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Special ArticlesROYAL SOCIETY EMPIRE SCIENTIFIC

CONFERENCE

AT the first morning session of the conference on July 3,held in Oxford, the subject for discussion was

Nutrition

Prof. R. A. PETERS, F.R.S., who was in the chair,quoted an article submitted by Dr. L. B. Pett whichpointed out that " the nutrition problem is a medicalone consisting in the diagnosis of those individuals whocould benefit by improved dietaries. The solution of theproblem is providing these people with the informationabout, and the means of obtaining, the necessary diets.In fact, however, there is still no sure way of diagnosingmuch of the malnutrition that may exist.... Under thesecircumstances it is understandable that the nutritionproblem is still one of research on the one hand and ofrather general public-health measures aimed at preventionon the other." Dr. Pett had called attention to the needfor further research on nutrition in Canada, and for bettercoordination among those engaged on such research.

MALNUTRITION IN THE COLONIES

Dr. B. S. PLATT (London) discussed the nutritionalstudies of the indigenous peoples of the Colonies. Ithad been thought necessary to find out whether a nutri-tional problem existed among the Colonial peoples, andfor this there were two main methods : (1) data onnutriture could be obtained from clinical observationsand from relevant vital statistics ; (2) data on food-con-sumption could be obtained from information concerningfood-production and importation, or from dietary surveys.Once the problem had been defined it was necessary toplan improvements and decide how the resources of landand labour could best be used to secure improved nutri-tion. This attack involved such matters as health, soilfertility, water-supplies, food technology, education, andadministration, so any plan for improvement must bea combined operation. This combined effort could bestbe achieved through a local nutrition committee, witha technical staff cooperating to implement its scientificfood policy. As a step towards assisting Colonial govern-ments in this, ten dietists had already been trained toprovide technical and other assistance to such committees.To illustrate the existence of malnutrition, Dr. Plattreviewed the work published since 1936. Many of theproblems of malnutrition were of long standing, but notall ; thus in Basutoland 967 cases of pellagra were reportedin 1943, but this appeared to be a new disease in theterritory, associated with a new method of milling.Pellagra is a troublesome problem in Hong-Kong, Nigeria,and the Gold Coast. Beriberi is still a common disease andcause of death in Hong-Kong and Malaya; in 1940 itwas responsible for no less than 7229 deaths in Hong-Kong. Apart from these and other classical nutritionaldeficiencies, diseases partly attributable to malnutritionare frequent, including tropical ulcer and toxaemia ofpregnancy. One of the clearest indications of thedependence of the infant’s nutrition on the nutrition ofthe mother during pregnancy was the relationship ofbirth-weight to the total protein in the mother’s dietduring pregnancy. In some Colonies the average birth-weight increases with the social status of the mother.Infant nutrition in Colonial territories would be a profit-able subject for research, and a start on these lines hadalready been made in the West Indies. The organisationsthat should be concerned in a nutrition programme inthe Colonies, totalling about 15, included the MedicalResearch Council and the Colonial Office, with theColonial Medical Research Committee linking them andacting through a subcommittee on nutrition. Thissubcommittee acted on the one hand through a fieldresearch station, and on the other through the Colonialterritory staff, who included the 10 trained dietists alreadymentioned. The field research station was linked to thehuman nutrition research unit and to a field workingparty. The importance of research into Colonial nutritionproblems needed no emphasis.

SOUTH AFRICA

Dr. E. H. CLUVER, director of the South AfricanInstitute for Medical Research, pointed out that mal-

nutrition was rife throughout Africa. Since tropicaldisorders of all kinds could be found in almost all partsof the continent, the aetiology of African nutritionaldisease was complex and its elucidation was very mucha thing of the future. It was wrong to suppose thatonly further advances in fundamental knowledge werenecessary-a more intensive study must be made of theapplication of such theories to the conditions among thedifferent areas and races of Africa. Starvation occurredonly rarely, but when found it caused even parliamen-tarians to react; the main problem however was one ofunbalanced diet containing excess starch. In 1928 acommission of investigation had been set up by thegovernment to investigate the problem of substandardEuropeans and South Africans, usually referred toas " poor whites." These persons were unemployablebecause of their poor state of health, partly due to mal-nutrition. The problem was not only confined to " poorwhites," and a nutrition council had been set up byparliament to define the whole problem. In 1928pellagra had been reported in a Durban prison and curedby adding yeast to the diet. For many years scurvyhad occurred in gold-miners put to work underground.Although there were 11 million Africans in the Union itwas not possible to recruit from these the 250,000 thatwere needed for the gold-mines, because of their poorphysique ; more than half had to be recruited from out-side the Union. A few years ago the Union healthdepartment of South Africa provided funds for the CapeNutrition Survey, whose primary object was to establishreliable criteria for the recognition of human malnutrition.Coordination of this and other nutritional research inAfrica should now be brought into effect. Existingknowledge should be applied and research extended ;and it was essential to train a body of nutritional researchscientists, adequate both in ability and numbers, to grapplewith the vast unexplored problems that lie before us.

