NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
39
CHAPTER IX.
The Causation of Periodicity in Outbreaks of Epidemic Dropsy.
A noteworthy feature in the history of this disease in Bengal and other places
has been a certain periodicity. Thus the outbreak of the disease in 1877-78-79 in
Calcutta and Bengal was followed by an interval of quiescence and the next severe
recurrence was the recent epidemic of 1907-08-09. The disorder is probably never
entirely absent during the interval. Rogers1 o b s e r v e d a f e w c a s e s o f E p i d e m i c
Dropsy in Calcutta in 1901. Delany 2 in his Report on Epidemic Dropsy in Eastern
Bengal and Assam considers that it is quite probable that the disease has remained
in the Sylhet District for 30 years, since the epidemic of 1878-79. In 1902 in.
Bombay I observed a limited number of cases of this disease.
The problem to settle, however, is the cause of the occurrence of severe out-
breaks at particular periods. I am engaged at present in collecting evidence to
ascertain the factor or factors likely to bring about this periodicity. I may state
that so far as my researches go I have observed that there is a remarkably close
relationship between the price of food grains and the prevalence of Epidemic
Dropsy. Thus the severe and extensive outbreak of 1877-78-79 was preceded
by the great famine of 1876—1878, which was, " In respect of the area and
population affected and the duration and intensity of the distress, the most grievous
calamity of its kind experienced by British India since the beginning of the
century. " 3 The price of food was very high in Madras, 4 Bengal 5 and elsewhere
during this period. With the drop in price in 1880 the epidemic disappeared.
A study of the price of food grains in India shows that in 1906 a sharp rise in
the price of rice and other grains in Bengal occurred, the point touched being higher
than in any previous year since 1880. In 1907 the price of rice in Bengal was still
higher, and in 1908, the highest level so far recorded in the present series was
reached.6 The commencement of this rise is followed by the recent (1907-08-09)
extensive and severe outbreak of Epidemic Dropsy in Bengal. It is noteworthy
that no severe epidemic of the disease has been reported so far (October 1910) this
year, and this became more significant when it was observed that it was correlated
with a decided drop in the price of food grains in 1909, and in the present year 1910
a further lowering of prices may be expected. These facts are of considerable
importance in relation to the explanation of the occurrence of periodic extensive
1 Fevers in the Tropics, 1910.
2 Report on the investigation into the causation of Beri-beri in jails of Eastern Bengal and Assam.
3Report of the Indian Famine Commission, Pt. I, 1880.
4Madras Administration Report, 1878-79.
5McLeod, Indian Medical Cazette, 1894.
6 Prices and Wages, compiled in office of Director-General, Commercial Intelligence, India, 26th issue,
1909.
40
outbreaks of Epidemic Dropsy affecting wide areas. When taken in conjunction
with the fact that all the evidence obtained points to Epidemic Dropsy being a.
nutritional disease dependent on defects in dietary, the relationship becomes all the
more. striking. It would appear, therefore, that economic factors, e .g ., price of
food grains, play an important part in determining the periodic character of the.
severe outbreaks of Epidemic Dropsy. It will be readily understood that such a
far-reaching factor as the price of food grains must affect directly or indirectly a
very considerable number of people, some more, some less, severely.
Chart No. IV at the end of this Report 1 s h o w s t h e v a r i a t i o n s f r o m t h e m e a n o f
the average retail price of rice in Bengal for each year from 1885 to 1909, and the.
occurrence or non-occurrence of extensive outbreaks of Epidemic Dropsy from
1885 to 1909 in Bengal.
Through the kindness of the Director-General of Commercial Intelligence
I have obtained the necessary figures and have prepared a chart showing the
fluctuations in the price of rice from 1875 to 1883, that is to say, a period before,
during, and after the severe and extensive outbreak of Epidemic Dropsy in.
1877-78-79 in Calcutta and Bengal.
Chart No. V shows the variations from the mean of the average retail price of
rice in Bengal for each year from 1875 to 1883, and the occurrence or non-occur-
rence of extensive outbreaks of Epidemic Dropsy in Calcutta and Bengal during
that period.
From a study of Charts Nos. IV and V it will be seen that the two occasions,.
in a space of thirty years, on which Calcutta and Bengal were affected by severe
outbreaks of Epidemic Dropsy, viz ., in 1877-78-79, and 1907-08-09., synchronised
with a period of high price of food. The fact that this has occurred twice in the
history of this disease in Calcutta strengthens the view that the occurrence of exten-
sive outbreaks of Epidemic Dropsy in Calcutta and Bengal is determined by an.
increase of the price of food grains.
