When prescribing diets for the working classes, we have to bear in mind the following important points : (1) the diet, in its general lines of construction, must be similar to the meals which the poorer classes habitually take; for instance, it must contain considerably more carbo-hydrates than fat, roughly in the proportion of 5 parts of carbo-hydrate to 1 of fat. (2) The diet must be cheap, generally speaking, not costing more than one shilling a day.

Principles Of Construction Of The Average Working Class Diet

The general lines of construction of dietaries taken by the working classes are well shown in the following table. This table represents an analysis which we have made of 100 efficient diets taken by working class families. The average nutritive value of these 100 diets works out at protein 127 grammes, fat 114 grammes, and carbo-hydrate 417 grammes, giving a calorie value of 3,290, the average cost, excluding a small amount spent on beer, being lOd. a day.

Man.

Woman.

Tea.

Three slices thin bread and butter.

Bread.

Butter.

Jam, cake, cress, etc.

Two slices thin bread and butter.

Supper.

3 oz. (a large helping).

Cold meat, boiled ham, tongue, fillets of fish, brawn, sausage, macaroni, cheese, etc., etc.

2 1/2 oz. (a large helping).

5 oz. (a fair-sized helping).

Cold sweet such as cream, blancmange, fruit and custard, trifle, etc.

4 oz. (a fair-sized helping).

1 pint.

Milk (possibly made into cocoa).

1 pint.

2 oz. (half a round, thick).

Bread or biscuit (with cheese if preferred).

11/2 oz. (half a round).

1/2 oz. (piece the size of a walnut).

Butter.

1/2 oz. (a piece the size of a walnut).

Table Showing The Average Of 100 Efficient Dietaries Taken By Working-Class Families

Foodstuffs.

Amount

Price (retail).

Cost in Pence.

Protein.

Fat.

Carbohydrate.

Grammes.

Milk .

1/2 pt. 280

@ 1 1/2d. per pt.

075

10

11

14

Meat1 .

9 oz. 250

@ 7d. per lb.

393

38

48

-

Butter .

2/3 oz. 20

@ 1s. per lb.

050

-

16

-

Fish. .

2 oz. 56

@ 4d. per lb.

050

5

1

-

Cheese .

1/2 oz. 14

@ 6d. per lb.

020

4

5

-

Egg. .

one one

@ 3 for 2d.

066

6

4

-

Bacon .

2 oz. 56

@ 6d. per lb.

075

6

24

-

Total animal food.............

729

69

109

14

Bread 2.

14 oz. 400

@ 2 1/2d. per 2 lb.

114

36

4

200

Flour .

1 oz. 28

@ 1s. 4d. per st.

008

3

-

21

Oatmeal

1/2 oz. 14

@ 2d. per lb.

007

2

1

10

Potatoes

9 oz. 250

@ 8d. per st.

032

4

-

52

Sugar .

3 oz. 85

@ 3 1/2d. per lb.

070

-

-

85

Rice, etc.

1/3 oz. 10

@ 2 1/2d. per lb.

003

-

-

6

Sundries, vegetables, etc.3

043

6

-

20

2.77

51

5

394

Beverages and unnecessary articles of low nutritive value...

0.75

7

9

Totals.........

1081

127

114

417

As shown by the above analysis, the average working man takes some 33 per cent of his protein in the shape of meat and fish (as compared with 60 per cent taken by the leisured classes in the same food-stuffs), 20 per cent in the form of dairy produce, 30 per cent in the shape of bread, and 17 per cent in other vegetable forms.

1 Includes beef, mutton, pork, liver, sausage, etc.

2 Includes cakes and buns.

3 Includes green vegetables, onions, tomatoes, currants, etc.; fruit, tea, coffee, condiments, etc.

The average working man's diet is a distinctly bulky one owing to the large amount of carbo-hydrate it contains. It is perhaps worth mentioning that we once prescribed a thoroughly adequate dietary, such as we would give to the leisured classes, to some working class patients, and they told us it did not satisfy their hunger. The very high nutritive value of the diet prescribed made it clear that it was perfectly adequate from a nutritive standpoint, and further observation showed us that it was lack of bulk wherein lay the fault. Apparently, in the case of many of the healthy working classes, a diet of considerable bulk, in addition to an adequate nutritive value, is necessary to satisfy hunger.

The exact construction of a diet for use by the working classes depends upon the amount of money available for food. In most working class families when the bread winner has full work, from five to eight shillings are usually available for the purchase of food per week for each adult of the family. When a patient can afford a shilling a day for his food his diet can be very closely modelled on the average diet shown in our analysis of diets taken by the working classes when in health.

