NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
56
Reference to Table XVI will show that this is a very much larger proteid meta-
bolism than found in any of the different classes of Bengalis investigated, the
prisoner of the Bengal Jails being the only case approaching it in quantity.
The influence of diet we consider is abundantly obvious in a comparison of
these Anglo-Indian and Eurasian boys and the 568 Bengali students already
analysed. The two classes enter College about the same age, live in the same
climate and under very similar conditions ; further, as we have pointed-out, there
is no racial reason why the Bengali should not grow out to be every bit as well
developed as the other class; but the results at the end of their College career
are very different. The Anglo-Indian and Eurasian boys develop into strong,
healthy men quite up to the average of European standards, while the Bengali
students almost remain stationary as regards development—the increase in
weight and chest-girth being at a minimum, while the increase in height is very
marked.
In any suggestions for an appreciable decrease in the proteid of the daily
diet results such as these should surely serve as a warning. Is it not better to
be guided by the practical effects of diet observed than follow out to its logical
conclusion any theoretical deduction however plausible ? The fact that nitro-
genous equilibrium can be established on one-third of the quantity of proteid
present in Voit's standard is no argument, in the face of the evidence obtained
from this study of the metabolism of the Bengali, for straining every effort
towards the establishment of a possible physiological economy.
( b) The physical development of Anglo-Indian and Eurasian students on
a fixed and known diet.
The College from which we obtained our information regarding the 568
Bengali students was also able to provide us with observations under the same
headings on 126 Anglo-Indian and Eurasian students. Again, the medical
officer of the College kindly furnished us with the scale of diet sanctioned
for these students. We have thus got the two classes—568 Bengalis and 126
Anglo Indian and Eurasian—each on a known diet, living under exactly similar
conditions as to climate, surroundings and work. A comparison of the physical
development of these two classes should give us an interesting view of the
effects of different degrees of nutrition.
The effects of a low proteid intake on the physical development of Bengali
students will be found under Heading V of this section. Let us examine in the
same way what the results are in the case of these Anglo-Indian and Eurasian
students.
From the records we Lind
(1) The average body-weight over the whole series is for first year 116 lbs.,
second year 123 lbs., third year 130 lbs. and fourth year 135 lbs.
57
That is, compared with a maximum increase in body-weight of
2 lbs. in the case of the Bengali students, we find an increase of
14 lbs. in Anglo-Indian and Eurasian students over a similar
period.
(2) In a comparison of weight on entrance and weight in the third year
only 2 per cent. show a diminution compared with 42.8 per cent.
in the Bengali ; practically 100 per cent. gained weight continu-
ously during the three years— a marked contrast to the 15.3 per
cent. of Bengalis who gained weight continuously.
(3) Less than 4 per cent. show a diminution in body-weight in the second
year of attendance while 55.8 per cent. of the Bengali students
lose weight during this period.
(4) In the Bengali the chest measurement does not alter, while the
following are the averages for Anglo-Indian and Eurasian students,
first year 33⅓ in. ; second year 34 in. ; third year 34¾ in., a very
great increase during the three years for which figures are available.
(5) Growth in height is even more marked than in the Bengali students ;
practically everyone gaining considerably in height.
The diet on which these splendid results were obtained is shown on
Table XX.
Table XX.
Proximate
Principles. Bread. Butter. Sugar. Milk. Ghee. Dhall. Oat-
meal.
Con-
densed
milk.
Rice. Vege-
tables. Beef. Chicken
curry.
Eggs. Total
consti-
tuents.
Proteid
. 23.86 ...
... .90 ... 12.18 1.58 3.25
12.70 2.02 30.35 5.31 3.82 94.97
Carbohydrate 153.42 ... 76.57 ...
... 34.04 17.91 2.13
152.05 34.88 ...
. . .
. . . 467.00
Fat .
.
1.56 22.56 ... .84 19.20 1.12 1.06 1.09
1.19
.27 3.10 .98 3.24 56.20
This is a very liberal diet compared with those analysed hitherto and is
even a more liberal allowance than sanctioned in the case of the other Anglo-
Indian and Eurasian students.
