
diseases we find: Pellagra, in all its evolutionary 
phases; beriberi, frequently disguised as alcoholic 
polyneuritis, diabetic polyneuritis or myocarditis; 
nutritional edema, frequently called “dropsy”; 
hyperchromic anemias, chiefly in infancy and in 
pregnancy; xerosis and cutaneous signs of “A” 
avitaminosis; riboflavin deficiencies; rickets found 
only in the mildest form, as in other tropical coun- 
tries. 
Among the consequences of malnutrition, one of 
the most prevalent and far-reaching is the lessened 
working capacity of the population. This can be 
seen even in children in relation to school work. The 
psychological attitude of lack of ambition and stain- 
JL O . , _ 
ina to overcome the obstacles of life is to be taken 
into special consideration. 
The effect on physical development is marked dur- 
ing infancy and childhood. Many characteristics 
which used to be considered as racial are only the 
effects of malnutrition. 
The decrease of resistance to infections and the 
high infant mortality are, to a great extent, the re- 
sult of malnutrition. Our infant-mortality rate is 
145 per thousand births. There is a high mortality 
from tuberculosis, 5.6 per 10,000 inhabitants; it used 
to be 14. Our general mortality is 232.1 per 10,000 
inhabitants. 
Summarizing these results, we can see that the 
chief cause of malnutrition is of economic origin 
Mean, 6. 
.Median, 3. 
Mean, 2.5. 
.Median, 2. 
Grams 
Fresh 
Dry • 
In summarizing, I would say that the diet of the 
low-income group of the population of Mexico 
(which is more than 50 percent) is insufficient in 
terms of calories, according to accepted standards. 
It is insufficient in protective foods, chiefly those of 
animal origin. It is unbalanced because of the pre- 
ponderance of carbohydrates. The insufficiency cor- 
relates clearly with the low economic level of the 
population. 
As regards the costs and consequences of malnu- 
trition and undernutrition in Mexico, the low con- 
sumption of foods such as I have outlined to you 
has many bad results. Diseases of the digestive tract 
are most common in Mexico. Diarrhea and enteritis 
caused 46.4 deaths per 10,000 inhabitants in 1939. 
Infectious diseases which increase human require- 
ments are also common. In 1939 we had 13.1 deaths 
per 10,000 inhabitants from malaria. 
Industrialization is not an important factor in 
malnutrition in Mexico as the low-income groups use 
more of the whole grains, and the high-income 
groups, which use more polished rice, wheat flour, and 
sugar, eat more meat and other protective foods. 
Corn “masa” is prepared in a different way from 
corn meal and polenta. Probably more of the niacin 
is conserved for pellagra is less frequent in Mexico 
than among other corn-eating populations. The Mex- 
ican Indian takes the whole grains of the corn, sof- 
tens them overnight with lime water, and then boils 
them to soften their cuticles. After the com has been 
thoroughly softened, it is ground either in the primi- 
tive way on a stone grinder or carried to the grinders 
or millers. And thus is formed what they call the 
“masa.” This the Indians employ for tortillas or 
tamales or other corn dishes. Tamales or tortillas 
and beans are the principal foods. We think that the 
amino acids contained in the com, added to the pro- 
teins of the beans, give a diet which, if not completely 
acceptable, comes as near as practicable to containing 
the amino acids needed for proper nutrition. 
Ignorance is an important factor in malnutrition, 
but before trying to change the food habits of our 
people, attention must be given to the wise composi- 
tion of mixtures used in the country. Com is de- 
ficient in certain amino acids, but the addition of 
beans is wise, as they complement the missing amino 
acids of corn. 
Frugality is dangerous when carried to an extreme; 
but, judiciously observed, it may mean freedom from 
certain diseases now increasing among highly civ- 
ilized nations. Dr. Chavez finds more cases of hy- 
pertension, arteriosclerosis, and coronary disease 
among the well-to-do who attend his private office 
than among the patients in the wards of charity 
hospitals. My own experience shows the higher fre- 
quency of obesity and diabetes among the well-to-do. 
Rheumatic fever, rheumatic heart disease, etc., are, 
3 and consists mainly in the fact that a large part of 
Mexico’s population works under conditions that do 
not allow the satisfaction of its physiological needs 
of food consumption. Ignorance of the basic prin- 
ciples of nutrition is common at all economic levels 
of population. The frequency of infectious tropical 
diseases, such as malaria, is also a factor of malnu- 
trition. Nutritional diseases are not so common as 
is sometimes supposed. The consequences of mal- 
nutrition are incapacity for work, disorders in 
growth and development, and high infant, general, 
and special mortality. 
the radio, home demonstrations, booklets, posters, 
and other means of spreading information to the 
public. 
(3) Nutrition clinics. The Institute has a staff of 
nutriologists who have done postgraduate work in 
the United States and Argentina. When sufficient 
trained personnel is available, we will establish nu- 
trition clinics throughout the Republic with a view 
to detecting malnutrition in its initial periods and 
checking its progress to the more evident stages of 
diseases. 
We are contemplating in the future an organiza- 
tion composed of three institutes: The National In- 
stitute of Nutrition, the Institute of Economic 
Studies, and the Institute of Agricultural Studies, 
coordinated by the National Commission to plan the 
National Food Policy. 
At the same time, we shall continue to watch the 
development of international organizations, such as 
the Health Organization of the League of Nations 
and the International Labor Office of the same organ- 
ization, which in the past have rendered great serv- 
ices to the world and we hope will continue to do 
so after the war. We shall also follow with great 
interest the work of the Pan American Sanitary Of- 
fice, which has also done excellent work in promot- 
ing nutrition advances in America, especially since 
the 1938 Sanitary Conference, held at Bogota. 
The activities of the Secretary of Public Assistance 
in trying to solve the nutrition problem in Mexico 
are growing in importance. As a part of the Com- 
mission of Studies of the Secretary, a Commission of 
Foods was created, which is in charge of study of 
the technical direction of food services in all the 
Institutions of public assistance, in which are grouped 
the feeding of children and hospital inmates, and 
feeding in public dining halls. 
The feeding of children is going on in homes for 
children, collective homes, and substitute homes, 
which are taking the place of the old orphanages and 
asylums for children. In Mexico we have consid- 
ered that there is no real replacement of the home 
atmosphere. We are doing away with asylums and 
orphanages which are so far from the spirit of the 
home. We are seeking women who have a good back- 
ground and giving them the opportunity to head 
groups of 8 to 20 children in their private homes. 
We are paying for all the assistance to these chil- 
dren. The results already attained are very 
favorable. 
The population of collective homes, which in 1941 
was only 272, increased to 1,179 in 1942 in the Fed- 
eral District alone, and that of substitute homes, 
which was 201 in 1941, grew to 579 during 1942 in 
the Federal District. 
The “Milk Provision” gave milk to 2,570 infants 
in the Federal District. The total number of chil- 
dren receiving assistance in food, not including the 
inmates of hospitals, was 16,020, including 3,625 chil- 
dren who receive school lunches in Mexico City. 
The first act of General Avila Camacho the day he 
took office as President of the Republic was to order 
the Secretary of Public Assistance to erect public 
Public Health and Public Assistance Measures To 
Improve Consumption Levels 
The Department of Public Health has followed 
with special interest the development of scientific 
studies of the problem of nutrition. As in all coun- 
tries, it began with the sanitary control of foods in 
an effort to prevent adulteration and alterations 
which would endanger health. The critical economic 
conditions of 1929-30, with all their consequences of 
“overproduction” and unemployment, brought forth 
an investigation of the effects of such conditions on 
the health of the nations involved. This was the 
starting point of the splendid work achieved by the 
health organization of the League of Nations. 
Mexico created its National Food Commission in 
1936. This commission, formed by representatives 
of the several interested branches of the Government, 
under the auspices of the Department of Health, has 
initiated some measures which have been carried 
out with success. 
At the beginning of this year, the Department of 
Public Health took another forward step in this 
direction, creating the National Institute of Nutri- 
tion, which I have the honor to direct. This is still 
in the process of organization and of obtaining the 
necessary equipment— which, because of priorities, 
is very difficult. Notwithstanding, we have initiated 
our work under a general program that includes the 
following subjects: 
(1) Research on malnutrition in the human being 
and the composition of foods used in the country. 
The first will comprise social and economic, clinical, 
anthropometric, and laboratory studies. Laboratory 
determinations now in use are carotene and vitamin 
A, vitamin C, protein and its fractions in blood. At- 
tention is being given to the employment of the slit 
lamp in clinical examinations. For the orientation 
of these studies and training of personnel we have 
had the valuable cooperation of Dr. W. D. Robinson, 
of the Rockefeller Foundation. Other possibilities 
of cooperation are now being contemplated and dis- 
cussed, especially the training of chemists for the 
determination of vitamins in foods. 
(2) An educational program comprising superior, 
intermediate, and popular education. Superior edu- 
cation will be given doctors planning to become 
nutriologists, and persons having had previous train- 
ing in home economics who are training to be die- 
titians and nutritionists. Popular education uses dining rooms for the benefit of the low-income fami- 
lies. Family dining hall No. 1 was opened in Novem- 
ber 1941 and serves 3 meals a day to 1,200 persons, 
of whom more than half are children of preschool 
and school age. The service is paid for in part by 
the family, but only one-fourth of the cost is thus 
recovered. Social workers and dietitians study the 
applications received for this kind of service. The 
second family dining hall will be opened this year. 
The benefits of this type of organization will be 
extended to other parts of the country. 
Special mention must be made of the work of the 
Secretary of Public Assistance in promoting private 
organizations which are cooperating in the school- 
lunch program. 
We know that our work for the improvement of 
nutrition in Mexico is just beginning. We have ac- 
cepted all the views expressed in the Conference on 
Food and Agriculture at Hot Springs, and we are 
going to carry on our program to extend the benefits 
of these ideas and policies. We know that Mexico 
is underdeveloped in its natural resources. We have 
the future before us. We know that guided by the 
United States and other nations that are far ad- 
vanced in their nutrition programs, Mexico has a 
greater future. 
5 NUTRITIONAL PROBLEMS OF EGYPT 
By Prof. Ali Hassan 
Hassan, Ali, professor of biochemistry, University of Fouad I, Cairo; b. Egypt. B. S. 
London University, M. D. University of Cairo. For the past 10 years intimately con- 
cerned with nutritional problems in Egypt. 
I must thank Dr. Sebrell for giving me this oppor- 
tunity to talk to you about nutrition in Egypt. 
Though for a long time our nutritional problems 
in Egypt were many, our interest in nutrition is 
of recent origin. The attention of the Government 
and peoples of Egypt has been forcibly drawn to 
the problem of nutrition, in its modern sense and 
its fundamental importance in the development of 
the country, only during the last few years. 
Soon after joining the League of Nations, the 
Egyptian representatives, from 1937 onward, began 
to be aware of the widespread activity of the Health 
Organization and the State members of the League 
in matters of health. The Egyptian Government 
was advised by the League at that time to set up a 
National Nutrition Committee to study and assist 
in the solution of nutritiop problems in Egypt and 
to cooperate in the general effort to improve the nu- 
tritional status of the world as a whole. 
In 1938, I represented the Egyptian National Nu- 
trition Committee at the meeting of the representa- 
tives of the national nutrition committees held in 
October at Geneva. There I met for the first time 
Miss Sybil L. Smith,1 representing the United States 
of America, who impressed me by her knowledge and 
experience. I also met many other famous nutri- 
tion experts, some of whom represented their coun- 
tries in the United Nations Food Conference held at 
Hot Springs lately. To me, this meeting was both 
a lesson and a stimulus. 
It was early in 1939 that the Egyptian Nutrition 
Committee began its activities, and it has ever since 
been trying to help the Government to carry out its 
nutrition program. Other Government departments 
are contributing in a varying degree to the solution 
of the problem, either directly or indirectly. These 
are: 
(1) The Biochemistry Department and the Department of 
Hygiene and Preventive Medicine, both of the Fguad I 
University. 
(2) The Chemical Department and the Departmnt of An- 
imal Husbandry, Ministry of Agriculture; 
(3) Some departments of the Faculty of Agriculture, Fouad 
I University; 
(4) The Ministry of Social Affairs, the Ministry for Pious 
Contributions, and the Ministry of Interior. 
We have in Egypt the Ministry for Pious Con- 
tributions, of which you have no counterpart here. 
Some people, before they die, give some of their 
possessions to charity. A ministry has been formed 
to look after such contributions, which are usually 
left for churches or mosques, for the poor, or to 
build hospitals and similar institutions. The Minis- 
tries of Social Affairs, Interior, and Pious Contri- 
butions are concerned primarily with the social 
and economic aspects of the gifts; the organizations 
listed under (1), (2), and (3) are more interested in 
the technical aspects. 
Before going any further, I should like to tell you 
something about the food habits and the food con- 
sumption of the country and explain the food sit- 
uation, which, to my mind, is influenced by the 
geographical peculiarities of our location. For this 
purpose, we can divide Egypt into five zones. But, to 
start with, Egypt is divided into two parts, what we 
call Lower Egypt and Upper Egypt; the latter ex- 
tends practically from Cairo down to the northern 
boundary of the Sudan. 
The Delta represents the first or northern part or 
zone. Then I shall divide Upper Egypt further into 
three more zones. The part from Assouan in the 
south, to Wady-Half a, i. e., to the northern boundary 
of the Sudan; then, the part from Assouan to Cairo 
may be divided into two zones. The division is neces- 
sitated by the difference in the mode of irrigation. 
In ancient times Egypt was flooded by the Nile, 
and immediately after the flood seed was sown, and 
one crop only was raised during the year. Now, be- 
cause of a very complicated system of irrigation, 
many parts of the land of Egypt are under irrigation 
all the year round, and sometimes we can raise two 
or three crops a year. But, some parts of Egypt still 
follow the same system of irrigation that was fol- 
lowed in earlier times. The land is flooded, and, dur- 
ing the flood, the whole area looks just like an im- 
mense lake. This is what we call the Basin area, 
and in this area only one crop a year is obtained. 
The other part of Upper Egypt is under perennial 
irrigation. So we have perennial irrigation in two 
places: In Lower Egypt, that is, the Delta, and in 
the major part of Upper Egypt with the exception 
of about half a million acres which are still under 
Basin irrigation. The remaining zone (I have just 
discussed four zones—the Delta, Upper Egypt, the 
Basin area, and the area south of Assouan, where 
the Nubians live) is formed of the scattered culti- 
vated areas in the desert which are dependent on well 
1 Office of Experiment Stations, Agricultural Research Administra- 
tion, U. S. Department of Agriculture. water and are known as the oases. The population 
of the oases and that of Nubia is only 170,000 per- 
sons, one-hundreth of the whole population. The 
population at present is 17 millions. Egypt, by the 
way, is a very thickly populated country. It has 
1,200 persons to the square mile; and in Menufia, one 
of the central Provinces of the Delta, it is still more 
densely populated. 
