NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
28
and the starvation of the tissues is still further accentuated, and this prevents the
patient from recovering his nutritional equilibrium.
The Japanese investigators 1 i n t h e i r s t u d y o f b e r i - b e r i s h o w t h a t n i t r o g e n
destruction in that disease is increased. However these problems of metabolism
are by no means solved and require further research for their complete elucidation.
It must be remembered that although starvation in regard to phosphorus and
nitrogen is taking place it may not be sufficient to bring about obvious signs of ill-
health, such persons may be merely weak and easily tired. It would be possible to
construct a scale, at the one end of which are the slight cases, unrecognisable to the
ordinary observer, and at the other, the severe examples of the disorder, with pro-
nounced œdema, heart troubles, etc., which frequently end fatally. Between these
extremes all varieties of clinical manifestations occur and the scale of transition
between them is extensive. Indeed the complex problem of the influence of nourish-
ment upon general health and muscular power is involved in this consideration. It
is certain that the present method of estimating the nutritional value of diet from
the amount of proteins, fats, carbohydrates and ash. contained in them will require
reconsideration, and probably readjustment, in the light of recent research, because
this method has been shown to be crude and incapable of showing differences which
may be of vital importance to the physiological requirements of the individuals.
The action of food poor in phosphorus on young animals has been studied recently
by Hart McCallum and Fuller 2 and by Heubner 3 and Lipschutz. 4 The latter
has observed nervous symptoms in one of the dogs, and mentions the possible
connection of this problem and beri-beri. Aron and Hocson 5 quoting from
Tigerstedt,6 Ehrstrohm,7 Renvall state that the minimum amount of phospho-
rus required by the average man in his daily allowance of food is about 3.4
grams P2O5 or 0.06 grain per kilo of body weight. It would be interesting to
determine for particular races how far this amount of phosphorus can be lowered
without detrimental results to the health. Hans Aron, Aron and Hoscon 8
have gone into this question for the Filipinos and they find that, " a diet consisting
of bread and rice (both poor in phosphorus), and some fat (bacon) and sugar, fur-
nishing 40 calories, 0.15 gram nitrogen and 0.025 P 2O5 per kilo body weight does
not cover the demands of the body for nitrogen and P 2O5 and therefore leads to
nitrogen and P 2O5 loss from body." They, also, arrive at the following im-
portant conclusions from their metabolism experiments : " (1) It is highly probable
1 Beri-beri or Kakke. Miura. Ergeb. d. inn. Med. u. kinderneilk (1910. 4. 282—318).
2 Amer. Jour. Phys., 1908, 23. 246—277.
3 &, 4 Verhandl . 26. Vers. Gesel l sch. f. Ki nderhei l k (1909), 146—161.
5 Ibid.
6 Handbuch d. Phys. Braunsweig, 1908.
7 S k a n d . A r c h . f . P h y s . ( 1 9 0 3 ) , 1 4 . 9 1 .
8
I b i d .
29
that living for an extended period on a one-sided almost exclusively vegetable diet,
which is characterised by its poverty in phosphorus and protein, may result in
beri-beri. (2) The process of polishing rice removes a fine skin and the outer layers
(bran) ; this rice bran is rich in phosphorus, especially in its organic, soluble form
(phytin) ; the content of phosphorus of the rice is considerably reduced by the re-
moval of the bran. (3) Polished rice, poor in phosphorus, may cause beri-beri in
man if it is the main constituent of the food ; but it is harmless if sufficient other
nourishment, rich in phosphorus and protein is taken. The same polished rice
causes a polyneuritis in chickens. White bread, a food of similar chemical com-
position as regards phosphorus and protein, cannot sustain monkeys in normal
health if it forms the entire diet."
30
CHAPTER VII.
Observations on the effect of Variations in Diet on the mortality from
Epidemic Dropsy in Calcutta.
