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                             An unsuitable and degraded diet?
                             Part one: public health lessons
                             from the mid-Victorian working
                             class diet
                             Paul Clayton1 + Judith Rowbotham2
                             1
                                 School of Life Sciences, Oxford Brookes University
                             2
                                 NottinghamTrent University – School of Arts and Humanities, Clifton Lane, Nottingham W8 7NP UK
                                                                                                                            ,
                             Correspondence to: Paul Clayton. E-mail: paulrclayton@gmail.com



         DECLARATIONS        Introduction to the series                                   wide range of types of primary source material, as
                                                                                          discussed in this first paper. This in itself has pro-
     Competing interests     Principal findings                                           vided a high degree of internal cross-checking of
             PC provides                                                                  the validity of the historical data. It has been con-
                             The research resulting in this series of three papers
    consultancy services                                                                  sidered necessary due to the reality that extensive
                             (further papers to be published in succeeding issues
           to a number of
                             of JRSM), drawing on a range of historical datasets          quantitative data for the Victorian age, in formats
        companies in the
                             viewed through the lens of current scientific under-         recognized by today’s scientific statisticians, do
          food and drink,    standing, indicates that cultural and other biases           not exist. Consequently, it could be argued that
         supplement and      have distorted the historical record, leading to con-        our perspective (like the conclusions based on
         pharmaceutical      clusions which test many current health policy               Rowntree et al.2) lacks representativeness and
       sectors, including    assumptions about a steady improvement in British            historicity. However, the full range of sources we
           Coca Cola Ltd,    nutrition since the nineteenth century. As these             have consulted provides the best possible survey
                             papers show, the urban mid-Victorians, including             of dietary habits, in ways that counterbalance the
     Univite Ltd, Biothera
                             the working classes, ate a notably good diet, includ-        consciously biased records of surveys like those of
         Pharma. JR is a
                             ing significant amounts of vegetables and fruit,             Booth3 and Rowntree2. We have re-examined the
           historian who
                             which enabled a life expectancy matching that of             urban (as distinct from the rural) mid-Victorian
             provides no
                             today. We follow the example of George Rosen (a              working class diet and its nutritional values by
    consultancy services                                                                  looking in detail at typical food consumption pat-
                             public health practitioner, and in his time editor of
        to anyone on any                                                                  terns of the time. The use of a qualitative approach
                             the American Journal of Public Health and Journal of
       commercial basis,                                                                  is thus not a weakness but a real strength, giving
                             the History of Medicine, among others), in believing
             but provides    that a historical dimension is essential to a sound          insights into life experience that cannot be readily
      academic comment       perspective in public health today.1                         deduced from quantitative statistics. The other
            to media and                                                                  author is a pharmacologist and pharmaconutri-
       academic outlets,                                                                  tionist, who has drawn on the fullest possible
      including Woman’s
                             Methods, strengths and weaknesses                            range of scientific and medical data to interpret the
          Hour, European     A strength, but also a weakness, of these papers is          historical material: his work is apparent through-
          Social Science     that they are not purely medical studies. They are           out but is most fully discussed in the final paper.
     History Conference,     based on genuinely interdisciplinary research and                In providing this challenge to assumptions
                      etc.   as such cannot be tested in the usual ways for               about the steady improvement in British nutri-
                             studies appearing in this, and similar, journals.            tional history since the mid-nineteenth century,
                 Funding     The authors revisited the historical record because          however, the authors acknowledge that historical
           No funding or     of the mismatch between the assumed content of               materials cannot provide the fully testable data
        sponsorship was      the Victorian working class diet and adult life              normally considered essential to medical studies.
      sought or obtained     expectancy. They then cross-referenced this                  Yet we argue that the historical data used, and the
                             material against current scientific/medical knowl-           methodologies employed to interrogate it, are
                             edge, using primarily a range of studies already in          appropriate to both science and social science, as
                             the public domain and so supportable by a wealth             the development of the argument that follows will
                             of scientific papers to reach their conclusions.             explain in detail. Inevitably, in the limitations of a
                             Amongst their strengths is the breadth of the                short series it is impossible to rehearse all the his-
                             research drawn on and the widely-tested nature of            torical data drawn upon. However, that incorpor-
                             the scientific data in particular. One of the authors        ated in these papers was identified on the basis of
                             is a historian experienced in data collection from a         historical typicality and connotations for both the




282 J R Soc Med 2008: 101: 282–289. DOI 10.1258/jrsm.2008.080112
Public health lessons from the mid-Victorian working class diet




