NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
28
still greater advantage ? We submit that the evidence obtained from a study of
metabolism of the Bengali has a distinct bearing on the answers to these
questions and throws a certain amount of light on the correctness or otherwise
of the different opinions put forward.
It will be at once apparent that the amount of proteid metabolised by the
Bengali—from 37 to 40 grammes a day—approaches the lower limits of physio-
logical requirements and that therefore, according to the arguments advanced by
Chittenden, the Bengali should show in a marked degree "many suggestions
of improvement in bodily health, of greater efficiency in working power, and
greater freedom from disease, in a system of dietetics which aims to meet the
physiological needs of the body without undue waste of energy and unnecessary
drain on the functions of digestion, absorption, excretion and metabolism in
general; a system which recognises that the smooth running of man's bodily
machinery calls for the exercise of reason and intelligence and is not to be trusted
solely to the dictates of blind instinct or the leadings of a capricious
appetite."(1) It will be our desire in the following pages to bring forward all
the evidence at our command with regard to the effects of the low proteid intake
of the Bengali and its bearing on the views put forward by Chittenden and
his followers. This we shall try to do in a manner as unbiassed as possible,
leaving the facts as we have found them to speak for themselves.
1.—THE DEDUCTIONS FROM THE TOTAL NITROGEN OF THE URINE.
We have shown in the first part of this paper that the average daily
amount of proteid material metabolised by the Bengali was about 37.50 gram-
mes ; this is the equivalent of 6 grammes of nitrogen.
The average weight of the Bengali over a very large series of weighments
(see later under body-weight) works out at from 52 to 54 kilos. The average
Bengali would therefore metabolise daily from 0.115 to 0.111 gramme of
nitrogen per kilo of body-weight. This amount is practically identical with
that stated by Chittenden to be quite sufficient.
He states " we have found that the average need for proteid food by adults
is fully met by a daily metabolism equal to an exchange of 0.12 gramme of
nitrogen per kilo of body-weight."
That this quantity was adequate to maintain the individuals investigated in a
condition of nitrogenous equilibrium indefinitely is evident from the fact that the
diet was not restricted but entirely a matter of choice ; also, those examined were
quite up to the standard of the adult Bengali in health, body-weight, physical
strength and mental attainments, Further, the averages obtained are based on
(1) Chittenden. The Nutrition of Man, 1907.
29
a sufficiently large number of individuals to eliminate the error due to any one
subject falling much below the ordinary standard.
It is, therefore, obvious that, so far as our analyses go, they bear out, in
every detail, all that Chittenden has contended for, viz. :—the feasibility of main-
taining the body in a condition of nitrogenous equilibrium over long periods of
time on a diet whose proteid or nitrogen value is one-third of that usually accep-
ted as necessary for the needs of the system. Regarding the people with whom
we dealt this low proteid intake is the ordinary amount present in the average
diet of the whole population ; on this amount they subsist during all the years
of their life.
The diet of the native population of Bengal meets Von Noorden's
criticism (1) of Chittenden's work—that it is almost impossible in ordinary life to
arrange a diet with so low a proteid content, that will not prove insufficient and
unsuitable. We shall have occasion later to present analyses of the different
food-stuffs ; at present, all we need say is that it is the diet of the masses and is
not only inexpensive but agreeable though somewhat monotonous in character.
While this and much more might be said corroborating most of the results
obtained by Chittenden we have shown sufficiently that the Bengali is able
to maintain the total proteid store of his organism unaltered in amount on a
nitrogenous supply that would be much below the amount decomposed during
starvation.
We shall now pass to the consideration of the evidence that this minimum
amount of proteid is amply sufficient for the maintenance of the body in a per-
fect condition of health and physical vigour. In this examination we shall deal
first with the evidence obtained from students and servants of the Colleges in
Calcutta.
II.—THE EVIDENCE FROM PHYSICAL DEVELOPMENT.
(a) The body-weight.—From the records of over 2,500 observations on
the weight of Bengali students we find the average to be just under 52 kilos.