Now, these areas differ in their food consumption. 
In the Delta, you have cereals, wheat, maize, rice, 
and legumes; these are the staple articles of food. 
You have milk, fish, especially in the northern parts, 
and also vegetables and fruits. Little meat is con- 
sumed. 
In Upper Egypt, which is under irrigation, you 
find the same products, but more legumes, less fish, 
less milk. That is very important when we talk of 
rickets and examine its relation to milk consumption. 
But in Upper Egypt there are plenty of dates. 
Dates are important, especially in the Basin area, 
and the area down south. In Nubia they have no 
vegetables, no fruits (except dates, which are plenti- 
ful) but milk is available; also eggs. In the Basin 
area and in Nubia, they eat millet. That, again, is 
important when we discuss pellagra, which is a com- 
mon deficiency disease. Pellagra is common in the 
Delta; you find it also in Upper Egypt, where the 
land is under constant cultivation, i. e., irrigated 
perennially. In both districts maize is cultivated, 
and the people have pellagra. In the Basin area 
and Nubia maize is not cultivated, but instead mil- 
let, and there are plenty of dates, and the people 
have no pellagra. 
In the oases the people live on cereals, grown either 
locally or imported from the Nile Valley; they have 
no milk; they don’t know what fish is, but they have 
plenty of fruits and vegetables. Their only fat ma- 
terial is olive oil. They grow olives and consume 
a large amount of olive oil. They don’t eat fish 
or milk, Egyptians in the north, except those in 
the towns, drink little fluid milk. The custom of 
making butter and selling it is universal. What is 
left, that is, the skimmed milk, is used locally or 
made into cheese which is highly nutritious and to 
my mind makes the peasant independent of meat. 
As long as he gets that milk, I think he doesn’t need 
meat, which he doesn’t get because usually meat is 
obtainable only in big villages, and there only once 
a week. They kill their cattle once a week and at 
festival times. But in big towns you can get meat 
daily. 
In the country the cooking is not complicated. 
The habit of boiling things and throwing the water 
away is not very common, since, when vegetables are 
cooked, meat is put into the pot with them and a 
sort of stew made of the whole. This is true espe- 
cially among the poorer classes, who have a hot meal 
in the evening. What is left from the evening meal 
is eaten hot in the morning. The two big meals 
are dinner and breakfast; lunch is taken casually in 
the fields. The peasants are in the habit of consum- 
ing large amounts of green leafy vegetables, raw. 
Wilson’s work on pellagra in Egypt has always 
been an excellent guide to those interested in the 
nutritional state of the country. Except for this, 
however, no systematic nutritional studies have been 
undertaken. 
In 1932, I paid a visit to two of the oases in the 
desert, Baharia and Farafra, and I was struck by 
the difference in the nutritional state of the people 
there. There was practically no anemia among the 
children, no gingivitis, very little dental caries, no 
pellagra, and no rickets. In the oases area the people 
live on cereals, dates, vegetables, and fruits, with 
practically no milk. My visit was in wipter, in Feb- 
ruary and March. In Baharia, they had about 5 
cows, very lean, and I am sure these did not give more 
than about a pint of milk a day, every one of them. 
There was practically no feeding stuff for these ani- 
mals, and, in Farafra, there were no hogs; there was 
only 1 cow, and to serve it, they had to travel 4 days to 
Baharia and 4 days back. 
In 193T Professor Ellinger was sent by the Lister 
Institute to Cairo, and we both made a tour of Upper 
Egypt. We made sure of two things that were al- 
ready known: That pellagra was practically absent 
in the Basin area where millet was eaten, although 
the people of this Basin area were undernourished. 
The wages were incredibly low, a man getting what 
corresponds to 2 cents in your money per day; and 
whereas in the north the women help their husbands 
by doing field work beside them; in the south they 
are not allowed to do so, and the man has the whole 
burden of keeping the family and looking after it. 
But regardless of these facts and the definite under- 
nourishment, the people in the Basin area are free 
from pellagra. In the other areas, where there is 
perennial irrigation, pellagra had begun to show it- 
self. Two things follow water in Upper Egypt, maize 
cultivation and parasitic infections. There the pic- 
ture is in many ways similar to what one sees in the 
Delta. 
In 1939 I visited Nubia, When the Assouan dam 
was built to enable us to store enough water for the 
summer, this caused the land of the Nubians to be 
flooded. Now they have only 4 months to cultivate 
their land. During these 4 months, they cultivate 
either millet or some legumes for their own con- 
sumption, using the dried stalks as food for their 
goats. They are very fond of tea, and drink it with 
milk, and to make sure that they get enough milk, 
they keep goats. I have been informed that some 
Nubians drink as much as 900 cubic centimeters of 
milk daily—something none of the people in the 
north do. Everyone drinks tea, even children, some- 
times as often as six times a day. These people, like 
those living in the oases, show less anemia, no rickets, 
no pellagra. In addition to drinking milk, they eat 
dates, and they have fish as well. The immense dam, 
behind which the water is stored, is swarming with 
fish most of the year. 
In the Delta most of the nutritional diseases are 
found. Pellagra is prevalent, also rickets, night 
blindness, and possibly some other ill-defined defi- 
ciency illnesses which we have not yet been able to 
575292°—44 2 
7 study. But you will have an idea about the prev- 
alence of pellagra when I tell you about its incidence 
in Shebin El Kanater, where I visited the hospital to 
investigate what was thought to be an epidemic of 
pellagra. It wasn’t an epidemic at all. 
The hospital had a doctor who showed a keen in- 
terest in pellagra, and it did not take the people long 
to know that and to flock to the hospital to be treated. 
His chief, making his usual round, found that the 
hospital contained more pellagra cases than any other 
hospital in the district. This, as I said, was due to 
the unusual interest in pellagra shown by this par- 
ticular medical man. 
I studied the situation because the question arose of 
combating pellagra there by mixing nicotinic acid 
with the maize as it was milled. It was a very ex- 
pensive procedure, and I was asked to investigate the 
case. I found, that the pellagra affected from 1.1 
to 6.5 percent of the population of the different vil- 
lages—on an average, about 2.5 percent. This aver- 
age includes only cases showing the typical rash. 
When the cases of pellagra that don’t show a rash 
are included, this figure goes up to about 6 percent. 
The women in that area and in Egypt as a whole, are 
less susceptible to pellagra than men. Among the 
cases examined, 30 percent were women and TO per- 
cent men. 
I said that no systematic nutrition studies on a 
large scale were undertaken, that is, none of the type 
which you perform here in America. There are many 
reasons for this. The first reason, to my mind, is 
that we started late, and another is the difficulty of 
obtaining trained staffs. It is possible to get men 
to help you, but in Moslem countries, Moslem fam- 
ilies do not like to mix with strange men, and it took 
us some time to train women to do the investigating. 
Women, in my view, are most suited for these inves- 
tigations, whatever may be the qualifications of the 
men. They can get from the housewife more in- 
formation than can a man assistant. 
Decently, we were so fortunate as to find an Ameri- 
can woman, the wife of an Egyptian, who a few years 
ago started a school for social studies. She is still 
training quite a large number of workers, and we 
are in a position now to start an investigation. 
Before I came away, the Ministry of Health, under 
whose direction all these things are done, was con- 
templating the formation of special units to go 
around the country making food surveys, etc. How- 
ever, on a very small scale, some investigations have 
been carried on by the Biochemistry Department 
and also by the Department of Hygiene and Preven- 
tive Medicine—by the Biochemistry Department 
among about 76 in Cairo poor families, and by the 
Hygiene Department, among university students and 
also among the pupils of the Ministry of Education. 
All these investigations show that there is malnu- 
trition and undernourishment, especially in the 
young. The students who were examined were a 
representative group from Fouad I University, who 
number about 9,000. Similar results were also ob- 
tained in the schools of the Ministry of Education. 
These results caused great alarm in the country be- 
cause of the poor nutritional state of the young, and 
at once steps were taken to improve the situation. 
I think I made it clear that we have pellagra and 
that we have rickets, too. The distribution of rickets, 
as I said at the Food Conference in Hot Springs, is 
very interesting. It is less in the north, where milk 
consumption is greater, than in the south, and the 
percentage of rickets in children attending the child- 
welfare centers increases as one goes southward, 
until it attains a maximum in Assouan. Assouan is 
the upper border of Nubia. The Nubians definitely 
consume more milk than the people of the Assouan 
area, and this may explain the relative absence of 
rickets there. Getting feed for milk animals in sum- 
mer is a very big problem with us; feed becomes very 
scarce, especially in the Basin area, where only one 
crop is raised. This difference in milk consumption 
explains the unequal distribution of rickets. In the 
oases, although they don’t drink milk, they don’t 
show signs of rickets. It seems to me that they get 
plenty of sunshine and enough calcium from the 
large quantity of vegetables and fruits which they 
consume, which are not available in the Basin area. 
There are not enough vegetables and fruits in the 
Basin area. This is most probably the cause of night 
blindness which appears especially before the flood. 
I can only hurriedly go through the methods for 
improving nutrition in Egypt. Some of them were 
undertaken by the Government; some were under- 
taken by the people. I shall discuss them all to- 
gether. We all agree that education is a very im- 
portant factor in any nutritional program. Educa- 
tion in Egypt is developing at a very rapid rate. 
You can learn a good deal about the rate at which it 
is developing by comparing the number of schools 
in 1922 and 1937. 
The difference is very great in all the schools, 
both those for boys and those for girls. But the 
most important factor has been the introduction of 
compulsory education. To supply the compulsory 
education, we have, at present, about 3,348 schools 
working 2 shifts. The number of pupils attending 
these schools is now 1 million boys and girls. Of 
course, education in nutritional matters is also pro- 
gressing. This education is being carried on in the 
training college and all the higher schools and the 
secondary schools, where the pupils get the facts 
about nutrition and enough knowledge to help 
them in the choice of foods. The Ministry of Agri- 
culture is encouraging the cultivation of vegetables 
and fruits. 
We have definitely more vegetables and fruits 
now than we had 10 years ago. I remember 4 years 
ago buying 25 tangerines for 2 cents, and 10 oranges 
for about 4 cents. Now, during war, that is not pos- 
sible ; everything has gone up, with so many troops 
in the country. 
The Department of Animal Husbandry is also 
getting much attention from the Ministry of Agri- 
culture. I left them trying to improve the breed of 
the buffalo, which is the milking animal par excel- 
lence because it gives more milk than the cow—milk that is much richer than cow’s milk in butter. Buf- 
falo milk has about 7 percent fat, on an average. 
That is why, at present, Egypt chooses the buffalo 
for butter production. 
The introduction of small industries to improve 
the economic situation and increase the purchasing 
power of the public is also being tried. 
The Ministry of Health has done a great deal to- 
ward the improvement of the nutritional state of 
the population. In 1922 we did not have a single 
center for child welfare. Now, we have many of 
these child welfare centers, and at present they are 
looking after one-seventh of all the infants born in 
the country. We get about 600,000 newborn every 
year; these centers look after about 95,000. They 
take care of the mother before and after parturition. 
The center supplies milk for the baby, clothes, etc., 
and educates the mother in the management of the 
baby and of herself. They have a propaganda sec- 
tion where they exhibit educational films and give 
short talks on the value of hygienic methods, etc., 
for the rearing of healthy babies. They also, on oc- 
casion, give prizes to mothers for the cleanliness and 
for the care they give their young. The Ministry 
of Health keeps an eye on foods to insure their 
quality and their freedom from injurious substances. 
The sale of foodstuffs is controlled by the Govern- 
ment. 
As to other measures, I should like to read you a 
report of one of the experts of our delegation which 
describes the activities of other ministries. Dr. A. 
Hussein, who represents the Ministry of Social Af- 
fairs, presented this report to the Food Conference 
at Hot Springs: 
1. Elementary public schools in Egypt teach about 1,000,000 
boys and girls from the age of 7 to 12. A large number of 
these boys and girls are undernourished, owing in the first 
place to the very limited resources of their parents. 
Some experiments have been made in the last few years 
in providing pupils of a number of these schools with a daily 
meal. The physical and mental development of these pupils 
exceeded very remarkably the development of those in other 
schools. 
Last year an act was passed whereby the State undertook 
to give a daily meal in all public schools. The State alone 
finances the scheme. All the pupils whether rich or poor 
get their meal free, as any differentiation would have a bad 
moral effect. 
The meals given are planned by a qualified dietitian. They 
are meant to make good the deficiencies in the ordinary diet 
of the pupils which is normally poor in protective foods. The 
meals given consist mainly of milk, eggs, cheese, legumes, 
fresh vegetables, and fruits. They are cheap and easy to 
prepare. 
The execution of this scheme started at the beginning of 
this year; 185,000 pupils are getting their meals now, and 
it will not be long before all the other boys and girls get 
their meals. 
2. Public kitchens are being opened in poor city districts, 
where hot luncheons are supplied at a very low price (21/2 
cents, which is only 25 percent of the cost). An investiga- 
tion is made in each district by a social worker. Poor families 
are selected and given cards which permit them to take meals 
from these kitchens to their homes. As in the former case, 
the meals were planned by a dietitian to enable these poor 
families to get the protective foods they lack. These kitchens 
are financed either by the State or by benevolent societies or 
private individuals. 
3. Similar kitchens are being established inside factories, 
giving hot luncheons at half cost to workers. The factories 
pay the difference. 
4. Poor families, examined by social agencies, get help 
either from State funds or from charitable societies subsi- 
dized to a great extent by the State. Relief is provided 
either in money or in goods, such as flour, sugar, cloth, shoes, 
etc. 
5. Consumer cooperative societies are spreading rapidly 
all over the country, especially in poor districts and in fac- 
tories ; they are having priority to dealers in getting, through 
the ministry of supplies, controlled commodities like sugar, 
oil, cloth, etc. 
The members of these societies get their commodities at 
very low prices, almost wholesale prices. 
6. Rural welfare centers, which started work in 1941, have 
been very successful in educating and inducing farmers to 
grow more and better foods for their own consumption; the 
area of vegetables expanded remarkably; chickens and egg- 
laying hens have increased in number and improved in 
quality. 
Very poor families have been given chickens, goats, and 
sheep. They are taught and helped to. cultivate a small 
vegetable area or start on their own some side industry like 
beekeeping, cloth and carpet weaving, etc. 