    Ethical approval     historical and the scientific perspectives. In this      of McKeown’s work,6,7 thereby restoring the
  Not appropriate or     series we present, respectively, analyses of mid-        emphasis on public health and medical interven-
relevant: all modern     Victorian levels of physical activity, dietary intakes   tions. Should this have led to a wholesale rejection
data cited is already    and public health patterns. The significance of our      of McKeown? We argue that there is one area
in the public domain,    findings and their relevance to health care design       where his thesis has considerable merit: that relat-
    and all historical   and delivery today are integrated and developed          ing to nutritional standards, which in turn rehabili-
       data is either
                         in the third paper, together with suggestions for        tates his claim for an improved adult life
                         future research. In this first paper, the issue of       expectancy in the period after 1850, a claim sub-
      anonymized or
                         Victorian life expectancy is revisited in the context    stantiated by later detailed statistical studies.8 To
         untraceable
                         of contemporary health policy.                           this we add the concept that to life expectancy was
           Guarantor                                                              also added health expectancy.
                   PC                                                                 A significant source of error is the established
                         Introduction to part one                                 view is that the mid-Victorian urban poor ate an
     Contributorship     Current expressions of concern about national lev-       inadequate diet that contributed to increased mor-
 This series of three    els of ill-health from government and leading            bidity; and that consequently, medical advances
  papers was jointly     health figures, often focusing on the nutritional        and post-1880 environmental sanitary improve-
      conceived and      value of the nation’s diet, are not original in either   ments were the crucial factors in expanding life
researched. JR took      motivation or substance. The importance of diet as       expectancy. In terms of reducing perinatal mor-
             primary     a determinant of health was first recognized by the      tality, the role of modern medicine from c1890
    responsibility for
                         state in the mid-nineteenth century because of           was central; but we argue that this does not hold
                         pressure from leading scientific and medical fig-        true for improvements otherwise. Improvements
 searching out both
                         ures of the day. One of the leading protagonists in      in adult life expectancy are discernable by the
         the primary
                         entrenching the concept of a medical dimension to        1861 census, when figures show that by com-
  historical sources
                         public health policy thinking was John Snow,             parison with the 1841 figures, twice as many men
    and the relevant                                                              and women per 100,000 births had an average
                         Medical Advisor to the Privy Council under the
          secondary      governments of Lords Aberdeen and Palmerston.            expectation of a further 20 years of life.8
references; PC took      Governments continue to rely upon this dimen-                The concept of a short, because malnourished,
             primary     sion in developing public health policies.               life has been promoted by numerous historians,
    responsibility for      We contend, however, that serious historical,         making assumptions about the nutritional value of
   searching out the     methodological and class-based biases about indi-        the mid-Victorian urban working class diet.9–11
       scientific and    vidual diet as a source of nutrition, dating back to     Sources for such scholars include reports from
  medical data. The      the Victorian era, have been integrated into the         nineteenth century philanthropists like Fanny
  general tenor and
                         public health model used today, and are now con-         Calder, who believed that the working classes ate
                         tributing to unnecessary ill-health and premature        an ‘unsuitable and degraded diet’,12 and from
  conclusions of the
                         death because they have obscured the debate              medical commentators like William Farr, seeking
   papers (including
                         about the relative merits of dietary guidance,           to relate what he saw as the flaws in the working
      the exercise of
                         intervention and individual responsibility. The          class (and particularly the workhouse) diet to
 drawing up dietary
                         purpose of this three-part series is to revisit the      causes of death, especially among infants.13
 patterns and levels     dietary patterns of those with the least money and,      Agenda-driven studies of poverty like Booth3
  of physical activity   supposedly, the worst health in the mid-Victorian        or Rowntree2 have also been influential in
           which are     era; to illuminate the historical biases that have       establishing a belief in consequent nutritional
  summarized in the      subsequently been integrated into twenty-first           inadequacy.14
    first and second     century public health policy; and to suggest                 In revisiting the issue of mid-Victorian urban
  papers) are a joint    ways in which the contemporary diet could be             nutritional standards and returning to the Mc-
 effort, representing    improved.                                                Keown thesis, we have a clear focus on the mid-
50% input from each
                            Nineteenth century public health policy               Victorian period, from c1850 to c1877–80. Rather
                         focused on reducing mortality rates.1 Seeking to         than taking the established view of an ongoing
  contributor. While
                         explain what he correctly identified as an improve-      dietary improvement during the Victorian era, our
        comment on
                         ment in life expectancy, Thomas McKeown sug-             analysis suggests the reverse: that mid-Victorian
  penultimate drafts
                         gested that an improved working class diet was           nutritional standards were significantly better
    was sought from
                         likely to have improved resistance to infectious         than generally realized, and then declined to a
  specialists in both    diseases.4 For him this, rather than public health       nadir at the end of the nineteenth century, making
   the historical and    interventions or medical improvements, explained         that date a highly misleading starting point for
  scientific/medical     the first improvements in morbidity rates.5 Demo-        illustrations of twentieth century nutritional
      fields, no other   graphic historians subsequently challenged much          ‘progress’. Consequently, there is a need to




                                                                                  J R Soc Med 2008: 101: 282–289. DOI 10.1258/jrsm.2008.080112 283
Journal of the Royal Society of Medicine




         contributor was     consider afresh the concept that it was indeed            and the effects of intemperance were the most
               directly or   dietary improvement via affordable available              common causes of ill-heath and death.21 This is
            substantially    foodstuffs, rather than public health and medical         amply borne out by the public health records of the
          involved in the    advances, which had the most positive influence           time, which clearly promote the role of disease and
         writing of these    on the quality of working class health.                   accident as the main causes of mortality.8 The only
           papers or the         This has considerable implications for the            common disease supposedly related to malnutri-
       research thereof.
                             present public health model, rooted as it is in medi-     tion was rickets22 but increased incidence of this
                             cal (pharmaceutical and surgical) intervention and        disease in the early Victorian period was largely
        Those cited have
                             moral exhortation. We argue that the lessons of the       due to decreased exposure to sunlight among
       been cited where
                             mid-Victorian period indicate that the most (cost-)       the urbanized working classes.23 Paradoxically,
         the contributors
                             effective way of maintaining and improving pub-           a re-classification of rickets as a primarily nutri-
        judged that their    lic health today is to promote standards of nutri-        tional disorder in the 1920s24 contributed to
      work was relevant      tion via facilitating informed individual choice          and exacerbated subsequent received views of
       and supportive, or    and educational strategies, rather than legislation       Victorian malnutrition.25
     where we wished to      and medical intervention.                                    Victorian misinformation underpins current
    identify work that we        There has been some development in this direc-        misconceptions. Much concern about nutrition
     wished to challenge     tion in the state-managed push for ‘five portions of      then was rooted in middle-class disapproval of
                             fruit and vegetables per day’. But it leaves              the way that the working classes supposedly
     Acknowledgements        untouched the vexed question of whether a ‘sensi-         ‘wasted’ food.26 Public health commentators
       We acknowledge        ble balanced diet’ is achievable today without the        believed that freedom to buy what they wanted
           gratefully the    additional intervention of supplements and/or             was ‘bad’ for the working classes; that they did
      comments made by       fortification programmes, given current levels of         not know what was ‘good’ for them nutritionally,
     BJ Harris, Professor    physical activity, food consumption patterns, and         nor how to cook what they did buy.26,27 Middle-
         of the History of   the nutritional content of many modern foods15            class views were also influenced by the food
           Social Policy,    compared to those of the past. In this series we seek     adulteration scandals of the time (see the second
            University of
                             to improve comprehension of this reality through          paper in this series), which affected all consumers
                             an exploration of the mid-Victorian diet and public       but the working classes most severely. These
       Southampton. Any
                             health profile.                                           were associated with the Victorian laissez-faire
          errors now are
                                 Much is made today of Victorian reports of indi-      approach to business, but it is only fair to point
               solely the
                             viduals so poor they died from starvation. It was         out that there are almost identical concerns today
     responsibility of the
                             undoubtedly an issue in the 1840s, appositely             about food content and composition, labelling
        authors. We also     labelled the ‘Hungry Forties’. By the end of that         and advertising.28 Victorian food adulteration
      with to thank Mike     decade, however, a real improvement in the econ-          was rightly a high-profile issue, arguably
       Lean, Professor of    omics of the working classes had taken place.             amounting to a ‘moral panic’;29 but its extent is
        Human Nutrition,     Measures such as the repeal of the Corn Laws in           unclear and assumed incidence should be bal-
            University of    1846 signalled the beginnings of the age of afford-       anced against the evidence for a diet-based
         Glasgow, for his    able food. The impact on the health of the poor was       improvement in working class health. (The often
              early input    swift.16 It is our argument that not only the dangers     intemperate media coverage of dietary issues and
                             of starvation were avoided, but also the dangers to       their implications for lifestyle and health provides
                             adult life expectancy associated with malnutrition,       an interesting parallel today!)
                             because by 1850 the working class diet had                   Prejudices about class and diet unduly influ-
                             improved markedly in terms of both quality and            enced first Victorian writers and policy-makers
                             quantity.                                                 reflecting on health, then those who have cited
                                 Between 1850 and 1870, deaths attributable to         them uncritically thereafter. They are still used as a
                             starvation and malnutrition accounted for around          basis for modern public health models.8,30 But
                             1.5% of reported causes of death in urban con-            by taking a wider range of sources into account we
                             ditions, though malnutrition undoubtedly contrib-         have reassessed the diet of the mid-Victorian poor;
                             uted to other causes of morbidity and mortality,          concluding (in contrast to received wisdom)
                             such as increased vulnerability to infection.17           that the majority ate a diet vastly superior to
                             However, these figures are not significantly higher       that generally consumed today, one substantially
                             than occur today.18,19 The comments of regular            in advance of current public health recom-
                             visitors to the poorest quarters of Britain’s cities in   mendations. Reverting to the nutritional essentials
                             this period underline the comparative rarity of           of the mid-Victorian diet and lifestyle would
                             death from starvation alone;20,21 instead, they           materially improve human well-being in Britain
                             noted that infectious illness, brutality, accident        today.