The cessation of the epidemic phase of the malady is observed to be associated
with a fall in the price of food grains, and during the period of quiescence the price
is at or below the mean. It is interesting to read in an editorial note in the Indian
Medical Gazette of May 1st, 1880, that, " Beri-beri has died out in Calcutta as the-
hot weather advanced. It is feared that it will re-appear at the close of the next
rains as in the three preceding years, most probably extending its area of preval-
ence." Fortunately this forecast by the Editor (Colonel McLeod) did not prove
correct. The interest of the above statement, however, lies in the fact that in
1880 a marked drop in the price of food grains occurred in Bengal as Chart No.
VI shows.
1 Figures obtained for the preparation of this Chart from Prices and Wages compiled in office of
Director-General of Commercial Intelligence, India, 20th issue, 1909.
41
Chart No. VI shows the variations from the mean of the average retail prices
of rice in Bengal for 1878-79-80 and the occurrence or non-occurrence of extensive
outbreaks of Epidemic Dropsy from 1878 to 1881 in Bengal.
From the foregoing it will be seen that the probable explanation of the cause
of the periodic recurrences in Bengal of Epidemic Dropsy is, that, from the nature
of the Bengali dietary, a condition of ' nutritional instability, ' if the phrase be
permitted, exists in those consuming it, and, in ordinary conditions, no very ob-
vious signs are apparent by which it can be recognised ; but when a severe strain,
e . g., famine prices for food grains, which is far-reaching in its effect, is superadded
t h e ' n u t r i t i o n a l b a l a n c e ' o f a v a r y i n g p e r c e n t a g e o f t h e p o p u l a t i o n i s u p s e t a n d
this breakdown manifests itself amongst the ' nutritionally unstable,' by various
unmistakable signs, which from their severe character, direct attention forcibly to
the condition. When the strain is removed by the drop in price of food grains the
nutritional balance adjusts itself more or less correctly and the epidemic ceases ;
this is illustrated by the course of the two severe outbreaks of Epidemic Dropsy
in Bengal.
There are many interesting points connected with this question. For example
the amount of rise in price of food grains necessary to determine these outbreaks.
From a study of the Chart No. IV the character of this rise during the last outbreak
is illustrated. It is high and sustained over several years. It is probable that it
is the combination of these two conditions, viz ., the high level and the maintenance
of this elevation for two or more years which is the determining factor in causing
the outbreak. It is probable that a rise for a single year is insufficient to produce
an epidemic : thus it will be observed that there was a sharp rise in price of food
grains in 1897, but in the next year a fall below the mean occurred. It will be
noted that the character of the price curve for 1906-07-08-09 is a sustained high
level for a considerable period, a similar character of the curve has not been ob-
served since the last severe famine of 1877—1879 ; no severe outbreaks of Epidemic
Dropsy were recorded between these periods.
By studying such a curve of food prices a forecast of the possibility of Epidemic
Dropsy occurring amongst the ' nutritionally unstable ' at a particular period
might be made with fair accuracy.
42
CHAPTER X.
The Prevention and Treatment of Epidemic Dropsy.
In the present Report it is proposed only to mention shortly the lines on which
preventive measures should proceed. When the work, which is now in progress,
is complete, further details may be available. It will be already obvious from the
results of the investigation that as the disease is brought about by a ' one-sidedness '
in dietary, the aim of prevention should be to remove this defect. In the Bengali
diet the researches have shown that this ' one-sidedness ' is due to the habitual
consumption of articles of food, viz . , ' p o l i s h e d ' r i c e a n d w h e a t e n f l o u r d e f i c i e n t i n
essential constituents,—the latter being more defective than the former. The
following indicate in general terms the possible methods of improving the nutritional
value of the dietary, (1) by using unpolished food grains, (2) by the addition to
the dietary of the rice and wheat bran removed in the cleaning process, (3) by
diminishing considerably the quantity of polished grains consumed and supplement-
ing or replacing them by an adequate quantity of other suitable food grains rich
in the required constituents. Of food grains the Mung dal (Phaseolus radiatus) is
the richest in the ingredients. The addition of fresh meat to the dietary is clearly
shown to be of high value as a prophylactic : even when consumed occasionally it
had the effect of greatly reducing the mortality from the disease. If consumed more
regularly still better results might be expected.
