NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
200
Physical development of the Sikh—
Average height
.
.
.
.
.
. 67 .5 to 68.5 inches.
Average chest-girth
.
.
.
.
.
33. 5 to 35 .5 „
No records of body-weight available.
7. THE PATHAN.
The food of the Pathan is much the same as that given for the Sikh.
except that the Pathan is a much greater meat-eater than the Sikh. He
will consume all forms of animal flesh given for the Sikh and will eat beef
as well. In their homes animal food is taken daily.
The figures obtained would show that the Pathan is superior in physique
to any of the races mentioned. His fighting qualities are too well-known to
require mention by us. As in addition to their superior type of dietary the
Pathan tribes belong to the hills, and have therefore the advantage of a bracing-
climate, we shall, for the present, avoid further details.
GENERAL SUMMARY.
This concludes our work on the jail dietaries of the United Provinces
and the information we have been able to obtain on the effects of food, as
exemplified in the different tribes mentioned above.
Our aim has been to determine experimentally the nutritive values of the
diets at present in use in the jails of the United Provinces, and to work out
the co-efficients of protein and carbohydrate absorption of the different food-
materials entering into those dietaries. From the data thus obtained, we have
been able to frame new dietaries, whose nutritive value depends on the degree
of nitrogen absorption possible from the food-materials and not on their gross
chemical composition. A series of eight such diets are given which are practi-
cally of identical nutritive values, and are, therefore, interchangeable ; the
particular diet in use at any stated time will depend on the season of the year
and on the food-materials available. We have discussed some of the side-issues
of the investigation, and shown how very great the loss of protein by the fæces
is when inferior vegetable food-stuffs are made use of. The practically constant
percentage of the nitrogen of the fæces, whatever the type of diet may be, is
worthy of note. Lastly, from the facts we have been able to collect with regard
to the inhabitants of the United Provinces and martial races of the plains, there
would appear to be abundant evidence that, other things being equal, diet is the
all-important factor in determining the degree of physical development and
general well-being of a people, and that with a low level of nitrogenous inter-
change deficient stamina, morally and physically, must be expected.
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CONTENTS.
PAGE
INTRODUCTION .
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1
CHAPTER I.
STUDY OF OUTBREAK OF EPIDEMIC DROPSY IN CALCUTTA IN 1909 .
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(i) METHODS OF COLLECTING INFORMATION REGARDING THE EPIDEMIC .
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(ii) EPIDEMIOLOGICAL INVESTIGATIONS —
1. Annual incidence of cases .
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2. Monthly incidence of cases
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3. Geographical distribution of cases in Calcutta
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4. Incidence amongst inhabitants of houses .
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5. General mortality .
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6. Incidence amongst castes and religions
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7. Age incidence . .
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8 . M o r t a l i t y a t d i f f e r e n t a g e s
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9. Occupations of persons attacked .
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10. Incidence amongst Hindu females
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11. Mortality amongst Hindu females
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12. Incidence in families
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13. Degree of communication amongst families .
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14. Movements of families in relation to Epidemic Dropsy .
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15. Incidence amongst servants
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16. Single cases of Epidemic Dropsy
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17. Sanitation of houses .
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(iii) SYMPTOMATOLOGY OF EPIDEMIC DROPSY
—
1. Duration of illness .
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2. Relapses .
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3. Fever .
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4. Gastro-intestinal symptoms
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5. Œdema .
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6. Cardiac signs .
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7. Condition of knee jerks .
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8. Eye symptoms .
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9. Skin lesions .
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10. Emaciation .
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11. Complications .
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12. Urine and blood in Beriberi
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(iv) DIET IN RELATION TO EPIDEMIC DROPSY .
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[ ii ]
PAGE
CHAPTER II.
NOTE ON OUTBREAK RESEMBLING BERIBERI AT BASTI JAIL
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. 34
CHAPTER III.
RELATION OF EPIDEMIC DROPSY TO "SHIP BERIBERI"
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39
CHAPTER IV.
RELATION OF EPIDEMIC DROPSY TO SCURVY
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44
CHAPTER V.
RESULTS OF EXPERIMENTAL INVESTIGATIONS
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49
CHAPTER VI.
GENERAL CONCLUSIONS
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7 8
DESCRIPTION OF ILLUSTRATIONS.
Nos. —
Pages.
1
Chart 1.—Monthly incidence of Epidemic Dropsy in 1909 in
Calcutta.—Shows that the majority of the cases occurred in the
rainy season in this outbreak. In last epidemic the cases occurred
in the dry season
.
.
.
.
.
.
.
. Facing page 7
2
Chart 2.—Age distribution of 1,000 of each sex in Calcutta.—
Shows large proportion of adult males in the population and the
small number of adult females
.
.
.
.
.
„
„
1 0
3 Chart 3.—Age incidence of Epidemic Dropsy in Calcutta.—
Shows that the curve of age incidence of Epidemic Dropsy
follows that of the normal population and is the same in males
and females
.
.
.
.
.
.
.
