Sunday, 24 March 2013

Health Advice from your Home Doctor

In the days before the NHS, when the British had to pay for a consultation, "home doctor" books seem to have been quite popular. I've been whiling away a chilly afternoon by dipping into one that was published in 1935. It contains a great deal advice on how to keep healthy. 
On alcohol consumption readers were advised thus:
"The counsel of perfection would be that of complete abstention from alcoholic liquor." The author though, obviously feels this is unrealistic and without explaining why he deems it unhealthy to consume too much liquor, goes on to recommend a sensible daily consumption:
"A glass of beer, light wine or claret at the middle-day meal is quite reasonable, but it is wise to eschew spirits, port, sherry etc" ... A sherry between 6 and 7 pm (the cocktail hour) is preferable to a "spirituous" cocktail "and with the evening meal, a glass or two of white wine, claret or burgundy may be taken as routine" ... "A glass of whisky and soda last thing at night may round off the day, and the average man has had all he wants in the way of alcoholic stimulant for twenty-four hours."
Sounds like a fair bit to me - five drinks a day - but it rather sounds as if this is what the author consumed routinely. So it must be alright.
On tobacco he starts by saying: "It is at least doubtful whether the habit often does any really very great harm," - an interesting sentence that reveals his conflicted feelings. We know that the majority of doctors smoked in the mid 20th century because in the huge study of the effects of smoking, conducted on a large group of British doctors, only 17% were lifelong non-smokers. He goes on to list a number of forms of possible harm caused by the habit: irritation and inflammation of the airways, smokers cough ("too well known to require description"), irregular heart beat, colitis, gastritis, constipation and a form of blindness.
On the subject of exercise the good doctor is cautious, recommending a brisk, 15 minute walk, out of doors, every day, ensuring that one's breathing is deep, head is thrown back and arms are swinging naturally. This is seen as primarily beneficial to the lungs and the reader is reminded: "It almost goes without saying that smoking should not be considered during such a walk."
He cautions against launching into team sports without prior conditioning and recommends that that such activities do not combine well with alcohol or smoking. Running meets with cautious approval but "Except in rare cases, men of over thirty-five years of age should not partake in competitive athletics."
It is notable that the tone of the book is of one middle class gentleman, advising another. Women are considered when specific female problems are dealt with, such as the menopause. Female readers are warned against the habitual consumption of brandy, whisky, gin or aspirin and: "Emotionalism is to be avoided."
There are many pages devoted to areas of life into which health professionals would never dream of venturing today, such as the time of day to take a hot (but not overly hot) bath. The evening is deemed the appropriate time, with perhaps a cold dip in the morning.
There are pages given over to the kind of clothing appropriate for the maintenance of health. Wool next to the skin is strongly recommended but not "old, washed and felted woollen garments" which are, apparently, "a common source of colds." Undergarments made from other fabrics are given cautious approval. Tight collars are mentioned, which "certainly hide that Adam's Apple, but they do impede a free flow of blood between the head and the heart".
He ends the section on clothing with the following: "It should be remembered that to be well dressed is to be inconspicuously dressed, and some of the various freaks and vagaries of attire one so often sees in some individuals are quite unnecessary and usually a sign of exaggerated self-importance." 
The only place that science informed health advice of the 1930s was the diet because it had recently revealed the existence of the key nutrients, so the importance of having a balanced diet was understood. 
We sometimes gripe today about ever-changing recommendations about diet or the consumption of alcohol, so it is interesting to look back and notice how much has changed since the childhood of today's great-grandparents. Long gone are the days when doctors thought that colds were caused by woolly undergarments that had seen better days and the time when they had no idea that smoking caused lung cancer and cardiovascular disease.
Thanks to a great deal of careful scientific enquiry, we all have much better knowledge about the factors that affect health than anyone could have dreamed of in 1935. The official health advice we receive is not perfect, but it is no longer based on firmly held opinions and nothing more.
The Modern Home Doctor, published by the Daily Express in 1935 and written by "members of the Medical Profession".
Doll R, Hill AB. (1954). "The mortality of doctors in relation to their smoking habits". BMJ 328 (7455): 1529.

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