NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Sanitation, Diet, Disease, etc.
307
of the lower classes will readily eat meat, and Chamars will
even consume the flesh of animals which have died of disease.
Rajputs, especially in Central India, and wild forest tribes, eat
what flesh may be killed in the chase, though some of pure
Hindu blood refuse that of deer and pigs. Fowls and eggs are
readily eaten in some parts of the country, but are regarded
with abhorrence in others. Milk, curds, " ghee, " or clarified
butter are universally consumed.
As above stated, the great majority of inhabitants are ve-
getarians and live upon the crops raised in the country, the
coarser grains being used by the poorer, and the finer by the
richer, classes of the community. The subjoined table and
remarks taken from the Report of the Famine Commission in
1880 will show the distribution and consumption of the various
staples.
PROVINCE.
Punjab
.
.
.
.
.
North-Western Provinces .
Bengal, Assam, and Burma
Central Provinces
Berar
.
B o m b a y
.
.
.
.
M a d r a s
.
.
.
.
M y s o r e
.
PERCENTAGE OF FOOD-GROWING AREA UNDER
Wheat or Barley.
54
57
Millets.
41
34
Rice.
5
9
Not. known (but principally rice).
27
17
7
—
—
39
82
83
67
34
34
1
10
33
16
" In the Punjab, North-West Provinces and Oudh, in Be-
har, in the northern part of the Central Provinces, and in Guj-
rat, the poorer classes live on the millets grown in the rains
and on barley and gram ; the richer classes eat principally
wheat and rice. In Bengal proper and Orissa, and the eastern
portion of Central India (and in Burma) rice is the principal
food, the coarse early rice being mainly taken by the poor, the
x 2
308
REPORT OF THE LEPROSY COMMISSION:
finer late rice by the rich. In the South, or Mahratta-speak-
ing part of the Central Provinces, in Berar, in Bombay, the
Deccan, and the northern part of Madras, the two large millets
—jowar and bajra—form the principal food, the Brahmins usu-
ally living on imported rice and wheat. In Mysore the ordi-
nary food is the small millet (ragi). In the southern part of
Madras and the western districts of Bombay rice is chiefly
consumed, though there is a good deal of millet grown and
eaten." All classes mix pulses with their food in order to ob-
tain the necessary nitrogenous elements. Maize, though grown
more or less everywhere, is not so largely consumed as might
have been expected. Vegetables, such as spinach, pumpkins,
carrots, potatoes, and useful wild herbs are largely used, and
condiments, such as chillies, are taken with the meal to assist
digestion. Fruit, such as that of the mhowa, mango, plantain,
and cocoanut are eaten when obtainable, and oil and salt form
part of every dietary.
Both sea and fresh-water fish are largely consumed wherever
they can be caught. Dried fish is used all round the coast>
especially in the Madras Presidency and Burma. In the latter
country " nga-pi " or dried fish, more or less in a state of
decomposition, is almost universally eaten, but in small quanti-
ties and more as a condiment than as a food.
It would be a mistake to suppose that the consumption of
fish in India is in any degree confined to the coast or the
vicinity of large rivers. Nearly every tank, pond, lake, or rivu-
let holds species which are caught and eaten. In many parts
of India this forms a portion of the dietary of even the higher
castes.
Food in India is usually eaten out of metal or earthen
vessels, or platters made of dried leaves, the consumer sitting
on the ground, or upon a mat, and using the fingers in place of
knives and forks. Among Hindus it is customary for the males
to eat before the females. Flesh is roasted, stewed, or boiled,
pulses are usually boiled, and grain is either parched, or far
Sanitation, Diet, Disease, etc.
309
more frequently ground, and the flour made into unleavened
cakes known as " chupatties." Rice is boiled and either eaten
alone or in the form of curries. As already stated, cooked
vegetables, salt, oil, and condiments form portions of almost
every dietary. Sugar, sweetmeats and fruits are also largely
consumed.
