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CHAPTER III.
Report on six months' use of special diets in Puri Jail.
By the end of 1908 we had obtained undoubted evidence of the beneficial
effect of a reduction of the bulk of the ordinary jail diet on the level of
protein metabolism ; it was therefore necessary to determine whether such a
reduction would be accompanied by a maintenance in the standard of the
prisoners' health and their physical condition. With this object in view it
was decided, in consultation with the Officiating Sanitary Commissioner with
the Government of India—Lieutenant-Colonel W. J. Bamber,
I . M . S . — a n d t h e I n s p e c t o r - G e n e r a l o f P r i s o n s , B e n g a l — L i e u t e n a n t - C o l o n e l W . J .
Buchanan, I.M.S.—to place all the prisoners in Puri jail on diets in which
the bulk had been considerably decreased. This arrangement was carried out
over a period extending from the beginning of January to the end of July
1909.
This experiment of some six months' duration is not really of much value
in determining the effects of the lessened diet on prisoners over long periods,
as Puri being a District jail few of the prisoners remained for more than
from one to two months. It shows, however, the effects of the diet on
the new admissions and on those prisoners under confinement when the
experiment was begun : by a comparison of the results thus obtained with
those of the same period in previous years, we are able to form a fair idea of
the effect of the reduction of the bulk of the ordinary jail diet.
The prisoners were divided. into two classes of a nearly equal number of
prisoners in each. One class was given a diet composed of
—
Class A.
Rice
.
.
. 18 ozs.
Fish
.
.
4 ozs.
Dals
.
.
.
4 "
Vegetables .
.
6 "
The other a diet composed of—
Class B.
Rice
.
.
. 18 ozs.
Wheat ata .
.
4 ozs.
D a l s
.
.
. 4 "
Vegetables
.
. 6 "
A batch of five men were selected from each of these two classes at the
beginning, in the middle and at the end of the experiment : these batches were
164
165
placed on accurately weighed diets given as above for classes A and B, and the
amount of nitrogen undergoing metabolism estimated. The figures obtained will
show that practical identical amounts of nitrogen were absorbed from the diet
of class A during the different periods, and from that of class B during the
different periods ; thus again proving that the level of nitrogenous meta-
bolism is dependent on the quantity of absorbable protein offered in a diet,
and not affected, at least to any great extent, by the time during which an
individual has been on that diet.
The work done in estimating the degree of nitrogenous metabolism
present during these periods also shows how very marked an influence a
diminution in the quantity of rice and dal and a substitution for them of a
certain amount of wheat ata or fish, has in raising the relative and actual
percentage of protein absorption.
We shall first give an account of this work and then analyse the figures
collected to show the effects of the diets.
Puri Jail.
Investigations to establish the level of protein metabolism at the beginning and at the
end of the six months' experiment: the two classes A and B of prisoners having
been kept on their respective diets continuously during the whole period.
TABLE XXIIa.
Class A.
Diet.
Five Ooriya prisoners observed over five consecutive days.
1 st Period, January 1909.
Country rice
.
.
.
.
. 20 ozs.
Mixed dal
. .
.
.
.
. 4 "
Fish.
.
.
.
.
.
4 "
Vegetables
.
.
. .
.
6 "
Total N. of intake = 325.7 grms.
Total nitrogenous metabolism = 240.01 grms.
=73.69 per cent. of the total N. of the diet.
=9.60 grams. N. per man daily.
2nd Period, July 1909.
Country rice
.
.
.
.
. 18 ozs.
Mixed dals
.
.
.
.
.
4 "
Fish
.
.
.
.
.
4 "
Vegetables
.
.
.
.
.
6 "
Total N. of intake = 313.36 grms.
Total nitrogenous metabolism = 238.13 grms.
= 75.99 per cent. of the total N. of the diet.
= 9.52 grms. of N. per man daily.
166
Class B.
Diet.
1st Period, January 1909.
Country rice
. .
. 20 ozs.
Mixed dals
.
.
.
4 "
Wheat ata.
.
.
.
4 "
Vegetables
.
.
. "
6 "
Total N. of intake= 296.30 grms.
Total nitrogenous metabolism= 204.70 grms.
