NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
18
certainly no better, possibly not so good as those in adjoining Wards ; yet not-
withstanding these circumstances no fatal cases of Epidemic Dropsy were recorded
from the Marwari population. This fact points strongly to Epidemic Dropsy
being a nutritional rather than an infectious disorder. The portion of the map
enclosed within the thick continuous line (Marwari Wards, 5 and 7) stands out
in m asked contrast to its neighbours (Bengali Wards, 9 and 8) as regards the
number of fatal cases of Epidemic Dropsy recorded. These Wards are all under
the same environmental conditions, etc., the populations inhabiting them vary
only in regard to the dietary habitually consumed.
Chart No. 1 shows the number of fatal cases of Epidemic Dropsy in Wards 5
and 7, and Wards 9 and 8, the population of the Wards, and their inhabitants.
The better class European quarter of Calcutta has been enclosed within a
thick broken. line. Here again it will be seen that the enclosed space is distinguished
in a remarkable manner by the complete absence of dots. It is interesting to note
that in the outbreak of Epidemic Dropsy in Calcutta, 1877—79, no Europeans were
attacked then also.1 A s i s w e l l k n o w n r i c e i s c o n s u m e d i n s m a l l q u a n t i t y o n l y ,
at irregular intervals, and forms only a trivial portion of the dietary of the European.
That Europeans do not possess any peculiar immunity from the disorder is shown
from the fact that, when their dietary approximates to the diet of the Bengali,
and they consume a large quantity of rice habitually, they may fall victims to the
disorder ; this has been shown by Megaw 2 in his observations on cases of Epi-
demic Dropsy amongst poor Europeans in the General Hospital, Calcutta. He
says, " The conditions under which Epidemic Dropsy occurs among European
patients in Calcutta are very significant in this connection. All the cases were in
persons who had been in the habit of consuming considerable quantities of rice,
and on the whole the severity of the cases seemed to be proportional to the amount
of rice taken. There is the remarkable fact that among Europeans who do not
take rice, except in very small quantities, Epidemic Dropsy is unknown, whilst
amongst those who take a moderate amount the disease occasionally appears,
usually in the mild form." Hence it will be seen that much valuable information
has been obtained by the study of the geographical distribution of the disease.
This information has formed the starting point for further research on the etiology
of the disease.
1M
c L e o d , K .
I n d i a n H e l i c a l G a z e t t e ,
Vol. XXIX, 1894.
2M
e g a w : F e v e r s i n t h e T r o p i c s , 1 9 1 0 .
19
CHAPTER V.
Polishing of Food Grains in relation to Epidemic Dropsy.
From a study of the foregoing it will be seen that the evidence points to
Epidemic Dropsy being a disorder of nutrition. It will now be necessary to
enquire into the presence or absence of defects in the dietary habitually consumed
by the race attacked by Epidemic Dropsy. The views of the Professor Axel
Hoist1 o n t h e e t i o l o g y o f ' S h i p B e r i - b e r i ' h a v e b e e n d i s c u s s e d a l r e a d y . H e
regards it as a food disease. In concluding his paper he states, " Several
chemical questions arise. For instance, which are, properly speaking, the nutritive
constituents, the presence of which prevent, and conversely the absence of which
produce the disease ? That such elements exist has been suggested by Grijns,
and seems to be proved by Eijkman2 who was able to cure the malady by adding
to the injurious food an aqueous extract of rice bran." Whilst the present
enquiry was in progress an important paper has been published by Fraser and
Stanton on the Etiology of Beri-beri.3 In this investigation they show that
the polishing of rice in steam mills removes substances which are essential for the
maintenance of the normal nutrition of nervous tissue. These substances exist
in adequate amount in the original grain and in superabundant amount in the
polishings of white rice. They state further that, " The estimation in terms of
phosphorus pentoxide of the total phosphorus present in the given rice may be
used as an indicator of the beri-beri producing power of such rice when forming
the staple diet in man." At the first biennial meeting of the Far Eastern
Association of Tropical Medicine held at Manila, March 5 to 14, 4 the question was
fully discussed and the results of several important original investigations on the
subject were communicated. The views of Fraser and Stanton were confirmed,
and further valuable additions to our knowledge of the subject were made ;
as a result of these far-reaching discoveries the following important resolution
was passed by the Association :
—
"Resolved, that in the opinion of this Association sufficient evidence has now
been produced in support of the view that beri-beri is associated with the con-
tinuous consumption of white (polished) rice as the staple article of diet, and the
Association accordingly desires to bring this matter to the notice of the various
Governments concerned."