This is very slightly higher than the average weight of the Bengali as worked
out from the Bengal Jail statistics by Major Buchanan, I. M.S. (2) From a collec-
tion of 28,863 weights and heights of prisoners in Bengal Jails Major Buchanan
obtained an average of from 110 —112 lbs. or from 50 to 501/2 kilos. We shall
not, therefore, be much in error if we take the average weight of the Bengali—.
student or otherwise—at 52 kilos. which is probably slightly over the mark
rather than under.
H ow does this average compare with the average European?
(1) Von Noorden.—The Physiology of Metabolism, 1907.
(2) Buchanan.—Manual of Jail Hygiene, 1901.
30
From the statistics at our disposal, collected from many different sources,
the average weight of the healthy adult male European is about 70 kilos.
Quetelet's(1) tables, however, give, a. somewhat lower average, viz., about 66
kilos. Taking the mean of these figures there is a difference of from 22 to
30 per cent. in favour of the European. In other words, we may say that the
average Bengali weighs about 25 per cent. less than the average European.
How does this fact modify the food requirements of the Bengali ?
Von Noorden states—" Although both exchange and need are lower in per-
sons of light weight, nevertheless the total individual combustion does not
fall in mathematical proportion to the decrease in weight, but by far smaller
Quantities. The minimal metabolism in children from 12—14 years old does
not markedly differ from that of adults." We could not, therefore, expect the
Bengali to be properly nourished on a diet 25 per cent. less in amount than the
minimal diet necessary for the European. If this be true for the food in general
it will be doubly so for the most important constituent of the food—the nitro-
genous element. When we find, therefore, his average proteid intake from.
60-70 per cent. less than that of the average European we may well ask the
question, is the lower average body-weight of the Bengali not the direct
consequence of a diet—poor in nitrogen and muscle forming properties—barely
sufficient to meet the physiological needs of the body ? As we shall show in
connection with the diets of Bengal, the ordinary food of the people contains
very abundant quantities of carbohydrate ; hut neither fat nor carbohydrate go
to form " flesh" or to build up any of the true nitrogenous tissues.
That the lower standard of body-weight is not the cause of the low
proteid intake is evident from what has been stated above with regard to boys
of 12-14 years of age, and also by the fact that the Bengali is not sprung from
an under-sized race ; his stature and the general build of body-frame compares
very favourably with that of Europeans. On the other hand the spareness and
very deficient muscular development of the working coolie form a striking con-
trast to the average European labourer.
While we cannot state that a high average body-weight is the all-important
criterion of physical fitness or power of resisting disease, other things being
equal, it will be generally admitted that good muscular development is a
desideratum in the condition of a people. If this were not the case the usual
rules and examination of the physical fitness of recruits for all services where
stamina and strength are required would have to be completely altered. In this
connection it has also been observed that a close relationship exists between the
physical and moral development of men; in fact any lowering of the physical
(1) Quetelet.—Anthropometrie, 1870.
31
means a lowering of the moral standard of recruits(1). With a low standard of
physical development we are apt to get recruits not only small, but unsteady,
wanting in mental ballast as well as in physical strength.
(b) The Height.—The average height of the adult male European accord-
ing to Quetelet's tables is 5'-5" to 5'-6".
From observations on the height of the same Bengali students quoted under
body-weight we find the average works out to be practically identical with
Quetelet's, viz., 5'-5½". Buchanan, from the analysis of his collection of
28,863 heights of prisoners, would place the average height slightly under the
.above figures, viz., about 5'-4".
The student series we examined and quote were for the great part entering
Government service and were perhaps slightly above the average in height and
weight.
(c) The circumference of the chest.— The chest measurement furnishes a
very good idea of the state of development and is made use of in every country
in the physical examination of recruits. A certain minimum girth of chest is
insisted on ; for the ordinary line regiments of the British army this minimum is
33", but is much above this figure for special regiments or brigades.
The average chest measurement of our series of Bengali students works out
to be just below the minimum—33"—for admission to the army. In this
comparison it must be remembered that with the height of 5'-5½" a chest girth
well above the mere minimum would he looked for in a clesirable recruit.