284 J R Soc Med 2008: 101: 282–289. DOI 10.1258/jrsm.2008.080112
Public health lessons from the mid-Victorian working class diet




Historical-nutritional context                          ing the need to provide school meals for working
                                                        class children, reinforced the idea that the urban
From 1877, historians generally agree that food
                                                        working classes were not only malnourished at the
costs fell as much as 30% due to imports of cheaper
                                                        start of the twentieth century but also (in a leap
basics such as cereals and meat. As a result, sup-
                                                        which seemed logical then and has ever since) that
posedly, ‘the first really appreciable nutritional
                                                        they had been so since the start of the nineteenth
improvement . occurred’.31 Imported American
                                                        century’s industrial urbanization.34
wheat and modern milling techniques reduced the
                                                            A detailed re-reading of Victorian sources,
price of flour, while fresh and tinned meat arrived
                                                        however, reveals that diet and public health
from the Argentine, Australia and New Zealand.
                                                        reached a high point in the mid-Victorian era, to
Canned fruit and milk became more widely avail-
                                                        decline noticeably at the end of the 1870s with the
able. These changes increased the variety and
                                                        introduction of the first generation of processed
quantity of the working class diet, and was adver-
                                                        foods. The increased sugar intake alone caused
tised as reducing the opportunities for adultera-
                                                        such damage to the nation’s teeth that many peo-
tion.31 Simultaneously, cheaper sugar promoted
                                                        ple could no longer chew tough foods, thereby
the huge increase in sugar consumption (in confec-
                                                        reducing their intake of vegetables, fruits and
tionery, processed foods like evaporated milk, and      nuts.35
fruit canned in heavy sugar syrups) from the 1880s          That some mid-Victorians (especially women
on. Consequent assumptions about what has been          and children but also seasonal workers at adverse
labelled an ‘improvement’ in food quality between       times) were malnourished is indisputable; but in
1877 and 1889 have led to the conclusion that pre-      this paper we contest the claim that it was a
viously, the value of the working class diet must       majority experience. Rather, we suggest that the
have been even worse, and that since malnutrition       first generation of processed foods, far from
was so widespread at the end of the century, it         improving the late Victorian urban working
must have been almost universal at the mid-             class diet, ‘degraded’ it to the state observed by
century.                                                Rowntree in 1901;2 and that prior to this in the
   This ‘progressive improvement’ conclusion,           period c1850–1880, the working class diet was far
however, is at odds with the evidence. Mid-             superior. While a substantive mass of Victorian
Victorian navigators (navvies), who as seasonal         quantitative data is not available, our sources com-
workers were towards the bottom end of the econ-        pensate for this in their range and depth. They
omic scale in terms of their purchasing ability,        include details (including statistics) provided by
could (when in work) routinely shovel up to             contemporary sources from official sources such as
20 tons of earth per day from below their feet to       Blue Books, Reports from charitable organizations,
above their heads;32 an enormous physical effort        Mayhew’s London Labour and the London Poor,20
that most modern workers would be totally unable        and information in medical texts and dietaries
to emulate, and one that required great strength,       from workhouses, hospitals and army records. We
stamina and robust good health. Yet after 50 years      drew on depictions of purchase, cookery and con-
of supposed ‘nutritional improvements’, the Brit-       sumption in contemporary fiction and periodicals,
ish army recruiting for the Boer war at the turn of     including authors like Dickens with his detailed
the century found around 50% of young working           descriptions of the consumption strategies of the
class recruits to be so malnourished as to be unfit     mid-Victorian poor. We also investigated infor-
for service.14,33 This was a rapid decline. The         mation from more neglected datasets, notably
recruiting sergeants had reported no such prob-         Victorian cookery books and diet advice for the
lems during the Asante (1873–4) and Zulu Wars           poor, where recent studies have also confirmed
(1877–8). Twenty years later, there is evidence of a    their relevance.27 This information (when inte-
precipitous drop in nutritional standards: the          grated with the other sources) can give a more
infantry were forced to lower the minimum height        nuanced picture of working class diets and its
for recruits from 5' 4$, where it had remained fairly   values.
constantly since 1800, to 5' in 1901. (Army recruits        Walton, reviewing Oddy’s From Plain Fare to
up to the 1870s were generally drawn from the           Fusion Food, noticed the absence of working class
better-nourished rural population: thereafter they      voices therein, and added, fairly, that we cannot
were mainly from the urban working class.)              trust the official records on working class diets,
   In 1903, and as a direct result of the Boer disas-   because in recounting what families and individ-
ter, the government set up the Committee on             uals consumed there was likely to be self-
Physical Deterioration. Its 1904 Report, emphasiz-      censorship.36,37 We recognize this, and have




                                                        J R Soc Med 2008: 101: 282–289. DOI 10.1258/jrsm.2008.080112 285
Journal of the Royal Society of Medicine