Of all articles of diet none has been held more responsible
for the causation of leprosy than fish. This view has of late
years gained considerable importance through the weight of the
authority of Mr. Jonathan Hutchinson who stated the fish
hypothesis with great force at the Tenth International Medical
Congress at Berlin. 9 As Virchow and Dr. Liveing have pointed
out, the theory is very old and has reappeared from time to
time. Virchow's views on the subject have not infrequently
been misrepresented, and it may, therefore, not be out of place
here to quote his own words : 10 " The more general use of
bad fish very (ungewöhnlich) frequently coincides with endemic
leprosy. This statement, however, is subject to exceptions,
but then, as a rule, another noxious dietetic article is accused,
and comparative observations might be made as to whether or
no the same deleterious substance exists in fish and these
other articles of food." It will not be necessary to say more
about the history of the fish hypothesis, as this has been done
so concisely by Dr. Liveing in his Goulstonian lectures. One
passage, however, of special interest with regard to leprosy in
India is worthy of notice. Dr. Liveing says 11 : " The com-
bination, however, of milk and fish seems to have been consid-
ered especially favourable to the disease. Bernhard Gordon
says : ' Comedere lac et pisces in eadem mensa inducit Lepram.'
And it is not a little remarkable that the same opinion obtains
in the present day in India." There is no doubt that in certain
( 9 ) Journal of the Leprosy Investigation Committee, No. 1, August 1890,
pages 77-87.
( 10 ) R. Virchow : op. cit., page 507.
( 11 ) R. Liveing: op. cit., page 33 and footnote, page 34.
310
REPORT OF THE LEPROSY COMMISSION:
parts of the empire this opinion is very prevalent, especially in
Kashmir and the hill districts. Lepers in India also frequently
assert that after a fish meal their state is exacerbated.
Coming now to the discussion of the fish hypothesis and
its application to Indian leprosy, it will be best to take it in its
two chief parts. Mr. Jonathan Hutchinson says 12 : " It is
possible that fish may cause the disease in one of several ways.
First, it may be by the direct introduction of the bacillus into
the stomach ; secondly, it may be that some element in fish-
food rouses into activity a bacillus already existing in the
tissues."
Taking the first point, it should be possible to find the
bacillus not infrequently in fish caught in endemic areas. À
priori, judging from the similarity between leprosy and tuber-
culosis, it would not seem impossible that the Bacillus lepræ
is capable of growing in a cold-blooded animal. The Commis-
sion paid special attention to this point, and some members
examined a large number of fish, fresh and dried, or prepared
as "nga-pi," but with absolutely negative result. Dr. Arning,
who has studied this part of the question most carefully, has
also never been able to find any leprosy bacilli in fish. The
value of such investigations is necessarily that of negative
evidence, but until positive cases have been shown, is worthy
of all consideration.
The fish hypothesis premises that all lepers at one time or
another have eaten fish in some form. Perhaps India is the
most suitable country to investigate this matter, for here people
of all castes and religions are thrown together. There is no
reasonable doubt whatever that the majority of Brahmins never
touch flesh or fish, and the same applies to many of the Banias
or traders in certain districts, and almost without exception to
the Jains. There are many Brahmins, however, settled on the
shores of the Bay of Bengal, who habitually eat fish, and it is
( 12 ) Loc. cit.
Sanitation, Diet, Disease, etc.
311
not at all rare to find Brahmins in hill districts and also in the
plains who do not refuse fish. But in the plains they are much
stricter in this respect. Jains, however, under no circumstances
touch any animal food. They are, in fact, so particular, that it
is a custom amongst many of them to fasten a piece of cloth
to the upper lip to avoid inhaling small insects. They will not
eat or drink in the dark, and always strain water through a cloth
before drinking. Their priests have a broom with which they
sweep the road before them to avoid the supposed guilt of
killing insects by treading them under foot. This is a regular
custom among the Bhabras in the Hoshiarpur District. 13 Now
leprosy occurs amongst all these classes, and it seems indeed
that the disease is impartially distributed among the fish-eating
and non-fish-eating communities. It is only possible to talk of
strong impressions, as accurate statistics and relative numbers
cannot be drawn up, partly on account of the uncertainty of
the present state of many castes and the changes which inter-
course with Europeans has brought about. For instance,
" among the lower ranks of Brahmins, great latitude is taken in
regard to labour, food, etc., and their claim to the distinction
of that caste is, in consequence, little recognised." 14 On the
other hand, the conditions in which the better castes live are so
different from those of the lower, which undoubtedly supply,
not only absolutely, but also relatively, the greater number
of lepers, that comparisons would be unfair. The Banias or
traders, of whatever caste or religion, for instance, are, generally
speaking, a wealthy class, and the disease is acknowledged to
be less common among prosperous people, though it does not
spare them altogether. Now among the mixed class of Banias
are many castes, the laws of which forbid the consumption of
meat in any form. Many of the Banias in certain parts of
India are attached to the Jain religion. In fact, it is a singular
( 13 ) Gazetteer of the Hoshiarpur District, 1883-84, page 46.
