NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
197
In order to obtain some information on this problem the following investiga-
tion was carried out:—
TABLE XXV.
Two batches of prisoners—one Hindu, one Mahomedan—were put on exactly
the same diet for three days before the collection of their urine began.
The diet was—
Bread
.
.
.
.
.
8 ozs.
Calculated value of this diet in nit-
r o g e n 1 6 . 2 9 g r m s .
Mutton
.
.
.
.
. 12
„
Fish
.
.
.
.
.
6 „
Rice
.
.
.
.
.
4 „
Potatoes
.
.
.
.
.
4
„
Four Hindu prisoners observed for five consecutive days.
B A T C H A .
Quantity
of urine.
Weight of
prisoners.
Total N.
of urine.
Value of diet in nitrogen
f o r b a t c h .
C. C.
L b s .
Grms.
Four prisoners, Hindus
.
.
.
6830
124.2
49.43
65.16 grms. each day.
6500
124.1
49.32
4980
124.1
50.33
5040
124.2
61.88
5470
124.1
56.51
Four Mahomedan prisoners observed for five consecutive days.
B A T C H B .
Four prisoners, Mahomedans
.
.
6450
124.3
50.25
65.16 grms. each day.
4170
124.3
48.74
3970
124.2
55.64
3920
124.3
60.52
4020
124.2
55.66
198
What do we learn from these results ?
BATCH A—
Total nitrogen of urine
.
.
.
267.47 grms.
Constant 0.5 grm per man
.
.
10.00 "
Total nitrogenous metabolism .
.
277.47 "
=13.87 grms. of nitrogen per man daily.
=85.16 per cent. of the nitrogen of the diet.
BATCH B—
Total nitrogen of urine .
. .
270.81 grms.
Constant 0.5 grm. per man
.
.
10.00
"
Total nitrogenous metabolism
.
. 2808.1 "
=14.04 grms. per man daily.
=86.19 per cent. of the nitrogen of the diet.
That is, practically identical results are obtained for the two classes when they are
on the same diet for the same length of time and under the same conditions. So
that it would not appear that the Mahomedan absorbs a higher percentage of the
protein in a diet containing a large amount of animal food than is absorbed by
the Hindu.
Another point brought out in this observation is the high percentage of pro-
tein absorbed from a diet which may be considered almost European in type. It
is doubtful if much better absorption could take place from a diet of this kind than
that shown by these batches of Hindus and Mahomedans. So that we are fairly
justified in opining that the degree of nitrogen absorption depends largely on the
manner in which. the protein of the diet is made up, and not on the absorptive
power of the intestinal tract of one class of people being much superior to that
of another class.
Voit1 a n d C r a e m e r
2 d i s c o v e r e d m a n y y e a r s a g o t h a t p e r s o n s w h o h a v e b e e n f o r
years accustomed to one form of diet absorb its constituents no better than
those to whom such a regimen is a comparative novelty. Further, the large num-
ber of observations which have been made on different persons with common.
articles of food have failed to elicit any striking disparity in the degree of ab-
sorption.3 From the results of the present investigations we are in a position
to endorse these opinions to a very great extent the exceptions would appear-
to be brought out by a comparison of the absorption obtained from the people.
of the plains and the hill-tribes of Bengal.
To this, however, we shall return in Part II.
1 Voit : Zeit. f. Biologie 1889.
2 Craemer. Zeit. f. physiolog. Chemie. 1882.
3 Hutchinson : Food and Dietetics.
PART II.
The relationship of Food to Physical Development.