It may be interesting to record the views of that careful observer Chevers in
regard to the prevention of the disease which he named " Morbus Bengalensis,"
and to which reference has already been made. In his Presidential address to the
Bengal Social Science Association on February 1870 he says : " I consider that the
only valid remedy for the Morbus Bengalensis, as well as the only means of enabl-
ing the Bengali to withstand the marsh poison of his country until he shall have
driven out the malaria by bringing his rice-swamps into dry cultivation, is the intro-
duction into Bengal of a higher staple of food.” 1
In the treatment of persons actually suffering from Epidemic Dropsy it has to
be remembered that probably their capability of utilising the essential consti-
tuents in the food is reduced, and the patients, therefore, demand a higher intake
of these constituents to attain physiological equilibrium. Hence in the treatment
of cases it is necessary to bear this in mind. It is possible that at certain stages
of the disease the capability of utilizing the essential ingredients may be lost
entirely.
Probably success in treatment would be attained by the addition of a con-
siderable quantity of fresh meat to the diet. Also the addition of the Phaseolus
radiatus, especially in the pods, would be clearly indicated. At the same time
the quantity of polished food grains should be very considerably restricted or
43
withheld altogether. The sifted rice bran which has been shown to prevent the
disease in animals should be given. It is an inexpensive preparation which could
be generally used, and would be most valuable both in the treatment and preven-
tion of Epidemic Dropsy.
The present method of estimating diets will require further investigation and
research. It is doubtful whether the determination of the quantity of proteins,
fats, carbohydrates and ash gives sufficient information to enable us to distinguish
differences in diets which may be of extreme importance for the physiological
requirements.
A much larger problem in the prevention of Epidemic Dropsy opens out,
namely, how to obviate a continued rise in in the price of food grains. If this factor
could be eliminated probably the extensive and severe outbreaks of the disease
might be prevented. This question is, of course, beyond the scope of my investiga-
tion. I understand, however, that a special investigation on the subject of prices
is being held at present under the Finance Department of the Government of India,
and the Report of this enquiry will be looked forward to with interest in connection
with the eradication of Epidemic Dropsy.
45
APPENDIX.
Forms on which information obtained in the house to house enquiry is
re-corded.
Epidemic Dropsy Enquiry Form A./No.
GENERAL.
Record of examination of inmates and house No.---- in
Street----Ward----District
Date of examination
Reference B/Nos.
Total No. of inmates ( a) adults (male and female)
( b) children (male and female)------No. of servants (male and female)
No. of families in house------Food and cooking
arrangements of families (separate or common)---
Food and
cooking arrangements of servants (separate or common, nature of food taken)
_____________________________________________________________________
Inmates recently arrived, number, date, previous address,
______________________________________________________________________
Communication between families (intimate or slight)
Total No. of cases of Epidemic Dropsy in house ( a) adults (male and female)
(b) children (male and female up to 12)----
No. of cases of Epidemic Dropsy in house at present ( a) adults (male and female)
______________________________(b) children (male and female)
Fatal
cases---------- No. of cases of Epidemic Dropsy which have left house
(a) adults (male and female)
(b) children (male and female)
Present address---
Fatal cases-
-
No. of cases among servants -----------------No. of cases
among recently arrived
If more than one family in house state incidence of cases in each
Month and year of onset of first case and month or months in which subsequent
cases occurred and in which fatal cases occurred---------------------------------------------
--------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------
General sanitation (poor, fair, good or excellent)
Additional notes -------.
Epidemic Dropsy Enquiry Form B/No.
46
SPECIAL.
Record of examination of case in No.
-Street-----------------Ward---- District
Date of examination
Reference V.
Nos.
Name
age-------sex----Married, single, widow or
widower
Occupation---------------------------Caste, religion, habits
Date of onset of disease------------Date of
recovery or death
Still suffering--------------------------
Symptoms and date of onset
Gastro-intestinal disturbance (diarrhœa, etc.)
Œdema (position)
Fever (temperature)
Eruptions (mottling over œdematous parts, petechiæ, etc.)
Cardiac (pain, palpitation dyspnœa, bruit, etc.)
Nervous system (K. J., tenderness of calf, muscles, etc.)