These efforts were very successful in increasing the income 
of these poor families and, in time, enable them to produce 
a large part of their food and clothing. 
7. A minimum wage has been fixed for laborers in industry 
and commerce. Its extension to agriculture is being con- 
sidered. 
8. A bill for social insurance against old age and invalidity 
has already been drafted by the Government and will be 
shortly presented to the Egyptian Parliament for consid- 
eration. 
You will see from this summary that we have 
started late, but I think you will agree that we have 
made a good beginning and that there is definite evi- 
dence that at least the general health of the country 
is improving. 
I mentioned at the Food Conference that measure- 
ments taken for the recruits in 1939 showed definite 
increase in height and chest figures over those of re- 
cruits in 1929. Dr. Shawky Bey, who is in charge 
of the Children’s Hospital in Cairo, said to me before 
I came here, “I don’t see now the rickets cases that I 
used to see 20 years ago.” So we are improving. 
Thank you very much. 
Dr. Sebrell: Would anyone like to ask Professor 
Hassan some questions ? 
Question: I should like to ask Professor Hassan a 
question concerning the population problem of 
Egypt. We understand that within the past 50 years 
or so the population has doubled and that the rate 
of increase is going on so that today there are about 
400 people per square kilometer of cultivated area. 
What is the outlook for the future ? 
Professor Hassan: We have done nothing so far. 
I personally calculate that the question will become 
acute when our population reaches 25 millions. The 
inhabited land is only one-thirtieth of the total area 
of the country—in other words, about 8 million acres. 
We can still reclaim an extra million acres of land, 
and also if we get the Basin area under perennial 
irrigation we can afford to increase without becom- 
ing crowded very soon. In addition, though the 
Egyptian farmer is very active and works hard to 
get the best out of his land, there is still a big scope 
for improving production. This will also help. In 
9 a discussion of this problem with a gentleman from 
Poland, he said: “Why not develop the desert?” 
This again is a possibility but a very expensive one. 
We may, however, be forced ultimately to emigrate 
and I think our chief outlet is down south in the 
Sudan. So I think Egypt may accommodate up to 
25 millions; we are now about 17 millions; we in- 
crease at the rate of a quarter of a million every 
year; and this rate will increase as the number 
increases. 
Question: Is the feeding of the population on an 
adequate nutritional basis? 
Prof. Hassan: The amount of food available at 
present is adequate. I believe we have enough food, 
but the distribution is poor; however, if it is well 
distributed among the population it can raise the 
general standard immensely. But now it is not dis- 
tributed well among the population. 
Question: Would Prof. Hassan indicate how the 
war has affected the food-supply situation in Egypt ? 
Prof. Hassan: I should be glad to, but with your 
permission I shall invite our Under Secretary of 
State for Supplies, who is with us here to talk about 
this problem. 
Mr. Enan: Ladies and gentlemen, I did not ex- 
pect to come here except to listen to my colleague, 
Mr. Hassan, but I am delighted to answer a question 
which appears to be a little foreign to his field. As 
a matter of fact, we are producing sufficient cereals 
and sufficient meat and vegetables and fruit for the 
consumption of the population on the basis of the 
standard established by our nutrition experts. The 
exigencies of the war and certain difficulties of trans- 
portation and cases of emergency have made it neces- 
sary to call upon the Egyptian Government to help, 
in particular with regard to perishables, such as 
fruits and fresh vegetables. 
We did our very best to accede to these requests, 
and, I think it is safe to say, that we have placed 
at the disposal of the forces of the various nations 
who are living on Egyptian territory, more than 10 
percent of the vegetable crops which we grow. 
With regard to other foods, we have also placed 
food in sufficient quantities, cereals, flour, etc., at the 
disposal of the forces whenever we have been asked 
.to. As a matter of fact, however, they have always 
tried to get their supplies from other sources when- 
ever they could, owing to the fact that with the lack 
of fertilizers in our country there was some fear 
that the supply would not meet the demand. But 
it was just very lately, that is to say, a few days 
before we left Egypt to come to the United States, 
that the Egyptian Government put at the disposal 
of the military authorities some 60,000 or 70,000 tons 
of cereals. 
Now, with regard to milk, eggs, and meat, I think 
you might be interested to know that many of the 
officers who are working in the headquarters in the 
Middle East are stationed in towns such as Cairo and 
Alexandria. Almost all of them get their daily sup- 
plies of green vegetables, milk, eggs, meat, etc,, from 
local supplies. I think that this has had, to some 
extent, a certain effect upon the nutrition of the 
country, but it wasn’t by any means objectionable, 
because we don’t consider that it would have any 
detrimental results as to the feeling of the public. 
That is, from one point of view, because the people 
were rather pleased to be of some help to the forces. 
We think that after the clearing out of the Axis 
forces from North Africa, a little less food will have 
to be supplied to the troops stationed in Egypt. The 
food thus released will help, we think, to cover the 
expected shortage in some of the supplies because of 
the lack of fertilizers. Thank you. INFLUENCE OF THE BELGIAN AGRICULTURAL PATTERN UPON THE 
NUTRITION HABITS OP THE COUNTRY 
Prof. E. J. Bigwood 
Bigwood, E. J., professor of biochemistry and nutrition, University of Brussels, Belgium; 
b. Brussels. M. D. Brussels University, 1920; postgraduate fellowship Belgian-American 
Foundation, 1920-22, at Johns Hopkins University and Columbia University. Collaborated 
with Health Section of the League of Nations. With Belgian Government in exile in London 
since early 1941. Now a member of the Advisory Council of the Belgian Government in 
London and Vice President of the Belgian Red Cross London Committee. Also member of 
the Allied London Committee for study of post-war requirements. 
May I say before beginning this lecture that it is 
a very great satisfaction for me to have the occasion 
of coming again to this country, I say “again” be- 
cause I lived in this country some 22 years ago while 
doing postgraduate work. In fact, it was in this 
country that I became interested in biochemistry. 
After that, I went back to Belgium and later on had 
tne opportunity of coming again to this country in 
1929 for the International Congress in Physiology, 
w7hich took place in Boston. Now this is the third 
time that I enjoy the privilege of coming here. If 
you consider also that my family is in this country 
and that I have not seen them for a little over 2 years, 
you can well imagine that to a certain extent I had 
the feeling of coming back home when I came here. 
It is a very great privilege that I appreciate, this 
opportunity of saying a few words on the question 
of food problems in my country. 
Belgium, as you know, is a very small country, not 
quite Sy2 million people, chiefly engaged in industry. 
It is also a very densely populated country, some 30 
thousand square kilometers (I think that corre- 
sponds to something like 11,736 square miles), which 
makes an average density of population of about 
280 people per square kilometer (716 people per 
square mile). 
But that is not the whole story as far as the density 
of the population is concerned: 38 percent of the 
total population, namely, 3.1 million people are con- 
centrated in 12 large urban and industrial centers 
occupying less than 15 percent of the total surface 
area of the country. Those centers range between 
60,000 and 950,000 in population. Seven hundred 
thousand people live in 29 semirural and semi-indus- 
trial centers having from 15,000 to 50,000 inhabit- 
ants, and finally a rural population of 4.4 million 
people live in 2,446 centers of less than 15,000 in- 
habitants. On the other hand, we have only 17 to 
18 percent of our people who are living on agricul- 
ture. That is about 1 person out of 6 of the total 
population engaged in farming. 
Let us now consider the total amount of food 
available in Belgium (I am speaking of normal pre- 
war conditions); at first glance, one might think 
the situation was fairly satisfactory. The amount 
of food available, whether home-produced or im- 
ported, supplies some 2,900 calories per head a day, 
on an average. About 45 to 50, nearly 50 percent, of 
that was imported, and 50 to 55 percent was home- 
produced. In terms of cost, the figure was different. 
Our deficit was of the order of something like 25 to 
30 percent; in calories, however, it was about 50 per- 
cent. But, if we take into consideration the amount 
of feeding stuffs that we had to import in Belgium 
in normal times in order to be able to produce the 
amount of dairy products and meat that we did, the 
proportion of the calories which were imported, cor- 
responded to something like 70 percent. 
Now, how is it—and this is a point I would like to 
emphasize, because I think it is rather interesting—• 
how is it, that a country like mine was so largely 
dependent upon importing foreign agricultural prod- 
ucts, and was it a normal condition? Was it right, 
or was it wrong ? I intend to show you that in peace- 
time it was a very satisfactory condition although 
in wartime, of course, it leads to a situation which 
is catastrophic. 
Let us first examine how the surface area of our 
country was used. The following tabulation shows 
what the situation was in 1938, Something like 62 
percent of the surface area of the whole of the coun- 
try formed our agricultural domain, and this was 
divided as follows: Nearly 50 percent of this domain 
was used as pastures, and at least three-fourths of it, 
that is to say the pastures and fodder crops, were used 
for the production of meat and dairy products. I 
shall refer to them as indirect food, that is to say, 
food that is not directly consumed by human beings 
but is consumed by animals and converted into dairy 
products, meat, and animal fat. Scarcely 25 percent 
of the agricultural domain was used for growing 
crops, that is, for direct foodstuffs. Our uncultivable 
lands, parks, and heaths occupied only 4 percent 
of the total surface area of the country; woodland, 
about 18 percent; and all other types of lands, 
houses, gardens, factories, roads, railroads, water, 
and sand took up something like 16 percent of the 
total surface area of the country. Our urban and 
11 industrial centers, in which the largest part of the 
country’s activities took place and where about 40 
percent of our people were concentrated, occupied 
about 10 percent of the total surface area of the 
country. 
Areas of land in the various uses follow: 
creased from 575,000 to 828,000 hectares. That was 
between 1880 and 1930, and ever since there has been 
some gradual change in that same direction. In 1938, 
900,000 hectares, something like 214 million acres, t>r 
about half of the total surface area of the country’s 
agricultural domain, were used as pastures and we 
had some 2 million cattle on these pastures—about 
1 million milk cows producing some 3,100 million 
liters of milk a year (average yield per cow of 675 
gallons of milk a year). In other words, our coun- 
try was not only very densely populated with human 
beings but also very densely populated with live- 
stock. In addition to that, we also had about 1 
million pigs in the country. 
This explains why Belgium, more than any other 
country, was importing such huge amounts of 
feedstuffs. The requirements of our country for con- 
centrates such as oilcakes alone, for instance, corre- 
sponded to something like 450,000 tons a year. We 
depended more on these imported concentrates for 
feeding our animals than did countries like Holland 
or Denmark, because the surface area of our pasture 
per head of livestock was very much smaller. The 
consequence of this orientation of agricultural pro- 
duction in Belgium with regard to the calorie yield 
of food in our country can be summarized as follows: 
Hectares Percent 
Agricultural land (1 hectare=2.47 acres)- 1,883,000 61.7 
Wheat crops 173,000 9. 2 
Sugar beets 50, 000 2. 6 
Potato crop 150,000 8. 0 
Pastures 900, 000 47. 8 
Various products (including chiefly 
fodder crops and vegetable crops)- 610,000 32.4 
Total 1,883,000 100.0 
Uncultivable land, parks, heaths 125, 000 4. 2 
Woodland (deforestation has already gone 
too far in Belgium) 541, 000 17. 7 
All other types of lands, namely, houses, 
gardens, factories, roads, railroads, 
water, sand, etc 501, 000 16. 4 
Total surface area of the coun- 
try 3, 050, 000 100. 0 
Only one person out of six engaged in agricultural 
production, and yet 62 percent of the surface area 
of the country was used for agricultural production. 
Nevertheless, we depended very considerably on our 
imports in order to meet the requirements of the 
population in food. 
Certainly, this cannot be explained exclusively by 
the fact that we were an industrial country before 
anything else. The point which must be emphasized 
is that our agriculture had developed towards the 
production of indirect food, meat and dairy products, 
and this is what rendered the country ever so much 
more dependent on its imports for its calorie re- 
quirements. This has taken place in my country ever 
since we had a very severe economic crisis between 
1883 and 1896 when the large producing countries 
started to produce large amounts of cereals and when 
on account of the fact that they had developed me- 
chanical means of agricultural production, they could 
sell on the world market at very much lower prices 
than those that our agricultural producers could af- 
ford. They could sell, therefore, on thehnternational 
market large amounts of cheap breadstuffs. The 
amount of wheat that one of their farmers produced 
required the labor of 20 of our farmers and the 
quality of grain they could produce was better than 
ours. Moreover, at that time, the mechanization of 
agriculture was not applicable on the small farms we 
had in our country. 
It is since that time that our farmers have oriented 
their activities towards the production of dairy prod- 
ucts—milk and butter, not very much cheese—and 
meat and eggs. In other words, the country was 
gradually engaging more and more in the produc- 
tion of perishable types of foodstuffs which were of 
the protective group, whereas the country depended 
very considerably on its imports for cereals. The 
surface area of our country which was used for cereal 
crop production gradually fell from something near 
935,000 hectares to 600,000, and the fodder crops in- 
Of the total surface area of the agricultural land, 12 percent 
was used for crops of direct food (breadstuffs, part of the 
sugar-beet and potato crops) corresponding to human con- 
sumption of potatoes. This small fraction of agricultural land 
provided about 34 percent of the calorie requirements of the 
Belgian population. 
Over 65 percent of the surface area was used for food in- 
directly produced by land (pastures and fodder crops includ- 
ing part of potato crops used as fodder. The pastures alone 
covered about 50 percent of the total surface area of Bel- 
gium’s agricultural land). This large fraction of the agri- 
cultural land provided only about 16 percent of the calorie 
requirements of the Belgian population. 
Thus 50 percent of the energy requirements of the popula- 
tion was provided by the agricultural land; the other 50 per- 
cent had to be provided by imported food. 
You will see that in 1938 only about 12 percent of 
the surface area of the agricultural domain in Bel- 
gium was used for direct food production and that 
yielded about 34 percent, a relatively large propor- 
tion of the calories required for the population; 
whereas a very much larger proportion of the surface 
area, 65 percent, was used for indirect production of 
food, that is, foods of animal origin (the pastures 
alone covered 50 percent out of the 65 percent) and 
they yielded only 16 percent of the calories. Those 
two fractions together make up the 50 percent of the 
total calorie requirements of the population, the other 
50 percent being provided by imported foodstuffs. 
One of the very interesting points that arises from 
this study is, I think, that there is a very small sur- 
face area with a high calorie yield for direct food, 
a very large surface area with a low calorie yield 
for the foods of animal origin; but, on the other hand, 
that the latter are foodstuffs which yield a large pro- 
portion of the protective nutrients that our popula- 
tion needs. 
