"The English disease" or "Asian rickets"? Medical responses to postcolonial immigration

Bulletin of the History of Medicine

Volumn 81, Issue 3, 2007, Pages 533-568

  Bivins, Roberta ^a  

^a CARDIFF UNIVERSITY   (United Kingdom)

Author keywords

Assimilation; British Asian; Ethnicity; Immigration; Osteomalacia; Postcolonial medicine; Rickets

Indexed keywords

BANGLADESH; ETHNOLOGY; HISTORY; HUMAN; INDIA; MIGRATION; OSTEOMALACIA; PAKISTAN; POLITICAL SYSTEM; REVIEW; RICKETS; TIME; TROPICAL MEDICINE; UNITED KINGDOM; VITAMIN D DEFICIENCY;

BANGLADESH; COLONIALISM; EMIGRATION AND IMMIGRATION; GREAT BRITAIN; HISTORY, 20TH CENTURY; HUMANS; INDIA; OSTEOMALACIA; PAKISTAN; RICKETS; TIME FACTORS; TROPICAL MEDICINE; VITAMIN D DEFICIENCY;

EID: 34848842776     PISSN: 00075140     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (185)

1. The following sample the different approaches to and contexts of colonial and imperial medicine: Warwick Anderson, "Immunities of Empire: Race, Disease, and the New Tropical Medicine, 1900-1920," Bull. Hist. Med., 1996, 70:94-118;
2. David Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India (Berkeley: University of California Press, 1993);
3. Amy Fairchild, Science at the Borders: Immigrant Medical Inspection and the Shaping of the Modern Industrial Workforce (Baltimore: Johns Hopkins University Press, 2003) ;
4. Mark Harrison and Michael Worboys, "A Disease of Civilisation: Tuberculosis in Britain, Africa and India, 1900-1939," in Migrants, Minorities and Health: Historical and Contemporary Studies, ed. Lara Marks and Michael Worboys (London: Routledge, 1997), pp. 93-124;
5. Mark Harrison, Public Health in British India: Anglo-Indian Preventive Medicine, 1859-1914 (Cambridge: Cambridge University Press, 1994);
6. Daniel Headrick, Tools of Empire: Technology and European Imperialism in the Nineteenth Century (Oxford: Oxford University Press, 1981);
7. Shula Marks, "What Is Colonial about Colonial Medicine? And What Has Happened to Imperialism and Health?" Soc. Hist. Med., 1997, 10: 205-19;
8. Megan Vaughan, Curing Their Ills: Colonial Power and African Illness (Oxford: Polity Press, 1991);
9. Luise White, Speaking with Vampires: Rumor and History in Colonial Africa (Berkeley: University of California Press, 2000);
10. Michael Worboys, "The Colonial World as Mission and Mandate: Leprosy and Empire, 1900-1940," Osiris, 2001, 15: 207-18;
11. Worboys, "Tuberculosis and Race in Britain and Its Empire, 1900-50," in Race, Science and Medicine, 1700-1960, ed. Waltraud Ernst and Bernard Harris (London: Routledge, 1999), pp. 144-66.
12. For critiques of this literature, see Warwick Anderson, "Where Is the Postcolonial History of Medicine?" Bull. Hist. Med., 1998, 72: 522-30;
13. Anderson, "How's the Empire? An Essay Review," J. Hist. Med. & Allied Sci., 2003, 58: 459-65.
14. See also Randall Packard, "Postcolonial Post-Colonial Medicine," in Medicine in the Twentieth Century, ed. Roger Cooter and John Pickstone (Amsterdam: Harwood Academic Press, 2000), pp. 97-112.
15. The actualities of colonial medicine have recently been explored from a range of perspectives, particularly in relation to the input of indigenous practitioners, and forms of popular resistance. See, e.g., Heather Bell, Frontiers of Medicine in the Anglo-Egyptian Sudan, 1899-1940 (Oxford: Oxford University Press, 1999);
16. Bell, "Midwifery Training and Female Circumcision in the Inter-War Anglo-Egyptian Sudan," J. Afr. Hist., 1998, 39: 293-312;
17. Christian Hochmuth, "Patterns of Medical Culture in Colonial Bengal, 1835-1880," Bull. Hist. Med., 2006, 80: 39-72;
18. Sarah Hodges, "'Looting' the Lock Hospital in Colonial Madras during the Famine Years of the 1870s," Soc. Hist. Med., 2005, 18: 379-98.