If Epidemic Dropsy has an origin in certain defects in dietary, obviously
a very important method of testing the truth of this view would be to place certain
groups of individuals on different dietaries, other conditions being constant,
the only varying factor being diet. In practice, however, it is almost impossible
in a large civil population like that in Calcutta to deliberately arrange such an
investigation and enforce its being carried out with the rigor necessary for a
scientific, observation. Fortunately a careful analysis of the data showed that
the population of Calcutta was divided up in a manner very useful for epidemio-
logical observations and provided material for working out the problem ; the
general conditions approximated closely to the requirements of a definitely planned
scientific experiment. The first set of observations to be considered is :—
1. The effect of the addition of meat to a staple rice dietary.
In the course of my enquiry the details of the dietary of cases of Epidemic
Dropsy which occurred in the outbreak of 1909 are being recorded. As a large
number of cases have been examined daily, a considerable amount of material is at
hand for analysis. A careful study of the above data enables us to appreciate, the
effect on the mortality from Epidemic Dropsy of the addition or non-addition to the
diet of certain important articles. Obviously one of the most important is meat.
It is a well known fact that Bengali males take meat fairly frequently : whereas
Bengali females seldom consume it and Bengali widows are not permitted, for
religious reasons, to partake of it at all. Hence it will be obvious that these three
groups of Bengalis furnished valuable information to enable us to ascertain the
effect on the mortality from Epidemic Dropsy amongst Bengalis in Calcutta of the
addition or non-addition of meat to the diet.
The results of this investigation have been set out in Chart No. II. The dark
portion of the upper columns represents the percentage of meat eaters amongst
the cases of Epidemic Dropsy in Bengalis (adult and children). The unshaded
portion of the upper column represents the percentage of non-meat eaters amongst
cases of Epidemic Dropsy in the same classes. The lower columns represent the
percentage of fatal cases of Epidemic Dropsy in these groups.
The exact percentage of Bengalis, males and females, affected with Epidemic
Dropsy, who took meat at all, was ascertained. It was known, and was confirmed
by our enquiry in each case, that Bengali widows took no meat, their dietary being
practically pure rice and ata. At the same time the percentage of fatal cases of
Epidemic Dropsy amongst those affected was ascertained, also, from our records
for all three groups of individuals. The results are given in graphic form in the
above Chart. A glance at it will show at once the strikingly close connection be-
31
tween the death rate from Epidemic Dropsy and the quantity of meat consumed.
In the case of the Hindu widows attacked by Epidemic Dropsy who do not consume
meat at all the mortality is very high. The females (excluding widows) attacked,
who consumed only a little meat, stand next, whilst the male Bengalis who con-
sumed a larger quantity of meat show the lowest mortality from Epidemic Dropsy.
If we turn to the mortality from Epidemic Dropsy in Bengali children under
12 years, male and female, it will be noted that the death rate is approximately the
same, and low compared to the death rate amongst females (adult); and this is
correlated with the observation made in the course of our investigations that the
percentage of meat eaters amongst male and female Bengali children under 12
years is high, and practically equal. This affords further proof of the close re-
lationship between the death rate from Epidemic Dropsy and the quantity of meat
consumed, and that sex, per se, does not appear to play any part in influencing the
mortality.
In Chart No. II the mortality from Epidemic Dropsy amongst male and female
Bengali children, and the percentage of these male and female Bengali children,
under 12 years, who consumed meat in their dietary, are shown.