CEYLON

Prof. W. A. E. KARUNARATNE recalled that althoughmalnutrition in Ceylon had had serious effects duringthe world economic depression of 1929-33, little or noattention was paid to the subject until Dr. LuciusNicholls investigated phrynoderma in a Colombo jail;de Fonseca had already shown that this eruption reactedvery favourably to cod-liver oil. It was soon recognisedthat other conditions caused by malnutrition were widelyprevalent in Ceylon, and this led to a more elaboratenutritional survey undertaken by Nicholls in 1936. Thedefects caused by malnutrition were many, and includedblindness ; of 147 children in the blind school, more than60 % were blind as a result of keratomalacia due to severedeficiency of vitamin A. In a recent investigation in alarge children’s hospital in Colombo, Professor Fernandofound that 72-9 % of the children had clinical evidence ofmalnutrition, 16-1 % having nutritional oedema. Ruraldietary surveys conducted by Nicholls and Nimalasuriyain 1941 had also revealed a serious state of affairs. SinceCeylon is far from self-supporting in essential foodstuffs,a higher standard of nutrition demanded a greaterdevelopment in agriculture and improvement in animalhusbandry and fisheries. An appreciable increase inincome was also essential. Other problems that wouldhave to be taken into consideration included the extentof land that could be cultivated, the further developmentof irrigation, the prevalence of malnutrition, and therapidly increasing population. In the last analysis,adequate nutrition is a matter of education andgovernment.

DISCUSSION

Sir JOSEPH BARCROFT, F.R.S., reminded the meetingthat agriculture had been defined as the science of gettingmore human food from a given number of acres, and thatthe late Lord Keynes had suggested amending this to" a given number of acres and energy." The mainproblem was to link medicine and agriculture.Khan Bahadur HUSAIN (India) regretted that soya

beans had been discouraged in his country, since in hisview they could contribute a great deal to Indianeconomy.

Dr. D. M. BLAIR (Southern Rhodesia) regretted thatfood crops had been improved from the economic pointof view but not from the nutritional: natives previouslygrew millet which would not sell and now grew white maize.

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Prof. A. M. BLACKMAN (Oxford) stressed the importanceof economics but believed there was no rational pricefor any crop.

Miss HARRIETTE CHICK. D.sc., gave an account of thework during the war of the Accessory Food FactorsCommittee of the Medical Research Council and theLister Institute. Two tests on human requirements ofvitamins A and C had vindicated the figures given bythe League of Nations in 1937 rather than those of theNational Research Council in 1941, which were three orfour times higher. The committee had carefully con-sidered the question of bread, and its two memorandapublished early in the war had had a great effect on foodpolicy.

PRACTICAL APPLICATION OF KNOWLEDGE

In opening the second session the CHAIRMAN said thatthe communications already delivered had clearly provedthe existence of a nutrition problem in the Empire, andhe regretted that many thousands of cases of beriberioccurred when synthetic vitamin Bl was available in largeamounts.

Mr. A. GLENDON HILL, PH.D., director of the EastAfrican Agricultural Research Institute, read a paperon the selection and improvement of food plants. Hebelieved that one of the strongest arguments in favourof undertaking plant breeding at the earliest possibledate was that it -provided the only scientific methodwhereby increased crop yields per acre could be achievedwithout at the same time changing agricultural methodsor making greater demands on the cultivator. But theshortage of plant breeders was likely to prove the mainhindrance to progress for some time to come. Theprimary consideration was yield of food per acre and notper ton of produce. One of the first items in a programmeof plant breeding should be a survey of the vast numberof existing food-crop varieties in our Colonies, about whichmuch had still to be learned.

Mr. HERBERT H. BROWN, PH.D., director of FisheriesInvestigations, West Indies, discussed food availablefrom Colonial fisheries ; and Mr. R. DAUBNEY (EastAfrica) dealt with improvements necessary in animalhusbandry.

Dr. G. A. C. I3ERIiLOTS (Hong-Kong), who spoke withpractical experience of malnutrition as a prisoner-of-war of the Japanese for nearly four years, wished to seethe production of fish increased, but believed that thenutrition and happiness of the Chinese depended onthe green vegetables they produced. He had introduceda new idea in Hong-Kong by starting a " balanced foodfactory." It was possible to obtain from this balancedmeals and supplements such as enriched biscuits con-taining vitamins of the B complex, calcium, iron, andshark-liver oil. This practical note was continued byColonel Sir S. S. SOKHEY, the only medical delegate fromIndia, who wished to see direct lines of ways and meansfor putting into action our present knowledge ; he wasa little sceptical of Dr. Platt’s diagram in which a largenumber of agencies were joined to one another in circles.He would have liked to break the circles and apply atonce our present knowledge to feeding the people.