                         looked at more inclusive secondary sources38 and         Victorian calorific intakes
                         also oral accounts where they exist for this period.
                         It is also why we amplify these with sources             It is not just the composition of the mid-Victorian
                         including fiction, periodicals, and records like         diet that is so distinct from our own, but also the
                         London Police Court Mission reports. We draw on          amount of the food typically consumed. Due to the
                         typical (and so cross-referential) ‘throwaway’           levels of physical activity routinely undertaken
                         comments in these sources, contextualizing them          by the mid-Victorian working classes, calorific
                         with data on food supply chains, food availability       requirements ranged between 150–200% of today’s
                         and pricing, and retailing practices,39–42 to give a     historically low values. Almost all work involved
                         composite overview of dietary patterns and a more        moderate to heavy physical labour, and often
                         realistic estimation of the mid-Victorian working        included that involved in getting to work. Seasonal
                         class diet.                                              and other low-paid workers often had to walk up
                            Important and relatively costly staples in the        to six miles per day.47 While some mid-Victorian
                         working class diet (meat, bread, potatoes) are the       working class women worked from home (seam-
                         key known constituents of the mid-Victorian              stressing for instance), more went out to work
                         working class ‘food basket’: but detailed study          as domestics or worked in shops, factories and
                         reveals that they were used as headline cost indi-       workshops, necessitating long days on their
                         cators of consumption. They were not the only            feet, plus the additional burden of housework.47,48
                         foodstuffs consumed in significant quantities.           Men worked on average 9–10 hours per day for
                         Because many commonly consumed ingredients               5.5–6 days a week, giving a range from 50–60 hours
                         were not considered sufficiently costly to count as      of physical activity per week.48 Factoring in the
                         part of even a poverty diet, they often went unre-       walk to and from work increases the range of
                         corded; their consumption being taken for granted        total hours of work-related physical activity up to
                         by all sides. One woman, when quizzed by the             55–70 hours per week. Women’s expenditure of
                         Charity Organisation Society in 1877 to explain her      effort was similarly large.48 While women also had
                         budget for a cheap rice-based dish to feed her           housework to do, male leisure activities, including
                         family of ten ‘What would the onions and the fat         gardening and informal football, also involved
                         that you put in the rice cost? You did not put that      substantial physical effort.
                         down at any cost’, responded ‘hardly a half-                 Using average figures for work-related calorie
                         penny’.43 There is extensive informal evidence           consumption, men required between 280 (walk-
                         indicating the major role played by vegetables           ing) and 440 calories (heavy yard work) per hour,
                         (especially onions), fruit (especially cherries and      with women requiring between 260 and 350 calo-
                         apples), and items like bones, dripping, offal and       ries per hour. This gives calorific expenditure
                         meat scraps in the mid-Victorian diet; but little in     ranges during the working week of 3000–4500
                         the official record simply because these foods were      calories/day (men) and 2400–3500 calories/day
                         so cheap that housewives took their purchase             (women). Total calorific requirements were likely
                         largely for granted44–46                                 to have been even higher during the winter
                            Yet the myth of widespread malnutrition per-          months. With less insulated, poorly-warmed
                         sists. According to Wohl, modern study locates the       homes, working class mid-Victorians used more
                         calorie consumption of the average Victorian             calories to keep warm than we do. The same held
                         working class adult at a mere 2,099 per head; while      true for workplaces, unless the work (certain
                         an intake of at least 3,770 calories represents the      factory operations, blacksmithing, etc) heated
                         amount then needed to undertake strenuous work           the environment to equally demanding unhealthy
                         and stay healthy.10 These figures are self-evidently     levels. At the top end of the physical activity
                         incorrect, as on this negative calorific balance these   range were the navvies, building (largely with-
                         average mid-Victorian working adults would not           out machinery) the roads and railways that
                         have been able to work, procreate or indeed sur-         enabled the expansion of the British economy, and
                         vive, as many did, into a surprisingly healthy old       when in work, expending 5000 calories or more
                         age. His figures assume that the diet consisted          per day.
                         largely of carbohydrates and fats and fail to take
                         into account calories regularly derived from fish,
                                                                                  Dietary summary
                         meat and plant foods. If the calorie count is so
                         obviously fallacious, what does this say about the       Clearly mid-Victorian working class men and
                         rest of the commonly held assumptions about the          women must have consumed between 50 and
                         mid-Victorian diet?                                      100% more calories than we do today to maintain




286 J R Soc Med 2008: 101: 282–289. DOI 10.1258/jrsm.2008.080112
Public health lessons from the mid-Victorian working class diet




their ability to work and survive. The next paper       A case for supplements?
argues that their diet was rich in vegetables and
fruits, with consumption of these amounting to          In marked contrast to this, modern diets are rich in
around eight to ten portions per day. It also con-      processed foods, have a higher sodium/potassium
tained significantly more nuts, legumes, whole          ratio, with less fruit, vegetables and wholegrains.
grains and omega three fatty acids than the             They are lower in fibre and phytonutrients, in pro-
modern diet. Much meat consumed was offal,              portional and absolute terms; and, because of our
which has a higher micronutrient density than the       high intakes of potato products, breakfast cereals,
skeletal muscle we largely eat today.49 These           confectionery and refined baked goods, are likely
factors ensured far higher intakes of micro- and        to have a significantly higher glycemic load. Given
phytonutrients than are consumed today. Prior to        this, and our low calorific throughput, it follows
the introduction of margarine in the late mid-          that we are more likely to suffer from dysnutrition
Victorian period, dietary intakes of trans fats         (multiple micro- and phytonutrient depletion)
were very low. There were very few processed            than our mid-Victorian ancestors were; this is now
foods and therefore little hidden salt, other than      being referred to as Type B malnutrition.55,56 This
in bread. Recipes also suggest that significantly       is supported by survey findings on both sides of
less salt was added to meals. At table, salt was not    the Atlantic; the USDA’s 1994 to 1996 Continuing
usually sprinkled on a serving but piled at the         Survey of Food Intakes by Individuals,57,58 and the
side of the plate, allowing consumers to regulate       National Diet and Nutrition Surveys59 both show
consumption in a more controlled way. In                that many individuals today are unable to obtain
general, the mid-Victorian diet had a lower             Reference Nutrient Intakes (RNI) values – or even
calorific density and a higher nutrient density         the Lower RNI values – of a variety of vitamins
than ours. It had a higher content of fibre (includ-    and minerals. Malnutrition in the UK is now reck-
ing fermentable fibre) and a lower sodium/              oned to cost in excess of £7.3 billion per annum.60
potassium ratio. In many respects, therefore, it        The authors believe that, since it would be unac-
resembles the dietary recommendations made              ceptable and impracticable to recreate the high
by today’s advocates of the paleolithic diet, but       calorie mid-Victorian working class diet, this con-
has the critical advantage of extensive Victorian       stitutes either a persuasive argument for a more
documentary evidence.                                   widespread use of food fortification and/or food
   In terms of alcohol consumption, the compari-        supplements, not only in hospitals and in long-
sons with today are particularly revealing. Many        term care facilities but in the community; and a
contemporary reports suggest that around a fifth        review of agricultural subsidies to make locally
of mid-Victorian working class men might, when          grown fruit and vegetables cheaper.
employed, spend up to a fifth of their income on
beer.50 Assuming an average urban income rang-
ing from £1–4 per week, and given mid-century           Conclusion
pub prices of 3d upwards per pint for beer,51 the
reported expenditure would account for around           Contrary to received wisdom, the mid-Victorian
16–20 pints per week maximum or between three           working classes appear to have been following
and four pints per night. As mid-Victorian beer         modern advice about healthy lifestyles almost to
generally had an alcohol content ranging between        the letter. Not yet having acquired the taste for
1–3.5%,52 this is equivalent to 1.5–2 pints of beer     processed foods, they were in fact eating some-
per day in contemporary terms. Seen in this light,      thing closer to the Mediterranean diet or even
the enormous Victorian concern about drunken-           the Paleolithic diet than the modern Western diet.
ness in the working classes appear to be more a         This should have created enormous public health
reflection of respectable morality than a real public   benefits; or, at the very least, very significantly
health issue.53 Cost implications ensured that, for     reduced levels of degenerative disease, in an inter-
most, the mid-Victorian ‘alcohol problem’ was cer-      esting reflection upon the McKeown thesis. That
tainly less significant than it is today, when the      this was indeed the case, at least for the mid-
frequency of public inebriation and levels of injury    Victorian period, will be demonstrated in the fol-
and illness have become a serious public health         lowing papers of this series; the second in the
concern.54 Finally, mid-Victorian tobacco con-          series analyses mid-Victorian dietary patterns in
sumption was very much lower than today, and            greater detail, and the third correlates the nutri-
their levels of physical activity were, as described,   tional pharmacology of the mid-Victorian diet
much higher.                                            with contemporary health records.