The above records are very instructive and indicate clearly the effect on the
mortality from Epidemic Dropsy of the addition of meat to a diet. The more
' one-sided ' the diet, as in the case of the Hindu widows, the more severe is the
disease. The consumption of the rice and ata is harmful in the case of the widows,
because they are the predominating articles of the dietary, the chief sources of
supply from which constituents, required to meet the physiological demands of the
human system, can be obtained. As we have seen these particular sources can-
not meet the demands and hence ' starvation' with its various manifestations,
results. The harmfulness of polished rice is rendered proportionately less, as
additional satisfactory sources of supply are added to the dietary. We see, there-
fore, that the danger in this connection of polished rice and wheaten flour depends
on the extent to which they enter into the dietary. In other words the more " one
sided " the dietary, the higher the death rate and, vice versâ . It is this " one sided-
ness " of the dietary which plays a very important part in the etiology of Epidemic
Dropsy. The problem is a complex one as will be readily understood. It is
not easy to say, for example, what precise degree of ' one-sidedness ' of dietary will
produce recognisable morbid signs in a previously healthy person. Further, the
personal factor will come in also ; some individuals will be able to live without show-
ing very obvious signs of disease on a degree of ' one-sidedness ' of dietary, which
would cause manifest and perhaps severe symptoms in others : certain factors,
e . g ., economic conditions, price of food, etc., may expose a larger number of indi-
v i d u a l s t o ' o n e - s i d e d n e s s ' i n d i e t a r y . Th i s p r o b l e m wi l l b e r e f e r r e d t o l a t e r ,
in section 9.
32
The second set of observations, which remains to be discussed, is :—
2. Supplementing. and replacing rice by other suitable kinds of grain in the diet.
In the geographical distribution of Epidemic Dropsy in Calcutta we have
referred to the interesting and important observation that a group of Hindus (Mar-
waris) living in the heart of the portion of Calcutta affected by Epidemic Dropsy
returned no fatal cases. Obviously, therefore, it was necessary to make careful
enquiry regarding the dietary of the Marwaris to see in what respects it differed
from that consumed by the Bengalis. This was done, and a chemical analysis of
the various articles was made by Mr. Hooper. It was ascertained that the quan-
tity of rice consumed by Marwaris is small, in fact 75 per cent. of them do not
take it at all. It is supplemented and replaced by the following articles :—
Ata—Wheat ( Triticum sativum)
Coarse.
„ —Bajri ( Pennisetum typhoidenm )
Besan—Pea flour ( Pisum sativum )
Dal—Mung ( Phaseolus radiatus )
Papar prepared from dal.
Kair—Fruit of Capparis aphylla.
Sangar—Pods of Prosopis spicigera.
Gourfali—Cyamopsis psoralicides.
Motha-ka-fali—Pods of Phaseolus.
The last four fruits are obtained from Bikanir and are not ordinarily met with in
Calcutta, and these and the Sangar fruits are often eaten in times of scarcity as these
trees grow in arid regions. The young pods of Cyamopsis and Phaseolus are
particularly nourishing.
The following is the result of the analysis :—
Moisture.
%
Ash.
%
Albuminoids.
%
P h o s p h o r i c
acid.
%
Wheat .
.
.
.
.
.
13.7
1.7
12.1
. 7 3
Bajri
.
.
.
.
.
.
11.5
2.5
1 0 . 4
.78
Basan .
.
.
.
.
.
13.8
3.2
23.6
.84
Dal
.
.
.
.
.
.
14.6
3.2
22.2
. 9 5
Papar .
.
.
.
.
.
18.8
6.5
21.9
. 8 5
Kair
.
.
.
.
.
.
18.5
4.2
16.8
.57
Sangar .
.
.
.
.
.
16.0
4 . 1
17.1
.54
Gourfali
.
.
.
.
.
18.0
8.1
1 7 . 1
. 7 6
Motha-ka-fali
.
.
.
.
16.0
5.5
2 0 . 1
1.10
33
From the quantity of the articles consumed in the diet the amount of phos-
phorus taken per day by Marwaris has been calculated as follows :—
Grains Phosphoric Anhydride.
Rice
.
.
. . ½ to 1 chittak
.
.
1.8
to
3.6
Wheat ata
.
.
. 7 to 8
„
.
.
46
to
52.5
Bajri flour
.
.
. 3 to 4
„
.
.
21
to
28
Dal .
.
.
.
.
½ to 2
„
.
.
