Effects of early nutrition on neurological and mental competence in human beings.

Nutrition and hunger have social, psychological and physical connotations, all documented since the first written records. Among documents of our own time that draw attention to these connotations are: Sorokin's (1975) volume on starvation in post-revolutionary Russia; the SHAEF report on the famine in the Netherlands in the immediate aftermath of World War II (Burger et al. 1948); the observational studies made by physicians during the siege of the Warsaw ghetto in World War II (recently made available in English; Winick, 1979); and the Swedish Nutrition Foundation Symposium on famine (Blix et al. 1971). The encyclopaedic Human Starvation (Keys et al. 1950) contains numerous historical sources and, in addition, provides details on behavioural effects from experimental and quasi-experimental studies of human starvation. These studies are a bridge to modern scientific approaches. In the latter genre we must place a moving study by Widdowson (1951), appropriately entitled' Mental contentment and physical growth'. Although her paper deals with physical growth and appeared more than 30 years ago, it aptly illustrates what will be a main interpretative line of this review. Widdowson reported a 12-month nutritional experiment carried out in occupied Germany after World War II. The children in two orphanages, 'Bienenhaus' and 'Vogelsnest', were started on identical diets. Unexpectedly, identical diets did not result in identical weight gain. At the end of the first six months, the children in Bienenhaus had gained consistently less than those in Vogelsnest. For the second six months, in a pre-determined cross-over design, the experimenters supplemented the original experimental diet in Vogelsnest, where the children were already doing better. Those in Bienenhaus continued unsupplemented with the initial diet. Unexpectedly again, the gains in weight were reversed. The Vogelsnest children failed to maintain their previous advantage, despite their supplemented diet. The Bienenhaus children, still on the original unsupplemented diet, began to make greater gains, and at the end of the second six months had overtaken the Vogelsnest children. The puzzled investigators finally discovered that the matron of Bienenhaus, the strict and authoritarian Fraulein Schwartz, had been transferred to Vogelsnest at the time of the cross-over, half way through the experiment. Throughout the experiment, it thus turned out, the same matron had been in charge of the children who did not thrive. The strict regime imposed by Fraulein Schwartz was in marked contrast to that of the matron she replaced at Bienenhaus, and also of the matron who succeeded her at Vogelsnest: both these other matrons were kind and motherly women. The part played by the relations of the children with the mother-substitute was clearly central (Susser & Watson, 1971). This part was further emphasized by the divergent patterns of the growth curves of eight children who were Fraulein Schwartz's 'favourites'. She had moved these eight children with her from Bienenhaus to Vogelsnest. During both the first six months in Bienenhaus, and the second six months in Vogelsnest, the growth of the eight favourites was superior to that of the other children with whom they lived. Widdowson epitomized her study in a Biblical quotation: 'Better is a dinner of herbs where love is, than a stalled ox and hatred therewith'. This study underlines a truism. From the moment a child is born it enters a social milieu, in which it gives and receives, in which it acts and responds. From a wealth of observations we can be sure