By a comparison of the records of the weight, height and chest girth a good
knowledge of the general physical development is obtained.
The facts, as we have found them, are
—
(a) The height, averaging 5'-5" to 5'-6", is well up to the standard of
Europeans.
(b) The weight, averaging from 50 to 52 kilos., is, in round figures,
25 per cent. below the European standard.
(c) The chest girth, averaging wider 33", is well below the average
European standard.
Sir W. Aitken was the first to point out the importance of the correlation
of height, weight and chest measurement in estimating physique, good weight
for height being of first importance. Several rules have been laid down for
guidance in the examination of physical fitness. One formula, which seems to
us to demand much too high an average weight, is that up to 5'-7" thrice the
height in inches ought to be about the weight in pounds ; this would mean that
the average European 5½' in height should weigh 198 pounds and the average.
Bengali only a few pounds less.
(1) Cf Notter and Firth.—Theory and Practice of Hygiene.
32
Another common rule is "normally developed individuals weigh as many
kilos. as their length measures in centimètres after subtracting the first metre''
(Landois). This works , out very accurately for the average height and weight
of Europeans—Europeans 168 c.m. in height should weigh 68 kilos. When we
come, however, to apply it to Bengalis, whose average height we have shown to
be 5½'o r 1 6 5 c . m . , w e f i n d t h a t t h e a v e r a g e w e i g h t s h o u l d n o t b e l e s s t h a n 6 5
to 67 kilos. His actual weight comes far short of this standard, by so much,
as we have already seen, as 25 per cent.
From the evidence put forward of the physical development of the Bengali
we may fairly come to the conclusion that, on the average, he does not reach
the same standard of general physique as is attained by races of European
origin ; and yet from the evidence we can find no cause inherent in the Bengali
as a race for this deficiency ; on the contrary, we consider that there may be
a very close relationship between the lower physical development of this
people and the meagre proteid constituent of the diet on which they subsist.
III.—THE EVIDENCE FROM THE CHANGES IN THE BLOOD.
We have already dealt to some extent with the changes found in the blood
of the Bengali ; Table IX gives the results we have obtained from the analyses
carried out.
The more important differences in the chemical composition of the blood
are closely connected with the deficiency in the percentage of the floating pro-
teids of the plasma and the low hæmoglobin value of the red blood corpuscle.
Further changes occur in the increased salinity of the blood, lessened
coagulation-time, and an increased alkalinity.
[Measured by Wright's method of titration of the serum against diluted
normal sulphuric acid with a litmus indicator, there is a distinctly higher degree
of alkalinity present than is found in the European.]
The lower level of the pressure of the blood in the arteries is also a point of
importance. This will he obvious when we recall the condition of the blood in
regard to its hæmoglobin value. We have in the blood of the Bengali a reduc-
tion, compared with the average European, of up to 25 per cent. in respect to
its hæmoglobin, and with this 25 per cent. decrease in its oxygen-carrying capa-
city we have, at the same time, the pressure at which it flows in the vessels on a
much lower scale than in the European.
The effects of these conditions must be to modify very markedly the
physiological requirements of nutrition, and to a considerable extent affect the
growth, power of muscular contraction and general metabolism of the individuals
of such a community.
33
From the evidence of differences in the chemical composition of the blood
enumerated above it may be fairly deduced that the diet—poor in nitrogen—is the
cause of the changes. The blood in chronic underfeeding does not as a rule
show any very great variations in composition, as it is able to maintain its com-
position more or less normal even under very adverse circumstances ; but the
changes that do occur are all of the same type as we have shown are to be found
in the blood of the Bengali. Von Hoesslin states that chronic underfeeding
influences the total volume of the blood, as well as the mass of all the tissues,
and produces individuals who are poorly supplied with blood, fat and muscle.
We may, therefore, conclude that, so far as the evidence obtained from the
blood is concerned, the Bengali falls short of the standard of the European in
this respect also. His nitrogenous tissues are not given the option of drawing
their nutritive material from so rich a source, nor have they the same opportunity
of obtaining as free a supply of the all-important life-sustaining oxygen.