= 69.00 p. c. of the total N. of the diet.
= 8.19 grms. of N. per man daily.
2nd Period, July 1909.
Country rice
.
.
. 18 ozs.
Mixed dals
.
.
.
.
4 "
Wheat ata.
.
. .
.
4 "
V e g e t a b l e s
.
.
.
.
6 "
Total N. of intake=296.30 grms.
Total nitrogenous metabolism=203.78 grins.
= 68.77 per cent. of total N. of diet.
= 8.15 grms. of N. per man daily.
Collating these results we find-
(i) With the fish diet an average metabolism of nitrogen of about 9.5
grammes per man daily ;
(ii) With the ata diet an average metabolism of nitrogen of about 8.1
grammes per man daily ;
which is to be contrasted with the degree of nitrogenous metabolism attained
on the ordinary jail diet, and which we have seen to be, for Puri prisoners, 7.4
grms. per man daily. Further, the percentage absorption of protein is greatly
increased by the change, viz. , from 50 per cent. to quite 74 per cent. with the
fish diet and to 69 per cent. with the wheat ata diet.
We therefore see that the level of nitrogen exchange can be greatly raised
and the percentage of protein absorption immensely increased by a very simple
change in the ordinary jail diet, and that, by the change that we have suggested
a good deal of the excessive carbohydrate of the jail diet will be got rid of
at the same time.
We shall now examine the evidence we have been able to collect as to the
effect of these dietary changes on the health and general well-being of the
prisoners under observation.
The first effect of the reduction of the bulk of the diet was to cause a
certain amount of grumbling on the part of the prisoners, particularly those in
class A, on the fish diet. This went on for a few days but in a very short time
the stomach became accustomed to the diminished bulk and the feeling of
emptiness complained of disappeared. This is all the more remarkable in
Ooriyas as they are the only people we have come across who are able to
consume consistently the full jail ration. Those in class B, on the wheat ata
diet, never complained much, probably on the whole less than they do on the
full jail diet. The period of the experiment was too short to draw any conclu
-
167
sions from the incidence of sickness. There were very few cases of sickness
serious enough to call for admission into hospital amongst the prisoners in
either class. Thus in the return for 1998 with an average daily strength of
174.59 there were 92 admissions into hospital, while during the six months
the prisoners were on these modified diets the total admission into hospital
were on a very much lower scale. While this is statisfactory, so far as it
goes, no conclusions can be drawn from it, as the sickness rates vary very
much from year to year quite independent of the diet.
The only means of contrasting the results of the change that gives any real
measure of comparison is its effects on the body-weight, and even this is apt to
be fallacious. If the special diets had only been given to prisoners newly
admitted and their effects on the body-weight noted, a comparison with the
results of former years would have been of value but we had to place the
total prisoners of the jail on the diets and the number of new admissions was
too small to afford conclusive evidence.
It is well-known that prisoners on first admission increase in body-weight
to a very marked extent.
Thus the percentage of those who increased in weight during the year 1907
was 58 and in 1908 was 53.8 in the jails of Bengal. In 1908, 62 per cent. of
the prisoners in Puri jail increased in body-weight.
We have by a comparison with these figures a means of measuring the
results obtained from the change of diet.
Class A.
Fish Diet.
(1). Total prisoners on this diet for a period up to one month=165.
Of these 94 increased in weight by an average of 2.6 lbs.
"
" 55 decreased
"
"
" 1.9 lbs.
"
" 16 remained stationary.
=56 per cent. gained in body-weight.
(ii). Total prisoners on this diet for a period up to two months=104.
Of these 64 increased in weight by an average of 3.6 lbs
."
"
19 decreased
"
"
"
"
"
21 remained stationary.
= 61 per cent. gained in body-weight.
(iii). Total prisoners on this diet for a period exceeding two months=31.
"
6 decreased "
"
"
"
" 2.0 lbs.
"
5 remained stationary.
=64 per cent. gained in body-weight.