                                                        J R Soc Med 2008: 101: 282–289. DOI 10.1258/jrsm.2008.080112 287
Journal of the Royal Society of Medicine




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Public health lessons from the mid-Victorian working class diet




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                                                                J R Soc Med 2008: 101: 282–289. DOI 10.1258/jrsm.2008.080112 289

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An unsuitable and degraded diet? Part one: public health lessons from the mid-Victorian working class diet

  • 1. SERIES An unsuitable and degraded diet? Part one: public health lessons from the mid-Victorian working class diet Paul Clayton1 + Judith Rowbotham2 1 School of Life Sciences, Oxford Brookes University 2 NottinghamTrent University – School of Arts and Humanities, Clifton Lane, Nottingham W8 7NP UK , Correspondence to: Paul Clayton. E-mail: paulrclayton@gmail.com DECLARATIONS Introduction to the series wide range of types of primary source material, as discussed in this first paper. This in itself has pro- Competing interests Principal findings vided a high degree of internal cross-checking of PC provides the validity of the historical data. It has been con- The research resulting in this series of three papers consultancy services sidered necessary due to the reality that extensive (further papers to be published in succeeding issues to a number of of JRSM), drawing on a range of historical datasets quantitative data for the Victorian age, in formats companies in the viewed through the lens of current scientific under- recognized by today’s scientific statisticians, do food and drink, standing, indicates that cultural and other biases not exist. Consequently, it could be argued that supplement and have distorted the historical record, leading to con- our perspective (like the conclusions based on pharmaceutical clusions which test many current health policy Rowntree et al.2) lacks representativeness and sectors, including assumptions about a steady improvement in British historicity. However, the full range of sources we Coca Cola Ltd, nutrition since the nineteenth century. As these have consulted provides the best possible survey papers show, the urban mid-Victorians, including of dietary habits, in ways that counterbalance the Univite Ltd, Biothera the working classes, ate a notably good diet, includ- consciously biased records of surveys like those of Pharma. JR is a ing significant amounts of vegetables and fruit, Booth3 and Rowntree2. We have re-examined the historian who which enabled a life expectancy matching that of urban (as distinct from the rural) mid-Victorian provides no today. We follow the example of George Rosen (a working class diet and its nutritional values by consultancy services looking in detail at typical food consumption pat- public health practitioner, and in his time editor of to anyone on any terns of the time. The use of a qualitative approach the American Journal of Public Health and Journal of commercial basis, is thus not a weakness but a real strength, giving the History of Medicine, among others), in believing but provides that a historical dimension is essential to a sound insights into life experience that cannot be readily academic comment perspective in public health today.1 deduced from quantitative statistics. The other to media and author is a pharmacologist and pharmaconutri- academic outlets, tionist, who has drawn on the fullest possible including Woman’s Methods, strengths and weaknesses range of scientific and medical data to interpret the Hour, European A strength, but also a weakness, of these papers is historical material: his work is apparent through- Social Science that they are not purely medical studies. They are out but is most fully discussed in the final paper. History Conference, based on genuinely interdisciplinary research and In providing this challenge to assumptions etc. as such cannot be tested in the usual ways for about the steady improvement in British nutri- studies appearing in this, and similar, journals. tional history since the mid-nineteenth century, Funding The authors revisited the historical record because however, the authors acknowledge that historical No funding or of the mismatch between the assumed content of materials cannot provide the fully testable data sponsorship was the Victorian working class diet and adult life normally considered essential to medical studies. sought or obtained expectancy. They then cross-referenced this Yet we argue that the historical data used, and the material against current scientific/medical knowl- methodologies employed to interrogate it, are edge, using primarily a range of studies already in appropriate to both science and social science, as the public domain and so supportable by a wealth the development of the argument that follows will of scientific papers to reach their conclusions. explain in detail. Inevitably, in the limitations of a Amongst their strengths is the breadth of the short series it is impossible to rehearse all the his- research drawn on and the widely-tested nature of torical data drawn upon. However, that incorpor- the scientific data in particular. One of the authors ated in these papers was identified on the basis of is a historian experienced in data collection from a historical typicality and connotations for both the 282 J R Soc Med 2008: 101: 282–289. DOI 10.1258/jrsm.2008.080112
  • 2. Public health lessons from the mid-Victorian working class diet Ethical approval historical and the scientific perspectives. In this of McKeown’s work,6,7 thereby restoring the Not appropriate or series we present, respectively, analyses of mid- emphasis on public health and medical interven- relevant: all modern Victorian levels of physical activity, dietary intakes tions. Should this have led to a wholesale rejection data cited is already and public health patterns. The significance of our of McKeown? We argue that there is one area in the public domain, findings and their relevance to health care design where his thesis has considerable merit: that relat- and all historical and delivery today are integrated and developed ing to nutritional standards, which in turn rehabili- data is either in the third paper, together with suggestions for tates his claim for an improved adult life future research. In this first paper, the issue of expectancy in the period after 1850, a claim sub- anonymized or Victorian life expectancy is revisited in the context stantiated by later detailed statistical studies.8 To untraceable of contemporary health policy. this we add the concept that to life expectancy was Guarantor also added health expectancy. PC A significant source of error is the established Introduction to part one view is that the mid-Victorian urban poor ate an Contributorship Current expressions of concern about national lev- inadequate diet that contributed to increased mor- This series of three els of ill-health from government and leading bidity; and that consequently, medical advances papers was jointly health figures, often focusing on the nutritional and post-1880 environmental sanitary improve- conceived and value of the nation’s diet, are not original in either ments were the crucial factors in expanding life researched. JR took motivation or substance. The importance of diet as expectancy. In terms of reducing perinatal mor- primary a determinant of health was first recognized by the tality, the role of modern medicine from c1890 responsibility for state in the mid-nineteenth century because of was central; but we argue that this does not hold pressure from leading scientific and medical fig- true for improvements otherwise. Improvements searching out both ures of the day. One of the leading protagonists in in adult life expectancy are discernable by the the primary entrenching the concept of a medical dimension to 1861 census, when figures show that by com- historical sources public health policy thinking was John Snow, parison with the 1841 figures, twice as many men and the relevant and women per 100,000 births had an average Medical Advisor to the Privy