Since the evidence obtained in regard to Epidemic Dropsy in Calcutta pointed
to its causation being associated with a particular kind of dietary it was necessary
to enquire very carefully into the composition of the articles making up this diet,
1 Holst, Axel. Experimental studies relating to " Ship Beri-beri " and Scurvy. Journal of Hygiene,
Vol. VII, Part II, 1907.
2 Arch. f. Hyg., 1906, Vol. LVIII.
3 Studies from the Institute for Medical Research, F. M. S., 1909, Kuala Lumpur.
4 Philippine Journal of Science, Vol. V, No. 1, February 1910.
D2
20
and to determine whether or not they contained certain essential ingredients
required to meet the physiological requirements. In the Bengali diet, rice and
to a less extent ata (wheat) are the staple articles, and as these are consumed after
polishing and milling, obviously it became necessary to determine the effect on
the nutritive value of these articles of these processes in the light of recent
researches. Accordingly Mr. Hooper made a very careful chemical analysis of the
rice and wheat with special reference to the phosphorus content.
Samples of rice were obtained from a representative steam mill, viz., the
Ram Kristopore Mill, Howrah, at every stage of the process of preparation.
The samples were described as follows :
—
(1) Anchata or unpolished rice.
(2) Kolchata or polished rice, first process.
(3) Polished rice after the second process.
(4) Koorah (polishings) removed by first polish.
(5) Koorah (polishings) removed by second polish.
The weight of a 100 of the rice grains was respectively 1.79, 1.74, 1.61
grammes.
They contained the following constituents :—
—
Water.
%
Ash.
%
P2
O
5
%
Percentage of P 2O5 in
ash.
1
11.10
1.7
.58
34.1
2
11.0
.9
.45
50.0
3
11.0
1.0
.38
38.0
4
7.6
16.5
3.39
20.5
5
8.3
13.8
3.27
23.7
The process of polishing has removed the layers containing the phosphated
compounds. The phosphoric acid in the first polished rice is reduced by 22.4
per cent. compared with the unpolished rice. The phosphoric acid is further
reduced by the second polishing, but the ash remains about the same.
The analysis of another series of samples of rice gave the following results :—
The samples were described thus :
—
(1) Rice husked, before polishing.
(2) Rice after first polishing.
(3) Rice after second polishing.
(4) Koorah after first polishing.
(5) Koorah after second polishing.
21
The weight of a 100 of the rice grains was respectively 2.02, 1.81, 1.74 grammes.
They contained the following constituents :—
—
Ash.
%
P2
O
3 %
S 1 O2
%
Percentage of P2O5 in
ash.
1
1.7
.80
. . 47.0
2
1.0
.50
..
50.0
3
1.0
.45
..
45.0
4
15.0
3.10
9.3
20.67
5
15.0
3.60
9.1
24.0
Considering that a different kind of rice is represented in this series, the results
compared with the first series are very similar.
As regards the fat content of rices
—
Unpolished rice has 2 to 2.5 per cent. of oil.
Polished rice has .5 per cent. or less of oil.
Rice bran (koorah) has 22 to 24 per cent. of oil.
The determination of the amount of nitrogen in polished and unpolished
rice gave the following results :
—
Unpolished rice contained 1.23 per cent. of nitrogen, which equals 7.68
per cent. albuminoids.
Polished rice contained 1.0 per cent. of nitrogen, which equals 6.25 per cent.
albuminoids.
It will be seen from this analysis that nitrogen is not concentrated in the
outer layers in the same proportion as the phosphorus and oil, but it is distributed
throughout the rice grain.
In addition to the chemical analysis the samples of rice at each stage of the
process were submitted to histological examination.
The drawing of sections of rice (vide ) grains shows the results of the histo-
logical examination of the rice grains at the different stages of preparation.
Paddy, that is the grains of the rice plant, consists of the fruit enclosed in the
paleæ, which constitute the husk. The fruit possesses a thin pericarp firmly
adherent to the seed and is either silver-like or varying from dark red to black
in colour. At the base of the dorsal edge may be seen the embryo lying in a
depression.