19. See, e.g., Colin Holmes, John Bull's Island: Immigration and British Society, 1871-1971 (London: Macmillan, 1988), esp. chap. 5 (pp. 209-72).
20. As a starting point, see Holmes, John Bull's Island (n. 3) ;
21. Colin Holmes, A Tolerant Country'? Immigrants, Refugees, and Minorities in Britain (London: Faberand Faber, 1991);
22. Daniel Lawrence, Black Migrants, White Natives: A Study of Race Relations in Nottingham (Cambridge: Cambridge University Press, 1974);
23. Panikos Panayi, ed., Racial Violence in Britain in the Nineteenth and Twentieth Centuries, rev. ed. (London: Leicester University Press, 1996);
24. Kathleen Paul, Whitewashing Britain: Race and Citizenship in the Postwar Era (Ithaca: Cornell University Press, 1997);
25. Robert Winder, Bloody Foreigners: The Story of Immigration to Britain (London: Abacus Press, 2004), esp. chaps. 20-22.
26. For examples of the twentieth-century relationship between medicine and immigration, see Fairchild, Science at the Borders (n. 1);
27. Alan Kraut, Silent Travelers: Germs, Genes, and the "Immigrant Menace" (Baltimore: Johns Hopkins University Press, 1995);
28. Nayan Shah, Contagious Divides: Epidemics and Race in San Francisco's Chinatown (Berkeley and Los Angeles: University of California Press, 2001).
29. Little has yet been published on this subject in the United Kingdom, but see Krista Maglen, "Intercepting Infection: Quarantine, the Port Sanitary Authority, and Immigration in Late Nineteenth and Early Twentieth Century Britain" (Ph.D. diss., University of Glasgow, 2001);
30. Marks and Worboys, Migrants, Minorities (n. 1).
31. In ongoing research, I am examining the perspectives of individual immigrant and British Asian patients, their families, and their communities. Here, however, I am primarily concerned with medical and policy responses to these groups. In the category of "visible responses" I include such material as research papers, editorials, letters, grant applications, and policy-statements from professional organizations.
32. No responsible or rigorous historian of medicine could argue that medical researchers, colonial or postcolonial, were unconcerned about the health or medical needs of their patients. Those studying rickets in Britain's Asian communities were certainly motivated to treat, as well as to study, the phenomena of vitamin D deficiency; some became advocates for their patient-communities. However, in general, their interest in the condition stemmed from, and their approaches to it were driven by, its scientific rather than its humanitarian merit.
33. See Melbourne Tapper, "An 'Anthropathology' of the 'American Negro': Anthropology, Genetics, and the New Racial Science, 1940-1952," Soc. Hist. Med., 1997, 10: 263-89, for another perspective on this phenomenon, in the case of sickle-cell anemia.
34. The language of "colonization" is that of the actors themselves. For instance, John Fishwick, town clerk of the London borough of Lambeth, complained to the Ministry of Health in February 1955: "A complication is that coloured immigrants naturally gravitate on first arrival to 'colonies' of their kind and remain there" (The National Archives, Public Record Office, Kew, Richmond, Surrey [TNA/PRO], MH 58/670). On the colonial case, see Michael Worboys, "The Emergence of Tropical Medicine: A Study in the Establishment of a Scientific Specialty," in Perspectives on the Emergence of Scientific Disciplines, ed. Gerard Lemaine, Roy MacLeod, Michael Mulkay, and Peter Weingart (Chicago: Aldine Press, 1976), pp. 73-96, on p. 83: "The investigation and teaching of the etiology and treatment of tropical diseases was developing in an environment and culture totally different from the tropics. Work on etiology became exclusively scientific, based on parasitological studies and the germ theory of disease. The clinical treatment of these diseases took precedence over prevention and epidemiological studies of disease incidence and control. In the metropolitan situation, remote from the practice problems of the tropics, the study of tropical diseases became increasingly preoccupied with scientific problems rather than with the problems of poor health."
35. TNA/PRO FD 1/1974. The Medical Research Committee (later Council) was established in 1913 to advise the government on matters of medical research relating to tuberculosis, and to distribute funds. Fletcher's skillful navigation and exploitation of wartime circumstances, however, saw the nascent organization transformed from a narrowly focused, tightly controlled, disease-specific research committee to a broadly defined, ambitious research organization with a great deal of autonomy in its own affairs; see Joan Austoker, "Walter Morley Fletcher and the Origins of a Basic Biomedical Research Policy," in Historical Perspectives on the Role of the MRC: Essays in the History of the Medical Research Council of the United Kingdom and Its Predecessor, the Medical Research Committee, 1913-1953, ed. Austoker and Linda Bryder (Oxford: Oxford University Press, 1989), pp. 23-33.