Belgium, before this war, was thus self-supporting 
as far as the actual consumption of indirect food was 
12 concerned. I am not speaking of what the require- 
ments were, of what the consumption of indirect food 
should have been, but what it actually was. In this 
sense, the country was approximately self-supporting 
in meat, milk, and butter. Belgium imported most 
of its cheese from Holland; on the other hand, it also 
imported very large amounts of cereals, chiefly wheat. 
Our consumption was nearly 1,300,000 tons of wheat 
grain, 1,000.000 of which was imported and only 
300,000 home-produced. 
This situation led to a food supply of which I am 
going to give you the main characteristics. I am 
speaking of the average diet of the population con- 
sidered as a whole. The available amount of food 
corresponded to something like 80 grams of protein, 
80 to 100 grams of fat, and 350 to 430 grams of carbo- 
hydrates, making up about 2,800 calories a day per 
head of the population. On an average the amount 
of calcium provided was low, about 0.6 gram per 
head a day, which was, in fact, the very minimum 
of what we considered as being necessary, with no 
safety margin whatsoever. 
The average calorie supply was nearly sufficient, 
but not quite. If we calculate the weighted average 
of the requirements in calories in Belgium, taking 
into account the proportion of the different age 
groups of the children and the different groups of 
workmen and their requirements according to their 
work and the requirements of expectant mothers, 
and so forth, the weighted average of the require- 
ments in Belgium corresponds to something very 
close to 2,700 calories per head of the population and 
the amount of calories in the available amount of 
food is something close to 2,800. Now this difference 
of 100 calories between available food and require- 
ments is certainly too small. In other words, in our 
country, the inevitable waste—household, industrial, 
and commercial—represents a larger margin than 
that given by the above-mentioned difference be- 
tween requirements and supply. So, one can see 
that there is a certain small shortage in calories, but 
there is a very considerable shortage in the average 
diet of the population in certain protective nutrients. 
Such is the case for calcium. 
The amount of iron which is taken in, on an aver- 
age, seems rather satisfactory; but the intake of 
vitamins is certainly below what is required. We 
have found it very difficult to calculate more or less 
exactly what the amount of vitamin intake is, be- 
cause we know that we cannot base our calculations 
simply on the content of the raw material in these 
vitamins but have to take into account the habits of 
the population and their way of preparing food, 
which, in many instances is very unsatisfactory. 
But on an average, we have certain indications which 
show that vitamin A intake is below 3,000 units, 
probably below 2,500 units per head, per day, which 
is certainly very much too low. 
We have considered so far the average Belgian diet 
in terms of calories and of certain essential nutrients. 
Let us also consider it now in terms of foodstuffs. 
The following table gives us the answer. There is 
a consumption of 430 grams per head a day of wheat, 
that is, cereals in general, but this consumption is of 
practically no other cereal than wheat. In fact, out 
of the 434 grams of cereals consumed, 430 is wheat. 
This shows quite clearly that wheat is practically ex- 
clusively the cereal which is consumed in Belgium. 
A very small amount of rice is consumed, but the 
consumption of potatoes is very high, an average of 
560 grams. 
The peasants in our country consume very large 
amounts of potatoes, about 750 grams per head a day; 
in towns, of course, the percentage is very much lower, 
but the average is 560 grams, just over one-half kilo- 
gram. These potatoes are an important source of 
vitamin C although a large proportion of the C is 
lost on account of existing cooking habits. 
Then the amount of meat is about 108 grams; and 
I might just say that as far as free fats are concerned, 
the average consumption is about 22 grams of butter, 
20 grams of margarine, about 10 grams of animal fat, 
and 7 grams of vegetable table oil, in all about 58 
grams of free fat out of the 80 to 100 total fat con- 
sumption per head of population. 
Let us turn now to milk consumption. The amount 
is extremely low, namely, 224 cubic centimeters. That 
is the average consumption per head of the population. 
The amount of cheese is not high either, so that we 
consider in our country that the low calcium intake 
in comparison to the total calorie intake is due to the 
fact that our milk-product consumption is so low. 
The average daily food intake of the Belgian popu- 
lation in 1938 was as follows: 
Food Consumed: Grams 
Cereals (of which 430 grams are wheat) 434.2 
Rice 9.3 
Potatoes 560.0 
Dried beans, peas, etc 1 8.3 
Coconut 3.3 
Sugar 77.0 
Margarine 20.0 
Vegetable oils and fats 8.2 
Fresh green leafy vegetables 100.0 
Canned vegetables 6.7 
Chicory 6.7 
, Coffee 13.3 
Imported fruits 50.0 
Home-produced fruits 
Meat 108.0 
Fish (fresh and canned) 24.0 
Eggs (0.44 apiece) 22.0 
Whole milk 224.0 
Skimmed milk 4.1 
Cheese 9.3 
White cheese 4.0 
Butter 21.8 
Animal fat 9.9 
Foods directly produced by land (largely imported) : 
Quantity 1, 297. 0 
In round figures 1, 300. 0 
Calories 
Energy value in net calories 2,121. 0 
Foods of animal origin indirectly produced by land 
(foods predominantly home-produced) : 
Grams 
Quantity 427.1 
Calories 
Energy value in net calories 672. 0 
In all: 1,724 grams of food per head and per 
day yielding 2,793 net calories. 
13 In general, in our country, we feel that the problem 
is to increase the consumption of dairy products, but 
not so much the consumption of meat, which already 
is satisfactory. The most important thing that we 
have to consider is to increase the consumption of 
dairy products and green leafy vegetables in order to 
be able to shift to a higher level the intake of some 
of the important protective nutrients. 
Now, how is it that we consume so little of these 
important foodstuffs? The characteristic feature 
of the conditions of malnutrition which prevailed in 
Belgium before the war was that almost enough cal- 
ories were consumed but our population’s diet was 
not an adequately balanced one. Indeed, our prob- 
lem was not an easy one to solve. All of the milk 
which we consumed was home-produced; it would 
have been difficult for us to increase its production 
very considerably, I have already said how very 
densely populated our country is, not only as far as 
human beings are concerned, but also livestock; that 
the yield of milk per head of cow was on the high 
side. It did not correspond to the highest figure that 
exists, it was not as high as in Holland or Denmark, 
but it was high. It corresponded to an average fig- 
ure of about 675 gallons a year, or nearly 2 gallons 
a day on an average for the whole year. It was be- 
cause of the very large consumption of feedstuffs. 
in concentrates, that we reached this high level of 
milk production. Of course, the adequate feeding 
of the animals and also the adequate selection of milk 
cows were the two major factors involved. 
Where we had to improve a good deal was in the 
quality of milk. It certainly was very far from be- 
ing satisfactory, I am speaking not only from the 
point of view of the bacteriological cleanliness of the 
milk, but also of its nutritive value. It is very strik- 
ing indeed that in those parts of the country where 
our producers of the small farmer types were en- 
gaged in production on a cooperative basis, the qual- 
ity of the milk produced was better from the bac- 
teriological point of view, and from the nutritive 
point of view, as well. In other parts of the coun- 
try where the small producers were working on their 
own, isolatedly, and were not selecting the proper 
types of animals for milk production or feeding their 
animals properly, production was low. Where pro- 
duction was inadequate, the average amount of fat 
in milk was below 3 percent, whereas it averaged 
above 3.4 percent in those areas where dairy pro- 
ducers worked cooperatively. 
This most paradoxical situation existed, that 
whenever the milk produced was of a higher fat 
content than 2.8 percent, and such a result was ob- 
tained at great pains, skimming was taking place 
in the distribution process. This skimming was dif- 
ficult to detect as long as the fat content was not 
brought below 2.8 percent, a figure often found in 
nonskimmed milk produced by a poor milk cow. 
So what had been gained, and with great effort on 
one side, was lost on the other side on account of this 
abnormal situation which existed in our country of 
farmers producing milk greatly varying in quality. 
The situation was a serious one, for it was impossible 
for us to think of trying to increase the consumption 
of milk as long as we had not, first of all, made a 
greater effort to increase the quality of the milk. 
Problems of that kind come up in addition to those 
concerning increased production and are intimately 
related to it. 
Let us now turn to another aspect of our studies 
in nutrition. We have had many surveys made re- 
garding family budgets of the low-income groups 
of our population. In many cases such economic 
studies were made at the same time as surveys re- 
garding food consumption, and these studies showed 
that in comparable groups of the population where 
the standard of living and the purchasing conditions 
are the same, there are very large variations in the 
balance of the diets. Some families are consuming 
better balanced diets than others. When one fig- 
ures out the calorie supply in comparison with the 
cost of the diet, one sees that the supply of calories 
can range all the way between 370 and 670 calories 
per Belgian franc. Thus, for food purchases, the 
per unit expenditure for the same number of calo- 
ries may vary from 1 to 2. 
We first thought that this was due to differences 
in housewives’ efficiency in dealing adequately with 
their household problems. That proved, however, not 
to be the case. The examination of our survey results 
indicated that those diets with a low calorie yield for 
a given expenditure—1 franc—were those diets which 
were better balanced than those yielding more cal- 
ories for the same expenditure. In the latter case 
the people were getting their calories cheaply by con- 
suming large amounts of bread and potatoes, foods 
which wTere high in starch content and were poor 
in protective nutrients. 
When calculating what the cost of the diet would 
have been if it had been adequately balanced, or at 
least partially so, we came to the conclusion that 
350 calories per franc of expenditure was closer to 
what the situation should have been. In other words, 
if a 3,000-calorie diet, normally balanced, was costing 
about 8Y2 Belgian francs per day, the people were en- 
deavoring to get the same amount of energy, namely 
3,000 calories, at a very much lower cost, for between 
4 and 8 francs instead of 8y2 francs. But in order 
to get these calories very cheaply, they had to do it 
by sacrificing the adequate intake of protective food- 
stuffs. When more of the latter were consumed and 
less of the other ones, the cost of the diet was raised 
very substantially, notwithstanding a constant cal- 
orie intake. The problem in our country, therefore, is 
really to obtain an increase in consumption of dairy 
products and green leafy vegetables and fruits among 
large sections of our population. 
The consequence of this situation has also been 
studied in our country. We have had several inves- 
tigations made on the state of nutrition of our pop- 
ulation. We have used the dark adaptation test for 
studying the situation with regard to vitamin A; 
whatever may be said with regard to the real prac- 
tical significance of this test, which has been im- 
proved technically very much since we used it in Belgium (we used the Zeiss Birch Hirschfeld adapt- 
ometer), we came to the conclusion that among the 
school children of various income groups, in practi- 
cally all groups in towns, one could improve the dark 
adaptation in some 40 percent of the children in 
large towns, such as, for instance, Brussels. 
All of these investigations have unfortunately been 
made in Brussels only. Since it has been the experi- 
ence* in most of the countries that the practical sig- 
nificance of these physiological tests is so often diffi- 
cult to interpret, we have found it advisable also to 
conduct certain food experiments in schools and to 
test their influence on the state of nutrition of the 
children getting the benefit of extra protective food 
intake at school without cost. Just before the war, 
we made a fairly important experiment of this kind 
on some 600 children in schools in Brussels. There 
we compared the results that we obtained by having 
milk consumed at school on the one hand, and the 
Oslo-breakfast type of meal that you all know of, 
on the other. 
I am very sorry, indeed, that I cannot show you a 
few charts with regard to our results. We were not 
dealing with the children of the poorest classes, but 
with families of low- or average-income groups of 
the population in Belgium. We knew the experience 
that England had with respect to the distribution 
of milk in schools, and, on the other hand, of the 
Oslo-breakfast type of scheme. We tried both, and 
we printed a fairly extensive publication on its ex- 
perimental bearing on the general physical condition 
of the children, on their height and weight, thus 
their growth; also on the influence on their mental 
fitness as judged from their behavior at school. This 
publication is a book of some 350 pages, which just 
came out of press 2 days before the Germans came 
into Belgium, “Une experience alimentaire en Bel- 
gique,” by E. J. Bigwood, G. Jaeguemyns, and Paul 
M. G. Levy—Imprimere Vronans, Brussels, 1940. I 
took two copies of it with me out of occupied Bel- 
gium. I left one of them in London, and I was 
hoping to find the other one in this country. I had 
given it to a friend of mine who brought it to Amer- 
ica, but I had unfortunately not succeeded in getting 
it for this occasion; otherwise, I might have shown 
you what the exact results were. I shall, therefore, 
quote them from memory. 
We found them important because of their ex- 
tremely beneficial results, showing how very much 
there was to be done in order to improve our country’s 
food position. We found that the Oslo-breakfast 
scheme gave us very much better results than the 
milk scheme, but this difference was chiefly observed 
among the boys. The milk scheme and the Oslo- 
breakfast scheme gave us, on the average, the same 
results in girls, but in boys the advantage of the lat- 
ter was tremendous. We had the children divided 
into three groups: One test group for comparison, 
receiving no extra food at school, a second group 
was put on the milk scheme, and the third one on the 
Oslo-breakfast scheme. If we represent the situation 
schematically, the results were as follows as far as 
the general physical condition was concerned. 
Comparison of relative growth of children fed on various 
diets: I, Test groups; II, milk-fed groups; III, Oslo- 
breakfast groups. 
The physical condition of- the children was assessed 
at the beginning and the end of the experiment, 
which lasted about 8 months. It had improved in the 
test group* (I) in a proportion of cases given ap- 
proximately by the dark section of the column I. 
The frequency of improvement in the milk group 
is given in column II and in the Oslo-breakfast group 
in Column III. We obtained consistently the same 
sort of results regarding growth curves as well as 
the improvement in mental fitness and behavior at 
school. The outstanding beneficial results obtained 
with the Oslo breakfast were practically all found 
in boys, whereas, with girls, the milk scheme gave the 
same beneficial results as those obtained with the 
Oslo breakfast. We were of the opinion, however, 
that further investigations were needed to confirm 
those findings. The schoolmasters, who were very 
skeptical at the beginning of the experiment, were 
fully convinced of the absolute necessity of improv- 
ing the health condition of our urban school-aged 
children by methods which would adequately influ- 
ence food habits. 
I have given you a general idea of what the sit- 
uation was in normal times, and what sort of inves- 
tigations were made in our country to ascertain it. 
May I just say one or two words before finishing, 
with regard to what has happened since the occupa- 
tion of Belgium? The Nazi policy in the occupied 
countries has been more or less the same everywhere; 
their tendency has been to try to induce the people 
in the occupied countries to become more self-sus- 
taining with regard to their calorie requirements. As 
far as Belgium is concerend, there are publications 
in Germany—of which I have the reference—which 
show what was to be done to reach that result. 