That is, for the usual period during which prisoners are retained in a small
district jail, like Puri jail, the percentage of those showing an increase in body-
168
weight is quite up to the average even when the total bulk of the jail diet is
considerably diminished by a decrease of 8 ozs. in the amount of rice, 2 ozs. in
the amount of dal—but when 4 ozs. of fish is added to the daily ration. This is
strong evidence that the new diet is sufficient and meets all the physiological re-
quirements of the body. We know that the level of nitrogenous exchanges is
very greatly raised, the excessive carbohydrate element largely curtailed and the
percentage of nitrogenous residue in the bowel much decreased by the substitu-
tion of a diet of this type for that laid down in the Jail Code ; the whole ten-
dency of the recent researches on metabolism is to show that these are the ends
to be aimed at in the framing of diet scales which are based on proper physio-
logical and rational principles.
Class B.
Wheat Ata Diet.
(i). Total prisoners on this diet for a period up to one month=240.
Of these 138 increased in weight by an average of 2.6 lbs.
"
"
55 decreased "
"
" "
"
" 1.9 lbs.
"
"
47 remained stationary.
=57 per cent. gained in body-weight.
(ii). Total prisoners on this diet for a period up to two months= 99.
Of these 60 increased in weight by an average of 4.2 lbs.
"
"
22 decreased " "
"
"
"
"
2.0 lbs.
"
"
17 remained stationary.
= 60 per cent. gained in body-weight.
(iii). Total prisoners on this diet for a period exceeding two months=25.
Of these 16 increased in body-weight by an average of 4.8 lbs.
"
"
5 decreased " "
" " "
"
" 2.6 lbs.
"
"
4 remained stationary.
= 64 per cent. gained in body-weight.
These results show that with a diet in which 4 ozs. of wheat ata replaces 8 ozs.
of rice and 2 ozs. of dal of the ordinary jail diet, the percentage of prisoners who
gain in body-weight is actually higher than is found to be the case on the jail diet.
Summary.—We may conclude from the evidence obtained from the Puri
experiment that a diminution in the bulk of the present type of diet is
urgently called for, and that by the substitution of a more assimilable form of
protein in the form of fish or wheat ata for the excess of rice and dal, the general
well-being and physical condition of the prisoners will be increased and placed
on a higher level. The results also show that a change in the dietary, such
as we have suggested, can be quite simply and easily carried out, and that, in
a very short time, the early feeling of emptiness complained of passes away,
the dilatation of the stomach so commonly met with in a rice-eating people
becoming distinctly diminished.
CHAPTER IV.
The effect of the large quantity of salt given in Bengal Jails dietaries.
The quantity of salt given in the diet scales of Bengal jails is 14/16th of an
ounce which, when added to the salt contained in the food materials, brings the
total up to well over an ounce or about 30 grms. of salt in the daily diet. It will
be readily admitted that this is an excessive quantity and much beyond the
physiological needs of the body.
Von Noorden states that probably the presence of as little as 3 or 4 grammes
of salt in the daily diet is a sufficient protection against the loss of chlorine ; and,
so long as the chlorine supply does not fall below this, the decrease in the
amount excreted in the urine will correspond to the diminished intake by the
mouth. In recent years, due mainly to the researches of Widal, the question of
salt in the diet has become a very important one, more particularly in connection
with the causation of œdema from kidney disease, disturbances of the circulation,
and even cirrhosis of the liver. It is generally admitted that by controlling the
proportion of sodium chloride in the diet, the œdema of Bright's disease can be
made to appear and disappear—a dechlorinated diet causing the œdema to
disappear in a comparatively short period. At the recent German Medical
Congress, on the discussion of Widal's paper it was conceded by all that
the symptoms of anasarca are due to retention of chlorides in the tissues.
Further, Dr. Magnus-Levy pointed out that, although the anasarca caused
by cardiac disease and cirrhosis of the liver is of a mechanical nature, and not
due to any impermeability of the kidneys to chlorides, he found that in these
conditions also a dechlorinated diet has the effect of reducing the dropsy.
Mendel in a most instructive paper on “ Salt-poor Diet as a Systematic
method of treatment ” published in the Münchener medizinische Wochenschrift,
March 1909, discusses this subject in the light of recent experimental researches.
