Malnutrition in Newfoundland and Labrador
In 1663 James Yonge, a surgeon from Plymouth, England came to Newfoundland to provide medical care for the fishermen at Renews and Fermeuse. In his memoirs, he wrote: “The diseases of this country are: breaking out of the arm wrests [sores on the wrists, or water pups], colds and coughs, and the scurvy, of which they have two sorts, the one an acute scurvy, soon caught, soon cured, the other a catchy, or dry scurvy, which makes the patient look thin, yellow, squalled, with pain and paresis of the limbs, and is often mortal.” Well over 200 years later, Dr. George Corner of the Grenfell Mission noted that medical work in northern Newfoundland was similar to anywhere else, with the exception of tuberculosis and nutritional deficiency diseases such as scurvy, rickets, and beriberi. The common cause or risk factor in these diseases is malnutrition, and as these two doctors found, malnutrition was (and in some ways, still is) one of the greatest medical problems in Newfoundland and in Labrador for hundreds of years.
Malnutrition occurs when people are unable (or unwilling) to eat a well-balanced diet that contains all the calories and nutrients that the body needs to survive and be healthy. Without an adequate supply of calories people do not have sufficient energy to work and carry out tasks necessary for survival. More familiar in Newfoundland and in Labrador were deficiency diseases, caused by diets lacking in certain vitamins and minerals, and common in places where poverty or isolation prevents access to a sufficient variety or quantity of food. Newfoundland's population was relatively isolated and spread out along a coastline that is difficult to navigate. This was especially true in the years before Confederation, after which transportation networks began to improve.
Both Newfoundland and Labrador have generally poor soil and short growing seasons, meaning that most food has to be imported, increasing the cost. Electricity, refrigerators and freezers were not widely available before the 1950s, and food would therefore spoil unless preserved by salting, smoking, or pickling, although root cellars could keep vegetables edible for some time. These factors made people dependent upon foods that were either locally grown (such as potatoes), preserved (such as salt fish or salt pork) or had a long shelf life (like flour, tea, and molasses). Vitamin rich foods such as fresh fruit and fresh meat were rare, although diets were improved by berry-picking, hunting, and so on.
Although there were extensive trade networks supplying food and other items to the population, fresh food could not be transported great distances without spoiling. Supplying small outports year round was especially difficult in the northern parts of the island and Labrador, where ice prevented the movement of ships for months at a time. By the spring, people would often be living mainly on flour, tea, and molasses. This diet could potentially be high in calories, but not if supplies were running low, and these foods are not rich in nutrients. This affected the health of the population. A 1948 survey of nutrition in Newfoundland, for example, found that boys aged 5 to 15 were on average about 2 inches shorter and 8 pounds lighter than boys of the same age in Toronto. Girls were about 2.75 inches shorter and 7.7 pounds lighter than their Torontonian counterparts, demonstrating that the diet was deficient in calories, vitamins and minerals. In addition, without those nutrients people are susceptible to various deficiency diseases.
One of those diseases, familiar to seafarers for centuries, is scurvy. Caused by a lack of vitamin C in the diet, symptoms of scurvy include spots on the skin, soft gums and loss of teeth, immobility and, if left untreated, death. Foods often eaten in Newfoundland such as potatoes, cabbages, carrots, black currents and berries contain some vitamin C, but common methods of cooking (peeling potatoes and boiling cabbage for a long time, for example) remove much of their vitamins. Although seriously advanced cases of scurvy were not usually seen except on long sea voyages, it was present in Newfoundland due to a lack of citrus fruit (a very rich source of vitamin C) and other fresh foods in most Newfoundland diets.
Rickets was commonly encountered by medical personnel in Newfoundland. A disease in which bones become soft and deformed, rickets causes bow legs, knock knees, soft skulls, sore muscles and joints, and fractures. Although it can occur in adults, rickets usually affects young children who have a vitamin D deficiency, which is common in areas without access to fresh fatty fish and meats and without much sunlight exposure, which causes vitamin D to be synthesized by the skin. Vitamin D is necessary to metabolize calcium and create strong bones and teeth. If children with rickets are not treated, physical deformities can be permanent. Cod liver oil is a rich source of vitamin D, and its use prevented rickets from becoming more prevalent in Newfoundland and Labrador.
The availability of food such as potatoes and cabbages to prevent scurvy, and the use of cod liver oil to prevent rickets meant that cases of these two diseases were usually mild. More serious was beriberi. Between 1912 and 1928, for example, the Grenfell hospital at St. Anthony admitted only thirteen cases of severe scurvy, but 174 cases of beriberi, and in 1914 Dr. Little reported treating two to three cases a day there.