4.3
to
28
Besan
.
.
.
.
½ chittak
.
.
3.75
to
3.75
76.85
115.85
In the same way the amount of phosphorus taken per day by Bengalis has
been calculated :—
DIET I .
Phosphoric
Anhydride.
Grains.
Morning meal
.
. Rice .
.
. 3½ chittaks .
. 1 3 . 5 4
Dal .
.
.
1/3 chittak .
. 2.49
Evening meal
.
. Rice .
.
. 3 chittaks
.
. 11.61
Dal .
.
.
1/3 chittak
.
. 2.49
TOTAL
.
30.13
DIET II.
Phosphoric
Anhydride.
Grains.
Morning meal
.
. Rice .
.
. 3½ chittaks .
. 13.54
Dal .
.
. 1/3 chittak .
. 2.49
Evening meal
.
.
Ata .
.
. 3 chittaks
.
7.02
Dal
.
.
.
1 / 3 c h i t t a k
.
.
2.49
TOTAL
. 25.54
Diet II is very commonly consumed by Bengalis in Calcutta ; the rice being
replaced by ata in the evening meal. It is evident from the above that the total
phosphorus content of the food grains composing the Marwari dietary is much
higher than that of the Bengalis.
In addition Bengali adult males and children consume meat occasionally, and
the beneficial effect of this addition to the dietary has been discussed. The Ben
galis, with the exception of widows, partake of a small quantity of fish and vege-
tables, and sometimes milk.
F
34
CHAPTER VIII.
Experimental Researches to note the effect of Feeding Pigeons on
various kinds of Rice and Grain.
In 1888 Eijkman1 observed the occurrence of an epidemic of polyneuritis
in Laboratory fowls which resembled beri-beri in many respects. The clinical
signs noted were—staggering, often followed by total paralysis, paresis of the
wings, dyspnœa and cyanosis, followed by death. The post-mortem exami-
nation revealed wasting of the muscles and subsutaneous tissue, fluid in the peri-
cardium, degeneration of nerve fibres, but no microscopic nor macroscopic altera-
tions of the brain or of the spinal cord. This was not a microbic disease, but was
closely associated with the food of the fowls. The disease always appeared after
an incubation period of varying duration (ranging from twenty to thirty days, some-
times more). The polyneuritis could not be caused by a poison present in the rice,
because fowls sickened much sooner when fed on boiled rice than when the same
variety of grain was given unboiled. Eijkman showed that when the diet consists
of rice alone, the appearance of the disease depends on whether the pericarp has
been removed. Fowls fed on starch (cakes made of sago meal, pearl tapioca, or
the starch of palm tree " Arenga saccharifera. Labill ") also suffered from poly-
neuritis, but they soon recovered exactly as fowls did which had fallen ill by being
fed on cleaned rice alone, when subsequently given raw meat.1 Grijns2 has
carried out feeding experiments on fowls. So, also has Axel Holst. 3 These ob-
servers have confirmed the results of Eijkman. Although Eijkman considered
that the polyneuritis was due to a definite poison in the rice ; Grijns 4 and Holst5
are of opinion that it is due to the non-consumption of certain essential constituents
necessary for physiological requirements. Fraser and Stanton 6 fed some fowls
on paddy and some on polished rice. All the former remained healthy whilst six
out of 12 in the latter series developed polyneuritis in five weeks. Aron7 investi-
gated the relationship of the non-consumption of Phytin* to beri-beri by feeding
experiments.
It will thus be seen that fowls are very useful experimental animals for the
demonstration of the food value of certain grains. Early in my enquiry I com-
menced feeding experiments on a number of different kinds of animals to ascertain
1 Polyneuritis by hœndere-. Genees. Tyds. V. Ned. Ind. (1890), 30: (1893) 32 and (1896) 36.
1 De Haan. Philippine Journal of Science, Vol. V, No. I, February 1910.
2 Over Polyneuritis gallinarum I en II. Genees. Tyds. V. Ned. Ind. (1900). 41 and (1909) 49.
3 Journal. Hyg. (1907)
4
I b i d .