36. The Ministry of Health, on the other hand, emerged as part of government in 1919, from a wartime promise made by Prime Minister David Lloyd George for a healthier Britain, fit for returning heroes; see Dorothy Porter, Health, Civilization and the State: A History of Public Health from Ancient to Modem Times (London: Roudedge, 1999). The two organizations drew up a concordat in 1924 to delineate research "territory," with the Ministry having responsibility for "applied" research, while the MRC took responsibility for directing and funding "new" research. Although the terms of the document have changed over the years, a similar agreement survives to this day.
37. See, e.g., Maneesha LaI, "The Politics of Gender and Medicine in Colonial India: The Countess of Dufferin's Fund, 1885-1888," Bull. Hist. Med., 1994, 68: 29-66;
38. Geraldine Forbes, "Medical Careers and Health Care for Indian Women: Patterns of Control," Women's Hist. Rev., 1994, 3: 515-30.
39. Walter Fletcher to A. V. Hill, 29 January 1929, TNA/PRO FD 1/1974.
40. Dagmar Curgel Wilson and Ella Surie, "Osteomalacia (Late Rickets) Studies. III. Dietary Factors in the Aetiology of Osteomalacia," 1929, pp. 2, 14, TNA/PRO FD 1/1974.
41. Ibid., p. 4.
42. C. W. Daniels, "Filariae and Filarial Disease in British Guiana,"J Trop. Med., 1898, 1: 15, cited in Anderson, "Immunities of Empire" (n. 1), on p. 113.
43. See Anderson, "Immunities of Empire" (n. 1); Arnold, Colonizing the Body (n. 1). Of course, an interest in habits and customs also typified particularly sanitarian studies of the European and American "underclass," and many studies of African American populations.
44. Walter Fletcher to George Newman, 13 November 1929, TNA/PRO FD 1/1974 (emphasis added). The letter also reflected the strong bias of the MRC toward biochemical models and biomedical scientists, rather than clinicians as researchers.
45. See Arnold, Colonizing the Body (n. 1), for the archetypal examples of variolation and pilgrimage practices in colonial India, and for the more cautious approach taken later in relation to plague. And see Bell, "Midwifery Training" (n. 2), for a counterexample.
46. Wilson and Surie, "Osteomalacia" (n. 13), p. 14.
47. See Kathleen Olga Vaughan, The Purdah System and Its Effect on Motherhood: Osteomalacia Caused by the Absence of Light in India (Cambridge: Heffer, 1928). Such research results might or might not be published monographically or in journals dedicated to colonial or tropical medicine; however, these publications were little cited by policymakers addressing British medicine or medical needs. I have found no reference to sources published in Indian or Pakistani journals, or by authors with identifiably Indian or Pakistani names, in the official records for this period, save for a few collaborations (generally based in British teaching hospitals) with recognized British researchers.
48. See Celia Petty, "Primary Research and Public Health: The Prioritization of Nutrition Research in Inter-war Britain," in Austoker and Bryder, Historical Perspectives (n. 10), pp. 83-108;
49. David F. Smith, ed., Nutrition in Britain: Science, Scientists and Politics in the Twentieth Century (London: Routledge, 1997);
50. Harmke Kamminga and Andrew Cunningham, eds., The Science and Culture of Nutrition, 1840-1940 (Amsterdam: Rodopi, 1995).
51. Rima Apple, Vitamania: Vitamins in American Culture (Rutgers: Rutgers University Press, 1996), pp. 33-53.
52. For a timeline of research on vitamin D, see Roberta Conlan and Elizabeth Sherman, Unraveling the Enigma of Vitamin D (Washington, D.C.: National Academy of Science, 2000), Web-published atwww.beyonddiscovery.org (accessed 12 December 2004).
53. David F. Smith and Malcolm Nicholson, "Chemical Physiology Versus Biochemistry, the Clinic Versus the Laboratory: The Glaswegian Opposition to Edward Mellanby's Theory of Rickets," Proc. Roy. Coll. Physicians Edinburgh, 1989, 19: 51-60.
54. Wilfred Sheldon, "Observations on Rickets," Lancet, 1935, 225: 134.
55. Craniotabes could be distinguished by the distinctive "rubber ball" (and later, "eggshell crackling") of sensations it presented to the experienced touch on an affected infant's skull.