We need not go into all the details but from a similar calculation to that above
we find that it affords a minimum metabolism of 0.203 grm. nitrogen per kilo. of
body-weight, compared with the metabolism of 0.148 grm. nitrogen per kilo. of
body-weight of the Bengali students of the same College. It is unnecessary to
labour the comparison of the resulting condition of these two classes, the facts of
the physical development gleaned from the medical officer's records speak with no
uncertain voice and force on us the lesson taught by the other lines of
58
investigation and by the general tendency of the evidence we have been able to
bring forward. It will be sufficient to put these facts in a concise form ; this we
have attempted to do in Table XXI.
Table XXI.
Class investigated.
No.
Nitrogen
per kilo.
Duration.
PHYSICAL DEVELOPMENT.
First year. Second year.
Third year. Fourth year.
I. Bengali Medical
Students.
44
0.116
life
...
Average 3445
. . .
. . .
II. Other Bengali
Students.
568
0.148
4 years
3920
3920
3993
. . .
III. Bengali Prisoners .
4
0.185
variable
. . .
Average 4125
. . .
. . .
IV. Anglo-Indian and
Eurasian Students
42
0.196
4 years
3795
4221
4588
. . .
V. Other Anglo-Indian
and Eurasian
Students.
126
0.203
4 years
3866
4172
4517
4825
Physical development is taken as being represented by the figures obtained from the multiplication of the weight in
lbs. by the chest-girth in inches.
The interpretation of this table is obvious and need not detain us. Taken
in connection with Table XV we get a very fair idea of the results attained by
Chittenden and of those attained by ourselves in Bengalis and Anglo-Indians.
We consider that the figures set forth in these tables prove conclusively that,
with a diet poor in nitrogen, individuals are produced who are deficient in
muscle, poorly supplied with blood and who exhibit defective development.
With a liberal scale of proteid intake results the opposite of these are the rule.
It would further appear from the results of computation of physical develop-
ment—Table XXI—that general body-growth increases pari passu with the
nitrogenous metabolism per kilo. of body-weight. Exactly where the line is to
be drawn regarding the amount of proteid necessary in an ideal diet we are
unable to say ; but we hold that the above figures would certainly seem to
show that increases in bodily vigour and development take place up to a
nitrogen metabolism of 0.203 grm. per kilo. of body-weight, or an interchange
corresponding to nearly 80 grammes of absorbable proteid in the daily intake of
food.
In connection with the growth and general physical development of the
different classes of students whose metabolism and nutrition we have investi-
gated, the following quotations from the discussion of anthropometrics in schools
at the recent meeting of the British Association are of importance.
59
Dr. Shrusball—" Comparing the stature and height in schools of different
classes it was found that at an age of 12 the children in the better schools
were as large as children of 13 in the poorer schools; but there was less deterio-
ration in the case of girls." ( Times Report.) Sir Victor Horsley—" Some
astonishing instances of results of school measurements were given. At
Marlborough for twenty years boys have been annually measured and from a
comparison of the, figures it appears that the 1906 boys of 14 years old are
about 5 lbs. heavier and nearly 1 ½ inch taller than the 1886 boys. The sixteen-
year old boys of the present date keep up in proportion, being ¾ inch taller
and 8 lbs. heavier. The meeting was amused by the evidence of a hatter who
provides no fewer than six schools with hats. He was quoted as vouching for
the scientific fact that a hat of 21 ½ inches used to be a rarity, but that now
22 ½ inches is continuously asked for." ( Empire Report.)
VII.—PHYSICAL ENDURANCE AND OTHER EVIDENCE.
(I) Physical Endurance.—In order to obtain a comparison between the
vegetable-eating Bengali and the more meat-eating European labourers with
regard to their power of performing work we have collected a certain amount of
evidence.
It is exceedingly difficult to obtain anything like fair comparative tests, but
anyone who has seen the ordinary Bengali coolie at work will not require much
statistical evidence to convince him of the marked superiority of the European.