As a matter of fact we knew before the war that 
if we plowed up some 25 percent of the pastures and mcreased by 33 percent the potato crops, increased 
by 100 percent the sugar consumption, if there was 
no change or not very much change in the cereal pro- 
duction, and if the whole of the rye produced in 
Belgium, which was used as feeding stuffs in normal 
times, was used for human consumption as well as 
wheat, we would reach a situation which would meet 
by home production alone the requirements as far as 
calories are concerned. This would reduce by one- 
fourth the amount of meat consumed, the amount of 
milk products, that is to say, the consumption of 
those foods which were either just normally or insuf- 
ficiently consumed in normal times. On the other 
hand, we would have to increase the consumption 
of those other foodstuffs which are stable, but which 
yield larger proportions of calories, namely, those 
foodstuffs of high starch or sugar content, which 
supply chiefly calories but none or very little pro- 
tective nutrients. It would have brought us back as 
far as diet balance was concerned to the situation that 
existed some 150 years ago, namely, one that lay 
in the opposite direction. 
In the beginning of the occupation, it was the 
intention of the Germans to try to engage our country 
in such an agricultural scheme, and they made great 
efforts to succeed in that direction but they met de- 
cided opposition on the part of our farmers, who 
have endeavored to preserve the surface area used 
as pastures. Crop land has been increased in surface 
area but chiefly at the expense of land other than 
that used for pastures. The Nazi’s policy has been 
one which would have led us to become in the future 
much more dependent on imports for the most perish- 
able type of our foodstuffs, those of the protective 
group of which we were already short; whereas we 
would have become more independent for those other 
foodstuffs yielding chiefly calories, which are much 
more stable and easier to transport throughout the 
world and to stock anywhere for a certain time. 
Indeed, it was a paradoxical situation in which the 
Nazis tried to engage the allied countries they dom- 
inate. It was the case in Holland and in Denmark, 
as well as in Belgium. In general, it was the case 
in most of the occupied countries or parts of countries 
where there was a large production of food of animal 
origin. Fortunately our farmers did not give in. 
They opposed such a policy as strongly as they could. 
But, we cannot expect that no harm at all has been 
achieved by the Germans during the last 3 years of 
Nazi domination. Our livestock has been reduced 
very considerably. Cattle have undergone a 30-per- 
cent reduction, and have now necessarily to feed on a 
proportionately larger surface of pasture, because 
the importation of feeding stuffs has stopped. < We 
have practically no pigs any more and hardly any 
poultry. (There is a reduction of about 80 percent 
in this livestock.) The production of milk has 
dropped by about 50 to 60 percent and the meat pro- 
duction has also gone down to the same extent. If 
we remember that the rationed diet in Belgium for 
the vast majority of the people living in towns and 
industrial areas, has fallen from a level correspond- 
ing to 2,850 calories, half of which was home-pro- 
duced, down to one varying between 900 and 1,800 
calories a day, and that this situation has been going 
on since the end of 1940, one can realize the gravity of 
the situation. 
During the 4 years of German occupation during 
the last war, the diet never dropped below 2,000 
calories per head a day. Only a very few wealthy 
people, can afford during the present war to spend 
large enough sums of money on the black market to 
obtain the food they need. The black market is 
developing very widely because what can be obtained 
by the Belgium population on the black market is 
that much that the Germans don’t get, so that there 
is a good deal of black marketing going on, but ex- 
tremely expensive it is. Those of you who have 
some idea of the purchasing power of the Belgian 
franc in pre-war times might be interested to know 
that a family of 4 people will expend at the present 
time something like 100,000 to 120,000 francs a year, 
on food alone. This sum is very far above the 
budgets of the vast majority of the people. 
Very few people in occupied Belgium, therefore, 
can now afford to live in conditions similar to those 
of the last war. That is the situation, ladies and 
gentlemen. Protein in the diet has fallen below 
30 grams a day for, something like two-thirds of the 
population. We have, of course, a certain number, 
some 300,000 or 400,000, of workmen who are being 
sent to Germany; but, on the other hand, we have 
something like 600,000 or 800,000 German soldiers 
to feed, and they get three times the 1,250-calorie 
theoretical ration of the civilians. The fat content 
of the diet—the free-fat intake— has fallen to a level 
corresponding to 10 grams a day, whereas in pre- 
war time it was of the order of 55 to 60 grams. 
These various figures will justify the very pessi- 
mistic outlook we have regarding the public health 
conditions we are going to face when we come back 
to our country. The only hope we have is that it 
won’t be altogether too late when we do. It is in- 
deed with anguish that we think of the future. One 
of our most urgent agricultural problems will be to 
rebuild as quickly as possible our livestock, which 
will take several years, and we shall, therefore, dur- 
ing that time, have to live on a very much more ill- 
balanced diet than the one we used to consume, dis- 
carding altogether the question of the quantity of 
calories. This kind of situation is going to be met 
within most of the allied countries which are com- 
pletely occupied by the enemy. That represents 
something like 140 million people for the 8 allied 
countries on the European continent, exclusive of 
Kussia, which is only partly occupied. I am speak- 
ing exclusively of those countries now entirely oc- 
cupied by Germany. 
Such is the situation as I see it. It is going to 
raise quite different problems from those that we 
would have had to deal with had there been no war 
at all. I think that is all, ladies and gentlemen, that 
I have to tell you. 
Question: I would like to ask a question, Dr. Big- 
wood. I noticed you did not mention any of the de- 
16 ficiency diseases. Could you tell us anything about 
the prevalence of deficiency disease in Belgium be- 
fore the war ? 
Dr. Bigwood: As far as clear-cut deficiency dis- 
eases are concerned, Belgium’s situation wTas rather 
satisfactory in normal times. We had rickets, which 
developed very extensively during the last war, but 
we improved the situation considerably since that 
time although there was a low calcium intake, which 
I mentioned. It corresponded to an intake without 
any safety margin at all, but we did favor very con- 
siderably the intake of cod-liver oil and, in fact, the 
proportion of rickets was going down very consid- 
erably. As far as the other deficiency diseases clin- 
ically evident are concerned, we had very little. We 
believe, though, that predeficiencies were widespread 
in our country. During the present war, as far as 
we know, the two major and very serious conse- 
quences of food deficiency have been nutritional 
edema, which is very widespread and which did not 
occur at all during the last war in Belgium; and, 
secondly, an alarming extension of tuberculosis, often 
developing acutely. 
Question: I would like to ask a question in con- 
nection with the Oslo breakfasts. I think you said 
you compared the school milk breakfasts with the 
Oslo breakfasts, and I am not sure we all know just 
what the Oslo breakfast is. 
Dr. Bigwood: The Oslo-breakfast type of school 
meal is one which is formed practically exclusively 
of protective foodstuffs. That is to say, it is composed 
of whole-meal bread with butter and cheese, half an 
orange, and a pint of milk. But in our experiment, 
we reduced the amount of milk in the Oslo breakfast, 
simply because we were comparing this type of meal 
with the scheme providing milk alone so that if we 
had given relatively the same amount of milk in 
both groups, we would not have had anything that 
might have been compared satisfactorily. We, there- 
fore, reduced somewhat the amount of milk in our 
Oslo-breakfast type of meal, whereas in the other 
group the milk ration was high and sugar was added 
to it in order to increase the calorie intake in this 
second group. In principle the Oslo-breakfast type 
of meal intends to supply at school as much as pos- 
sible of the protective foodstuffs so that it doesn’t 
matter so much if the other meals of the day are 
deficient in these types of food. 
Question: May I ask, did you form any opinion 
of why the boys improved more on the Oslo breakfast 
than the girls? 
Dr. Bigwood: We had the impression, but this 
was only an impression, that most boys probably are 
a more vulnerable group than girls. For a given 
inadequacy of the diet, boys are liable to feel it more 
than girls. We were of the opinion, however, that 
no explanation could really be given and our inten- 
tion was to repeat the experiment, had not the war 
broke out. This intention was mentioned in our 
published conclusion. 
Question: I suppose the home food habits of these 
children were the same: 
Dr. Bigwood: Oh, yes, exactly, the same. 
Question: Dr. Bigwood, can you give us the com- 
parison of the calories in this center ? 
Dr. Bigwood: The calories were inevitably higher 
in the Oslo breakfast group; we could not adjust 
our two experiments in order to have the same cal- 
orie intake; that was not only impossible but also 
not desirable because the children on the milk scheme 
had breakfast at home before coming to school, 
whereas those on the Oslo-breakfast scheme did not. 
Question: How much milk did you give in the 
Oslo breakfast? 
Dr. Bigwood: In the Oslo breakfast, we only 
gave, I quote from memory, about a quarter of liter, 
that is 250 cubic centimeters. Whereas, we gave 500 
to 750 cubic centimeters of milk in the other group. 
17 DIETARY HABITS OF THE CHINESE 
By Dr. J. Heng Liu 
Liu, J. Heng, physician; b. China; B. S., M. D., Harvard University. Director of 
Peiping Union Medical‘'College, Peiping; Minister of Health, Nanking; Surgeon-General of 
Chinese Army Medical Service; President, Chinese Medical Association; organized and is 
member of Chinese National Health Administration. Now head of the Division of Medical 
Supplies, China Defense Supplies, Inc., and attached to Chinese Embassy, Washington, D. O. 
I suppose everybody here knows something about 
Chinese food. It is really quite astonishing to us 
Chinese that Chinese food should be so popular in 
the United States. 
When I passed through India last October on my 
way here, I stopped at a place called Karachi and 
there we went to a Chinese dinner in a Chinese res- 
taurant. The restaurant was new, it had just been 
opened. The proprietor was telling us that in that 
month, October, 10 new Chinese restaurants were 
opened in that city—not for the Hindus, who don’t 
care anything about Chinese food, not for the Eng- 
lishmen there, not for the Chinese of whom there were 
very few in Karachi, but for the benefit of the Ameri- 
can Army in Karachi. 
I suppose the American boys get tired of the food 
served in the camps. Although all of your Army 
camps serve excellent food, the soldiers must get tired 
of it, and want something different, and immedi- 
ately they think of chop suey. 
Talking about chop suey, it really is not a Chinese 
dish. I mean, those of you who might walk into a 
Chinese restaurant in China and order chop suey 
would not get it, and the people would not know what 
you were talking about. 
A few years ago an American in Shanghai opened 
a restaurant, and outside the door he put up a great 
big neon sign “American chop suey.” This, as I 
remember, was the first chop suey. 
Anyway, Chinese food is popular; I don’t know 
why, but I suppose because it is different and it is 
tasty. 
But as I say, all Chinese food is not alike. The 
food you get here in the Chinese restaurants is 
Cantonese food. I mean that other than chop suey 
there are a good many dishes which are Chinese, but 
they are Cantonese in style, in the way of their prep- 
aration, and in the materials which are used. 
China is such a big country that there are great 
differences between the food used by the northerners 
and by the southerners and by the people in the east 
and those in the west. 
The main difference is in the staple foods which 
the people use. In the north—I come from North 
China—the food we eat consists mainly of wheat 
flour, that is, we eat much more bread than rice. 
Rice is the staple diet of all the provinces south 
of the Yangtze River. That is a very rough lay of 
the distribution of the food habits of the northerners 
and the southerners, and it may be the main reason 
why the northern Chinese is a larger person than the 
southerner. 
Compared to the average, I am a short fellow. In 
North China the people are tall and heavy and it 
isn’t at all unusual to see groups of people who aver- 
age 5 feet 10 inches or over, and who weigh 150 
pounds and more. In the south, however, the people 
are much smaller, their average height being prob- 
ably 5 feet 3 or 4, and the average weight, 120 pounds. 
And as you go into the interior—go in west from the 
coast—the people are very much smaller. In the 
Province Szechuan, in which Chungking is located, 
the average is even smaller, probably 5 feet 1, the 
average weight less than 110 pounds. 
We do not know whether the diet has very much 
to do with the size of the people or whether it is 
heredity. But anyway, wherever wheat and cereals 
other than rice are the staple diet, the people are 
larger in stature. They are taller, and they are 
heavier. 
You must have heard of Chinese feasts where 
sharks, bird’s-nest, and such unusual food materials 
are used. We do have these delicacies, but they do 
not amount to very much as general items of food, 
probably not more than one in a million or half a 
million people ever eat sharks’ fiqs. 
The ordinary food that we eat, as you know, is 
quite different from your diet. We never eat large 
pieces of meat like your roasts, steaks, or chops. You 
know that in chop suey or chow mein, the meat is 
chopped up, and that is the way we eat meat. It is 
almost always chopped into small pieces before it is 
cooked, and most of the time it is mixed with a lot 
of vegetables. 
As you have seen, we depend largely on rice or on 
other cereals. By “other cereals” I mean wheat flour 
—in the form of bread—or millet, corn, sorghum, 
barley, and oats, eaten sometimes in the form of 
gruels and sometimes in the form of bread. 
In addition to consuming these cereal elements— 
wheat flour and other cereals in the north, and rice 
in the south, which supply the energy intake, or the 
18 calories—the general average population, and par- 
ticularly the poorer people, have to depend on vege- 
tables. 
All kinds of the common vegetables are grown in 
China; and in addition, we have different kinds of 
beans, of which the soybean is very generally used. 
Then we make different food materials from soy- 
beans—bean-curd, bean milk, bean sprouts, and so 
forth—so that the soybean becomes a very important 
food element in China. 
In the preparation of Chinese foods, the vegetables 
are not cooked the way you cook them. We do not 
prefer the way that Americans or the Englishmen 
cook their vegetables, for your vegetables are boiled in 
water, and you eat them after adding a little butter 
or milk. We chop up the vegetables and usually 
fry them in a little oil. Very often a little meat is 
added to the vegetable, not much, just enough to give 
a better flavor, and then some salt is added and often 
a little soy sauce, made from soybeans, which is com- 
monly seen in all the Chinese restaurants in this 
country. Now that gives us a much more tasty vege- 
table dish than what yqu have; but then, of course, 
your vegetable dishes are what you call side dishes, 
whereas with most of our people, this vegetable dish 
is the main dish of the meal. 
Depending on the number of persons to a meal, you 
can have several kinds of vegetables prepared in 
different ways: Some with meat, some without meat, 
some with pepper, some with sweet sauce, and so on. 
But with the very poor families, you get only one 
dish, only one kind of vegetable, and very often this 
is cooked with a few drops of oil and some salt and 
no meat at all. 
The consumption of meat in China is very small. 
As I said, we never eat a very large piece of meat 
the way you eat a roast or a steak. Too, the or- 
dinary person cannot afford to eat such an expensive 
item as meat. But before the war, meat was very 
cheap according to American standards of living. 