( 14 ) Lewis and Cunningham ; op. cit., page 61, footnote.
312
REPORT OF THE LEPROSY COMMISSION:
circumstance that many of them are devoted to this or some
other modification of the Buddhist faith. When, therefore, a
Bania or Brahmin leper denies ever having eaten fish, it is
at least possible from what is known of the habits and customs
of these communities. This is especially true of Agra and the
North-West Provinces, so far as the Banias are concerned. 15
The Jains form one of the richest communities in India, yet
the disease, though rarely, is found amongst them. Thus, at
Hoshiarpur two of the Commissioners gathered, through the
kindness of the Civil Surgeon Dr. Datta, reliable information
concerning a leper from the Bhabra class, in whose case the
cause of the disease could certainly not be ascribed to fish-
eating.
It is not claimed that the fact of a man calling himself a
Brahmin or a Bania is identical with saving that he has never
eaten fish. It has already been said that many of the former
consume animal food, and the latter include amongst their
numbers many castes whose laws do not prohibit such a diet.
This short exposition is meant to show that many of these
people do never touch fish, and that, therefore, if a leper
belonging to either class denies ever having done so, there is a
fair probability of his statement being true.
Now Mr. Jonathan Hutchinson 16 objects and says: "In
recording the denial on the part of leprosy patients that they
have been fish consumers, caution must be exercised. Those
who belong to castes which are forbidden to eat animal food
will naturally be prone to deny that they have deviated from
the rule. The temptation to eat fish as a condiment must, in
the case of those restricted to an exclusively vegetable diet, be
very great. It is, under those circumstances, precisely those
who eat it most seldom (dwellers far inland, for instance) who
are likely to receive it in its most dangerous state of decom-
( 15 ) M. A. Sherring : Hindu Tribes and Castes, 1872, pages 285-299.
( 16 ) Journal of the Leprosy Investigation Committee, No. 1, August 1890, page 79.
Sanitation, Diet, Disease, etc.
313
position. It must always be remembered that members of
castes forbidden to take life often eagerly avail themselves of
all opportunities as regards what has been found dead or killed
by others. Thus the bare statement that leprosy prevails in
classes who, from religious scruples, never eat animal food is
usually of no real value. Careful and even sceptical inquiry
must be made as to whether the individual lepers had really,
in the case of preserved fish, invariably abstained."
There is of course much truth in these assertions of Mr.
Hutchinson, and the above facts have only been mentioned
to show that it is possible to find amongst lepers, individuals
belonging to castes not allowed to touch animal food. Now
Mr. Hutchinson is inclined to doubt the statement of lepers
who profess to observe the rules which caste or religion enforce
on them. Yet if a comparatively large number of lepers are
found who state that they have never eaten fish, and these
belong to castes or tribes of which it is known that their rules
forbid the strict observer to touch meat or flesh in any form
or shape, it seems improbable that all of them should have
deceived the questioner or themselves. The Commission paid
particular attention to this question, and found that one
hundred and sixty-two individuals denied ever having touched
fish (Table I). Many of these were allowed to partake of
animal food, but denied ever having eaten fish, though in all
cases leading questions were avoided as much as possible.
To see in what percentage of cases an abstinence from this
article of diet could be traced, every leper of a certain number
of asylums was interrogated, with the result that out of 464
lepers 99, or 21.3 per cent., denied having ever partaken of
fish.
314
REPORT OF THE LEPROSY COMMISSION:
TABLE I.
Number of Lepers who denied having ever eaten fish.
ASYLUM OR LOCALITY.
A g r a
......
A l i g a r h
......
A l m o r a
......
B a n g a l o r e
......
B e l g a u m
......
B e n a r e s
.
....
B u r d w a n
......
C a l c u t t a
.
....
C a l i c u t
......
C a w n p o r e
......