" It is food that supplies the material for that perpetual series of transforma-
tions in which life consists, and it must be adequate in quantity and suitable in
quality if these transformations, of so many different kinds, in so many different
organs, are to proceed with that nicely balanced adjustment that is known as
health ; nutrition is therefore an important branch of preventive medicine." 1
In our work so far we have had no necessity to face the much-discussed ques-
tion raised by Chittenden, viz., what is the proper daily protein intake necessary
to meet the needs of the body ? Much has been said, and well said, for and against
the views put forward by Chittenden. In the presidential address from which we
quote above, published in the Journal of the Royal Institute of Preventive
Medicine, Sir J. Crichton-Browne deals with the evidence for and against in a
masterly manner. His general conclusions—and in these he is in agreement with
most European physiologists, so far as Europeans are concerned—are that
Chittenden's views and standards cannot be accepted in their entirety. At the
same time it must be admitted that in the " Physiological Economy in. Nutrition "
and in " The Nutrition of Man" Chittenden makes out a very strong case, founded
on the most painstaking and laborious experimental study. In some researches 2
on the metabolism of the Bengali and on his nutrition, we have shown that the
average native of Bengal on the ordinary diet of the province—rice and dal—
reaches an even lower limit of nitrogenous metabolism than any of Chittenden's
subjects. We found that students and members of the fairly well-to-do classes
exist on a metabolism of less than 40 grms. of protein per man daily. The great
mass of the population. are on an even lower scale than this.
These results bear out Chittenden's views as regards the possibility of man
existing on a protein content of the general diet less than one-half of the ordinary
standards and, so far as that goes, we freely admitted that the protein metabolism
of the Bengali confirmed and corroborated his opinion.
It was when we tried to judge the effects of this dietary on the physical de-
velopment of the race, their capacity for manual labour, the condition of their blood
and tissues, and above all their resisting power to disease and infection, that we
were forced to part company from Chittenden and the opinions he has expressed
with regard to the great beneficial effect of a reduction of protein on mankind.
We showed—by observations on students, prisoners and servants of this College
1 Sir J. Crichton-Browne : Parcimony in Nutrition, Presidential Address to the Section of Preventive
Medicine. Journal, August 1908.
2 Scientific Memoirs No. 34. Government of India.
199
200
and by an analysis of the records of the physical development of Bengali and Anglo-
Indian students in the same College, under the same climatic conditions, doing the
same work, but on a different diet—the miserable standard of the Bengali's physi-
cal development, seemingly entirely due to the low scale of protein absorption.
Without entering into any detail of the work carried out on these lines we may state
that, from the evidence brought forward, we had to admit that, while it is quite
possible for an individual or the members of a whole race to live on the metabo-
lism of 6 grms. of nitrogen daily, the results of this on their general well-being,
health, physical development, vigour, resistance to infection or even immunity
from kidney disease were not such as to confirm a belief in the sufficiency of
Chittenden's standards.
In our work on the nutritive value of Bengal jail dietaries we were relieved
from all necessity of looking at this side of the problem. The prison diet scales
have now been in use for over twenty years and there has never been any doubt
as regards their sufficiency, the general opinion, on the contrary, being that they
were much more liberal than was necessary.
Accepting the established fact, therefore, that the dietaries were sufficient, all
we had to do was to estimate the average level of nitrogenous metabolism from
those scales, and use this as our standard of the protein requirements of Bengali
prisoners.
In accordance with our belief in the favourable influence of an excess of pro-
tein over bare sustenance, it has been our object in framing new diet-scales to raise
the level of protein metabolism for both Bengali and Behari, by suggesting mea-
sures to decrease the bulk of the diet, and thus permit of a better absorption and,
at the same time, to add some of the more easily assimilated proteins such as are
furnished by wheat ata or an animal protein to their dietaries.
It will, therefore, be evident that our proposals are in direct opposition to the
views expressed by Chittenden and his followers. According to his results the
metabolism of 0.12 grm. of nitrogen per kilo of body-weight daily is all that is
necessary for the protein requirements of the body. " These are perfectly trust-
worthy figures with a reasonable margin of safety and carrying perfect assurance
of really being more than sufficient to meet the true wants of the body, adequate
to supply all physiological demands for reserve protein, and able to cope with the
erratic requirements of personal idiosyncrasies."
How do our results and proposals compare with this standard ?
We have seen that the average nitrogenous metabolism of Bengali prisoners on
Lower Bengal jail diets works out at 7.55 grms. per man daily.