Council under the secondary governments of Lords Aberdeen and Palmerston. expectation of a further 20 years of life.8 references; PC took Governments continue to rely upon this dimen- The concept of a short, because malnourished, primary sion in developing public health policies. life has been promoted by numerous historians, responsibility for We contend, however, that serious historical, making assumptions about the nutritional value of searching out the methodological and class-based biases about indi- the mid-Victorian urban working class diet.9–11 scientific and vidual diet as a source of nutrition, dating back to Sources for such scholars include reports from medical data. The the Victorian era, have been integrated into the nineteenth century philanthropists like Fanny general tenor and public health model used today, and are now con- Calder, who believed that the working classes ate tributing to unnecessary ill-health and premature an ‘unsuitable and degraded diet’,12 and from conclusions of the death because they have obscured the debate medical commentators like William Farr, seeking papers (including about the relative merits of dietary guidance, to relate what he saw as the flaws in the working the exercise of intervention and individual responsibility. The class (and particularly the workhouse) diet to drawing up dietary purpose of this three-part series is to revisit the causes of death, especially among infants.13 patterns and levels dietary patterns of those with the least money and, Agenda-driven studies of poverty like Booth3 of physical activity supposedly, the worst health in the mid-Victorian or Rowntree2 have also been influential in which are era; to illuminate the historical biases that have establishing a belief in consequent nutritional summarized in the subsequently been integrated into twenty-first inadequacy.14 first and second century public health policy; and to suggest In revisiting the issue of mid-Victorian urban papers) are a joint ways in which the contemporary diet could be nutritional standards and returning to the Mc- effort, representing improved. Keown thesis, we have a clear focus on the mid- 50% input from each Nineteenth century public health policy Victorian period, from c1850 to c1877–80. Rather focused on reducing mortality rates.1 Seeking to than taking the established view of an ongoing contributor. While explain what he correctly identified as an improve- dietary improvement during the Victorian era, our comment on ment in life expectancy, Thomas McKeown sug- analysis suggests the reverse: that mid-Victorian penultimate drafts gested that an improved working class diet was nutritional standards were significantly better was sought from likely to have improved resistance to infectious than generally realized, and then declined to a specialists in both diseases.4 For him this, rather than public health nadir at the end of the nineteenth century, making the historical and interventions or medical improvements, explained that date a highly misleading starting point for scientific/medical the first improvements in morbidity rates.5 Demo- illustrations of twentieth century nutritional fields, no other graphic historians subsequently challenged much ‘progress’. Consequently, there is a need to J R Soc Med 2008: 101: 282–289. DOI 10.1258/jrsm.2008.080112 283
  • 3. Journal of the Royal Society of Medicine contributor was consider afresh the concept that it was indeed and the effects of intemperance were the most directly or dietary improvement via affordable available common causes of ill-heath and death.21 This is substantially foodstuffs, rather than public health and medical amply borne out by the public health records of the involved in the advances, which had the most positive influence time, which clearly promote the role of disease and writing of these on the quality of working class health. accident as the main causes of mortality.8 The only papers or the This has considerable implications for the common disease supposedly related to malnutri- research thereof. present public health model, rooted as it is in medi- tion was rickets22 but increased incidence of this cal (pharmaceutical and surgical) intervention and disease in the early Victorian period was largely Those cited have moral exhortation. We argue that the lessons of the due to decreased exposure to sunlight among been cited where mid-Victorian period indicate that the most (cost-) the urbanized working classes.23 Paradoxically, the contributors effective way of maintaining and improving pub- a re-classification of rickets as a primarily nutri- judged that their lic health today is to promote standards of nutri- tional disorder in the 1920s24 contributed to work was relevant tion via facilitating informed individual choice and exacerbated subsequent received views of and supportive, or and educational strategies, rather than legislation Victorian malnutrition.25 where we wished to and medical intervention. Victorian misinformation underpins current identify work that we There has been some development in this direc- misconceptions. Much concern about nutrition wished to challenge tion in the state-managed push for ‘five portions of then was rooted in middle-class disapproval of fruit and vegetables per day’. But it leaves the way that the working classes supposedly Acknowledgements untouched the vexed question of whether a ‘sensi- ‘wasted’ food.26 Public health commentators We acknowledge ble balanced diet’ is achievable today without the believed that freedom to buy what they wanted gratefully the additional intervention of supplements and/or was ‘bad’ for the working classes; that they did comments made by fortification programmes, given current levels of not know what was ‘good’ for them nutritionally, BJ Harris, Professor physical activity, food consumption patterns, and nor how to cook what they did buy.26,27 Middle- of the History of the nutritional content of many modern foods15 class views were also influenced by the food Social Policy, compared to those of the past. In this series we seek adulteration scandals of the time (see the second University of to improve comprehension of this reality through paper in this series), which affected all consumers an exploration of the mid-Victorian diet and public but the working classes most severely. These Southampton. Any health profile. were associated with the Victorian laissez-faire errors now are Much is made today of Victorian reports of indi- approach to business, but it is only fair to point solely the viduals so poor they died from starvation. It was out that there are almost identical concerns today responsibility of the undoubtedly an issue in the 1840s, appositely about food content and composition, labelling authors. We also labelled the ‘Hungry Forties’. By the end of that and advertising.28 Victorian food adulteration with to thank Mike decade, however, a real improvement in the econ- was rightly a high-profile issue, arguably Lean, Professor of omics of the working classes had taken place. amounting to a ‘moral panic’;29 but its extent is Human Nutrition, Measures such as the repeal of the Corn Laws in unclear and assumed incidence should be bal- University of 1846 signalled the beginnings of the age of afford- anced against the evidence for a diet-based Glasgow, for his able food. The impact on the health of the poor was improvement in working class health. (The often early input swift.16 It is our argument that not only the dangers intemperate media coverage of dietary issues and of starvation were avoided, but also the dangers to their implications for lifestyle and health provides adult life expectancy associated with malnutrition, an interesting parallel today!) because by 1850 the working class diet had Prejudices about class and diet unduly influ- improved markedly in terms of both quality and enced first Victorian writers and policy-makers quantity. reflecting on health, then those who have cited Between 1850 and 1870, deaths attributable to them uncritically thereafter. They are still used as a starvation and malnutrition accounted for around basis for modern public health models.8,30 But 1.5% of reported causes of death in urban con- by taking a wider range of sources into account we ditions, though malnutrition undoubtedly contrib- have reassessed the diet of the mid-Victorian poor; uted to other causes of morbidity and mortality, concluding (in contrast to received wisdom) such as increased vulnerability to infection.17 that the majority ate a diet vastly superior to However, these figures are not significantly higher that generally consumed today, one substantially than occur today.18,19 The comments of regular in advance of current public health recom- visitors to the poorest quarters of Britain’s cities in mendations. Reverting to the nutritional essentials this period underline the comparative rarity of of the mid-Victorian diet and lifestyle would death from starvation alone;20,21 instead, they materially improve human well-being in Britain noted that infectious illness, brutality, accident today. 284 J R Soc Med 2008: 101: 282–289. DOI 10.1258/jrsm.2008.080112