Relapses (No. and date) ----
Emaciation ---------------------------------------------
Diet ----------
Rice
kind----new or old------ Quantity taken per day
( a) before illness
(b ) during illness
----------------------
Where purchased
Do other inmates of the house
take this rice (a) healthy
(b) sick --------------------Do servants take
this rice
Mustard oil
quantity per day ( a) before illness------
( b ) during illness-------------------Where purchased
---Do other inmates of the house take this oil.
( a ) healthy
(b ) sick-----------------------Do servants take
it
Fish----kind----quantity per day ( a ) before illness -------( b )
during illness
Ot her art i cl es of di et ---------------------------------------------------------
Cooking arrangements (common or separate)-----------------------------
Additional remarks and notes
Result of Examination .
Date.
ŒDEMATOUS.
BLOOD.
URINE. FÆCES.
Specimen taken of
R.B.C. H.B.
%
W.B.C. P.N. S.M. L.M.E. Culture.
_ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _
47
MAP OF CALCUTTA.
SHOWING.
DISTRIBUTION OF FATAL CASES OF EPIDEMIC DROPSY IN 1909 .
THICK LINE ENCLOSES WARDS No 5 AND 7 = MARWARI QUARTER.
INTERRUPTED THICK LINE ENCLOSES WARDS No 15,16, AND 17=EUROPEAN QUARTER.
EACH BLACK DOT REPRESENTS A FATAL CASE OF EPIDEMIC DROPSY.
CHART 1.
FATAL CASES OF EPIDEMIC DROPSY, 1909.
Reg No. 3060 E., 10.—H —1,080.
SECTIONS OF RICE GRAINS.
Fig. I.
SECTION OF A RICE GRAIN
(CARYOPSIS) BEFORE POLISHING
WITH ONLY HUSK REMOVED.
Fig.II.
SECTION OF A RICE GRAIN
AFTER FIRST POLISHING.
Fig.III.
SECTION OF A RICE
GRAIN AFTER FINAL POLISHING.
A.—PERICARP AND SEED-COAT COMPOSED OF TABULAR CELLS.
B.—FAT AND ALEURONE LAYERS.
C.— STARCH-CELLS AT THE PERIPHERY CONTAINING STARCH GRANULES AND A LITTLE PROTEID.
D.—STARCH-CELLS IN THE INTERIOR CONTAINING STARCH GRANULES BUT HARDLY ANY PROTEID
(AS INDICATED BY THE XANTHOPROTEIC TEST).
B. C AND D= ENDOSPERM.
CHART II.
SHOWING THE PERCENTAGE OF MEAT EATERS AMONGST BENGALI ADULTS
(MALE AND FEMALE), WIDOWS, CHILDREN (MALE AND FEMALE) AND MORTALITY FROM
EPIDEMIC DROPSY IN EACH CASE.
CHART Ill.
1
EXPERIMENT II.
2 .
EXPERIMENT XI AND XXII.
THIN CONTINUOUS LINES SNOW THE WEIGHT OF PIGEONS IN GRAMMES FED ON POLISHED RICE.
,, DOTTED ,, ,, ,, ,,WHEAT& PULSES (CONTROLS).
THICK COTINUOUS LINES SHOW THE PERIOD THE PIGEONS WERE FED ON POLISHED RICE.
,, DOTTED
,,
,,
,, WHEAT & PULSES (CONTROLS).
3.
EXPERIMENT, XXII.
4.
EXPERIMENT, XXVII.
CHART III. CONTINUED.
THIN CONTINUOUS LINES SHOW THE WEIGHT OF PIGEONS IN GRAMMES FED ON POLISHED RICE.
THIN DOTTED ,,
,,
,,
,,
,,
,,
,,
,,
,, WHEAT AND PULSES (CONTROLS).
THICK CONTINUOUS LINES SHOW THE PERIOD THE PIGEONS WERE FED ON POLISHED RICE.
,, DOTTED ,, ,, ,, ,, ,, WHEAT AND PULSES (CONTROLS).
EXPERIMENT XXII.
PIGEON FED ON POLISHED RANGOON RICE.
SCIATIC NERVE SHOWING DEGENERATIVE CHANGES IN FIBRES.
Photo-Engraved & printed at the Offices of the Survey of Calcutta, 1911
CHART IV.
SHOWS THE VARIATIONS FROM THE MEAN OF THE AVERAGE
RETAIL PRICE OF RICE IN BENGAL DURING THE PERIOD FROM 1885-1909
AND ITS RELATION TO EPIDEMIC DROPSY IN BENGAL.
