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There is a great void in medical education today. I refer to specific training in the preventive aspects of nutrition. Several
years ago I surveyed the curricula and course offerings of a random sample of 38 American medical schools. My findings confirmed
fully the situation revealed by the Select Subcommittee Hearings of the United States Senate, January 30, 1979. In essence
it isn't done. Many programs do not formalize preventive medicine in general. I found only one school with a good program
directed at applied clinical nutrition.
Nonetheless, one sees growing evidence of awareness among American physicians on the importance of nutritional support in
the treatment of disease. One good example is the salutary effect of specific nutritional support during cancer chemotherapy.
Another is the relationship of nutritional status and survival following surgery for perforated duodenal ulcer.
If nutritional preparation for stressful events makes sense en passant, is it not at least equally logical to make
that preparation in advance whenever possible?
The flaw in the plan is the easily demonstrated lack of a working knowledge of applied nutrition on the part of physicians
generally. Even when a doctor has this skill, one has to deal with often deep seated cultural bias, lifelong (bad) habits,
and for some, the cost of better foods, especially good quality protein.
Of even greater importance is the role of good nutrition in pregnancy. Human fetal growth and development are a majestic
exercise in the accumulation of protein. Good animal husbandmen will not breed stock showing poor nutrition and will feed
pregnant stock specially constructed diets. The same is true of breeders of animals for research, where uniformity of genetic,
nutritional and physical attributes are required for the validation of experiment.
Human pregnancy nutrition is a subject in disarray, not for lack of certain basic information, but because it is so largely
ignored in practice. The nutritional history of the obstetric patient may be taken by a trained associate, but nutritional
instruction must come from the physician. In this activity the obstetrician reassesses the patient's command of the subject,
and uses his or her authority role to reinforce the instruction.
Thomas H. Brewer, M.D., the author of this interesting and remarkable book, is one of a handful of pioneers of this educative
approach. He stands in a long line of noted physicians making contributions to this field, such as Eva Dodge, John Ebbs,
Winslow Tompkins, Reginald Hamlin, J.F. Kerr Grieve, James Henry Ferguson, Robert A. Ross, Maurice B. Strauss.
The work also commends itself to the practicing obstetrician because it shows what just one doctor can do to find evidence
to support an insight derived from careful reflection on a clinical problem.
Dr. Brewer provides evidence that protein-calorie malnutrition is a causal factor of high significance in the so-called "mysterious
disease," eclamptogenic toxemia, or gestosis. He points out the necessity of adequate salt intake to meet the physiological
expansion of the extracellular water compartment of pregnancy. This awareness leads naturally to complete avoidance of saluretic
diuretics, use of which reduces this compartment. In like fashion increased amounts of protein, iron and ascorbic and folic
acid are required to build up expansion of the red cell mass which occurs, not to mention the fetal needs.
Equally flawed is the old concept of fetus as perfect parasite. If the mother does not receive adequate nutritional support
from her environment, both mother and fetus will suffer the harmful consequences. The book that follows is an excellent point
of departure for interested professionals in their quest for enhancing awareness on this vital subject.
Douglas R. Shanklin, M.D.
Formerly Professor Obstetrics and Gynecology,
University of Chicago and Pathologist-in-chief,
Chicago Lying-in Hospital
June, 1982
(Dr. Douglas R. Shanklin)
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