  • 4. Public health lessons from the mid-Victorian working class diet Historical-nutritional context ing the need to provide school meals for working class children, reinforced the idea that the urban From 1877, historians generally agree that food working classes were not only malnourished at the costs fell as much as 30% due to imports of cheaper start of the twentieth century but also (in a leap basics such as cereals and meat. As a result, sup- which seemed logical then and has ever since) that posedly, ‘the first really appreciable nutritional they had been so since the start of the nineteenth improvement . occurred’.31 Imported American century’s industrial urbanization.34 wheat and modern milling techniques reduced the A detailed re-reading of Victorian sources, price of flour, while fresh and tinned meat arrived however, reveals that diet and public health from the Argentine, Australia and New Zealand. reached a high point in the mid-Victorian era, to Canned fruit and milk became more widely avail- decline noticeably at the end of the 1870s with the able. These changes increased the variety and introduction of the first generation of processed quantity of the working class diet, and was adver- foods. The increased sugar intake alone caused tised as reducing the opportunities for adultera- such damage to the nation’s teeth that many peo- tion.31 Simultaneously, cheaper sugar promoted ple could no longer chew tough foods, thereby the huge increase in sugar consumption (in confec- reducing their intake of vegetables, fruits and tionery, processed foods like evaporated milk, and nuts.35 fruit canned in heavy sugar syrups) from the 1880s That some mid-Victorians (especially women on. Consequent assumptions about what has been and children but also seasonal workers at adverse labelled an ‘improvement’ in food quality between times) were malnourished is indisputable; but in 1877 and 1889 have led to the conclusion that pre- this paper we contest the claim that it was a viously, the value of the working class diet must majority experience. Rather, we suggest that the have been even worse, and that since malnutrition first generation of processed foods, far from was so widespread at the end of the century, it improving the late Victorian urban working must have been almost universal at the mid- class diet, ‘degraded’ it to the state observed by century. Rowntree in 1901;2 and that prior to this in the This ‘progressive improvement’ conclusion, period c1850–1880, the working class diet was far however, is at odds with the evidence. Mid- superior. While a substantive mass of Victorian Victorian navigators (navvies), who as seasonal quantitative data is not available, our sources com- workers were towards the bottom end of the econ- pensate for this in their range and depth. They omic scale in terms of their purchasing ability, include details (including statistics) provided by could (when in work) routinely shovel up to contemporary sources from official sources such as 20 tons of earth per day from below their feet to Blue Books, Reports from charitable organizations, above their heads;32 an enormous physical effort Mayhew’s London Labour and the London Poor,20 that most modern workers would be totally unable and information in medical texts and dietaries to emulate, and one that required great strength, from workhouses, hospitals and army records. We stamina and robust good health. Yet after 50 years drew on depictions of purchase, cookery and con- of supposed ‘nutritional improvements’, the Brit- sumption in contemporary fiction and periodicals, ish army recruiting for the Boer war at the turn of including authors like Dickens with his detailed the century found around 50% of young working descriptions of the consumption strategies of the class recruits to be so malnourished as to be unfit mid-Victorian poor. We also investigated infor- for service.14,33 This was a rapid decline. The mation from more neglected datasets, notably recruiting sergeants had reported no such prob- Victorian cookery books and diet advice for the lems during the Asante (1873–4) and Zulu Wars poor, where recent studies have also confirmed (1877–8). Twenty years later, there is evidence of a their relevance.27 This information (when inte- precipitous drop in nutritional standards: the grated with the other sources) can give a more infantry were forced to lower the minimum height nuanced picture of working class diets and its for recruits from 5' 4$, where it had remained fairly values. constantly since 1800, to 5' in 1901. (Army recruits Walton, reviewing Oddy’s From Plain Fare to up to the 1870s were generally drawn from the Fusion Food, noticed the absence of working class better-nourished rural population: thereafter they voices therein, and added, fairly, that we cannot were mainly from the urban working class.) trust the official records on working class diets, In 1903, and as a direct result of the Boer disas- because in recounting what families and individ- ter, the government set up the Committee on uals consumed there was likely to be self- Physical Deterioration. Its 1904 Report, emphasiz- censorship.36,37 We recognize this, and have J R Soc Med 2008: 101: 282–289. DOI 10.1258/jrsm.2008.080112 285
  • 5. Journal of the Royal Society of Medicine looked at more inclusive secondary sources38 and Victorian calorific intakes also oral accounts where they exist for this period. It is also why we amplify these with sources It is not just the composition of the mid-Victorian including fiction, periodicals, and records like diet that is so distinct from our own, but also the London Police Court Mission reports. We draw on amount of the food typically consumed. Due to the typical (and so cross-referential) ‘throwaway’ levels of physical activity routinely undertaken comments in these sources, contextualizing them by the mid-Victorian working classes, calorific with data on food supply chains, food availability requirements ranged between 150–200% of today’s and pricing, and retailing practices,39–42 to give a historically low values. Almost all work involved composite overview of dietary patterns and a more moderate to heavy physical labour, and often realistic estimation of the mid-Victorian working included that involved in getting to work. Seasonal class diet. and other low-paid workers often had to walk up Important and relatively costly staples in the to six miles per day.47 While some mid-Victorian working class diet (meat, bread, potatoes) are the working class women worked from home (seam- key known constituents of the mid-Victorian stressing for instance), more went out to work working class ‘food basket’: but detailed study as domestics or worked in shops, factories and reveals that they were used as headline cost indi- workshops, necessitating long days on their cators of consumption. They were not the only feet, plus the additional burden of housework.47,48 foodstuffs consumed in significant quantities. Men worked on average 9–10 hours per day for Because many commonly consumed ingredients 5.5–6 days a week, giving a range from 50–60 hours were not considered sufficiently costly to count as of physical activity per week.48 Factoring in the part of even a poverty diet, they often went unre- walk to