5 Ibid.
6 Studies from Institute for Medical Research, F. M. S., 1909.
7 Philippine Journal of Science, Vol. V., No. 1, February 1910.
* Vide footnote, page 11.
35
which would be most suitable for my purpose. After testing a number, e.g., rab-
bits, guinea pigs, cats, rats, monkeys, pigeons and fowls, I decide to use pigeons
and fowls for the experimental investigations. I had large cages constructed con-
sisting of a wooden frame closed by wire netting. The floor is of wood. The cages
are cleaned out ; carefully washed With a solution of Lysol ; and fresh, clean sand
sprinkled on the floor daily. The cages are placed in an open veranda. The birds
have plenty of space and fresh air. Thus during the experiment they are placed
under the best hygienic conditions. A measured quantity of the particular grain
is given to the birds twice daily. They are supplied with water. Each bird is
weighed weekly. The precautions taken are necessary to avoid complicating
factors entering into the observations and so rendering the results uncertain.
Feeding Experiments (Bengal Rice).
The Bengal rice selected for experiment was a sample received from Khulna.
It was chosen because it had been sent to the Medical College for examination on
account of Epidemic Dropsy being prevalent at the time in the district. This
rice was given raw to healthy pigeons, 30 grms. per pigeon daily. No other food
was allowed.
The weekly weight of the pigeons, the duration of the feeding experiments,
and the presence or absence of neuritis are shown in graphic form in Chart No. III.
It will be seen from this experiment that all the pigeons fed on this rice lost
weight. They developed signs of polyneuritis : when this occurred the animal was
killed to obtain the nerves in a fresh condition. Both sciatic nerves were carefully
dissected out to their finest terminations and placed in a solution of Osmic acid,—
pressure and stretching being avoided. The nerves were passed through alcohol
and clove oil, in which they were carefully teased out and examined under the
microscope.
In each case we conclusively proved by microscopic examination that the
bird had polyneuritis.
The chemical analysis of the rice on which these pigeons were fed gave the
following results :—
Water.
Ash.
P O
N.
Protein.
Weight of 100
grains of the rice
in grammes.
10.2
.85
.43
1.45
9.06
2.45
The histological examination of the rice grains showed that they had been
polished.
F 2
36
Feeding Experiments (Rangoon Rice).
(1). Unboiled rice.—The Rangoon (Burmah) rice selected for experiment was
purchased in Calcutta. This rice was given unboiled in this experiment to healthy
pigeons, 30 grms. per pigeon daily. No other food was allowed.
The weekly weight of the pigeons fed on Burmah rice, the duration of the feed-
ing experiments, and the presence or absence of neuritis are shown in graphic form
in Chart No. III.
The drawing at the end of this report shows a well marked degeneration of
the fibres of the sciatic nerve of one of these pigeons.
The chemical analysis of the rice on which these pigeons were fed gave the
following results :—
Water.
Ash.
P2O5
N.
Protein.
Weight of 100
grains of the rice
in grammes.
10.2
.63
.36
1.23
7.68
2.06
A histological examination of the rice showed that it had been polished, the peri-
carp and sub-pericarp layers having been completely removed.
Feeding Experiments (Rangoon Rice).
(2). Boiled rice. —In order to determine whether or not the neuritis could be
prevented by submitting the rice to high temperature, the same Burmah rice as
was used in the above experiment was submitted to a temperature of 100°C for one
hour. This boiled rice was given to healthy pigeons, 30 grammes per pigeon daily.
No other food was allowed.
The weekly weight of the pigeons fed on boiled Burmah rice, the duration of
the feeding experiment, and the presence or absence of neuritis are shown in graphic
form in Chart No. III.
For chemical analysis of the rice see the previous experiment.