MEAN =3-5 RUPEES PER MAUND OF RICE (COMMON).
PERIOD DURING WHICH NO EXTENSIVE OUT-BREAK OF EPIDEMIC DROPSY OCCURRED
IN BENGAL.
PERIOD DURING WHICH EXTENSIVE OUT-BREAK OF EPIDEMIC DROPSY OCCURREDIN BENGAL.
CHART V.
SHOWS THE VARIATIONS FROM THE MEAN AVERAGE RETAIL PRICE OF RICE IN BENGAL
DURING THE PERIOD FROM 1875 -1883, AND ITS RELATION TO EPIDEMIC DROPSY IN BENGAL.
MEAN 2.0 RUPEES PER MAUND OF RICE.
PERIOD DURING WHICH NO EXTENSIVE OUT-BREAK OF EPIDEMIC DROPSY
OCCURRED IN BENGAL.
PERIOD DURING WHICH EXTENSIVE OUT-BREAK OF EPIDEMIC DROPSY OCCURRED IN BENGAL.
CHART VI.
SHOWS THE VARIATIONS FROM THE MEAN AVERAGE RETAIL PRICE OF
RICE IN BENGAL DURING THE PERIOD FROM 1878-80, AND ITS RELATION TO
EPIDEMIC DROPSY IN BENGAL.
MEAN =2.5 RUPEE PER MAUND OF RICE (COMMON).
PERIOD DURING WHICH EXTENSIVE OUT-BREAK OF EPIDEMIC DROPSY OCCURRED IN BENGAL.
,, ,, ,, N O ,, , , ,, ,, ,,
ICAR,
15. XII / 500
Vol. XII
1942
THE
Indian Journal of Veterinary Science
AND
Animal Husbandry
Issued under the authority
of
The Imperial Council of Agricultural Research
Annual subscription
Rs. 6 or 9s. 9d.
Price per part
Rs. 2 or 3s. 6d.
PUBLISHED BY THE MANAGER OF PUBLICATION, DELHI
PRINTED BY THE MANAGER GOVERNMENT OF INDIA PRESS, NEW DELHI
1944
Price annas 5 or 6d.
ORIGINAL ARTICLES
SOME STUDIES ON THE APPLICATION OF THE
FREEZING POINT TEST TO BUFFALO'S AND
COW'S MILK IN INDIA
BY
ZAL R. KOTHAVALLA
J. S. BHALLA
AND
N. D. LAVANGIA
Imperial Dairy Institute, Bangalore
(Received for publication on 16 October 1941)
INTRODUCTION
THE great utility of the freezing point test in dealing with milk samples sus¬
pected of carrying added water has been fairly well established in recent
years. It provides a simple and reliable method for detecting the presence of
added water in milk. The present milk legislation in most municipalities and
provinces in India is based mainly on the determination of fat and solids-not-
fat but these values vary considerably under the prevailing conditions of milk
production and handling. The formulation of a common standard for milk
for the whole of the country presents special difficulties, as there are two types
of milch cattle in India, viz. the cow and the buffalo. Thus it is necessary to
fix these values for at least three classes of milk, viz. the cow's milk, the
buffalo's milk and mixed milk, all of which show marked differences in their
composition. Again the normal daily variation, as well as variations due to
such factors as breed, individuality, stage of lactation, etc. tend to be more
conspicuous under Indian conditions, due to the fact that in the vast majority
of cases the milk is collected from a very small number of animals and no special
care is taken to bulk the supply properly.
Under these circumstances it was felt that if the freezing point test could
be standardized under Indian conditions it would prove of particular value to
health authorities in exercising a more efficient control over the milk supply
of the place. With this end in view this method of detecting adulteration in
milk was examined systematically. In recent years a number of countries
have adopted this method as a standard test for the detection of added water
in milk. It is also significant that in countries where this method has been
officially adopted, the number of cases of adulteration has shown a remarkable
drop. A similar step in this country should go far in helping the public health
authorities to fight the evil of adulteration, which is very widespread. It is
not likely that the freezing point of genuine cow's or buffalo's milk will show any
marked difference but still it was considered desirable to confirm this assump-
tion. So far no work has been done to test the suitability of this method for
Indian conditions except for some data obtained by Leather [1914] by a few
trials with it.
1