From analyses of over 30,000 weighments l the average weight of the prisoner
is 50.0 kilos. This means the metabolism of 0.15 grm. nitrogen per man daily—
1Scientific Memoirs, Government of India, No. 34.
201
a quantity that Chittenden would consider excessive, particularly so, when the
large carbohydrate and fuel value of their present dietaries is taken into,
account.
The Behari, we found, averaged .a nitrogenous metabolism of 9.50 grms. per
man daily ; his body-weight may be taken in round numbers to be, on the average,
55 kilos. This means the metabolism of 0.173 grm. of nitrogen per man daily,
again very much in excess of what Chittenden would consider the protein require-
ments of the body.
Our proposals would increase the nitrogenous metabolism of the Bengali on
the Lower Bengal diet up to 9.00 gems. per man daily or 0.180 grm. nitrogen per-
kilo of body-weight, while the suggested diet scale for the Behari would permit
of a nitrogenous metabolism on even a higher level than at present.
The effects, therefore, of the proposed changes in Bengal jail diets would be to.
increase very considerably the protein metabolism of the Bengali and slightly so
that of the Behari, while at the same time getting rid of some of the excessive
carbohydrate and heat value of the dietaries, the beneficial effects of which we
have already fully discussed. This is entirely at variance with Chittenden's
views, as according to his standards the dietaries are already excessive in both
protein and carbohydrate. The question, therefore, arises, is there any necessity
to raise the level of the protein metabolism of the prisoners ?
We have given one very good and sufficient reason, viz., the urgent necessity to.
obtain a higher percentage of protein absorption and thus reduce to as low a figure
as possible the large protein waste by the bowel, thereby lessening putrefaction.
This we have shown can be done by decreasing the rice and dal of the Bengali diet,
and the rice of the Behari. The necessity of raising the level of nitrogenous meta-
bolism by the addition of a more assimilable protein is on a different footing, and
to a consideration of this question we shall now turn.
We shall not go into details regarding the criticisms that have been made on
Chittenden's proposals, or the experimental evidence that has accumulated against
them ; we shall content ourselves with stating the results obtained from our work
in Bengal, and the practical deductions to be drawn therefrom.
One or two points we should like, however, to refer to as they will be found to
have a somewhat close relationship to the conditions present in Bengal.
Chittenden's standard of protein food is less than one half of that of Voit, and
conflicts violently with the common practice of the majority of mankind. " It is.
an initial objection to Chittenden's views which is not easily met, that it contra-
venes all human experience. If he is right, then all the world up to this time has.
been wrong. It is Chittenden contra mundum
deep down beneath all
superficial fluctuations and gradual evolutions there are certain fundamental, 2 D
2n
202
instinctive nutritional demands that cannot be interfered with without risk. These
are embodied, in old time tradition and customs, and one of these is a demand for
a protein intake much more than double, indeed nearly treble, what Chittenden
would allow."1
How do these hereditary instincts and customs in the formation of his dietetic
habits and in the choice of food stand with respect to the Bengali ? We may at
once say that another factor, and a very important one as regards the great mass
of mankind, comes in, viz., the cost of food materials.
The Bengali lives on. the cheapest food available and, in a country not yet
thoroughly opened up, the cheapest food is usually the home-grown product. We,
therefore, find the Bengali living almost entirely on his home-grown rice and dal ;
the Behari on his home-grown rice, dal and ata ; the hill tribes, which we shall have
to deal with separately in this connection, are not satisfied with these simple vege-
table materials but demand a much more varied and costly diet.