56. "Rickets," Lancet, 1940, 235: 84-85, on p. 84.
57. See Smith and Nicholson, "Chemical Physiology" (n. 23), pp. 55-59.
58. Anne Murcott, "Food and Nutrition in Post-War Britain," in Understanding Post-War British Society, ed. James Obelkevich and Peter Catterall (London: Roudedge, 1994), pp. 155-64.
59. David Krestin, "Treatment of Rickets with Single Massive Doses of Vitamin D2," Lancet, 1945, 245: 781-83. TNA/PRO MH 55/1558, MH 55/2336, and MAF 256/219 also document the emergence of an increasingly judgmental stance.
60. See Charles Webster, "Government Policy on School Meals and Welfare Foods, 1939-1970," in Smith, Nutrition in Britain (n. 21), pp. 190-213;
61. Ministry of Health and Department of Health for Scotland, Report of the Joint Sub-Committee on Welfare Foods (London: HMSO, 1957);
62. W T. C. Berry, "Nutritional Aspects of Food Policy," Proc. Nutr. Soc, 1968, 27: 1-8.
63. The papers of Charles E. Dent, a pioneer in the field of metabolic rickets and founder of the University College Hospital Metabolic Ward in 1951, offer invaluable material on this subject: Contemporary Medical Archives Centre, Wellcome Library, London (CMAC), PP/ CED, esp. PP/CED/C.3/1/2, PP/CED/C.3/1/3, PP/CED/E.1/65, and PP/CED/E.1/77 (the first two files illustrate collaborations with Glaxo and Bayer; the last two, Dent's view of the shift from nutritional to metabolic rickets).
64. Webster, "Government Policy" (n. 30).
65. "Draft letter to Hospitals/Consultants from Secretary, Vitamin D subcommittee of the BPA, 5 January 1959," TNA/PRO MH 55/2335.
66. Medical Research Council, "Report of the Conference on Hypercalcemia in Infants," May 1956, p. 1, TNA/PRO MAF 256/219. By 1971, the Food and Agriculture Organization and the World Health Organization were using Britain as a model of the risks of oversupplementation with a potentially toxic nutrient: FAO/WHO, Joint FAO/WHO Expert Committee on Nutrition, Eighth Report: Food Fortification, Protein-Calorie Malnutrition, World Health Organization Technical Report Series, no. 447 (1971), pp. 27-28.
67. W. K. Stewart, R. G. Mitchell, H. G. Morgan, K. G. Lowe, and J. Thomson, "The Changing Incidence of Rickets and Hypercalcaemia as Seen in Dundee," Lancet, 1964, 283: 679-82, on p. 680.
68. The files of the British Ministries of Health (MoH) and Agriculture, Fisheries and Food (MAFF) and the Division of Maternal and Child Welfare offer rich evidence of these debates and the intersections between food manufacturers, food policy, and concerns about "mass medication" and the public health. See, e.g., TNA/PRO MH 55/2335, MH 55/2336, MAF 256/219. Some historical analysis of these debates is provided in Petty, "Primary Research" (n. 21); and see, of course, Hansard for both the House of Commons and House of Lords.
69. MRC, "Report of the Conference on Hypercalcaemia in Infants" (n. 34), p. 2.
70. In the 1940s margarine was selected as the vehicle for mandatory vitamin D supplementation, along with the National Dried Milk, based on the dietary habits of the majority population, in combination with the rationing of butter.
71. PQ 1498/72/73,14 March 1973, Parliamentary Debates, Lords, 5th ser., vol. 340, cols. 300-303.
72. For examples and cases, see Roy MacLeod and Milton Lewis, eds., Disease, Medicine and Empire: Perspectives on Western Medicine and the Experience of European Expansion (London: Routledge, 1988);
73. Biswamoy Pati and Mark Harrison, eds., Health, Medicine and Empire: Perspectives on Colonial India (Hyderabad: Orient Longman, 2001); Tapper, "'Anthropathology'" (n. 8);
74. Michael Worboys, "Germs, Malaria and the Invention of Mansonian Tropical Medicine: From 'Diseases in the Tropics' to 'Tropical Diseases,'" in Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500-1900, ed. David Arnold (Amsterdam: Rodopi, 1996), pp. 181-207;
75. Jennifer Beinart, "The Inner World of Imperial Sickness: The MRC and Research in Tropical Medicine," in Austoker and Bryder, Historical Perspectives (n. 10), pp. 109-35.