And eggs, for instance, I still remember the time 
10 or 12 years ago when you could get 100 or 150 
eggs for one Chinese dollar. One Chinese dollar 
would be worth about 50 cents in American money, 
so that you could get eggs, three or four, for one of 
your pennies. But even at that price many people 
could not afford them. 
I was looking up certain figures, and I found that 
before the war, in 1935-36, Chinese exports of eggs 
and egg products amounted to 40 million dollars, 
and most of those eggs and egg products came to this 
country. From a nutritional point of view, China 
really could not afford to export all these eggs; I 
mean they were not a surplus stock of eggs. The 
people were so poor that they could not afford to 
eat them so the eggs were exported so as to get money 
in order to buy rice and other cereals. At the Food 
Conference at Hot Springs, it was shown that the 
main causes of malnutrition are poverty and ignor- 
ance. When a person cannot afford to buy the food 
materials—well—he has to go hungry; but when 
he can afford to buy food, but still is malnourished, 
then, of course, the cause is ignorance. 
In China, 85 percent of our people are farmers, 
and living is very difficult for them. The income or 
these farmers per year per person before the war 
was so little that they had a difficult time just get- 
ting enough to eat. 
At the Food Conference, when delegates from sev- 
eral countries spoke of food, they immediately talked 
about milk, cheese, butter, and dairy products in gen- 
eral. Now China has been getting along without 
dairy products of any kind. When you go into a 
Chinese restaurant, you will see that the menus 
do not contain butter; there is no milk served, no 
cream, and no cheese. We do not use these foods 
except among the Mongols and Tibetans, who do 
take milk and butter, and even cheese, but they are 
a very small percentage of the population of China. 
In general, we do not get fresh milk except in a few 
of the larger cities where there are modern dairies. 
In those cities you can get fresh milk, and, of course, 
you can buy evaporated milk and condensed milk, but 
certainly more than 99 percent of the Chinese people 
do not use milk at all from the time they leave the 
mother’s breast. 
This may be a good thing for China, because milk 
products are expensive in the first place, and also, 
milk requires very expensive equipment to keep it in 
drinkable condition. We know that many diseases 
can be conveyed by means of milk, and China has 
enough cases of gastro-intestinal diseases without 
those carried by milk. We have typhoid, we have 
cholera, we have the dysenteries, but these diseases 
could be very much worse if China used more milk.' 
But there is another factor which has kept down 
the incidence of gastro-intestinal diseases, and that 
is the habit of drinking tea instead of cold water. 
No Chinese would think of drinking cold water. He 
always drinks tea, and tea, of course, is always hot, 
and that helps to keep down the gastro-intestinal 
diseases. 
So I say, those two factors are really very im- 
portant, and I would hesitate very much to introduce 
milk and other dairy products into China, to the 
Chinese. It isn’t that I think milk is not an im- 
portant food in countries like yours; it is a very 
important one, and I have no doubt that it would 
be a very good thing if the Chinese people as a 
whole could get the benefits of utilizing milk products, 
but according to the present economic standards, 
and keeping in mind the dangers which may come 
from the use of milk improperly cared for, I think 
it will be many years before we should try to encour- 
age milk drinking in China. 
In order to supply the food elements which are 
necessary, we can use in place of cow’s milk a bever- 
age prepared from the soybean. It tastes very much 
like cow’s milk and has chemical properties and nu- 
tritional values very similar to those of cow’s milk. 
A good deal of that is used, and it is always used 
hot. Also, we utilize a good deal of soybean curd. 
It is used as a fresh curd or as a compressed or dried 
curd and can take the place of your cheese. 
Now a few words on diseases caused by deficiencies 
in diets. The northerner, being a wheat eater or 
19 mixed-cereal eater, very seldom gets beriberi, so that 
in North China we almost never see a case of beri- 
beri. But as soon as we cross the Yangtze River, 
there is a good deal of beriberi, also pellagra. The 
rice that is used is always polished rice. That, we 
know, is very bad, because it lacks vitamin B. 
Now in the last couple of years, the Government 
has promulgated regulations against the polishing of 
rice. Just this year I heard that the Chinese armies 
are supplied with unpolished rice only. It used to be 
that the armies were full of cases of beriberi. I still 
remember some years ago during one of the civil 
wars, I was visiting one of the interior Provinces. 
The sight was a terrific one. I could see so much 
beriberi among the soldiers, and particularly, a con- 
dition which you cannot imagine—a combination of 
beriberi and dysentery. These men, of course, would 
become very anemic, very thin; they also had nutri- 
tional edema so that they had edema of the abdomen, 
of the legs, and of the face. In certain camps I saw 
hundreds and hundreds of these cases. Of course, 
the disease is fatal in most of the cases. 
Scurvy is not very common in China, and neither 
is rickets. In certain regions, there is a disease 
called osteomalacia, particularly in women. In 
North China, we have a very good climate. In winter 
there is plenty of sunshine almost all the time. The 
reason that the women get osteomalacia, which is, as 
you know, due to lack of calcium and vitamin D, is 
because of their habits of staying indoors. The 
women, particularly before the habit of foot-binding 
was abolished, just sat in their rooms where there 
was a fire, the outside being very cold, and they de- 
veloped osteomalacia. It is a disease in which the 
person afflicted has soft bones which later become 
deformed, and the deformity is very often in the 
pelvis so that these women have terrible difficulties 
at childbirth. In many cases they have to have 
Caesarean sections or their lives would be en- 
dangered—their own lives as well as those of their 
babies. In one or two Provinces in North China, 
osteomalacia has been very common indeed. 
Goiter from lack of iodine is quite common in 
certain mountainous regions. In the Province of 
Yunnan, where Kunming is located, there is a great 
deal of it. In many villages almost every woman 
has a great cystic goiter in the neck. The Govern- 
ment is trying to remedy this by iodizing the salt 
and issuing tablets of the iodides. Then, in certain 
places, there are many bladder stones; particularly 
in Kwangtung Province, it is very common to have 
people in the hospital to be operated on for bladder 
stones. 
I just want to say one word about the preparation 
of the North China diet. I have told you that flour 
is eaten either as bread or as cereal or gruel. You 
know the story, I suppose, that the Italian spaghetti 
was brought to Italy from China by Marco Polo, 
so that China is really the home of spaghetti and 
macaroni. 
I want to say a word also about the Chinese bread. 
We do not bake bread in large loaves, as you do. We 
have both raised and unraised breads, made in the 
home. Our wheat-flour bread, the raised bread, is 
always steamed. 
For yeast, we don’t go out to buy a yeast cake be- 
cause there are none for sale in China. We mix a 
little flour with a little water and just put it aside 
somewhere. A mold from the air soon grows in the 
mixture and this ferments the flour. But this isn’t 
a very good yeast, because the dough becomes very 
sour, and if you make a bread out of it you would 
not be able to eat the bread. This sourness, the acid- 
ity in the dough, has to be neutralized with soda. 
For this purpose the Chinese housewife uses, not 
sodium bicarbonate, not baking soda, but cleaning 
soda, sodium carbonate; and she knows exactly how 
much to put in. She makes a very concentrated solu- 
tion of soda and puts it in drop by drop—at the same 
time, kneading the dough—and then she smells it 
ever so often until the neutral point is reached. The 
expert housewife knows exactly when to stop adding 
the soda solution. If she puts in too much soda, the 
bread becomes yellow and the taste is very bad; and 
if not enough soda is added, she still gets a sour 
bread. But anyway, the average Chinese housewife 
knows how to make a very good steamed bread which 
consists of nothing but water and flour and yeast. 
We never use sugar, milk, or anything else in these 
breads. 
The unleavened bread is usually made in the form 
of a pancake. We mix flour with water, knead it, 
and then take a piece of the dough, and roll it out 
into a pancake. Very often some vegetable oil or 
lard is mixed in and between layers ox this pancake 
and the whole is cooked, not in an oven, but in a flat 
frying pan. Now that is a very good bread that is 
very tasty, although it is a little hard. The corn-meal 
bread also is sometimes raised and sometimes not. 
Sorghum, or kaoliang, which you call broomcorn, 
also makes a very good flour and gruel and is used 
quite extensively in North China. Millet, too, is used 
as a gruel or as a flour. Millet flour, by the way, is 
very much more tasty than corn flour for making 
bread. 
As I said, the farmer, the average Chinese, gets 
very little to eat. There are many farmers, par- 
ticularly in the poorer sections of the country, who 
do not see meat more often than a few times a 
year. That is only at the time of New Year, two 
or three festivals, the birthday of the head of the 
family and that sort of occasion, so that as far as the 
whole country is concerned, there is a good deal of 
malnutrition, and deficiency diseases are prevalent. 
But there is less malnutrition as a whole in North 
China than in South China. The food habits of the 
northerners and southerners are quite different. 
The people in the north, for instance, eat more 
vegetables and fruits. It is because they are cheaper, 
I suppose. I remember traveling one time from the 
north to the south, and on the train I remarked to 
my friends, “Now, see the difference in the diets as 
soon as we cross the Yangtze River; there is a very 
marked difference.” It was in the summer time and 
the northerners were eating a lot of onions and fruits, 
particularly melons and cucumbers, in very large 
20 quantities, and they were very cheap; for one copper, 
you get several melons, or several cucumbers. The 
largest watermelons in North China cost only a few 
cents but as soon as you cross the Yangtze River, you 
will see small watermelons of this size (indicating) 
selling for a dollar apiece. Of course, one reason 
is that transportation is bad and foods which are 
produced plentifully in one part of the country do 
not get to the other part of the country. That 
explains a good deal of it, but anyway the northerners 
get more fresh vegetables and fruits to eat. They 
have the habit of eating more of these foods, mainly 
because they happen to be very cheap. 
That is why the northern Chinese is a very much 
healthier and larger person than the southerner. 
On the other hand, the Cantonese are very proud, 
saying they eat the best food there is in the world. 
There is a proverb in China that if you want to eat 
properly, go to Canton. That is only a part of the 
whole proverb. There is another place, Hangchow, 
where silk is produced. You go there to be dressed 
properly. Then there is a place in Kwangsi where 
the best wood for coffins is produced, so another part 
of the proverb says you have to go there to die prop- 
erly, or to be buried properly. 
But the Cantonese are great eaters. I mean you 
go into the richer people’s homes, they spend more 
per unit of income for food than other Chinese. We 
give a reason for that. In Canton, the climate is 
terribly hot for 6 months of the year. It can be 
much worse than it was in Washington last Thurs- 
day and Friday, [laughter] with a temperature of 
96° to 105° F., and 100 percent humidity. The 
people perspire all the time so it is no use for them 
to spend any money to buy decent clothes. For 
them any kind of garment will do and so they spend 
all their money on food. But farther north, of 
course, the climate isn’t so bad. People think more 
of their appearance and spend more of their income 
on clothing. 
That is a very general picture of the food problem 
in China. Now, as I have told Dr. Sebrell, I do not 
pretend to be a nutrition expert at all. I never call 
myself that. In fact, my interests have always been 
in general problems in public health, and it is only 
in that connection that I have any interest in nu- 
trition whatsoever. However, I am very glad to 
have this opportunity today of meeting so many of 
you and giving you a little idea about China. Thank 
you. 
Chairman: Would anyone like to ask Dr. Liu a 
question ? He has kindly consented to spend a few 
minutes in discussion. 
Question: I would like to ask whether the land 
south of the Yangtze River is poorer, and if that is 
the reason that they do not have—1— 
Dr. Liu: I don’t believe that is true at all. The 
land, if anything, is more fertile. Most of the rice 
is grown south of the Yangtze, and they have two 
crops a year, so there is no doubt about the fertility 
or difference of fertility in the soil. 
Question: Is the wheat flour used in the north of 
China white, fine, or whole ? 
Dr. Liu: It used to be crude flour until we started 
to import what ’we call foreign flour. Now, the 
people, particularly the people in the larger cities, 
are spoiled. I mean when they saw this nice (white) 
flour, how much nicer it is than the native flour, 
everybody wanted it, so for some years we were im- 
porting flours from America and from Australia, 
and then we started mills of our own in the larger 
cities in Tientsin and in Shanghai, and everybody 
was eating white flour, very refined flour. For the 
health of the people as a whole, the native coarse 
flour is, of course, much better. 
Dr. Sebrell: Someone in the audience wanted me 
to ask you about how much malignancy and how 
much infantile paralysis there are in China. I don’t 
know what the connection is with nutrition, but if 
you have any estimates on those two diseases in your 
mind 
Dr. Liu: I don’t think that these two diseases are 
as a whole as common in China as in this country. 
Infantile paralysis we do have, but I am sure the 
extent is nothing compared with what you have 
here. I don’t know why, but it is a fact that we do 
not see many cases of infantile paralysis. 
As far as cancer is concerned, our expectation of 
life is not as long as yours. I mean our average 
length of life is probably within 30 years, while yours 
is about 60, isn’t it ? Over 50, anyway, and of course, 
there is a difference of 20-odd years in which you 
would have more chances of having cancer. 
I have operated on a good many women with can- 
cers of the breast, and cancer of the uterus is a com- 
mon disease. There is also cancer of the stomach, 
probably more common in the north than in the south, 
but as a whole I don’t think it is as common as here. 
It may be because we do not have as many ulcers of 
the stomach as you have. There is more cancer of 
the skin. 
Question: To what extent has the processing of 
fruits and vegetables taken place in China, if any? 
Dr. Liu: Would you include canning? 
Questioner: Yes, sir. 
Dr. Liu: In the larger cities, we have started a 
good many canning factories. But talking about de- 
hydrated foods, I was saying the other day that 
China has had dehydrated foods for many many 
years, probably thousands of years. We have dried 
meats, dried vegetables, dried fruits of all kinds, 
dried shrimps, dried fish, all of which is really de- 
hydrated foods. But it is dried in the sun without 
machinery. But we do use a good many dehydrated 
foods. One reason for that, of course, is the large 
size of the country; there is very poor communica- 
tion between points, so that the people in the interior 
mountainous regions where there are no fish can be 
able to buy the dried fish and fish products. It is 
only in the last 30 or 40 years that people started 
to use processed foods, I mean canned foods and that 
sort of thing, and I think that will develop in China 
very rapidly after the war is over. With reference 
to milk, of course we must try to provide infants 
and growing children with milk products or evapo- 
21 rated milk. We don’t think soybean milk would 
entirely replace cow’s milk for that group of persons. 
Dr. Sebrell: Any further questions? 
Question: I would like to ask to what extent the 
Chinese people adapt themselves to the different 
diet in one part of the country from that in another. 