The Bengali or Behari is in the great majority of cases only a vegetarian by
force of circumstances : where he can afford other additional items as fish, milk or
mutton, he readily avails himself of the opportunity of thus increasing his assimil-
able protein intake. This desire for nitrogenous food. and particularly food of an
animal nature was well brought home to us in the feeding experiments on prison-
ers, when the promise of meat, or the threat of withholding it, was quite sufficient
to induce the prisoners to carry out without a murmur whatever was desired of
them. It was further exemplified by the difficulty that we sometimes experienced in
having fish or meat cooked without a fair proportion of it disappearing ; this neces-
sitated our having to place guards over the meat until it had been distributed to
the batches for whom it was intended. The great mass of the people, however, can
only afford the cheap home-grown rice and dal with occasional additions of more
palatable elements. Their instincts, therefore, for a better form of dietary are held
in check by an inability to meet the cost of gratifying them. In order to make up in
quantity for deficiency in quality we find that the Bengali has accustomed himself
to consume what to a European seem enormous quantities of rice and even dal ;
the same also is true to some extent of the Behari.
We know what the results of this limited diet of rice and dal in the Bengali, or
rice, dal and ata in the Behari mean as regards the level of nitrogenous metabol-
ism. We have shown previously that the average amount of protein undergoing
metabolism in the case of the Bengali reaches the very lowest physiological limits
in fact it would be more accurate to call it almost protein starvation. This is
not by any means so marked in the Behari, who, with part of his diet made up of
1 Sir James Crichton-Browne: loc. cit.
203
the more assimilable protein of wheat ata, is placed on a higher level of
nitrogenous metabolism.
We may conclude, therefore, that the people of the province of Bengal are
largely vegetarians, but are so only through force of circumstances—that they live
on what they are able to obtain, and not on rice and dal from free choice; that,
given the opportunity of obtaining animal food, they readily and greedily avail
themselves of it; that, in order to provide for an absorption of protein attaining
even the lowest physiological limits, very large quantities of rice and dal have to be
consumed—so large, as we found in the case of prisoners, that the actual bulk of
the diet interferes with its absorption. While this is true for the mass of the
population it is more particularly so for the inhabitants of Lower Bengal, and to a
less extent for the Behari.
What are the effects on the general well-being of the people of these compul-
sorily limited dietaries, which are characterised not so much by a deficiency in
the amount of protein they offer, as by the exceedingly poor protein absorption
possible from them ?
Before going on to contrast the effects of these diets on the Bengali and Behari,
respectively, we should like again to refer to another grave objection brought against
Chittenden's standards.
"It is obvious that in the study of dietetic customs those most widely dissemi-
nated and followed by many races and vast populations are of higher validity than
those confined to small communities, and further, that the practices of the more
successful races and the more affluent classes of a nation are more likely to yield
good dietetic models than the practices of the more backward races and poorer
classes. The former have greater freedom of choice, and their success in the struggle
for existence is evidence of the suitability of their food habits. All the successful
races have habitually consumed protein far in excess of what was required for tissue
repair and far in excess of Chittenden's standard, and when we find a definite re-
lation between protein consumption and racial success that is good ground for be-
lieving that behind it there is a biological law." 1
Further, Benedict 2 states "Dietary studies all over the world show that in
communities where productive power, enterprise and civilization are at their
highest man has instinctively and independently selected liberal rather than
small quantities of protein." He instances the immense improvement that takes
place both in physique and morale of the negro and "poor white" of the
Southern States, and the Italian labourer in South Italy, when fed on a higher
protein diet.
1 Sir James Crichton-Browne : loc. cil.
2 Benedict : Am. Journ. of Physiology.
204
Nitti 1 e x p r e s s e s t h e c o n v i c t i o n t h a t t h e p r o p o r t i o n o f p r o t e i n i n a d i e t i s
one of the great determining factors in the productive capacity of a nation.
We need hardly instance, in this connection, the rapid and remarkable rise of Japan
amongst the nations coincident with a vastly increased consumption of animal
food, or the recorded fact that during the late war the Japanese troops had a more
abundant protein diet than any other army in the field has ever enjoyed.
There is, therefore, a fairly general consensus of opinion that the sociological
conditions, enterprise, vigour and physical development of a people are intimately
bound up with the quantity of assimilable protein in their dietaries. These
influences of dietaries, and the effects of the different amounts of protein offered
capable of absorption, are remarkably well brought out by a study of the general
status and physical welfare of the different classes of the inhabitants of Bengal.