After preliminary polishing the whole of the pericarp, much of the aleurone
layer, and some starch cells are removed ; and after final polishing almost the
whole of the aleurone layer with some of the exterior starch cells are removed.
The aleurone layers contain nitrogen, phosphoric anhydride, and fat.
22
Experimental observations on pigeons were made, the animals being fed with
different kinds of 'polished' rice. The results of these experiments will be des-
cribed shortly.
It will be seen from a consideration of the above results that valuable nutrient
constituents are removed from the rice in the process of polishing : and races
who depend on rice, as the main source of these food constituents, which are of
high physiological importance, must be in a state of unstable nutritional equili-
brium ; disturbing factors, which will be discussed later may precipitate the phe-
nomena associated with 'starvation' in respect of these constituents. Amongst
the obvious signs of such 'starvation' are, swelling of the feet and heart trouble,
anæmia, polyneuritis, etc. Alteration of the dietary to meet the physiological
needs restores the nutritional balance and brings about a disappearance of the
phenomena of the disorder and a return to normal.
During the course of the present enquiry a very important fact emerged,
namely, that the wheat (ata) consumed by Bengalis is very poor, even poorer
than 'polished' rice in its nutritive constituents. During the course of our house
to house enquiry in regard to Epidemic Dropsy we have ascertained that it is the
custom to consume a particular kind of fine wheat (ata), and an analysis of this
by Mr. Hooper showed that it has a remarkably low phosphorus content. Accord-
ingly samples of wheat were obtained from a well known representative steam mill
in Calcutta at every stage of the process of preparation, and these were analysed
by Mr. Hooper with the following results :—
Calcutta Mill.
Moisture.
%
Ash.
%
Phosphoric
anhydride.
%
Ata (wheat) No.4 entire grain .
. .
.
11.86
1.13
.59
Ata (wheat) No. 2 .
.
.
.
.
.
11.93
.60
.32
Ata (wheat) B
.
. .
.
.
.
12.53
.33
.21
Wheat bran
.
.
.
.
.
.
.
13.33
4.20
2.02
Soojee, small .
.
.
.
.
.
.
13.06
.66
.26
„ large
.
.
.
.
.
.
13.00
.60
.22
Flour
.
.
.
.
.
.
.
12.33
.53
.22
„ 2
.
.
.
.
.
.
.
12.93
. 53
.21
„ 1
.
.
.
.
.
.
.
11.46
.53
.20
It will be seen from this series that in the process of milling in Calcutta the
23
ata (wheat) is deprived of a large amount of phosphates. The flours, which appear
to be fairly constant in composition, contain only 1/3 of the phosphoric anhydride
present in the entire grain.
It is well to bear in mind that the same phenomena may be produced by the
habitual consumption of other articles poor in these constituents. Thus Aron
and Hocson 1 record their occurrence in a man who was fed on bread and water
for 41 and 2/ 3 days. Schaumann2 h a s p r o d u c e d t h e l e s i o n s i n p i g s , c a t s , a n d
rats by feeding them on horse flesh which had been heated in a 20 per cent.
solution of sodium carbonate for three hours.
We see, therefore, that the question is an interesting but complex one, and
involves difficult problems in metabolism. In the present instance the food, habi-
tually consumed by the person presenting the phenomena of the disorder, is ' po-
lished' rice and to a less extent ' sifted' wheaten flour, and to these attention
has to be directed. It is interesting to note in this connection that the number of
steam mills for polishing rice have increased in India, especially in Madras, in
recent years. It is difficult to obtain exact figures on this point as no note is taken
of mills of less than 20 hands in official records.
1
P h i l i p p i n e J o u r n a l o f S c i e n c e ,
Vol. V, No. 1, February 1910.
2
A r c h . f . S c h i f f s , U . T r o p . H y g . B e i h e f t ( 1 9 0 9 ) , 1 3 , 8 2 — 9 0 .
24
CHAPTER VI.
Chemical and Histological Examination of samples of Food Grains of
the kind consumed by patients suffering from Epidemic Dropsy.