He shows that even normal amounts of salt in the diet increase the fluid in the
body from 1. 5 to 3 litres, and that an excessive intake of salt may entail retention
of salt and water even in healthy individuals with sound kidneys. The healthy
organism tolerates this excessive amount of fluid without much sign of disturbance,
but there is transudation and exudation whenever the vessels are damaged from
any cause. The effects of hydræmic plethora, from salt accumulating with its
accompanying water, is shown to be peculiarly striking in various skin and serous
affections, especially in inflammations accompanied by exudations of serum through
169
170
the altered vessels. He finds that retention of salt and water not only alters the
clinical picture of inflammation, but has a more or less injurious influence on its
course. If the serous membranes are involved in the inflammation there is greatly
increased effusion.
In inflammation generally the effusion is reabsorbed the more rapidly the
less the salt taken in the food. The reduced proportion of salt leads to a power-
ful osmotic current from the tissues out into the blood and increases the diuresis,
which further reduces the pressure in the interstices of the tissues, and this in turn
favours reabsorption of the morbid effusion. Mendel des cribes striking cases to
show how the course of a burn can, thus be modified, also eczema, epididymitis,
joint affections, venous thrombosis and arterio-sclerosis.
The whole bearing of the results of recent research on the salt question is to
show that, when given in quantities above the physiological limits, salt is retained
in the tissues ; and, as it cannot be retained as crystals of sodium chloride, but
only in a more or less isotonic solution, water to form that solution must also
be retained in proportion to the amount of salt stored up in the body. The result
is a more watery condition of the tissues of the body and, therefore, an increase
in body-weight. Marey and Widal's experiments have clearly demonstrated these
results in healthy individuals whose kidneys were quite permeable to chlorides.
Now, so long as the tissues are healthy and uninjured no sign of this water-logged
condition appears beyond the increase in body-weight ; but, if for any reason
injury is received, no matter what form of injury it may be—the water-logged
tissues react to a much greater degree than would normal healthy tissues. If,
at the same time, the kidneys are diseased the hydræmic plethora results in
œdema, but long before any visible signs of œdema appear careful daily
weighing will reveal a steady gain in body-weight. Much work has now been
recorded showing the marked antiphlogistic and absorbent action of a salt-poor
diet, and the favourable influence exerted on acute inflammatory processes by
limiting the salt intake to as great an extent as possible.
We refer to these researches to show that the quantity of salt given in the
daily food is not a matter of little importance but, on the contrary, that it may
influence in a very unfavourable manner the ordinary ailments or diseases pre-
valent amongst the prisoners of Bengal jails. This is a side of the question we
have had no opportunity of studying, but there is little doubt that careful ob-
servation would confirm the claims of Widal, Marey and Mendel and extend the
list of morbid conditions in which limitation of the salt intake forms a most useful
adjunct to the ordinary methods of treatment.
We shall now deal with our investigations on the effects of the large salt
intake sanctioned for the prisoners of the jails of Bengal.
171
It may be accepted with regard to salt metabolism that, like protein, its level
i s det ermi ned by suppl y—wi t h t hi s di fference t hat , whereas prot ei n may be very
defectively absorbed, salt is under ordinary circumstances almost completely ab-
sorbed by the intestinal tract. There is a widespread belief that, in consequence
of man's habit of consuming an extravagant amount of salt, a certain superfluity
of it remains in. the body. How large this excess from salt consumed may be is
best seen from investigations in which its disappearance can be traced, as in
fasting or in abstinence from sodium chloride alone.
From observations on professional fasters who, previous to the period of
fasting, had contented themselves with moderate quantities of common salt—about
10 grammes daily—the amount of salt given off by the body during the fast was
estimated at 17 or 18 grammes. It has not been absolutely determined whether
larger amounts are amassed in the body in cases where salt is taken in larger quan-
tities—20 to 25 grammes. It is very probable, however, that such is the case. The
effect of placing an animal on large quantities of sodium chloride has been shown
to cause an increase of body-weight, which can only be explained by a retention of
water in sufficient quantity to dilute the salt retained to a solution isotonic with
the fluids of the body. The opposite holds true to an even greater extent ; for,
while salt equilibrium may become established so quickly on increasing the amount
of salt that no, or only a slight, increase in body-weight results, the effect of de-
creasing or stopping salt altogether is to cause at once a loss in body-weight which
is greater than can be accounted for by loss of flesh, and is due to water being lost
together with the sodium chloride. That is, when the administration of salt is
largely decreased or stopped the excretion of chlorides in the urine is greater
than the salt intake so that the body becomes poorer in salt, and less water is
required to maintain the isotonicity of its solution : the body-weight therefore
falls.