There is no deficiency in the absolute number of the red and white cells of the
blood ; but more or less similar conditions have been found in the blood of the
several professional fasters during the periods of their fast. This, as far as one
can say, would appear to be an effort on the part of the cell-forming tissues to
maintain the composition of the blood as nearly normal as possible—in this way
attempting to make up for the deficiency in hæmoglobin and proteid elements.
The increased salinity of the blood, which we hold is ever an accompanying
feature of anæmia, is present also in the anæmia of the Bengali and is probably
the explanation of the increase in the coagulability, alkalinity and specific gravity.
How far these different conditions may be explained by an inspissation of the
blood—an oligæmic rather than an anæmia condition—is a question that cannot at
present be decided.
While it is impossible to state dogmatically that these different factors
are due to the insufficient supply of proteid in the food it would appear to be the
most plausible, and, as far as the facts go, the only explanation.
We think we are justified in saying that a people, on a diet containing only
37.50 grammes of proteid, live in a more or less chronic state of nitrogenous
starvation leading to a loss of body-fat and tissue-proteid with the inevitable result
of loss of vigour and strength and a comparatively low capacity for prolonged
or sustained muscular effort. We shall have further evidence to produce with
regard to the comparative strength and power of performing work of the Euro-
pean and the Bengali ; at present it will be sufficient to say that the latter in this
respect falls far short of the former—up to, in many instances, as much as from 60
per cent. to 75 per cent. This is not due to any deficiency in the energy-producing
carbohydrates and fats, for, as we shall show later, their diet is very rich in the
carbohydrate elements We hold, on the other hand, that it is due to a lack of F
34
muscular development and to the lower condition of vitality that must follow
from the presence of a composition of the blood exhibiting the lower physiological
limits of such necessary constituents as hæmoglobin and floating proteids of the
plasma combined with a lower scale of arterial pressure.
All these factors react not only on the muscular tissues but affect every
tissue of the body, and particularly the delicate mechanism of the central nervous
system.
Mosso's work has taught us that fatigue has much more to do with changes
in the central nervous system than with mere fatigue of muscle-substance due
either to accumulation of waste-products or consumption of the reserve of
energy-producing material. It would, therefore, appear that in a condition in
which the metabolic chemical changes of the central nervous system are kept
continually on a low level—as in the Bengali—fatigue will be more easily and
readily produced. Such, indeed, is in accordance with our everyday experience
and such we believe to be an important factor in the causation of the lack of
energy and vigour which is characteristic of the race.
IV.—THE EVIDENCE OBTAINED FROM THE NITROGEN BALANCE IN
BENGALIS.
In order to be in a position to measure the proteid intake of the different
persons investigated, a large number of the different kinds of food-stuffs had first
to be analysed.
In carrying out this part of the work samples of each different food material
were obtained from the reserve store of articles actually used as food. The
percentage of each proximate principle was then determined ; the following table
gives the average results of the estimations. Analyses published by other
authorities are added for comparison :—
Table X.
Food-stuff.
Proteid.
Carbohydrate.
Fat.
Ash and
m i n e r a l s .
Authority.
Rice .
.
.
.
6.39
83.30
.15
.76
Med. Coll., Cal.
6.94
77.61
.51
.53
Blythe.
7.30
78.30
.60
1 . 0 0
Church.
AMOUNT OF NITROGENOUS MATTER VARIES FROM 3% — 75% NOTTER AND FIRTH.
35
Table X—contd.
Food-stuff.
Proteid.
Carbohydrate.
Fat.
Ash and
minerals.
Authority.
Atta .
.
.
.
11.50
67.10
2.90
3.85
Med. Coll., Cal.
12.04
68.65
1.85
4.09
Notter and Firth.
12.35
67.91
1.75
4.34
König.
Chana .
.
.
.
19.69
56.20
3.95
5.66
Med. Coll., Cal.
21.70
59.00
4.20
4.70
Church.
Arar Dhall (Husked) .