We shall give, however, a summary of a few of the more pertinent points of
evidence which will speak for themselves.
(a)The ordinary shovel or spade used by the European workman requires
two Bengalis to work it—one makes use of it in the same manner as the
European, the other by means of a rope tied above the iron part assists in lift-
ing the spade-full or shovel-full of material.
(b)Some years ago the competition of " brown " labour was one of the bug-
bears of trade unionism owing to the institution of crude comparisons between the
wages payable and the hours worked in India and England respectively. An
expert, who has recently written on this subject, demonstrates that five or six.
times as many hands are needed in Indian spinning mills, and three times as
many in weaving sheds, to produce the same result as in England.
The following table, modified from the recent report on factory labour
in India, brings out very clearly and forcibly the relative productive capacity of
the English and Indian worker :—
England.
India.
Operatives per 1,000 spindles
.
.
.
.
4 . 2
28
Operatives per 1,000 looms
.
.
.
.
43
125
Annual outturn of yarn per operative .
.
.
7,736 lbs. 4,000 lbs.
12
60
England.
India.
Weekly outturn of cloth per operative
. .
.
767 yds. 240 yds.
Average approximate counts
.
.
.
.
40 s.
20 s.
Working hours per week
.
.
.
.
55½
8 0
Working hours per year .
. .
.
. 2,775
4,120
Monthly wages per spinning operative .
.
. Rs. 70
Rs.13
Monthly wages per weaving operative
.
. Rs. 72
Rs.15
Neither wages alone nor hours alone can form a basis for comparing British
and Indian labour costs. Indian labour is lacking in continuous application,
punctuality, energy and regularity. Men have often to be employed in India for
work that women will do in England. The Indian workers have little skill or
education and consequently they make much waste ; their sense of discipline is
imperfect ; their attendance irregular ; and they take long intervals for rest,
smoking, etc. (Commercial Supplement of the Times. )
(c) In the coal mines of Europe and Bengal we have perhaps the best
comparative test of the capabilities of the different classes of workmen. It
must be remembered, however, that in the United Kingdom coal is mined at
ten times the depth of the average depth of mines in Bengal ; the great
majority of Bengal mines being worked by inclines of only a few hundred feet
in depth.
The relation between the number of hands employed and the output of the
collieries varies considerably in different districts, being highest in those where
the coal is moderately thick, soft, easily cut and with a good roof, and least in
faulted and disturbed seams and those with a bad roof where the accessory
operations of timbering and driving stone drifts requires the employment of a
large number of the working staff on non-productive work, i. e., other than
cutting coal.
The following figures give the relative force employed above and below
ground in two large steam collieries in South Wales each producing about 500
tons per day:—
Colliers cutting coal
.
.
.
.
. . 225
200
Other underground hands
.
.
.
.
. 229
174
Surface hands
.
.
.
.
.
. . 43
36
497
410
showing in the one case an average of one ton, in the other about 1¼ tons per
head per day.(1)
The annual output per man on the total force employed in the United
Kingdom is about 300 tons.
(1) Encyclopædia Britannica.
61
For the last year for which statistics are available—1904—the output per
man per annum was 287 tons in England ; in America, where mining is simpler,
it was 589 tons and in Germany 243 tons.
Compare these amounts with the following figures.
STATEMENT SHOWING THE PRODUCTION OF COAL IN INDIA FROM
THE YEAR 1896 TO 1906. (1)
Quantity produced. Number of persons
employed.
1897
.
.
.
.
.
.
.
.
4,066,294
59,859
1898
.
.
.
.
.
.
.
.
4,608,196
62,974
1899
.
.
.
.
.
.
.
.
5,093,260
74,450
1900
.
.
.
.
.
.
.
.
6,118,692
89,284
1901
.
.
.
.
.
.
.
.
6,635,727
95,318
1902
.
.
.
.
.
.
.
.
7,424,402
98,312
1903
.
.
.
.
.
.
.
.
7,438,386
88,530
1904
.
.
.
.
.
.
.
.
8,216,706
92,740
1905
.