Dr. Liu: Well, I am a northerner, and I have lived 
a good many years in South China, and the southern 
Chinese would eat two meals of rice. Personally I 
refuse to eat two meals of rice, so for one of my meals 
I would have rice and for the other, I would have 
bread or noodles. Even the southerner going to 
North China, after a short while, gets to like one 
meal of rice and one meal of wheat flour. I don’t 
think it is too much of an effort for people from one 
part of the country to get used to the food practices 
in another part of the country. 
Dr. Sebrell: Any further questions? I noted at 
the Food Conference, Dr. Liu, that there was a little 
discussion of the various methods of farming con- 
cerning the very small patches of land that were used 
by the Chinese farmer. A word or two about 
those farming practices might be of interest to this 
audience. 
Dr. Liu: I cannot give you any figures on the size 
of the farms, but anyway the average size of a farm 
is very much smaller in China than what you have 
here. The Chinese farmer is a very poor man and 
often he doesn’t own his farm; he is a tenant. The 
average size of the Chinese farm is one-half acre, 
and he does everything on it himself, and raises a 
family on the income from this small piece of land 
on which he has to pay rent and taxes. That is, of 
course, one reason for the poverty of the Chinese 
farmer. In recent years, the Government has started 
cooperatives and has been adopting methods whereby 
these poor farmers can be helped so that their in- 
come would be increased and their standard of living 
raised. 
22 PUBLIC HEALTH AND NUTRITION IN INDIA 
Dr. W. R. Aykroyd 
Aykroyd, W. R., physician; b. Ireland; M. D., Trinity College, Dublin. Leading 
nutrition expert for the League of Nations, Geneva. Director of the Indian Institute of 
Nutrition Research at Coonoor since 1936. 
I am going to talk to you on public health and 
nutrition in India. The Principal Public Health 
Commissioner with the Government of India said 
in a report which was written in 1935: 
week after birth. The percentage of stillbirths to 
live births is known to be abnormally high, though 
the recorded figures are very inaccurate. Respiratory 
diseases account for a large number of deaths in the 
later stages of infancy. 
At present we have very little accurate information 
about the causes of infant mortality in India, and 
investigations of this problem are very badly needed. 
In one part of the country, the Northern Circars, 
where adult beriberi is prevalent, we have observed 
a very high mortality in breast-fed infants at about 
the third and fourth months of life, which is unques- 
tionably due to infantile beriberi. This is an ex- 
ample of how a deficient maternal diet may pro- 
foundly influence infantile mortality. And I think 
there is no shadow of a doubt that in India generally 
the faulty feeding of mother and child is a factor 
of major importance in producing the high infantile 
mortality rate. General experience is strongly in 
support of that. We know that in any ill-fed popu- 
lation group, whether human or animal, it is the 
newly born and the very young that suffer most se- 
verely from the ill effects of malnutrition. 
In Coonoor, my predecessor, Robert McCarrison, 
was very fond of pointing out how he had eliminated 
from our colony of rats the infantile mortality of 
suckling rats by providing an excellent diet. Our 
rats have an admirable diet, which we have adopted 
from McCarrison and have not changed since, based 
on whole wheat, milk, and vegetables; and the mother 
rats invariably rear successfully their litters of 6 to 
12 young. And quite recently, we have been carrying 
out a series of experiments in which we have given 
part of our rat colony instead of this admirable 
McCarrison diet, as we often call it, the diet of cer- 
tain peoples in certain parts of India—we give them 
what we call the poor rice diet, which corresponds 
to the type of diet consumed by the rice eaters in 
India generally, and we immediately find that our 
infant mortality on suckling rats rises enormously. 
The vital statistics of the ill-fed colony assume a very 
different nature. They move, in fact, more closely 
towards the vital statistics of the mortality among 
human infants in India. 
Mortality in India remains high throughout early 
childhood. I quote now from the Public Health 
Commissioner’s Report for 1936: 
No preventive campaign against malaria, against tuber- 
culosis or against leprosy, no maternity relief or child wel- 
fare activities are likely to achive any great success unless 
those responsible recognize the vital importance of this factor 
of defective nutrition and from the very start give it their 
most serious attention. Abundant supplies of quinine and 
the multiplication of tuberculosis hospitals, sanatoria, leprosy 
colonies, and maternity and child welfare centers are no 
doubt desirable, if not essential, but none of these go to the 
root of the matter. The first essentials for the prevention 
of disease are a higher standard of health, a better physique, 
and a greater power of resistance to infection. These can 
only be attained if the food of the people is such as will give 
all the physiological and nutritional requirements of the 
human frame. 
How far that is true is the subject which I shall 
discuss. India is a very unhealthy country. In 1931 
the expectation of life at birth was reckoned as be- 
tween 26 and 27 years, which is a very low figure 
compared with the figures current in a number of 
other countries. For example, the figure for New 
Zealand some 10 years ago was 68, and that for Sweden 
almost equally high; and, since then, the expectation 
of life has increased considerably in such countries. 
The nutrition worker in India often asks himself: 
What proportion of disease in India has its roots in 
malnutrition? Medical officers in hospitals, in reply 
to such a question, will often say that half of the 
patients would not be there if they had had enough 
of the right sort of food to eat, but such estimates 
scarcely constitute scientific evidence. Actually it is 
quite impossible to make any satisfactory quantita- 
tive assessment of faulty and insufficient diet as a 
disease-producing factor in India. But some light 
can be thrown on the question by the study of avail- 
able morbidity and mortality statistics, by the study 
of the trends of diseases in times of food scarcity 
and famine, and by study of the incidence of de- 
ficiency diseases which are known to be directly due 
to a dietary factor. 
First, consider infant and childhood mortality. 
The recorded infantile mortality rate for births in 
India in 1939 was 155 per 1,000 live births. This 
means that a little less than a million and a half in- 
fants died before reaching the age of 1 year. Deaths 
among infants amounted to 23.6 percent of total 
mortality. Of the total infant deaths, 47.3 percent 
took place during the first month of life, and of these 
neonatal deaths 61.3 percent occurred during the first 
About 49 percent of the total mortality in any given year is 
among those below 10 years of age, while the corresponding 
figure for England is only 12 percent. During the first year 
of life India’s proportionate mortality is about three-and-a- 
23 naif times that of England, at the next period (1 to 5) it 
is about five times greater, and between 5 and 10 years it is 
more than three times as high. 
hospital will provide confirmatory evidence, for such 
wards are always thronged with cases of nutritional 
disease and of disease indirectly due to malnutrition, 
so that one has little doubt that what De Haas says 
is correct, as far as India is concerned; and that a 
very high percentage of mortality in the preschool 
child is due to malnutrition. And when we consider, 
as aforesaid, that some 50 percent of the total mor- 
tality in the country in any given year occurs in that 
group, it obviously emphasizes the importance of the 
nutritional factor in public health. 
In 1939, total deaths of those under 10 years 
amounted to 2.9 millions, or 47 percent of all deaths. 
It will be recalled that in most western countries early 
childhood, after infancy, is one of the healthiest 
periods of life. It is far from being so in India. 
Here, again, I must admit that the causes of this 
extraordinarily high childhood mortality have not 
been adequately studied. They have scarcely been 
seriously studied anywhere else in the Tropics or the 
East, but one series of observations which have been 
made by a pediatrician in Java is extremely signifi- 
cant. The pediatrician’s name was De Haas, and he 
was physician to the Children’s Hospital in Batavia 
for a period of 12 years or more. He found that, 
in Batavia, about 22 percent of total mortality occurs 
in what he called the preschool group of children, 
aged 1 to 4; whereas, in Holland, the percentage in 
1939 was 3.1. The actual death rate within this age 
group in Batavia was 76 per thousand. And De Haas 
strongly emphasizes the importance of malnutrition 
as a factor in producing this very high mortality. I 
quote from De Haas: 
Maternal Mortality 
The female death rate during the reproductive pe- 
riod of 15 to 45 years is higher than that of the male, 
and the excess is largely due to mortality from child- 
bearing. Estimates of maternal mortality in various 
parts of India vary from 16 to 24 per thousand live 
births, a very high rate. As far as I remember, the 
maternity mortality rate in England is somewhere 
in the neighborhood of 2 or 3 per thousand live births, 
I can’t remember the figure for the United States. 
Some inquiries in India have been carried out into 
the causes of this high maternity mortality. In Cal- 
cutta it was found that some 23 percent of maternity 
deaths were due to anemia. Coexistent anemia 
probably plays a part in the high death rate from 
puerperal sepsis, the principal recorded cause of ma- 
ternal mortality. It is extremely difficult to make 
a quantitative assessment of the part played by mal- 
nutrition in this very high maternity mortality, but 
it is very reasonable to suppose that diet deficiency 
is responsible for much of the illness among preg- 
nant and nursing women in India. The relation be- 
tween diet and the anemias of pregnancy requires 
further elucidation, but it can be assumed that faulty 
diet is one of the causes, and probably the major 
factor. 
It is a striking experience to visit maternity hos- 
pitals, in many parts of India, and to see rows of 
women suffering most severely from pregnancy and 
anemia. A few years ago the mortality rate among 
such women was extremely high. Some of the fig- 
ures which I have quoted were not very recent ones. 
The introduction of the treatment of anemias of 
pregnancy by liver extracts has unquestionably done 
something to reduce maternal mortality. We know, 
of course, as a general principle, that the pregnant 
organism is highly sensitive to the ill effects of diet 
deficiency, and we recognize that fact in drawing up 
our dietary standards by setting the requirements of 
pregnant and lactating women for vitamins, min- 
eral salts, and so on, at a higher figure than those 
of normal nonpregnant women. We certainly have 
other evidence on the positive side from other coun- 
tries that maternal mortality rates can be influenced 
by improving the diet. 
It would be impossible for me, within the limits 
of a short talk, to discuss fully the relation between 
nutrition and a number of various common diseases 
of India. 
1 think we can dismiss at once the possibility of 
any close association between malnutrition and 
Tropical nutrition in general and the food of preschool 
children in particular show deficiencies for the poorer classes 
among which shortages of calories, animal protein, and vita- 
min A are the most important. [I, personally, as far as 
India is concerned, would place more emphasis on deficiency 
of vitamins of the B2 group.] Dairy produce practically does 
not appear in the native diet of Batavia. . . . After 
breast feeding has ceased, the children, then about 1 year 
old, are still too small to select food for themselves. It is 
the children of preschool age, therefore, who suffer most 
from the insufficient tropical nutrition. Their menu consists 
mostly of rice and a few vegetables, and so it is not surpris- 
ing that such serious deficiency diseases as xerophthalmia 
and nutritional oedema are found most among children of 
preschool age and that dystrophic development is most con- 
spicuous among those from a half to three years old. 
De Haas goes on to say that among children of 
preschool age, pneumonia and bacillary dysentery 
take the first place as causes of death. He remarks 
that “it appears likely that the frequency and fatality 
rate of broncho-pneumonia and the general state of 
nutrition of the children are in closer interrelation 
than is the case in the majority of other infectious 
diseases.” His general experience in the Children’s 
Department of the Medical College in Batavia leads 
him to believe that malnutrition is a major factor 
in causing disease and death in young children. 
“Since the state of nutrition is nearly always defec- 
tive, too much significance cannot be given to the 
causes of death in children of preschool age.” 
We have in India exactly the same situation. We 
have the same amount of malnutrition among the 
preschool children. One of the major problems of 
nutrition is how to improve the diet of the child 
after it has been taken off the breast. That problem 
exists throughout the Tropics and the East. There 
is no reason whatever to suppose that the state of 
nutrition of the preschool child is very different in 
most parts of India than that which is observed in 
Batavia. A visit to a children’s ward in an Indian 
24 cholera, smallpox, and plague, diseases which oc- 
cupy the major part of the attention of public health 
departments. It is to be observed that they are to- 
day, numerically speaking, not important causes of 
death. The ordinary public health measures against 
such diseases can be applied with a very reasonable 
degree of success. It has often been suggested that 
deficient diet is a predisposing cause of leprosy, but 
actually there is very little evidence of a scientific 
nature in support of this hypothesis. Further in- 
vestigation of this problem is required. 
In India the incidence of leprosy is unquestion- 
ably a peculiar one. It is much higher in the rice- 
eating parts of India than it is in those parts of the 
country where whole wheat is the staple cereal. 
That is a fact which certainly does suggest some re- 
lation between leprosy and malnutrition because 
people in wheat-eating areas are generally better 
fed, having,, for example, a higher intake of milk. 
But so far in our investigations of various cases, we 
have not found much further evidence in support of 
a close relationship between leprosy and malnutri- 
tion; we have not been able to hasten the cure of 
leprosy in any striking way by improving the diet, 
and this remains a problem which requires much fur- 
ther investigation in many parts of the world. 
The greatest single cause of deaths in the mortality 
returns is “fevers,” the generic name which is used 
in the Public Health Commissioner’s report for a 
heterogeneous group of diseases in which malaria 
stands preeminent. It has been estimated that about 
a hundred million persons suffer annually from ma- 
laria in India and that the annual number of deaths 
exceeds 1.5 millions. Many malariologists have 
drawn attention to an association between malaria 
and economic stress, and the invariable' accompani- 
ment of the latter, malnutrition. This question has 
recently been discussed by Passmore and Sommerville 
(1940), who found that the course of primary at- 
tacks of experimental malaria in monkeys was unaf- 
fected by differences in state of nutrition. There 
does not appear to be any conclusive evidence that 
nutrition influences the epidemiology of malaria or 
the susceptibility to, or severity of, the disease in in- 
dividual cases. There is, however, a close relation 
of the opposite kind between malaria and malnutri- 
tion. Malaria is a direct cause of malnutrition be- 
cause its languid victims cannot cultivate their land 
properly and thus improve their lot. Vigorous anti- 
malarial measures will improve the food supply and 
the national diet. 
There are available in India voluminous official re- 
ports of famine commissions, published during the 
second half of the last century. They often repay 
detailed study; they are full of quite remarkable 
and interesting material. They describe the effect 
of famine on the incidence of various diseases, the 
effect of famine on the birth rate, the death rate, and 
the influence of food scarcity and famine on the in- 
cidence of various diseases, which even today would 
repay further study. 
In more recent times some interesting analyses of 
mortality and morbidity rates in famine areas have 
been made. Quite recently, Lieutenant Colonel Nicol 
(1941), Director of Public Health in the Punjab dis- 
trict, has published an interesting analysis of mor- 
tality and morbidity in the Hissar famine of 1939-40. 
It was fortunate that at that time there was a Di- 
rector of Public Health in the Punjab who took a 
close interest in problems of nutrition and had a 
short time before appointed as Nutrition Officer to 
the Public Health Department a worker who had 
been trained in the famine-code idolatries. Thus a 
possibility arose of making more detailed studies of 
the effect of food scarcity on the incidence of disease. 