We shall consider the effects of the large sodium chloride intake of the pri-
soners on body-weight, diuresis and number of red blood corpuscles. We shall
also give some observations on the effect of the large salt intake on its elimina-
tion by the fæces and skin.
Investigations to determine the effects of large quantities of salt on :—
(i) The amount of chlorides passed in the urine.
( i i )
”
”
”,
”
”
”
”
fæces.
(iii)
„
”
”
”,
”
”
”
sweat.
(iv) The body-weight.
(v) The total amount of urine passed.
(vi) The number of red blood corpuscles.
1 Von Noorden, The Physiology of metabolism.
172
Puri Jail.
1. The effects of a sudden decrease in the amount of salt in the diet. The unit
worked with was five prisoners ; the urine and fæces were collected and pooled.
TABLE XXIII.
Five Ooriya prisoners observed for fifteen consecutive days.
Batch A.
Total
quantity
of urine.
Chlorides
of urine.
Chlorides
of fæces.
Weight
of pris.
R.B.C.
average
count.
Salt
intake.
Chlorides of
sweat=differ-
ence of total
intake and
output in
urine and
fæces.
c.c.
grms.
grms.
lbs.
grms.
Average per
man daily.
Five prisoners,
Ooriyas.
8,500
85.00
2.80
98.6
Average
of 13
counts
on two
prisoners
=4,790,000
99.71
=2.37
grms.
9,940
86.97
2.60
99.0
99.71
10,000
71.00
2.65
97.8
99.71
10,150
06.34
1.10
96.8
99.71
7,800
80.38
1.83
97.5
99.71
9,080
77.18
1.96
96.7
99.71
9,100
86.40
3.48
97.1
99.71
9,930
99.60
2.35
96.3
99.71
8,700
87.00
1.92
96.4
99.71
8,820
85.55
2.29
96.9
99.71
8,490
72.38
2.20
96.4
32.80
Transition
day.
Do.
..
7,420
31.16
2.20
95.8
4,734,000
32.80
=.19 grms.
5,790
35.89
2.44
95.8
32.80
7,350
30.12
1.89
95.4
32.80
7,460
29.16
2.12
95.1
32.80
173
What do we find from this investigation ?
With practically 20 grms. of salt per man daily :—
(i) 86 per cent. is absorbed and passed. out in the urine.
(ii) 2.4 per cent. is unabsorbed and passes out in the fæces.
(iii) 11.6 per cent. is absorbed and passed out in the sweat.
(iv) average body-weight = 97.31 lbs.
(v) average quantity of urine passed = 1,840 c. c. per man daily.
(vi) number of corpuscles = 4,790,000 (average).
With. 6.5 grms. of salt per man daily :—
(i) 93.4 per cent. is absorbed and passed out in the urine.
(ii) 6.6 per cent. is unabsorbed and passes out in fæces.
(iii) 2.8 per cent. is derived from the excess of salt stored in the body.
(iv) average body-weight = 95.4 lbs.
(v) average quantity of urine passed = 1,401 c.c. per man daily.
(vi) number of corpuscles = 4,734,000.
That is, with the same batch of men on the same diet throughout the whole
experiment, the effects of reducing the quantity of salt from 20 to 6.5 grms. per
man daily were :—
(i) to cause a distinct fall in body-weight from an average of 97.3 to
95.4 lbs.,
(ii) to decrease the average amount of urine passed from 1,840 c.c. to
1,401 c.c. per man daily.
Other points brought out in this investigation are :—
(iii) The very high percentage of salt absorbed even when large amounts
are given in the diet : thus, in the 20 grammes period, no less than
over 97 per cent. of the total salt given was absorbed by the
bowel.
(iv) The very constant quantities eliminated by the fæces so long as there
is no actual diarrhœa : with, an intake of 20 grms. 0.46 grm. NaCI