It will be seen from these experiments that boiling has no effect at all in pre-
venting the occurrence of neuritis in pigeons. This is an important point because
the prolonged heating would destroy moulds, poisons in the rice, etc., which have
been erroneously assumed to be the cause of the neuritis of fowls.
F e e d i n g E x p e r i m e n t ( C o n t r o l ) .
Wheat, Pulses, Barley. —In order to observe the effect of feeding pigeons on
other grains than rice an experiment was carried out with the following mixture :—
Wheat
. .
.
.
.
.
.
.
.
.
82.0 parts
Pulses
.
.
.
.
.
.
.
.
.
.
13.0 „
Stones, etc.
.
.
.
.
.
.
.
.
. 3.1
„
Barley
.
.
.
.
. .
.
.
.
.
1.9
„
100.0
37
The pulses were—Pigeon pea, Ahrar ( Cajanus indicus), Green mung (Phaseolus
radiatus). 30 grammes of this mixture were given to each pigeon daily. No
additional food was allowed. The conditions otherwise were precisely the same as
in the rice experiment.
The weekly weight of the pigeons, the duration of the feeding experiments,
and the presence or absence of neuritis are shown in graphic form in Chart
No. III.
The chemical analysis of the ingredients of the mixture on which these pigeons
were fed gave the following results:—
Constituent of diet.
Water. %
Ash.
%
Phosphoric
acid.
%
1. Wheat, large
.
.
.
.
.
.
13.7
2.1
.74
2. Wheat, small
.
.
.
.
.
.
14.1
2.0
.85
3. Barley, husked .
.
.
.
.
.
13.4
1.3
.67
4. Pigeon pea, Arhar .
.
.
.
.
.
16.6
4.0
.80
5. Green mung dal .
.
.
.
.
.
11.3
4.3
1.16
The analysis of the mixture used for feeding gave the following results on
analysis:—
Water.
%
Ash.
%
Phosphoric acid.
%
12.8
2.7
. 7 6
The above feeding experiments are very instructive and throw a considerable
amount of light on the problem. In the rice feeding experiments all the pigeons
lost weight progressively, and all developed signs of polyneuritis and were killed
in order to obtain a fresh undecomposed preparation of the nerves for histological
examination, as post-mortem changes in the nerves set in very rapidly in this climate,
and to avoid this the animals were killed when the signs of polyneuritis were
marked, and the nerves were removed with as little delay as possible. The analysis
of the rice shows that the phosphorus content is about the same as that in the
milled rice partaken of by the Bengalis attacked with Epidemic Dropsy. In
striking contrast to the rice experiments are the feeding experiments with wheat,
and pulses ; none of the pigeons on wheat-pulses have lost weight, in fact they
have rather gained, and none of them have developed neuritis. The wheat and
pulse experiments, as will be seen, have been going on for some months, and
the pigeons are quite healthy. Further, the results of the chemical analysis of
38
the rice and wheat-pulse diets are very interesting and important. The wheat-
pulse diet shows a high phosphorus content, in fact about double that of the rice
diets. It will be seen that one of its constituents, Mung dal, is particularly rich
in phosphorus, containing 1.17 of phosphoric anhydride, whilst Burma rice con-
tained only 0.36. The chemical and experimental results therefore agree. These
diets imitate approximately the food consumed by the Bengalis and Marwaris,
respectively. In the former rice is the staple, whilst in the latter, as already des-
cribed, wheat-pulses largely supplement or entirely replace rice. As we have
observed the Marwaris had immunity from Epidemic Dropsy during the outbreak
in Calcutta in 1909, and we have an experimental explanation of this immunity
from the feeding experiments on pigeons.
These feeding experiments prove that an exclusive diet of polished rice, which
is poor in essential constituents, is unable to meet the physiological requirements,
and signs of starvation result, but that a diet of wheat and pulses, containing these
constituents in abundance, is capable of meeting all the physiological demands,
and the animals remain well.