1. The Bengali.—In our work on the nutrition of the Bengali, 2 already
more than once referred to, we showed, from observations on the urine and blood,
how very low the level of interchanges going on within the body was—the
total nitrogen undergoing metabolism being only about one-third that of Euro-
peans. The only comparatively high figure we obtained was for sulphates, pointing
to a higher degree of intestinal putrefaction, in the Bengali than in Europeans.
Similarly with regard to the chemical analysis of the blood we found a higher
percentage of water and a lower percentage of total solids and protein: the
hæmoglobin was markedly reduced and the blood pressure was on a distinctly lower
level. We found that the result of these conditions was markedly to modify the
physiological requirements of nutrition and, to a considerable extent, affect the
growth and power of muscular contraction of the average individual, whose nitro-
genous tissues are not given the option of drawing their nutritive material from so
rich a source, nor have they the same opportunity of obtaining as free a supply of
oxygen. We concluded from this study that a people on a diet, from which only
37.50 grams. of protein are absorbed, live in, a more or less chronic state of nitrogen
starvation, leading to a loss of body-fat and tissue-protein with an accompanying
loss of vigour and strength and a comparatively low capacity for prolonged or
sustained muscular effort. From the evidence as to physical development we
showed that the general physique of the Bengali was on a par with his diet, and
that a close relationship existed between the poor physical development of this
people and the meagre protein absorption possible from the diet on which they
subsist.
This was particularly well brought out by an analysis of the recorded
weigh-ments, chest measurements, and heights of Bengali and Anglo-Indian students
1 Nitti : The Economic Journal, 1896.
2 Scientific Memoirs No. 34.
205
during the several years of attendance at one of the residential Colleges in
Calcutta. Under the same conditions but on difference diets we saw that :—
(i) Compared with an average increase in body-weight of 2 lbs. in the case
of the Bengali students on their diet, there was an average increase
of 14 lbs. in Anglo-Indian and Eurasian students over similar periods.
(ii) Of the Bengali students 42.8 per cent. showed a diminution of weight
compared with 2 per cent. amongst the Anglo-Indian students, in
a comparison of the weights on entrance and at the end of the third
year: of the Bengalis only 15.3 per cent. gained weight continuously
at College, whereas practically all gained weight continuously
amongst the Anglo-Indian students.
(iii) The chest measurements bear out the same conclusions: the Bengali
practically remains unaltered, whilst the Anglo-Indian increases his
chest-girth very considerably.
The diets on which these results were obtained were :—
I—Bengali Students.
II—Anglo-Indian Students.
Protein 67.11 grms. (of which 9.3 grms. were
derived from an animal source).
Protein 94.97 grms. (of which 38.32 grms. were
derived from an animal source).
C a r b o h y d r a t e
. . ,
5 4 8 . 7 3 g r m s .
Carbohydrate
.
.
167.00 grms.
Fat
.
.
71.55 "
Fat
.
.
.
.
56.20 "
Comment on these results is unnecessary, The figures were obtained from the
records of the medical officer of the College and were worked out in collaboration
with F. E. Dempster, Esq., C.I.E., who makes statistical work one of his hobbies.
They show very conclusively the results to be expected in growing lads from diets
deficient and rich respectively in absorbable protein.
The further evidence brought forward regarding the physical endurance,
capabilities of performing work and the experience of life insurance companions,
all place the Bengali on a low plane of physical development. The general
consensus of opinion also showed that his power of resistance to disease was
markedly inferior to the more highly-fed European. Even in the very condition
that Chittenden lays such stress on as most likely to be avoided by a decrease in
the protein intake, viz., renal disease, we find the facts do not bear out his conten-
tion renal disease being more common amongst the ordinary working population
of Bengal—and very much more so amongst the higher classes in combination
with diabetes—than amongst Europeans in Europe or India. This is all the more
remarkable in a country where scarlet fever is unknown, and amongst a
people where the consumption of alcohol is, comparatively speaking, negligible.