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.
„
„ 10
4
Chart 4.—Mortality from Epidemic Dropsy at various age periods,
male and female.—Shows the mortality is much higher amongst
.
females than males
.
.
.
.
.
.
.
.
„
„ 10
5
Chart 5.—Occupations of 243 cases of Epidemic Dropsy.—Shows
the important fact that the majority of cases occurred amongst
the section of the population with small fixed incomes
.
.
„
„ 11
6
Chart 6.— Fowls fed on polished rice and unpolished rice.—Shows
the progressive loss of weight and development of neuritis in the
former series, whilst the fowls fed on unpolished rice did not lose
weight or develop neuritis and remained well
. .
.
.
„
„ 68
7
Chart 7.—Prevention of neuritis.—Pigeons fed on polished rice and
Mung dal.—Shows that if pigeons are fed on polished rice alone
they develop neuritis with progressive loss of weight, but if 1/3 of
the polished rice is replaced by green Mung dal the pigeons
remain well. This shows the value of Mung dal as a prophylactic
in Epidemic Dropsy
.
.
.
.
.
.
.
.
„
„ 68
8
Chart 8.—Curative treatment of neuritis.—Fowls fed on polished
rice and subsequently on pulses.— Shows that the fowl had lost
weight to a very considerable extent and had developed neuritis.
The beneficial effect of administration of Mung dal and pulses
when the animal was in this state is striking
.
.
.
.
„
„70
9
Chart 9.—Curative treatment of neuritis.—Pigeons fed on polished
rice and subsequently on pulses.—Illustrates also the curative
effect of Mung dal
.
.
.
.
.
.
.
.
„
„ 70
10
Photograph, Pigeon 1.—Shows very early stage of neuritis. The
experiment had lasted 18 days and the pigeon had lost 30 gram.
in weight, that is, 12 per cent. of body weight
. .
.
. At end of report.
[ iv ]
Nos.
—
Pages.
11
Photograph, Pigeon 2.—Shows more advanced stage of neuritis.
The experiment had lasted 24 days and the pigeon had lost 70
gram. in weight, that is, 26.9 per cent. of body weight
.
. At end of report.
12
Photograph, Pigeon 3.—Shows advanced stage of neuritis. The
experiment had lasted 31 days and the pigeon had lost 70 gram.
in weight, that is, 30 per cent. of body weight. All three pigeons
were fed on polished rice .
.
.
.
.
.
.
„
„
13
Photograph, Pigeon 4.—Shows a healthy pigeon ; this pigeon was
fed on polished rice until it was in the condition seen in photo-
graph of pigeon 3 ; it was then put on Mung dal and pulses and
rapidly recovered weight and lost the symptoms of neuritis as will
be seen from the photograph .
.
.
.
.
.
.
„
„
14
Photograph, Pigeon No. 5.—Shows a healthy pigeon. This pigeon
was fed on polished rice and Mung dal. The experiment has
lasted for 187 days and its weight is stationary and it has no
symptoms of neuritis
. .
.
.
.
.
.
.
„
„
Epidemic Dropsy in Calcutta.
INTRODUCTION.
HAVING completed my epidemiological enquiries at Calcutta and as no
fresh cases of the disease were occurring I proceeded on 11th December
1910 to Kasauli to officiate (for three months) as Director of the Central
Research Institute and also to continue my experimental investigations in
relation to the etiology of Epidemic Dropsy. On my leaving Calcutta the
services of Assistant Surgeons Taraknath Sur and Charu Chandra Bose
were replaced at the disposal of the Inspector General, Civil Hospitals, Ben-
gal. Assistant Surgeon J. G. Mukerji assisted me in the experimental
investigations at Kasauli.
This is the final report so far as the present enquiry is concerned; there
are, however, interesting problems arising out of the investigations deserving
of further study : these problems are connected with the important question
of diet.
In recent years, especially in connection with the study of tropical.
diseases, a great deal of attention has been directed to the parasitic origin of
disease, and deservedly so, because it is a subject of very great importance;.
this has, however, somewhat overshadowed the question of the relation of
defects of dietary to the causation of disease in the tropics. The time has
now come when the older methods of determining the nutritive value of food
materials require reconsideration, and further investigation is wanted on
this important subject. Defects in dietary not only require careful atten-
tion from the point of view of diseases which result directly from them, but
they are of equal importance as affecting the course of certain diseases occa-
sioned by parasites, as well as the general health of communities.
The conclusions arrived at in my first report1 have been confirmed by my
subsequent investigations.
It may be desirable to summarise shortly the facts connected with the
etiology of Epidemic Dropsy as determined by my enquiry at Calcutta. In
the first place it will be seen that the two severe epidemics, in 1878-79 and
1908-09, in Calcutta have commenced and declined with a rise and a fall in
the price of food grains. During the periods of both the above-mentioned
1 First Report on Epidemic Dropsy in Calcutta by Major E. D. W. Greig, M.D., D.Sc., I.M.S. Scientific
Memoir No. 45.