The necessary increase of 30 grammes of protein can be conveniently given either as :-

(1) New milk, 2 pints; this will cost 3d. or 4d. per day.

(2) Meat; this will cost 3d. or 4d. per day according to the kind of meat used.

(3) Pulse food, 4 oz.; this will cost 1/2d. per day.

(4) Pulse food, 3 oz. with 1/2 pint new milk or 1/2 pint separated milk; this will cost 2d. per day, or less.

Of these various methods of increasing the protein, the giving of pulse and milk is perhaps the most economical and satisfactory, and the actual diet prescribed to the patient can thus be bought for a shilling a day.

The following diets, which have the requisite nutritive value and which can be bought for a shilling a day, we have found to be most satisfactory.

Men.

Women.

Breakfast.

Soup-plateful.

Porridge (sugar and milk).

Four tablespoonfuls.

1 1/2 oz. (ordinary helping).

Bacon (cooked) or egg.

1 1/2 oz. (an ordinary helping).

5 oz. for tea and porridge.

Milk.

5 oz. for tea and porridge.

3 oz. (a round).

Bread.

2 oz. (half a round, thick).

1/4 oz.

Butter.

Dinner.

5 oz. (=9 oz. as purchased) (a large plateful).

Meat (cooked).

4 oz. (a large helping).

5 oz. (four the size of an egg).

Potatoes.

3 oz. (two the size of an egg).

Green vegetables.

5 oz. (a large helping).

Suet pudding.

A large helping.

1/2 pint.

Milk.

1/2 pint.

Tea.

6 oz. (two thick rounds).

Bread, cake, etc.

4 oz. (a round and a quarter).

1 or 2 oz. (a tablespoonful).

Jam.

1 or 2 oz.

1/2 oz. (a piece the size of a walnut).

Butter.

1/2 oz. (a piece the size of a walnut).

Supper.

Soup-plateful.

2 oz.

Pulse soup, or

Sausage, ham or cold meat.

Soup-plateful.

2 oz.

Soup-plateful.

Or oatmeal porridge and milk and cheese, 2 oz.

Soup-plateful.

5 oz.

Milk or light pudding.

4 oz.

2 oz. (half a round).

Bread.

2 oz. (half a round).

1/4 oz.

Butter.

1/4 oz.

These diets have the following approximate nutritive values.

Men . . . . P. 156 F. 120 C.H. 468 Cals. 3,674 Women ... P. 130 F. 100 C.H. 380 Cals. 3,021

The cost of the above diets works out at about 1s. 1d. a day for men, and a little less for women.

Cheaper Diets For The Working Classes

When the amount of money available for the purchase of food is below 7s. per week, cheaper diets than those just described must be given, it being absolutely essential that a diet prescribed for a patient should be compatible with his means.

Our standard working class diet can be reduced in cost in various ways without impairing its nutritive value, viz. : -

(1) By reducing the amount of whole milk, and replacing it either in part or entirely by separated milk.

(2) By using the cheaper forms of meat.

(3) By increasing the amount of bread or pulses.

(4) By the substitution of margarine for butter.

In the following table we give, in parallel column, details of four dietaries, all of which are adequate in nutritive value, for the efficient treatment of tuberculosis, and the cost of which varies from 4s. 6d. to 7s. per week.

The palatability and variety of these diets vary directly with their cost; the cheapest of these diets, costing 7.7d. per day, can be made quite sufficiently palatable with a little care. It is scarcely possible to prescribe a really adequate diet which will cost less than 4s. 6d. per week; to be efficient, such a diet would have to contain a very large amount of vegetable protein, viz., pulses, etc., and to make such a diet palatable requires very careful, almost skilled, cooking.

Diet 1 on our table we know by experience to be in every way satisfactory. The amount allowed for the purchase of the several items of food allows of a considerable variation being made from time to time in the diet. Thus, purchasing meat at an average price of 7d. per pound allows of the inclusion of every joint of foreign beef at 7 1/2d. per pound, Canterbury lamb or mutton at 7d. per pound, meat for meat puddings at id. or 5d. per pound, and of liver, kidney, sausage, etc. Findon haddock, cod, etc., and especially tinned salmon, to which the working classes are particularly partial, may also be included in the list of foodstuffs from which selection can be made. The composition of this diet also allows for a suet or milk pudding every day. It will be noticed that a pint of milk and an ounce of butter are also included.