.
.
.
.
.
.
.
8,417,739
89,995
1906
.
.
.
.
.
.
.
.
9,783,288
99,138
On the whole production for the last ten years the average output per
head per annum is under 80 tons or about 27 per cent. of the average of a
European miner.
So far as conditions of work go both European and Bengali miner is paid on
the output ; on the other hand the European labours under very great
disadvantages compared with the Bengali. As we have seen, he works at a
much greater depth and usually from a very thin seam of coal, often being
quite unable to stand upright to his work ; the Bengali, on the other hand, cuts
his coal from great thick seams usually ; in fact, his work is more like quarrying
than mining proper.
The output from lignite quarry mines in Europe is about 600 tons per man
per annum.
The physical conditions are altogether in favour of the Bengali and the
result is an outturn barely 27 per cent. of that of the European.
(1) Capital; 1907.
62
Many other instances of the inferior capabilities of the native workman
might be given, but we have said enough to support our contention that, physical
development depending largely on diet and environment, the vegetable-eating
Bengali on a diet poor in nitrogen is incapable of performing the same amount
of work—physiologically, of liberating the same amount of energy per unit time
—as the meat-eating European workman. We do not mean to imply by this
statement that the energy of muscular contraction comes from the nitrogen of
the food, but we do assert that the deficient nitrogenous intake of the Bengali
does not permit of the development of the muscular tissue necessary for the
performance of the same amount of work.
(2) Life Insurance.
The lowest rate for insurance of Indian lives is 33 per cent. higher than for
Europeans in Europe.
From information acquired from several insurance offices we have obtained
evidence pointing to the fact that, from an insurance point of view, the life of
the Bengali is very inferior to the European. The manager of one of the largest
offices dealing with native lives said that, if it were not for the fact that the
policies on Bengalis were, in a large percentage of cases, closed after a few
years' premia had been paid, the company would be compelled to stop whole-
life insurances on natives.
The company, as it is, rates all Bengali lives five years, i.e., a Bengali insur-
ing at age 30 next birthday pays the same rate as a European aged 35 next
birthday.
One large office in Calcutta which does an exceedingly lucrative business
in native insurances will only accept the policies of well-educated Bengalis of the
higher castes, and even then only up to an age of 35 to 38 years ; this company
will not accept a whole-life policy at all and the medical examination is very
strict—a slight excess of measurement round the waist being quite sufficient to
cause rejection.
Another method by which insurance companies safeguard themselves is to
accept lives insured only for a certain number of years—10, 15 or 20— the fewer
the years and, therefore, the higher the premia the more welcome the policy.
Under conditions such as these and others the specially selected native life
is superior to the European in India. There is no such thing as a general
acceptance of policies on the life of anyone who can pass a physical examina-
tion as holds in Europe and America. Another important point throwing light
on the expectation of life in the Bengali is that an endowment policy is very
rarely granted maturing above the ages of from 50 to 55 years. The explanation
given of this is that policies maturing beyond these ages were found not to pay,
death occurring before the companies had obtained sufficient in premia to
c o v e r t h e a m o u n t o f t h e p o l i c y .
63
(3) The power of resistance to disease.
Chittenden states "the smallest amount of food that will serve to maintain
bodily and mental vigour, keep up bodily strength and preserve the normal
powers of resistance to disease, is an ideal diet. Any excess over and above
what is really needed for these purposes imposes just so much of an unnecessary
strain upon the organism. It imposes on the excretory organs the needless
labour of removing waste products which could well be dispensed with—the
elimination of these bodies through the kidneys places upon these organs an
unnecessary burden which is liable to endanger their integrity and possibly
result in serious damage". The amount of proteid food required by adults, he
says, is fully met by a daily metabolism equal to an exchange of 0.12 grm.
nitrogen per kilo. of body-weight.
While agreeing with the view expressed above to a large extent, we consider
the whole importance rests on the amount of food that "preserves the normal
powers of resistance to disease". We have found that the Bengali exists on a
proteid metabolism very close in amount to that stated by Chittenden to be
sufficient ; let us, therefore, examine the evidence of his resisting power to disease.
