A lifetime of NHS

Dietetics at the start of the NHS: The science of dieteteics has been around for a while now like the NHS.

I have always known the National Health Service (NHS) here in the UK. It has been a major part of my life having been employed in it for the last 16 years. Growing up I was also surrounded by it as my mother was a Physiotherapist and her sister a Nurse. My 2 sister in laws also work in the NHS; a Speech and Language Therapist and a Clinical Psychologist, plus two of my cousins are doctors and one cousin has gone into NHS management!  My Grandparents were around at the start. My paternal Grandmother was a Nurse working at Hartlepool Hospital and my Grandfather a Hospital Engineer. Both maternal Grandparents were Doctors (and my Grandfather a Dentist also). My maternal Grandmother trained in Glasgow as a Doctor, but only after her father made her train as a Teacher first as it was a more ladylike profession! My Grandfather trained in Birmingham and had his first junior doctor job in the hospital I work in now! We are a family of NHS workers. Not only does the NHS provide us with free health care, but it has provided half my family with employment!

Dietetics has evolved

Over the past 70 years Medicine, Nutrition and Dietetics have evolved. Dietetics is a fairly young science and the first Dietetic department appeared at the Edinburgh Royal Infirmary in 1924. The first meeting of the BDA was in 1936 with 77 members (1). There are now 9,585 qualified working Dietitians in the UK (2) with most having worked in the NHS at some point in their career.

Back in 2010 when we cleared out our old Dietetic offices at Selly Oak Hospital ready to move into the brand new Queen Elizabeth Hospital Birmingham, I saved some old dietetic textbooks heading to the skip. They included ‘The Handbook of Diets’ by Rose Simmons published in 1937, ‘The Diabetic Life, Its Control by Diet and Insulin’ by R.D. Lawrence published in 1945 (including a wartime supplement) and ‘Hutchinson’s Food and the Principles of Dietetics’ 5th edition published in 1922 and the ninth edition in 1944. These books would have been used by some of the first Dietitians who worked at Selly Oak Hospital. They would have been using these books 70 years ago when the NHS started.

Some of what we knew about nutrition 70 years ago has not changed. Hutchinson’s 9th edition from 1944 states that

‘Dietetics stands foursquare upon calories, protein, inorganic elements and vitamins and it is only an effort that we can imagine that there may be more legs for dietetics to stand on’.

He was quite right as these are still the principles of nutrition today (macro and micronutrients). He went on to say

‘What directions the future progress of dietetics will take it is impossible to say. It is probably that more vitamins will be discovered or subdivided further and new ‘accessory’ food substances may be brought to light’.

We have not found many more vitamins in 70 years, but we have found new ‘accessory food substances’ which could include substances such as probiotics, prebiotics, antioxidants, FODMAPs and many more.

Comparing diets from the 1940’s to today

The diet for diabetes is similar today. Simmons in her Handbook of Diets from 1937 tells us that patients with diabetes should weigh their foods, particularly bread and potatoes (much like carbohydrate counting now). Patients under Simmons care were given food lists – 1 of sugar forming foods (carbohydrates) and the 2nd of bodybuilding foods (proteins) and then taught how to substitute foods from the lists.

There are also diets we do not use any more such as the Lenhartz diet for gastric ulcer. Simmons describes how gastric ulcers can be healed if giving a diet of eggs and milk fed by a spoon building up over a week.  Or the Sippy Diet which consists of small repeated doses of alkali with milk to neutralise acid in the stomach. She warns

‘when patients are taking a continuous dose of alkali watch for symptoms of alkali poisoning such as bad dreams, headaches, nausea, delirium and tetany!’

This makes me giggle as now unqualified nutritionists try and tell us that an alkaline diet is good for us!

All fascinating stuff. What more complexities of diet and nutrition will we find out about in the next 70 years and will the NHS still be there to see it?

 

References

  1. Mary Bownes. The Work of Dietitians in Great Britain. (1993) Social Policy and Administration, volume 27, number 4, p335.
  2. Health and Care Professions Council website. www.hpc-uk.org

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