Having seen that by the process of manufacture (milling) rice and wheat are
deprived of certain constituents of high physiological value, it became a matter
of importance to determine to what extent the rice and wheat partaken of by
families who had been affected by Epidemic Dropsy during the recent outbreak
in Calcutta had lost these constituents in the process of milling. It may be
mentioned the more it has been polished the more elegant the preparation of the
rice appears, and it commands a higher price in the market. A beautifully milled
sample of rice prepared in England was examined recently chemically and
histologically, and was found to have had all the aleurone layer with its constituents
removed. Since Epidemic Dropsy presents the features of a nutritional disorder,
at first sight it might be thought that it would not attack well-to-do persons, yet
as a matter of fact it has affected this class also during the recent outbreak.
The explanation of this largely lies in the fact that in paying a higher price for
elegant preparations of rice and wheat, articles containing the essential physiological
constituents in sufficient quantity are not obtained, and if this deficiency is not
compensated for by an adequate addition of suitable ingredients to the dietary a
condition of defective nutrition results. It may be stated in general terms that
the higher the polishing of the rice the lower will be its content in the essential
constituents. Hence in this respect the high-priced, highly-polished rice is more
dangerous than the cheap coarser varieties.
During the course of the enquiry houses in which cases of Epidemic Dropsy
have occurred are being visited daily to record certain information, and during
these visits samples of rice and wheat have been obtained from the inhabitants
of the houses. The rice was of the same kind as that used by them during the
outbreak of Epidemic Dropsy last year. In this way a number of samples are
being collected and submitted to chemical and histological examination. The
25
results of the analysis of some of these samples of rice are given in the following
table :—
No. of
sample.
Kind of rice.
Weight of
100 grains.
Moisture.
%
Ash.
%
Phosphoric
acid
%
281
Balam
.
.
.
1.27
12.3
1.1
. 4 3
287
Atap
.
.
.
2.07
13.2
.6
.33
287
Desi
.
.
.
1.69
13.1
.9
. 4 5
296
Balam
.
.
.
1.44
12.8
.7
.43
320
Desi
.
.
.
1.52
13.0
.7
. 2 9
Barisal .
.
.
1.82
11.3
1.1
. 4 6
327
Balam
.
.
.
1.42
12.3
1.0
.40
340
Desi
.
.
.
1.41
12.2
.9
.39
348
Desi Pubna
.
.
1.57
12.2
.9
. 3 4
349
Balam
.
.
.
1.40
12.1
1.0
. 4 2
356
Balam
.
.
.
1.50
12.1
1.0
. 4 6
359
Desi
.
.
.
1.64
12.0
1.0
. 4 5
362
Balam
.
.
.
1.61
12.3
1.3
. 4 6
363
Balam
.
.
.
1.19
12.4
1.0
. 4 4
370
Balam
.
.
.
1.52
11.8
1.0
. 4 8
From Banga-
lore.
Patna
.
.
.
2.09
13.2
.9
.21
At the same time a histological examination of the grains showed that the
phosphorus content varied directly with the amount of removal of the aleurone
layers, that is to say, if the chemical analysis of the grain showed a low phosphorus
content, as in the last sample of rice in the table, the aleurone layers were found
to have been very completely removed, whereas if the phosphorus content was
higher it was found that the process of polishing had been less complete. Hence
the estimation of the phosphorus serves as a useful indicator of the amount of
polishing which the grain has undergone, and, therefore, will have a special value
in determining the dietetic value of rices. In addition to the (1) chemical, and (2)
histological investigations, (3) the polished rice has been used for feeding pigeons.
26
and fowls experimentally; the results of these experiments are of great importance
and will be dealt with later. It is seen, therefore, that the highly-priced, highly-
polished and elegant-looking preparations are largely deprived of essential con-
stituents of high physiologic importance—some samples to a greater, others to a
lesser degree. The rice bran (or polishings), called in Bengali koorah, which
is removed in the manufacture, contains the necessary constituents in superabund-
ance, and is thus a very valuable food material. This koorah is sold at a compa-
ratively very low price; a considerable proportion of it being exported from India,
and is used as a cheap source of oil. It is also employed for feeding animals.
In addition to rice many of those who were attacked by Epidemic Dropsy
consumed ata, wheaten flour, generally at the evening meal. Samples of this
fine ata were obtained from the inhabitants of houses in which Epidemic Dropsy
had occurred; the ata was of the same kind as that consumed by them habitually.