Chittenden attaches great importance to the strain thrown on the excretory
organs from an excess of proteid over and above what he considers necessary;
we are forced to the conclusion, however, that there is another and a very
important side of the question to be considered, viz., the danger of malnutrition
of the renal epithelium from a lowered or impoverished condition of the blood
accompanying a low proteid intake. We have searched in vain for any reference
to this probable source of danger in Chittenden's publications and in the works of
other authors. That it is a point worthy of investigation and not to be overlooked
we shall endeavour to show.
It is well known that stoppage of the flow of blood through the renal vessel
—as by ligature of the renal artery or vein or temporary stoppage by pressure
on the abdominal aorta—even for a very short time will cause extensive changes
in the renal epithelium and, if at all prolonged, will mean total loss of its vitality.
With a transitory stoppage or even with a sluggish flow from back pressure
albuminuria results; that is, the epithelial cells are unable to prevent the albumen
of the plasma from filtering through. It may, therefore, be accepted that the
delicate cells lining the renal tubules require for the up-keep of their normal vitality
a certain minimum of a constant supply of nutritive materials brought by the
plasma of the blood; any diminution in the supply below this minimum will
inevitably lead to loss of vitality and loss of function. It will not matter so
far as the malnutrition of the renal cells is concerned whether this is brought
about by a diminution in the velocity of the flow of blood or by a diminution
in the percentage of nutritive material present in the blood ; in both instances the-
64
necessary nutritive exchanges are deficient and the cells suffer. We can quite-
easily imagine a condition of the blood it which this malnutrition of the renal
epithelium obtains with even a full free flow of blood through its vessels. Such
is met with in the extreme forms of anæmia due to ankylostomiasis so prevalent
in this province. As has been shown already ( 1 )
a s i m i l a r c o n d i t i o n o f " r e n a l
impermeability" to chlorides, as seen in ordinary nephritis, was found to-
be present in ankylostomiasis, and the recent report of the Porto Rico
Commission would prove conclusively that albuminuria is a very common
feature of this infection. Further, the Commission emphasizes the fact that the
accompanying albuminuria with casts should be regarded as the evidence of a
degenerative process in the kidney, not as an inflammation or, more specifically,
nephritis. We have, therefore, in the anæmia of ankylostomiasis a degenera-
tion of the epithelial cells and impairment of function due to an impoverished
condition of the blood.
That the total solids and nutritive materials of the blood are very deficient
in ankylostomiasis we have satisfactory analyses to prove. In certain cases we
have found the dry residue decreased well over 50 per cent.
Exact information is wanting regarding the degree of impoverishment of the
blood plasma the kidney epithelial cells are capable of withstanding before
degenerative changes begin to occur. We do know, however, that on a liberal
proteid intake the blood contains about 20 per cent. of proteid and, on a diet
containing 50 per cent. less proteid, it can and has been proved that there is a
considerable fall in the total solids and in the floating proteids of the plasma—.
the source from which these epithelial cells derive their nutrition.
With this knowledge at our disposal the question arises: are we justified in
lowering the nitrogenous constituents of the plasma by lessening the amount of
proteid din the daily food, even though with this lessened proteid intake certain
theoretical dangers may be obviated ? We use the word theoretical advisedly,
as it has not been proved that the healthy individual is injured by a proteid diet
of the ordinary standards. Von Noorden asks the pertinent question in this
connection, are carnivora less healthy than herbivora because they consume a
larger quantity of flesh ?"
Instead of the theoretical dangers that are to be avoided by a greatly dimi
nished proteid intake, we consider that very real dangers may arise from this very
diminution, viz., degenerative and fatty changes from lack of proper nutrition in
the delicate glandular and excretory cells of the body.
In order to obtain the available evidence of the low proteid diet of the
Bengali on the incidence of renal disease compared with the more nitrogenous.
food of the. European we examined the records of the medical cases treated in.
(1) M'Cay ; Lancet, 1st June 1907.