76. On the programmatic aims and methods of tropical medicine, see David Arnold, "Introduction: Tropical Medicine before Manson," in Arnold, Warm Climates (n. 40), pp. 1-19;
77. Worboys, "Germs, Malaria" (n. 40). On nutritional diseases as tropical medicine,
78. see Beinart, "Inner World" (n. 40). Not all fieldwork was done in tropical locations: the working-class slums of Britain and Europe were also research sites (in nutritional work, particularly after World War I). Their populations were "colonized" by biomedicine in almost identical ways - a fact that either problematizes or valuably extends the concept of "colonial medicine," depending on the interpreter's historiographic perspective.
79. But see Philippa Levine, Prostitution, Race, and Politics: Policing Venereal Disease in the British Empire (New York: Routledge, 2003), for a cogent discussion of differences between even ostensibly similar practices in colonial and metropolitan settings.
80. See, e.g., Helen Sheiham and Allison Quick, The Rickets Report: Why Do British Asians Get Rickets? (London: Haringey Community Health Council, 1982), p. 6.
81. See G. C. Arneil and J. C. Crosbie, "Infantile Rickets Returns to Glasgow," Lancet, 1963, 282: 423-25;
82. Panel on Child Nutrition: Meeting of the Chairmen of Working Groups, 18 December 1972, p. 1, TNA/PRO MH 148/623; and below.
83. E.g., in chronological order, J. A. Ford, "Proceedings: Aetiology of Asian Rickets and Osteomalacia in the United Kingdom," Arch. Dis. Childhood, 1973, 48: 827-28;
84. Ford, "Asian Rickets and Osteomalacia," Nursing Times, 1974, 70: 49-50;
85. S. W. Stanbury, P. Torkington, G. A. Lumb, P. H. Adams, P. de Silva, and C. M. Taylor, "Asian Rickets and Osteomalacia: Patterns of Parathyroid Response in Vitamin D Deficiency," Proc. Nutr. Soc., 1975, 34: 111-17;
86. I. Robertson, A. Kelman, and M. G. Dunnigan, "Chapatty Intake, Vitamin D Status and Asian Rickets," Brit. Med. J., 1977, 1: 229-30;
87. J. A. Ford, W. B. McIntosh, S. Haase, A. W. Wright, and M. G. Dunnigan, "Treatment of Severe Asian Rickets with Vitamin D-Fortified Chupatti Flour," Arch. Dis. Childhood, 1977, 52: 743-44;
88. M. G. Dunnigan and I. Robertson, "Residence in Britain as a Risk Factor for Asian Rickets and Osteomalacia," Lancet, 1980, 315: 770;
89. M. G. Dunnigan, W. B. McIntosh, G. R. Sutherland, et al., "Policy for Prevention of Asian Rickets in Britain: A Preliminary Assessment of the Glasgow Rickets Campaign," Brit. Med. J. (Clin. Res. ed.), 1981, 282: 357-60;
90. "Asian Rickets in Britain," Lancet, 1981, 318: 402. As the list of authors suggests, this is a small community-but a prolific and highly influential one. I found no evidence of reservations about this terminology, which was widely used within articles and policy papers.
91. Berry, "Nutritional Aspects" (n. 30), p. 3.
92. Ibid., p. 7.
93. Ibid., p. 3.
94. COMA Panel on Child Nutrition, "Minutes of the meeting held on October 5 1972 at the DHSS," CMAC PP/CED/B.2/5.
95. Helen K. Valier, "The Politics of Scientific Medicine in Manchester, c. 1900-1960" (D.Phil, diss., University of Manchester, 2002);
96. Helen K. Valier and John V. Pickstone, The Manchester Royal Infirmary, 1945-2002 (in press), p. 108.
97. Quoted in COMA, Interim Report on Vitamin D by the Panel on Child Nutrition; First Report of the Panel on Nutrition of the Elderly (London: Stationery Office, 1970), pp. 12-13. See also TNA/PRO MH 55/2335 for records of this study.
98. C. E. Dent to J. Kyle Smith, 10 September 1960, CMAC PP/CED/C.3/1/3.
99. Among some workers, low rates of referral had become a cause for despair by 1972. See K. P. Dawson and M. S. Mondhe, "Nutritional Rickets among the Immigrant Population of Bradford," Practitioner, 1972, 208: 789-91, on p. 790: "Despite the publicity given to the patterns of illness in immigrants, we have been surprised by the complete absence of reference to rickets or vitamin D deficiency in the referral letters from general practitioners."
