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London in 1936 is the best known of the marches which took place in the early 1930s to protest against the high rates of unemployment and the low rates of benefit. It was another of these marches on which I, and a small group of third year medical students from University College London, met on the outskirts of London in 1933. Our intention was to show support for the march and to provide any first aid that might be necessary. This turned out to be mainly the dressing of blisters. It was this experience, combined with the publication by the British Medical Association in 1933 of its report on minimum diets considered adequate for those on unemployment benefit that stimulated me to write the article on malnutrition in England.1 Sir Richard Doll described a similar experience when interviewed by Sue Lawley on the UK BBC Radio programme ‘Desert Island Discs’ in 2002. He related how he, with another recently qualified doctor, marched a good part of the way with the Jarrow marchers and how he had been moved to see one of the men take the meat out of his sandwich and put it into an envelope to send home to his family, because they had not had meat for some weeks. In 1934 we began our clinical studies. I do not think that our teachers, the ‘honoraries’, most of whom were at the top of their specialties, ever discussed the relationship between the harsh living conditions which many people suffered, as revealed by the hunger marches, and the diseases we studied. Large areas of ill health in which social conditions were very important, such as mental illness, infectious diseases, pulmonary tuberculosis, and the disabilities of old age were relatively neglected. This was probably because patients with these conditions were not normally admitted to teaching hospitals. These diseases were covered to a small extent by lectures and by sending students on a few visits to the municipal hospitals that cared for them. Tuberculosis was a huge problem. In 1934, for example, there were 30 882 deaths from this disease in England and Wales. Looking back it seems surprising, in view of its prevalence, that so little time was devoted to it in our training, or to the underlying social conditions—including overcrowding and malnutrition—which were so important in its causation. © International Epidemiological Association 2003; all rights reserved. International Journal of Epidemiology 2003;32:496–498 DOI: 10.1093/ije/dyg213

‘Malnutrition in England’ University College Hospital Magazine 1934 Some reflections in 2003 on the 1930s