19.86
57.30
3.20
8.34
Med. Coll., Cal.
17.10
55.70
2. 60
12.20
Church.
Masur Dhall.
.
.
23.25
59.40
2.70
2.55
Med. Coll., Cal.
24.81
54.78
1.85
6.09
Blythe.
Maize .
.
.
.
9. 50
70.70
3.60
3.70
Church.
9.85
68.41
4.62
4 00
König.
Suttoo .
.
.
.
25.46
57.35
1.83
4.68
Med. Coll., Cal.
Molasses
.
.
.
...
69.70
...
6.90
Blythe.
Potatoes
.
.
.
1.79
20.56
.16
1.72
König.
Cabbage
.
.
.
5.00
7.80
. 5 0
I.20
Notter and Firth.
Mustard oil .
.
.
...
. . .
99.78
. . .
Med. Coll., Cal.
Goat's flesh .
.
.
24.06
. . .
2. 50
1 . 1 0
Do.
Fish (Tank) .
.
.
17.50
. . .
7.14
. . .
Do.
18.10
. . .
2.90
...
Do.
Milk (Bazar).
.
.
2.12
. . .
1.92
...
Do.
Vegetables: cabbage, car-
rots, turnips, spinach,
cauliflower.
2.05
5.33
.34
1.05
Med. Coll., Cal. and
various authorities.
We shall now proceed to a consideration of what is to be learned regarding
the metabolism of the Bengali from investigations on certain individuals in whom
a record of the total nitrogenous intake and output was carefully preserved.
These fall into two sets of experiments—the first consist of observations on two of
the Medical Assistants of the department. These men were actually engaged in
the investigation and were keenly interested in obtaining accurate data. They
kept an absolutely correct record of every particle of food eaten. Samples were
analysed each day and the total nitrogen of their diet estimated. Owing to
F 2
36
accidental circumstances the investigations had to be dropped after the fourth
day ; but, as the results are of importance regarding the minimal proteid intake
necessary for nitrogenous equilibrium, we reproduce them in Table XI.
This table is of interest from another point of view as, we believe, it is the
first time a nitrogen balance sheet has been worked out in India
:—
No.
Weight.
Kilos.
Nitrogen
intake.
Urine in
C. Cs.
Sp. Gr.
Nitrogen
in
Urine.
Nitrogen
in
Færces.
Freezing-
point of
Urine in C°.
Chlorides of
Uri ne i n
grms.
1
.
.
61.81
7.81
1570
1013
8.93
1.38
—1.25
17.56
61.40
9.46
1490
1 0 1 1
5.73
1.54
—1.14
16.68
61.62
7.81
1370
1013
5.91
1.61
—1.24
17.81
61.62
9.46
1005
1017
6.33
2.31
—1.48
13.16
2
.
.
50
10.56
1980
1008
6.90
2.31
—.92
14.65
50
10.56
2670
1009
8.72
1.82
—1.00
22.69
50.5
10.56
1830
1012
7.68
1.28
—1.24
19.21
50.5
10.56
3090
1 0 1 0
10.39
2.63
—1.10
29.35
No. 1.—Nitrogen intake during four =34.54 grammes.
days under observation.
Nitrogen output during four =33.74 „
days under observation.
Urine 26.90 grmms.
Fæces 6.84 „
Nitrogen balance for the four = +0.80 „
days.
No. 2.—Nitrogen intake during four =42.24 „
days under observation.
Nitrogen output during four =41.73 „
days under observation.
Urine 33.69 „
Fæces 8.04 „
Nitrogen balance for the four = + 0.51 „
days.
While these observations were not of sufficient duration to provide a com-
plete standard for comparison, they afford very exact information, and it will be
instructive to analyse the results in the light of the knowledge already obtained
from the two hundred observations on students and servants.
The amount of nitrogen metabolised during the four days by No. 1 was
26.90 grms., or an average daily amount of 6.72 grms. His average body-weight
being 61.50 kilos ; we find this is equivalent to the metabolism of 0.109 grm.
of nitrogen per kilo. of body-weight. Translating this into terms of proteid it