100. Dent to Dr. Tizard, 14 JuIy 1956, CMAC PP/CED/C.3/1/3.
101. Although this was and is the most common way in which any/all patients can be at the heart of research, it is not the only way: see Helen Valier and Roberta Bivins, "Organization, Ethnicity and the British National Health Service," in Innovations in Health and Medicine: Diffusion and Resistance in the Twentieth Century, ed. Jennifer Stanton (London: Routledge, 2002), pp. 37-64, for an alternative model of patient and community involvement, as displayed in Manchester's responses to sickle-cell anemia and thalassemia.
102. On colonial malnutrition, see Beinart, "Inner World" (n. 40), pp. 121-26;
103. Michael Worboys, "The Discovery of Colonial Malnutrition between the Wars," in Imperial Medicine and Indigenous Societies, ed. David Arnold (Manchester: Manchester University Press, 1988), pp. 208-25.
104. For the notion of (racially or regionally identified) disease as a commodity, see Keith Wailoo, Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health (Chapel Hill: University of North Carolina Press, 2001).
105. Glasgow research, of course, drew upon a heritage of environmental rather than molecular explanations of rickets, while research output from Birmingham and Bradford focused strongly on public health and population studies of the reemergent disease.
106. See, e.g., Sheiham and Quick, Rickets Report (n. 42);
107. Community Nutrition Group, "Food and Ethnic Minorities," Information Sheet 16, 1989; Health Education Authority, "Nutrition in Minority Ethnic Groups," 1991.
108. The Glasgow researchers studying phytate and promoting fortification did distinguish between different "Asian" populations (albeit with some prodding from Subcontinental colleagues - e.g., S. P. S. Teotia and M. Teotia, "Nutritional Rickets in Immigrants," Brit. Med. J., 1972, 4:111-12):
109. see, e.g., J. Pietrek. M. A. Preece, J. Windo, J. L. H. O'Riordan, et al., "Prevention of Vitamin-D Deficiency in Asians," Lancet, 1976, 307: 1145-48.
110. COMA Panel on Child Nutrition, "Minutes of the meeting held on October 5 1972" (n. 48).
111. Panel on Child Nutrition: Meeting of the Chairmen (n. 43), p. 1.
112. For figures on tuberculosis morbidity and mortality among immigrants, related debates, and examples of public and press sentiments on the subject, see TNA/PRO MH 55/2275 and 55/2276.
113. S. W. Stanbury toJ. M. L. Stephen, 6 March 1973, p. 1 (emphasis added), TNA/PRO MH 148/623.
114. Ibid., p. 2.
115. Ibid., pp. 2-3.
116. See C. E. Dent and J. O'Riordan, "Project for Joint UCH/Middlesex Hospital Research on Metabolic Bone Disease," 20 March 1974, CMAC PP/CED/A.2/2.
117. See, e.g., M. A. Preece, J. A. Ford, W. B. McIntosh, M. G. Dunnigan, S. Tomlinson, and J. L. H. O'Riordan, "Vitamin D Deficiency among Asian Immigrants to Britain," Lancet, 1973, 301: 907-10.
118. Ibid., p. 910.
119. Stephen Tomlinson, interviewed by author, 22 April 2004, Heath Hospital, Cardiff, Wales. This is not to say that they were not interested in finding a solution for their patients and the British Asian community-indeed, members of the group became active supporters of fortification programs. See, e.g., Pietrek et al., "Prevention" (n. 57), and other group publications post-1974.
120. J. L. H. O'Riordan to J. M. L. Stephen, 22 May 1973, TNA/PRO MH 148/623.
121. P. J. Everett [Committee for Community Medicine, British Medical Association] to R. P. Pole [Public and Environmental Health Division, DHSS], 16 June 1978, TNA/PRO MH 148/624.
122. O'Riordan to Stephen, 22 May 1973, TNA/PRO MH 148/623 (a chapatti is an unleavened flatbread made of a mixture of wholegrain and other wheat flour).
123. J. A. Sutherland to L. G. Smith, 5 September 1975, ibid.
124. S.J. Darke to Dr. G. A. H. Elton, 13 February 1975, ibid.
125. H. M. Goodall, "Background notes and draft answer," 7 May 1976, ibid.
126. The classic studies of this phenomenon in the literature are Arnold, Colonizing the Body, and Vaughan, Curing Their Ills (both n. 1).