C o n j e e v e r a m
.....
D a r j e e l i n g
......
D e h r a D u n
......
D e l h i
D h a r m s a l a
......
F y z a b a d
......
G w a l i o r
......
G y a
.......
H y d e r a b a d . . . . . .
J u b b u l p o r e
.
J u m m o o
......
Kapurthalla
.
No. of persons
who never
ate fish.
7
3
3°.
..
...
11
...
...
...
3
...
...
1
1
...
1
3
5
...
1
4
REMARKS.
3 Brahmins; 4 Banias.
1 Brahmin ; 1 Bania.
9 Brahmins.
6 Brahmins.
3 Brahmins.
1 Brahmin.
1 Brahmin.
2 Brahmins.
1 Bania.
!
Sanitation, Diet, Disease, etc.
315
Table I—continued.
Number of Lepers who denied having ever eaten fish.
ASYLUM OR LOCALITY.
L a h o r e
......
L u c k n o w
......
M a d r a s
......
M a d u r a
......
M a n d a l a y
......
M e e r u t
......
M o u l m e i n
......
N a g p u r
......
N a i r n a n d A l l a h a b a d .
N a i n i T a l
P a t i a l a
......
P e s h a w a r
......
P o o n a
......
P r o m e
P u r u l i a
......
R a n g o o n
......
R a w a l p i n d i
.
S i a l k o t
......
S u b a t h u
......
T a n j o r e
......
T a r n T a r a n
.
.
.
.
No. of persons
who never
ate fish.
...
I
I
2
...
I
3
1
5
...
3
...
30
15
5
...
8
REMARKS
I Brahmin.
2 Brahmins.
3 Brahmins.
1 Brahmin.
2 Brahmins ; 1 Bania.
1 Brahmin.
1 Brahmin.
5 Brahmins.
316
REPORT OF THE LEPROSY COMMISSION«.
Table I.—concluded.
Number of Lepers who denied having ever eaten fish.
ASYLUM OR LOCALITY.
Thayetmyo
.
Trichinopoly
Umballa
Yerrowda Prison.
.
TOTAL
No. of persons
who never
ate fish.
...
14
3
162
REMARKS.
1 Brahmin; 1 Bania,
1 Brahmin.
44 Brahmins and 8 Banias.
The leper asylums of Almora and Dehra Dun are occupied
by residents of the Himalayan hill tracts of Kumaun and
Garhwal. The great elevations at which many of the villages
in these tracts are situated, and their remoteness from rivers
and streams, make fish a very rare article of food among the
people. Some indeed have never seen it. A careful enquiry
was therefore made from the leper residents of the asylums
quoted, and the result is given in the subjoined table :—
No. of Cases examined.
200
Habitually.
39
ATE FISH
Occasionally.
57
Very seldom.
58
Never.
46
It will be seen from this table that 23 per cent. of well-
marked lepers had never tasted fish, while a very large number
only used it now and then. This is quite in accordance with
local opinion on the subject, not only in Kumaun and Garhwal,
but also in Kashmir, where leprosy is common among the
Gujars, a people in whose dietary this article of food seldom
finds a place.
It is not within the limits of mathematical probability that
the statement of all these people should have been intentionally
Sanitation, Diet, Disease,
etc.
317
or unintentionally incorrect, and the onus of proof, therefore
may fairly be considered to lie with them who discredit the
statements of all patients alike.
There is thus, in the opinion of the Commission, no doubt
that the consumption of fish is not the cause of leprosy. The
fact that a fair number of cases of leprosy exists amongst
people who have never touched such food argues sufficiently
strongly against the exclusive fish hypothesis as above stated.
Salt also has been mentioned in connexion with leprosy,
though by laymen rather than scientific writers. Mr. Cony-
beare during the early part of this year asked the Under-
secretary of State for India in the House of Commons
" whether in the Presidencies of Madras and Bombay the price
of salt has risen from 9 annas and 8 annas per maund in 1800
to R2-11 and R2-8 in 1890 respectively ; whether he can state
the facts, as to the increase or otherwise, in the price of
salt for the other presidencies during the same period ; whe-
ther in India the average consumption of salt per head
for all purposes is only 10lb, while in the United Kingdom it is
72ft ; whether it be a fact that leprosy has also increased
during the same period ; and whether the Government will di-
rect the special attention of the Medical Commission on Le-
prosy in India to an investigation of the apparent connexion
between the want of cheap salt and the spread of leprosy."