B
2
epidemics there was a very high and sustained rise in the price of food
grains. In the interval between these severe outbreaks the price curve did
not show such a change, and associated with this there was no severe out-
break of the disease. Further, conditions of dietary remaining the same as
at present, an outbreak of Epidemic Dropsy may be expected in the future
when the curve of the price of food grains again assumes the characters met
with during the two previous outbreaks in Calcutta. Hence it will be evi-
dent that a study of this curve is a very important matter, and the curve may
be used as an indicator for forecasting the occurrence or non-occurrence of
conditions favourable or unfavourable to the development of so-callel Epi-
demic Dropsy amongst the population. The modus operandi of this factor in
the production of Epidemic Dropsy will be understood from a consideration
of the following facts which have been scientifically demonstrated. The
signs and symptoms of this disease are liable to develop when a diet, largely
composed of polished rice or poor in certain constituents, is consumed. In a
dietary largely composed of polished rice these essential constituents, which
are required to meet the physiological demands of the body, and especially of
the peripheral nervous system, are not present in sufficient quantity; but the
necessary constitutents can be supplied by supplementing the dietary by
suitable articles of food containing them; a full discussion regarding the
nature of these essential constituents will be found in the chapter devoted to
experimental investigations in this report, page 49. When the price of food
grains is low, it is possible to purchase these supplementary articles, but when
the price of food grains rises and remains high the capacity for purchasing
additional suitable articles of diet diminishes and the diet becomes danger-
ously " One-sided." Enquiry showed that the section of the population in
Calcutta, amongst whom the disease was most prevalent, was the class with
small fixed incomes, vide page 10 of this report; the reason for this is obvious,
seeing that the purchasing power of this class is definitely limited, and there-
fore a rise in the price of food grains affects them most severely, because they
become unable to purchase the additions necessary to render the diet safe.
In this research it has been shown that a most valuable portion of the
rice, namely, the Koorah or polishings, is not being utilised, this could be pro-
perly cleaned and sifted, and made available as an article of diet. If an
adequate percentage of rice bran is consumed daily, scientific investigation
shows that considerable protection will be afforded against the accidents
classed under the heading Epidemic Dropsy. In this report the subject of
rice bran is fully discussed in its various aspects. The question of the addi-
tion of rice bran to the diet and other questions dealing with the removal of
defects in dietary considered in my reports on Epidemic Dropsy should
3
receive careful attention from those responsible for the administration of
Jails, Asylums, etc., etc., in India. Further, in regard to ships, especially
those carrying Indian crews and other rice-eating peoples, the responsible
authorities should have their attention specially directed to this and other
matters dealt with in my reports as they are of very considerable importance
to shipping communities.
B2
4
CHAPTER I.
Study of the Outbreak of Epidemic Dropsy in Calcutta in 1909.
In the first place I shall deal with the complete study of the outbreak of
Epidemic Dropsy in Calcutta in 1909. Before proceeding to give a detailed
account of the investigations it may be well to record a few facts regarding
the city of Calcutta. The notes have been taken from the Gazetteer of India. 1
Calcutta, the capital of the Indian Empire, is situated 22° 34" N., 88° 22" E.,
on the east bank of the Hooghly river, within the 24-Parganas district, Bengal.
The city lies about 86 miles from the sea and is only about 18 to 21 feet above
mean sea level. It covers an area of 20,547 acres of which only 1,792 are
rural, and 1,113 acres form the maidan. The city is bounded on all sides by
suburban municipalities which have been excluded from Calcutta for the
purpose of municipal administration. These are Cossipore Chitpore on the
north, Maniktala on the east, Garden Reach on the south-west, Howrah on
the west bank of the Hooghly river. If these be included Calcutta has a
population of 1,106,738, which is greater than any European city except
London, Constantinople, Paris, and Berlin, and of any city in America,
except New York, Chicago, and Philadelphia. Excluding China, the popula-
tion of whose cities is uncertain, the only city in Asia with more inhabitants
than Calcutta is Tokio : and next to London is the most populous city in the
British Empire.
In the centre of the town stands Fort William, surrounded by the noble
expanse of park known as the Maidan. North of this are the shops and busi-
ness houses of the Europeans, whose residential quarter bounds it on the east.
Surrounding the European quarter is Burra Bazar, the chief centre of native
business : the buildings are mainly one-storeyed masonry shops, and it is only
here and in the adjoining quarters of Joraabagan and Bow Bazar that brick
buildings are more numerous than tiled huts. Three-fifths of the whole popu-
lation live in the latter which have mud or wattle walls and are known as
k a c h c h a , h o u s e s . T h e n a t i v e t o w n i s t r a v e r s e d b y t h r e e m a i n r o a d s f r o m
north to south, and by five or six roads from east to west, but with these excep-
tions it is extremely ill-arranged. The lanes are tortuous and badly lit;
the dwellings are overcrowded and insanitary; and the overwhelming propor-
tion of one-storeyed houses gives this portion of the town a peculiarly squalid
appearance.