I say “food scarcity,” because the famine code of India 
was in full operation at the time. 
For people who are interested in practical nutri- 
tion work the famine code of India is well worth a 
little study because it represents a very early attempt 
at what one might call practical nutrition work. It 
was evolved during the second half of the last cen- 
tury, mainly by administrative officers, but the meth- 
ods which they adopted certainly proved effective in 
preventing the worst effects of famine. 
When the famine code is in operation, the popula- 
tion which is being carried through the famine is 
by no means at the starvation level; they are receiv- 
ing nearly enough food to meet their requirements. 
In Hissar the famine code was put into operation 
at quite an early date, and the population was by no 
means underfed; they probably had nearly enough 
calories, but their diet was very restricted from the 
standpoint of quality. In a famine area in which 
there has been drought for 3 years, there are not only 
no vegetables, but also not a single plant of grass for 
hundreds of miles. The cattle go dry and die, so 
that there is no milk. The population is largely re- 
duced to a diet composed of a single grain, of which 
they may get, at any rate, nearly enough. 
In the Hissar famine, the total number of deaths in 
the worst famine year, which was 1939, was 37,767, 
as compared with 20,910 in 1937. The rise in the 
death rate was greatest in the age groups under 10 
years and 60 years and upwards, that is, among the 
very young and the very old. Of the 37,767 deaths 
in 1939, 21,160 were of children under 10. There was 
no rise in the incidence of malaria, and smallpox and 
cholera were kept under control. But there was a 
striking increase in the number of cases of almost all 
other diseases during the period when food supply 
was deficient in quantity and also in quality. 
I would now like to give you some figures, showing 
the number of cases of various conditions treated in 
hospitals and dispensaries in Hissar in 1937 and 1939, 
respectively, taken from the Health Director’s report: 
Respiratory diseases, excluding pneumonia and pulmonary 
tuberculosis, 1937, 25,178 cases; 1939, 44,117 cases. 
Pneumonia, 1937, 1,409 cases; 1939, 1,942 cases. 
Tuberculosis of the lungs, 1937, 696 cases; 1939, 973 cases. 
Dysentery and diarrhea, 1937, 10,268 cases; 1939, 19,907 
cases. 
Enteric fever, 1937, 282 cases; 1939, 539 cases. 
Trachoma, 1937, 21,031 cases; 1939, 26,550 cases. 
Pyrexia of uncertain origin, and other diseases due to 
infection, 1937, 2,925 cases; 1939, 5,216 cases. 
25 Some of the increase can no doubt be attributed to 
tlie disorganization of living conditions inevitable 
in famine times; also, allowances must be made for 
the inaccuracy of hospital and out-patient-depart- 
ment statistics. The figures are nevertheless strik- 
ing, and illustrate how the resistance of a population 
to disease in general is conditioned by the dietary 
factor. 
We have seen and are seeing, of course, precisely 
the same thing happening at the moment in the 
countries of Europe which have been overrun by the 
Nazis and are suffering from food shortage. The 
incidence of all kinds of disease is rising rapidly. 
As far as India is concerned, a large percentage of 
the population always lives on a diet which is de- 
fective in quality and often in quantity. And I 
think it is not unreasonable to suppose that the in- 
cidence of diseases which become more prevalent in 
times of food scarcity is influenced by diet in normal 
times. 
Much has been written about the association be- 
tween malnutrition and tuberculosis, a disease of 
growing public health importance in India, and, for 
that matter, throughout the East and the Tropics 
generally. It appears to be generally accepted that 
a poor diet lowers the resistance of the body to the 
tubercle bacillus. There is a growing problem of 
tuberculosis in many parts of the world which be- 
comes more acute as industrialization proceeds 
among populations which have hitherto enjoyed a 
very rural existence. 
I want to mention in passing one group of dis- 
eases—those falling into the category of dysentery 
and diarrhea in the health returns. It is interest- 
ing in studying the old famine reports to which I 
referred a few moments ago to note how, invariably, 
in times of food scarcity the death rate from dysen- 
tery and diarrhea doubled or more than doubled 
the deaths during the Hissar famine. Colonel Mc- 
Carrison, in 1921, as a result of some experimenta- 
tion he carried out in Coonoor, reached the conclu- 
sion that the health of the gastro-intestinal tract is 
dependent on an adequate provision of accessory 
food factors and observed that experiments with ani- 
mals have led us to expect that acute intestinal dis- 
orders will be among the commonest of the conse- 
quences of deficient and ill-balanced food. 
More recently, Rao has produced in monkeys a 
chronic diarrhea accompanied by atrophic changes 
in the small intestine by feeding with ill-balanced 
rice diets. It is perhaps significant that the death 
rate from dysentery and diarrhea in the Punjab 
(probably the best-fed province in India), where the 
staple foods are wheat and milk, is usually from one- 
fourth to one-sixth that of Orissa, the Central Prov- 
inces, and Madras. The Punjab is a Province of 
wheat-eating population with a relatively high con- 
sumption of milk, while in the latter Provinces rice 
is the principal or an important staple and the con- 
sumption of milk is low. This is certainly a ques- 
tion which requires much further investigation. 
Now let me briefly refer to food-deficiency diseases, 
that is to say, diseases which are directly due to the 
insufficiency of some necessary constituent in the diet 
and which are capable of being prevented or cured 
by supplying that constituent. They are in them- 
selves a problem of public health importance in India. 
In the Northern Circars beriberi in adults is a com- 
mon disease, leading to much suffering and disability 
but not often to death. We have one area in which 
beriberi is prevalent both in infants and adults. 
Beriberi in infants, as has already been pointed out, is 
probably the cause of many infant deaths in this 
area. 
There is not time enough to discuss the rice prob- 
lem in India, the curiously limited geographical 
incidence of beriberi of the Indian territory, or the 
difference in the vitamin content of parboiled milled 
rice and raw milled rice. As many of you know a 
great proportion of the rice eaters in India consume 
home-pounded rice which, whether parboiled or raw, 
retains a good proportion of its outer layers and, 
therefore of its vitamins. 
Another very considerable group consumes par- 
boiled milled rice, and parboiled rice retains its vita- 
min content if it has been machine-milled; but we 
have the raw-rice area, which is quite extensive, with 
a population of about 20 million people, and there is 
plenty of beriberi in that area. 
Quite recently we have been obtaining remarkable 
results by injecting infants who have beriberi with 
two milligrams of vitamin Bx, and the effects are 
most striking. The recovery can be almost as rapid 
as that which one can observe in a patient suffering 
from acute diabetes upon injection of insulin. 
Keratomalacia is probably the commonest cause 
of permanent blindness in south India; it is also 
prevalent in other parts of the country. In fact, I 
think it is certainly the commonest cause of per- 
manent blindness in South India. The treatment of 
keratomalacia has become very much more effective 
within the last few years because it has been dis- 
covered that very rapid and immediate effects can be 
produced by injecting large doses of vitamin A, 
100,000 units, and more, perhaps; and with such 
treatment, you can save eyes which previously would 
have been lost, because the old, almost traditional, 
method of injection with cod-liver oil did not supply 
enough vitamin A quickly enough. 
Osteomalacia and rickets present a formidable pub- 
lic health problem in certain parts of northern India. 
We have very full knowledge of the ideology behind 
this, and of how the diseases could be prevented, but 
it is a tremendous social problem which will be ade- 
quately tackled only when the education of women 
has been developed. Osteomalacia is very largely, 
except in certain areas, a disease of women who re- 
main in seclusion and who receive no direct sunlight, 
since even when they go out of doors they are covered 
from head to foot. With these groups, the incidence 
of osteomalacia is extremely high. 
One of the commonest deficiency states is a syn- 
drome including stomatitis, dermatitis in the genital 
regions, and sometimes superficial keratitis, which 
is associated with lack of the B2 group of vitamins, 
and in particular with riboflavin deficiency. Goiter 
26 is another nutritional disease highly prevalent in cer- 
tain Himalayan and sub-Himalayan areas. 
I think there is more deficiency of riboflavin in 
India than of any other vitamin, and it is one of the 
most difficult vitamins to supply cheaply. That, of 
course, is associated with the very low per capita 
consumption of milk. 
Goiter is an enormous problem, of which we 
scarcely have as yet full information. 
Severe scurvy is uncommon, except in famine times. 
During the Hissar famine we had a very acute out- 
break of scurvy, which was the only time I have had 
the opportunity of seeing really acute cases of scurvy. 
The disease was brought under control by the issue 
on a very large scale of sprouted legumes which, al- 
though the amount of ascorbic acid supplied ap- 
peared to be very small on a per capita basis, never- 
theless apparently was able to bring the outbreak 
of scurvy very rapidly under control. 
Further clinical research will probably reveal other 
deficiency diseases, at present unrecognized. Dia- 
betes—tne scourge of the middle classes in India— 
can scarcely be included under this head, though its 
cause is presumably some long-continued error in 
diet. It has so far received little attention from nu- 
trition research workers in India. 
Quite apart from such diseases, we have a whole 
row of relatively obscure conditions, which, in all 
probability, are closely associated with the dietary 
factor. I could mention a number of those: We 
have a condition of sclerosis of the liver, occurring 
in middle-aged people of the poorer classes which, 
in some ways, unquestionably, is related to malnutri- 
tion. We have a condition of chronic duodenal ulcer, 
which again is certainly of dietary origin. We have 
obscure nervous diseases related to lathyrism which 
again may require further detailed investigation. 
I would like, before stopping, to refer very briefly 
to what has been done in the public health nutrition 
line in India. I have attempted to outline the sit- 
uation with regard to the importance of nutrition 
in public health. 
Public health nutrition work in any country is 
extremely difficult, but it is peculiarly difficult in 
a very poor country because at the outset the public 
health worker comes up against the basic difficulty 
that the primary cause of malnutrition in India and 
elsewhere is the economic factor over which he has 
little control. But this point I would emphasize: 
That even in the existing economic circumstances, 
progress can be made in raising dietary standards if 
the best use is made of available resources. The first 
essential is the education of those who in turn can 
educate the people. This means that greater emphasis 
must be laid on nutrition in the training of doctors 
and public health workers of all grades. It means 
the education of the professional and administrative 
classes generally, including workers in agricultural, 
animal husbandry, and development departments. 
We have attempted in Coonoor to do something in 
the educational field by the issue of bulletins, which 
have received a pretty wide circulation throughout 
the country. Yarious other pamphlets have been pro- 
duced, and other educational methods have been fol- 
lowed. For the last 6 years we have given annually 
in Coonoor a training course in nutrition lasting from 
2 to 3 months, mainly for public health workers, 
but also for any other type of worker, including 
agricultural workers who would be likely to be bene- 
fited by the course. In India, we have full-time nutri- 
tion officers, trained in Coonoor, employed in public 
health departments in Bengal, the Punjab, Bihar, the 
Central Provinces, Baroda, and Hyderabad. We have 
also a nutrition officer in Burma. Some of these nu- 
trition officers have been able to do extremely useful 
work both in the investigation of malnutrition and 
also in public health. But although a beginning has 
been made, we perhaps haven’t gotten very far. 
The feeding of school children, about which we 
had a great deal of talk at the Food Conference, 
has not been developed very far in India. In certain 
cities, there are quite extensive schemes for feeding 
poor children, for example, the province of Madras 
supplies a daily meal to school children, consisting of 
rice pulp and vegetables which I think has brought 
quite good results. The provision of milk to school 
children is usually impossible because of the difficulty 
of getting a reasonably good supply of milk in suffi- 
cient quantities. In a few places, there has been an 
issue of milk to a certain number of school children, 
but it is usually almost impossible on account of ex- 
pense and one has to be satisfied with a meal con- 
sisting, say, of rice and of some vegetables as is done 
in the Madras. 
We had, here and there, before the war, encouraged 
the use of imported dried separated milk, which is 
relatively cheap, for distribution to children in in- 
stitutions, and also to day-school children. The die- 
tary side of maternity and child welfare work, in- 
fant welfare work generally, has shown some devel- 
opment, but there again a great deal more work needs 
to be done. 
There is one genuinely successful piece of work 
which has been achieved in nutrition in India, and 
that is the improvement of diet in institutions. That 
is the easiest thing of the lot to do. There is no par- 
ticular reason why a government or a charitable in- 
stitution should not at least, although it may be very 
poor, do the best it can with its available funds. And 
there has been a visible and striking improvement 
in the diet and health of children’s institutions in 
south India during the period that I have been in 
the country. Visibly, its effects are clear to see. 
The problem is often a very acute one. 
We received a request in Coonoor for an adequate 
diet coupled with the information that the total 
amount of money which is available to spend on the 
food is under 3 rupees1 or, shall we say, under 5 
shillings per child per month, and it is by no means 
an easy task to devise a suitable diet within those 
limits. 
I should say, in conclusion, that it would seem, 
when you look at the public health picture in general 
1 About a dollar in United States currency. 
27 in India (and the same applies to countries in the 
East, in the Tropics generally), that the public 
health has not disposed its forces so that the most 
dangerous- section of the front is most strongly de- 
fended. The most dangerous section of the front 
is the child from under the age of 10 and perhaps 
we can also include the expectant and nursing 
mothers. 
So far, I think it is generally true to say that the 
public health mission in such a country as India has 
not adjusted itself so that in that particular direc- 
tion I feel that as time goes on it will be necessary 
to consider a reorganization of the usual public 
health scheme. It is, of course, extremely difficult 
to devise public health measures which will be ef- 
fective against malnutrition in a poor country. We 
have methods of dealing with infectious diseases, as 
far as cholera, smallpox, and so on, are concerned, 
that have been laid down and worked out over a 
period of years. The public health people under- 
stand them, they know what to do when an epidemic 
of cholera occurs. But it is very difficult for them 
to act when it is a case of chronic malnutrition, al- 
though the malnutrition may, in fact, be a far more 
potent factor in producing ill health, disease, and 
death than some of these great killing diseases. 
With certain qualifications, the statement from the 
Public Health Commissioner’s Report with which 
my talk began may be endorsed. I feel that in gen- 
eral the standpoint which he adopted can be taker 
as justified, with certain qualifications, of course, 
I feel that the vital statistics of India, inaccurate 
though they may be, provide clear indications for the 
future orientation of public health work, and of the 
importance of nutrition in public health in India 
One could conclude from that, I think, that if we are 
to maintain the goal of a healthy nation in India 
or, for that matter, of most other countries of the 
world, the improvement of diet is a factor of essen- 
tial importance. 
28 
«, •. SOVEBNHEHT BRUITING OFFICE* l»«4