Accordingly special attention was paid to this subject, and,
as far as possible, the most accurate information obtained.
For the financial and statistical data regarding the price and
consumption of salt the Commission are indebted to Mr. J. E.
O'Conor, Assistant Secretary of the Government of India in
the Department of Finance and Commerce, and they gladly
here give expression to their obligation to him.
For the present argument, that is the relation between the
want of cheap salt and the spread of leprosy, it will not be
necessary to go further back than 1861. It is true that in the
following provinces, viz., Burma, Rajputana, Central India,
318
REPORT OF THE LEPROSY COMMISSION:
Bombay, Sind and Baluchistan, Nizam's Territory, Madras, My-
sore, and Coorg, in the decennial period of 1861-70 salt was
cheapest, and has risen in price during the two succeeding
decennial periods, and in some instances has done so to a con-
siderable degree. On the other hand, in Assam, Bengal
North-Western Provinces, Oudh, Punjab, Central Provinces,
and Berar, salt has steadily become cheaper. 17
Thus, if there be any connexion between leprosy and salt,
the best means are given for studying such connexion. For if
the spread of the disease depend on want of salt it should have
been much more rapid throughout the first mentioned provinces.
Before proceeding to the discussion of this point, a few words
must be said as to the average consumption per head of salt
in India.
The total quantity of salt passed into consumption during
1890 last year amounted to 2,801,800,000lb. There is, how-
ever, also a considerable quantity of salt made in Burma, of
which no exact account is kept, but this is estimated at (at
least) 41,143,000lb. There is, again, a considerable quantity
manufactured from saltpetre, and some not inconsiderable quan-
tities made in Native States. Adding all this to the quantity
of which there is an account, and making allowance for quan-
tities illicitly made and consumed, there cannot be less than
3,000 millions of pounds for the population of 286,697,000, or
between 10 and 11lb per head: 11lb being perhaps the more
accurate estimate.
Now, in comparing this with the 72ft per head in the
United Kingdom, it must be remembered that in India this salt
is used almost exclusively for personal consumption, very little
being employed for cattle and economic or industrial purposes.
Again, the majority of people being vegetarians salt is not in
so great demand as in Great Britain and Ireland, nor, owing to
( 17 ) " Prices and Wages in India," compiled in the Statistical Branch of
the Finance and Commerce Department of the Government of India : Eighth
Issue; pages 86—93.
Sanitation, Diet, Disease,
etc.
319
the manner in which food is eaten, is there such a waste of salt
in India.
Between 1870-71 and 1880-81 the consumption of salt in-
creased by 19 per cent., and during the next ten years the in-
crease was 21 1/2 per cent. The increase of population in each
decade is about 10 per cent., so that the ratio of increase in
the consumption of salt was about twice as great as the ratio
of increase in the population. And as the consumption is
almost entirely human, it seems evident that if the people had
enough salt twenty years ago, they have more than enough
now.
In the interior of the Himalayas the price of salt is very
high, not on account of the duty, for the salt consumed there
is imported across the frontier duty-free, but as a result of
the cost of transit. Excluding such exceptional tracts as
Kumaun, Garhwal, and the Naga Hills, where the price of salt
may be said to be about 7 seers to the rupee (about 2 1/4 annas
per seer), the highest price of salt in India anywhere is 8 seers
per rupee (or 2 annas per seer). The consumption per head
being 11lb, the annual cost of salt per head is equal to 11
annas, less than one anna (exactly eleven pie) per month.
The average price may, however, be taken to be about 10
seers to the rupee, and the annual cost per head at this
rate is under 9 annas, or about 9 pie per month. It may
be assumed that the highest cost per head is one anna
monthly, which is less than one penny at the present rate
of exchange. This is an extreme and exceptional price, for
salt ranges at about 8 seers to the rupee in comparatively
but few places.
Now while discussing the assumed connexion between
salt and leprosy, it is necessary to enquire whether the price of
this article prevents the native from procuring the amount
of salt required to keep his body in proper health. It is
difficult to say exactly how much salt a working man actually
requires. It is certain " that the various saline matters are