The samples of ata were very white and highly screened.
The following table gives the results of the analysis of the samples of ata:—
No. of samples of ata.
Moisture.
%
Ash.
%
Phosphoric anhydride.
%
396
.
.
.
.
12.5
.70
. 2 6
410
.
.
.
.
13.2
.73
. 2 4
431
. .
.
.
12.0
.73
. 2 3
437
. .
.
.
13.2
. 7 3
. 2 5
439
. .
.
.
12.6
.80
.37
441 (flour)
.
.
.
12.8
.53
.26
441 (ata)
. .
. 12.8
. 5 3
. 2 2
442 (ata)
. .
. 12.2
. 6 5
. 2 3
Average . .25
Remarks.—It will be seen that the wheaten flour is very starchy and the phosphorus content is remark-
ably low, even less than the average of the rice (0.40). Such flour is incapable of supplying the nutrient
constituents which are defective in the rice.
The composition of the bran (polishings) from rice and wheat has only recently
received serious consideration. Jordan, Hart and Patten,1 Hart, Andrews2 and
1 Amer. Journal Physiology (1906), 16, 268. Amer. Chem. Jour. (1904), 37, 564.
2 Bull. New York. Exp. Stat. (1903), No. 238.
27
others, have shown that an organic substance containing phosphorus, termed
phytin, the calcium magnesium salt of phytic acid, is found therein. Phytic acid
or anhydroxymethylendiphosphoric acid was discovered by Postemak 1 as a
constituent of green plants. Suzaki, Yoshimura and Takaishi 2 proved that 85
per cent. of the phosphorus in the bran of rice is in the form of phytin. The phos-
phorus of phytic acid being readily absorbed is a valuable compound to supply
phosphorus in a form which can be readily assimilated. Aron 3 has shown that
if 100 grams of white rice were extracted with 0.5 per cent. hydrochloric acid a yield
of 0.123 grams of soluable P2O5 was obtained, whilst if 100 grams red rice were
extracted with 0.5 per cent. hydrochloric acid a yield of 0.330 gram of P 2O5 was
obtained. This if equal quantities of rice (unpolished) and white rice (polished)
be consumed by different persons the former will ingest nearly three times the
quantity of soluable phosphorus compounds that the latter does. Aron4 is inclined to
consider that the important constituent in bran, the non-consumption of which is
liable to produce disease, is an organic compound of phosphorus.* It is important
to remember in this connection that the metabolism experiments of Clerk and Cooks
and Aron and Hocson6 have shown that the addition of organic phosphorus
to the diet increases the retention of nitrogen, showing that there is a close con-
nection between nitrogen and phosphorus metabolism in general. 7 Hence this
important fact emerges that a diet poor in phosphorus is not only detrimental by
depriving the. human system of this constituent, but it also operates by reducing
the power of retaining nitrogen. Aron and Hocsons have brought out a further
very interesting point, namely, that a patient suffering from beri-beri in a fairly
advanced stage has his capability of utilizing the nitrogen and phosphorus in his
food reduced. He, therefore, demands a higher intake of nitrogen and phosphorus
than a normal person to attain nitrogen and phosphorus equilibrium. Hence it
will be seen that the non-consumption of rice and wheat bran or its equivalent by a
normal individual probably brings about the following events :—In the first place
the want of bran constituents occasions a disorder of metabolism, one of the signs
of which. is the inability of the patient to utilize these constituents when supplied,
1 Compt. rend. Soc. Biol. (1906), 55, 1190.
2 Bull. Coll. Agric. Tokyo (1907), 7,495—572.
3 Philippine Journal of Science, Vol. V, No. 1, February 1910.
4 Ibid.
5 Jour, Biol. Chem. (1909), 59, 405—491.
6
I b i d .
7 Tunnicliffe. Arch. int. D. Pharm. U. Therap. 12. 1907.
8 Ibid.
* Whilst this Report was passing through the press Fraser and Stanton (Lancet, December 17th, 1910)
have published important results regarding the essential constituents of rice bran, and by their experiments
have disproved the importance of phytin in connection with the production of beri-beri. This paper
will be referred to more fully in my second Report.
E2