Sir EDWARD MELLANBY, F.R.S., reminded the meetingthat in agriculture the farmer was in control, and inmedicine the scientist was in control; coordinationbetween the two was required. We could carry onindependently of the agriculturists and had done so inthe past with great effect-calcium, iron, and food yeastwere examples-but such isolated action was not thetrue goal, and the problem of malnutrition must betackled at once by a combination of the medical andagricultural scientists.

A NEW monthly journal, Nutrition and Child Welfare,should prove useful to those who have care of children,including health visitors, school nurses, midwives, nurserymatrons, and nursery-school teachers. The first issue containsarticles by Prof. Alan Moncrieff, Dr. Ursula Shelley, andDr. R. P. Cook, as well as a discussion by Dr. G. E. Breen,the editor, on the pasteurisation of milk. This journal may wellfill the place of Maternity and Child Welfare, which unfor.tunately came to an end in 1934-an informative little

publication which could still provide a useful pattern in somerespects. We wish Dr. Breen, and Miss Alma Fox, the nursingeditor, success in this new venture.

THE WORLD HEALTH CONFERENCE

FROM OUR SPECIAL CORRESPONDENT IN NEW YORK

WITH the preliminaries of the first three days over,lthe conference began its first full week of work on Monday,June 24, with the addition of delegations from theU.S.S.R., the Ukraine, and Byelo-Russia, an observerfrom Hungary, and three other delegations who had beendelayed en route.

Five working subcommittees were set up, in accordancewith the proposals of the expert committee in Paris-namely, on the scope and functions of the Organisa-tion (chairman, Dr. Shousha Pasha, Egypt) ; on admini-stration and finance (chairman, Dr. G. Chisholm,Canada) ; on legal questions (chairman, Dr. Karl Evang,Norway) on relationships with the United Nationsand other organisations (chairman, Dr. A. Gabaldon,Venezuela) ; and on regional arrangements (chairman,Dr. W. Timmerman, Netherlands). In addition, a

general or steering committee was set up to meet dailyand control the work of the conference.At the beginning of the week things moved very slowly

and a great deal of time was lost in procedural details.Many of the delegates lacked experience, and theirvolubility was often in inverse ratio to the importanceof the State they represented. Thus a delegate from acountry with very recent and dubious claims to statehooddistinguished himself by making three speeches followedby three retractions 1 also the chairmen rightly felt thatany limitation of the discussions might reduce theenthusiasm with which delegates would further theacceptance of the conclusions of the conference on theirreturn home. A third cause of delay was an obviousfailure of the secretariat in certain directions such asinterpreters and distribution of documents ; thoughthis should be laid at the door of the U.N. secretariatrather than the ad-hoc conference secretariat under thedirection of the secretary to conference, Dr. Yves Biraud.However, a shade temperature of round 90° in the

Bronx-" The only difference between New York inJuly and Hell is that the rent and humidity are higherin New York "-and the desire of delegates to get backto their posts within a reasonable time, led to a minorrevolt in the middle of the week. The steering com-mittee tightened things up and some real progressbegan to be apparent. By the end of the week it wasat least clear what were the main subjects of disagree-ment, and that these broadly were the same as thosedisclosed in Paris. While it was generally conceded thatmembership should be open to all, the delegates fromRussia expressed the hope that Spain, for instance,would not be admitted, and most delegates felt thatresponsibility for excluding any State should be placedon a political body such as the U.N. Assembly and thatthe Health Organisation should keep clear of politics.It was agreed that the governing body of W.H.O.-whose name was changed from " conference " to"assembly "-should be composed of three, not one,delegates, with alternates and advisers, and that theseshould " preferably " be drawn from the health authoritiesof their countries. A new point, as yet unsettled, wasraised in a proposal that dependencies, such as coloniesand trustee territories, should be admitted to theassembly as associate members : most delegates thoughtthat this would make an already unwieldy body com-pletely unworkable, and favoured representation ofdependencies at the regional level. Views on the entryinto force of the convention establishing the new WorldHealth Organisation varied from a Yugoslav proposalthat it should require ratification by 26 members ofthe United Nations to the original proposal in Paris for15 signatures. The former proposition carried the dayin committee, and it seems clear that an interim com-mission will have to be set up until such time as thepermanent organisation is established.As in Paris, the greatest difficulty arose on regional

organisations and notably the position of the Pan-American Sanitary Bureau. The Latin American blocrefused to consider putting the bureau under the controlof the new W.H.O., and the U.S. delegation felt bound tosupport this somewhat parochial view ; but the questionis still far from decided.

1. See Lancet, June 29, p. 970.