127. For earlier examples in relation tononwhite immigration, see Nayan Shah, Contagious Divides (n. 5).
128. Sheiham and Quick, Rickets Report (n. 42), p. 24 (emphasis in original).
129. "Health Education and Diet for Ugandan Asians: Meeting with Community Relations Commission 19 October, 1976," p. 1, TNA/PRO MH 148/624.
130. S.J. Darke to K. Nagda, 22 December 1977, ibid.
131. O'Riordan to E. M. Widdowson [Chairman of COMA, Dunn Nutritional Laboratory], 31 July 1978, ibid.
132. Quoted in Derek Humphrey, "MP Seeks to Curb Rickets," Sunday Times, 20 November 1977, clipping in TNA/PRO MH 148/624.
133. Dr. W. T. Cooke to S. J. Darke, 5 May 1977, TNA/PRO MH 148/624.
134. "Rickets in Asian Communities," New Statesman, 23 February 1979, clipping in TNA/ PRO MH 148/624; D. K. Smith to L. Fosh, 28 February 1979, TNA/PRO MH 148/624.
135. "Aid Urged for Asians Affected by Rickets," Guardian, 5 July 1979, clipping in TNA/ PRO MH 148/624.
136. Memo, Darke to Dr. A. Yarrow, 13 December 1978 (emphases in original), TNA/ PRO MH 148/624.
137. Memo, Yarrow to Darke, 21 December 1978, ibid.
138. Harrison and Worboys, "Disease of Civilization" (n. 1).
139. MRC, Annual Report, 1937-38 (London: HMSO, 1939), p. 17, quoted in Beinart, "Inner World" (n. 40), p. 125.
140. There have, however, been exceptions to the rule: clinicians have often noted certain areas in which difference has been associated with health. For example, in the first half of the twentieth century, medical professionals frequendy cited the diets of Jewish and East Asian immigrants in explaining the health of those supposedly degenerate populations. See Lara Marks and Lisa Hilder, "Ethnic Advantage: Infant Survival among Jewish and Bengali Immigrants in East London, 1870-1990," in Marks and Worboys, Migrants, Minorities (n. 1), pp. 179-209.
141. Arneil and Crosbie, "Infantile Rickets Returns" (n. 43), on p. 424.
142. "Rickets and Osteomalacia," Lancet, 1962, 279: 1168-69, on p. 1168.
143. See, e.g., W. R Stewart, R. G. Mitchell, H. G. Morgan, K. G. Lowe, and J. Thomson, "The Changing Incidence of Rickets and Infantile Hypercalcaemia As Seen in Dundee," Lancet, 1964, 283: 679-82, on p. 679: "Recently a surprisingly high incidence of rickets has been reported in the Pakistani community in Glasgow . . . and in various immigrant communities (mostly coloured), in London. . . . Except in such communities and in problem families, nutritional rickets is no longer a major problem."
144. Ibid., p. 681.
145. M. R. Wills, J. B. Phillips, R. C. Day, and E. C. Bateman, "Phytic Acid and Nutritional Rickets in Immigrants," Lancet, 1972, 299: 771-73, on p. 772.
146. "Annotations: Rickets in Immigrant Children," Lancet, 1965, 285: 1106-7, on p. 1107.
147. Ibid.
148. C. E. Dent, D.J. F. Rowe, J. M. Round, and T. C. B. Stamp, "Effect of Chapattis and Ultraviolet Irradiation on Nutritional Rickets in an Indian Immigrant," Lancet, 1973, 301: 1282-84, on p. 1284.
149. See also Wills et al., "Phytic Acid" (n. 92);
150. P. Hodgkin, G. H. Kay, P. M. Hine, G. A. Lumb, and S. W. Stanbury, "Vitamin-D Deficiency in Asians at Home and in Britain," Lancet, 1973, 302:167-73 (with its piquant assumption that "Home" for Asians was in South Asia) ;
151. K. M. Goel, E. M. Sweet, R. W. Logan, et al., "Florid and Subclinical Rickets among Immigrant Children in Glasgow," Lancet, 1976, 307: 1141-45
152. (and Lancet passim);
153. T. C. B. Stamp, "Factors in Human Vitamin-D Nutrition, and in the Production and Cure of Classical Rickets," Proc. Nutr. Soc., 1975, 34: 119-30
154. (and Proc. Nutr. Soc. passim);
155. J. A. Ford, E. M. Colhoun, W. B. McIntosh, and M. G. Dunnigan, "Rickets and Osteomalacia in the Glasgow Pakistani Community, 1961-1971," Brit. Med. J., 1972, 2: 677-80;
156. E. Barbara Mawer and Anne M. Holmes, "Rickets in Glasgow Pakistanis," ibid., 3: 177-78
157. (and Brit. Med. J. passim).