Beriberi is caused by a diet lacking thiamine (vitamin B1). Thiamine is needed to break down sugars into energy and is important for nerve function. Without it, people become tired and lethargic, suffer from mental problems and develop weak, tingling and painful limbs. If the disease affects the heart, it can cause irregular heart rate and ultimately be fatal.
Thiamine is found in fresh meat, fruits and vegetables, but the best source is whole grains, and diets rich in these foods usually prevent beriberi. However, when whole grain is refined into white flour, the thiamine-rich bran (or grain husk) is lost, and bread made from that flour is no longer a source of thiamine. This made beriberi endemic amongst the population of Newfoundland and Labrador in the winter, when isolated families' supplies of meat and vegetables were dwindling and diets were dependent upon white flour.
Malnutrition as a Risk Factor for Infection
Both Newfoundland and Labrador had very high rates of infectious disease until the middle of the twentieth century, and one of the reasons for this was malnutrition. A diet low in important nutrients weakens the immune system and leaves people vulnerable to infections such as colds and influenza. Tuberculosis especially would often attack those with poor diets, while those better fed were able to fight off the infection. This was one of the reasons why TB rates in Newfoundland and in Labrador were so high compared to Canada and Britain. In 1940, for example, the death rate per 100,000 people in Newfoundland from TB was 172, but only 64 in Great Britain and 51 in Canada. (See articles about TB in Newfoundland and Labrador)
Efforts to Cure and Prevent Deficiency Diseases
With little or no changes in the techniques of preserving food or advances in transportation, there was little that could be done about malnutrition until the early twentieth century. At that time the germ theory of disease was prevalent, and quite often doctors believed that diseases such as scurvy, rickets, and beriberi were caused by germs. However, the fact that citrus fruits cured scurvy had been known in the British Royal Navy since the mid-1700s, and researchers with the Japanese Navy had discovered that a diet of brown rice instead of polished white rice (which, like white flour, had the thiamine-rich bran removed) prevented beriberi. By the 1910s, doctors better understood the role of vitamins and minerals in preventing these diseases, and recognized that improved diets could largely prevent them.
Accordingly, health care providers such as the Grenfell Association began to provide health education in addition to primary health care. Recognizing that poor nutrition was often as much a result of poor education as it was of economic hardship and isolation, Grenfell sought to teach people about the importance of a varied diet. Doctors and nurses with the Association taught patients, especially mothers with young children, about the importance of proper nutrition. Originally the Association organized lectures to encourage the use of whole wheat flour and the consumption of more fruits and vegetables, and when this approach met with limited success, they recruited women trained in home economics to act as nutritionists. In the 1920s, 24 women, many from the United States, worked as nutritionists. By being more culturally sensitive and aware of local tastes and food preferences, they had more success in teaching people about nutrition. The Department of Public Health and Welfare hired a nutritionist in 1947, who worked through teachers and public health nurses to distribute information about nutrition.
But education was of little use if food was unavailable or unaffordable. Grenfell recognized this problem, and worked to improve the economy in rural areas to reduce poverty and allow people to purchase better supplies. To that end, the Newfoundland Government also made attempts to improve the nutritional value of the food it distributed as relief supplies to the unemployed. Dr. Nigel Rusted, during his term as doctor aboard the MV Lady Anderson on Newfoundland's south coast in 1935-36, wrote notes for food for undernourished children, a note for extra milk for a pair of young twins for example. The Commission of Government distributed food as part of their relief efforts, and began purchasing vitamin B-enriched flour in an effort to prevent beriberi. It also tried to convince people to switch from white flour to brown flour, but people did not like the brown flour and were reluctant to use it. The nutritionally-enriched beverage Cocomalt was made available to school children starting in 1936, and margarine (or butterine) was fortified with vitamin A starting in 1945.
The coming of war in 1939 and the relative prosperity brought on by the base construction boom and employment opportunities in the armed services made the population better able to supply their nutritional needs. The Canadian social security system improved matters in 1949, and with the increasing availability of refrigeration and better transportation, fresh fruit and vegetables finally became accessible to most of the population.
Although deficiency disorders such as scurvy, rickets and beriberi are now rare, malnutrition is still a problem in Newfoundland and Labrador. Obesity, heart disease, high blood pressure and diabetes are all linked to diets with too much fat, sugar and salt and lacking fresh foods that are rich in vitamins and minerals. Newfoundland and Labrador has some of the highest incidence rates of these health problems in Canada. In 2004-2005 for example, the prevalence rate of diabetes (per 100 people) in Canada was 5.2 for females and 5.8 for males, but in Newfoundland and Labrador the rates were 7.1 for females and 6.9 for males, or about 25 percent higher. The combined rate in Newfoundland and Labrador increased to 9.3 percent in 2010, and is projected to reach almost 15 percent by 2020. Although serious deficiency disorders are rarely encountered, malnutrition in the form of unhealthy eating is still a problem in Newfoundland and Labrador.