and from work increases the range of corded; their consumption being taken for granted total hours of work-related physical activity up to by all sides. One woman, when quizzed by the 55–70 hours per week. Women’s expenditure of Charity Organisation Society in 1877 to explain her effort was similarly large.48 While women also had budget for a cheap rice-based dish to feed her housework to do, male leisure activities, including family of ten ‘What would the onions and the fat gardening and informal football, also involved that you put in the rice cost? You did not put that substantial physical effort. down at any cost’, responded ‘hardly a half- Using average figures for work-related calorie penny’.43 There is extensive informal evidence consumption, men required between 280 (walk- indicating the major role played by vegetables ing) and 440 calories (heavy yard work) per hour, (especially onions), fruit (especially cherries and with women requiring between 260 and 350 calo- apples), and items like bones, dripping, offal and ries per hour. This gives calorific expenditure meat scraps in the mid-Victorian diet; but little in ranges during the working week of 3000–4500 the official record simply because these foods were calories/day (men) and 2400–3500 calories/day so cheap that housewives took their purchase (women). Total calorific requirements were likely largely for granted44–46 to have been even higher during the winter Yet the myth of widespread malnutrition per- months. With less insulated, poorly-warmed sists. According to Wohl, modern study locates the homes, working class mid-Victorians used more calorie consumption of the average Victorian calories to keep warm than we do. The same held working class adult at a mere 2,099 per head; while true for workplaces, unless the work (certain an intake of at least 3,770 calories represents the factory operations, blacksmithing, etc) heated amount then needed to undertake strenuous work the environment to equally demanding unhealthy and stay healthy.10 These figures are self-evidently levels. At the top end of the physical activity incorrect, as on this negative calorific balance these range were the navvies, building (largely with- average mid-Victorian working adults would not out machinery) the roads and railways that have been able to work, procreate or indeed sur- enabled the expansion of the British economy, and vive, as many did, into a surprisingly healthy old when in work, expending 5000 calories or more age. His figures assume that the diet consisted per day. largely of carbohydrates and fats and fail to take into account calories regularly derived from fish, Dietary summary meat and plant foods. If the calorie count is so obviously fallacious, what does this say about the Clearly mid-Victorian working class men and rest of the commonly held assumptions about the women must have consumed between 50 and mid-Victorian diet? 100% more calories than we do today to maintain 286 J R Soc Med 2008: 101: 282–289. DOI 10.1258/jrsm.2008.080112
  • 6. Public health lessons from the mid-Victorian working class diet their ability to work and survive. The next paper A case for supplements? argues that their diet was rich in vegetables and fruits, with consumption of these amounting to In marked contrast to this, modern diets are rich in around eight to ten portions per day. It also con- processed foods, have a higher sodium/potassium tained significantly more nuts, legumes, whole ratio, with less fruit, vegetables and wholegrains. grains and omega three fatty acids than the They are lower in fibre and phytonutrients, in pro- modern diet. Much meat consumed was offal, portional and absolute terms; and, because of our which has a higher micronutrient density than the high intakes of potato products, breakfast cereals, skeletal muscle we largely eat today.49 These confectionery and refined baked goods, are likely factors ensured far higher intakes of micro- and to have a significantly higher glycemic load. Given phytonutrients than are consumed today. Prior to this, and our low calorific throughput, it follows the introduction of margarine in the late mid- that we are more likely to suffer from dysnutrition Victorian period, dietary intakes of trans fats (multiple micro- and phytonutrient depletion) were very low. There were very few processed than our mid-Victorian ancestors were; this is now foods and therefore little hidden salt, other than being referred to as Type B malnutrition.55,56 This in bread. Recipes also suggest that significantly is supported by survey findings on both sides of less salt was added to meals. At table, salt was not the Atlantic; the USDA’s 1994 to 1996 Continuing usually sprinkled on a serving but piled at the Survey of Food Intakes by Individuals,57,58 and the side of the plate, allowing consumers to regulate National Diet and Nutrition Surveys59 both show consumption in a more controlled way. In that many individuals today are unable to obtain general, the mid-Victorian diet had a lower Reference Nutrient Intakes (RNI) values – or even calorific density and a higher nutrient density the Lower RNI values – of a variety of vitamins than ours. It had a higher content of fibre (includ- and minerals. Malnutrition in the UK is now reck- ing fermentable fibre) and a lower sodium/ oned to cost in excess of £7.3 billion per annum.60 potassium ratio. In many respects, therefore, it The authors believe that, since it would be unac- resembles the dietary recommendations made ceptable and impracticable to recreate the high by today’s advocates of the paleolithic diet, but calorie mid-Victorian working class diet, this con- has the critical advantage of extensive Victorian stitutes either a persuasive argument for a more documentary evidence. widespread use of food fortification and/or food In terms of alcohol consumption, the compari- supplements, not only in hospitals and in long- sons with today are particularly revealing. Many term care facilities but in the community; and a contemporary reports suggest that around a fifth review of agricultural subsidies to make locally of mid-Victorian working class men might, when grown fruit and vegetables cheaper. employed, spend up to a fifth of their income on beer.50 Assuming an average urban income rang- ing from £1–4 per week, and given mid-century Conclusion pub prices of 3d upwards per pint for beer,51 the reported expenditure would account for around Contrary to received wisdom, the mid-Victorian 16–20 pints per week maximum or between three working classes appear to have been following and four pints per night. As mid-Victorian beer modern advice about healthy lifestyles almost to generally had an alcohol content ranging between the letter. Not yet having acquired the taste for 1–3.5%,52 this is equivalent to 1.5–2 pints of beer processed foods, they were in fact eating some- per day in contemporary terms. Seen in this light, thing closer to the Mediterranean diet or even the enormous Victorian concern about drunken- the Paleolithic diet than the modern Western diet. ness in the working classes appear to be more a This should have created enormous public health reflection of respectable morality than a real public benefits; or, at the very least, very significantly health issue.53 Cost implications ensured that, for reduced levels of degenerative disease, in an inter- most, the mid-Victorian ‘alcohol problem’ was cer- esting reflection upon the McKeown thesis. That tainly less significant than it is today, when the this was indeed the case, at least for the mid- frequency of public inebriation and levels of injury Victorian period, will be demonstrated in the fol- and illness have become a serious public health lowing papers of this series; the second in the concern.54 Finally, mid-Victorian tobacco con- series analyses mid-Victorian dietary patterns in sumption was very much lower than today, and greater detail, and the third correlates the nutri- their levels of physical activity were, as described, tional pharmacology of the mid-Victorian diet much higher. with contemporary health records. J R Soc Med 2008: 101: 282–289. DOI 10.1258/jrsm.2008.080112 287
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