158. Meanwhile, Stanbury's bristling response to press assumptions of racial (e.g., skin pigmentation) etiology for "Asian rickets" in interpreting his group's research results reveals the persistence of that claim in popular culture: see S. W. Stanbury, "Vitamin-D Deficiency in Asians," Lancet, 1973, 302: 446.
159. "Rickets and Osteomalacia" (n. 89), p. 1168.
160. For a discussion of such factors and fears, see Sheiham and Quick, Rickets Report (n. 42), pp. 35-36.
161. Not all medical professionals ignored the role of poor-quality housing and hostile social conditions: see J. M. Gertner and Brenda Lawrie, "Preventing Nutritional Rickets," Lancet, 1977, 309: 257.
162. See TNA/PRO MH 148/264.
163. L. Willcocks to Caroline Ralston, 17 March 1980, p. 1, ibid.
164. Ibid., p. 2.
165. Joan Stephens, "Epidemiological and Dietary Aspects of Rickets and Osteomalacia," Proc. Nutr. Soc., 1975, 34: 131-75, on p. 137.
166. For other examples, see Dunnigan and Robertson, "Residence in Britain as a Risk Factor" (n. 44);
167. Goel et al., "Florid and Subclinical Rickets" (n. 95);
168. Pietrek et al., "Prevention" (n. 57);
169. Wills et al., "Phytic Acid" (n. 92).
170. W. P. Stephens, P. S. Klimiuk, S. Warrington,J. L. Taylor, J. L. Berry, and E. B. Mawer, "Observations on the Natural History of Vitamin D Deficiency amongst Asian Immigrants," Quart. J. Med., 1982, 51: 171-88, on p. 171.
171. K. M. Goel, E. M. Sweet, S. Campbell, et al., "Reduced Prevalence of Rickets in Asian Children in Glasgow," Lancet, 1981, 318: 405-7, on p. 406.
172. Ibid., p. 405.
173. W. P. Stephens, P. S. Klimiuk, S. Warrington, and J. L. Taylor, "Observations on the Dietary Practices of Asians in the United Kingdom," Hum. Nutr. - Appl. Nutr., 1982, 36: 438-44, on p. 444.
174. C. W. Lo, P. W. Paris, and M. F. Holick, "Indian and Pakistani Immigrants Have the Same Capacity as Caucasians to Produce Vitamin D in Response to Ultraviolet Irradiation," Amer. J Clin. Nutr., 1986, 44: 683-85, on p. 683.
175. S. J. Iqbal, I. Kaddam, W. Wassif, F. Nichol, and J. Walls, "Continuing Clinically Severe Vitamin D Deficiency in Asians in the UK (Leicester)," Postgrad. Med. J., 1994, 70: 708-14, on p. 708.
176. See also M. Lawson and M. Thomas, "Vitamin D Concentrations in Asian Children Aged 2 Years Living in England: Population Survey," Brit. Med. J., 1999, 318: 28;
177. Brian Wharton and Nick Bishop, "Rickets," Lancet, 2003, 362: 1389-1400.
178. Many of the articles cited above, published from the mid-1970s onward, advocate supplementation; see also the influential editorial in the Lancet, "Asian Rickets in Britain" (n. 44), which lambasted "ineffective preventive action by health services" and condemned governmental resistance to supplementation as a "pursuit of perfection [that] may remain the enemy of progress" (p. 402).
179. See, e.g., Jenny Donovan, "Ethnicity and Health: A Research Review," Soc. Sci. & Med., 1984, 19: 663-70;
180. Donovan, "We Don't Buy Sickness, It Just Comes": Health, Illness and Health Care in the Lives of Black People in London (Aldershot: Gower, 1986);
181. D. Kelleher and S. Hillier, eds., Researching Cultural Differences in Health (London: Roudedge, 1996);
182. Nayan Shah, Contagious Divides (n. 5) ;
183. Valier and Bivins, "Organization, Ethnicity" (n. 54) ;
184. Wailoo, Dying the City of the Blues (n. 55);
185. J. Ramakrishna and M. Weiss, "Health, Illness and Immigration: East Indians in the United States," Western J. Med., 1992, 157: 265-70.