NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
37
means the daily metabolism of only 0.681 grm. per kilo. of body-weight—an
amount even below the average we obtained for students and servants.
Yet with this very small intake of proteid there was, as shown by the plus
nitrogen balance, a retention during the four days of 0.80 grm. of nitrogen ; so
that not only was the amount of proteid food consumed quite adequate to meet
the demands of the body, but the latter was able to store up 5 grms. of proteid
during the period of observation.
Chittenden states that 0. 12 grm. of nitrogen per kilo. of body-weight is quite
sufficient to meet all proteid requirements. As will be evident the above results
bear out his contention. This particular individual was well nourished, muscular,
with no excessive amount of fat.
A point of considerable importance brought out by the analyses is the large
quantity of nitrogen in the fæces. During the four days no less than 25°42 per
cent. of the total nitrogen of the food re-appeared in the fæces, having passed
through unabsorbed. This is a very high percentage of waste ; even in an
entirely vegetable diet, as understood by Europeans, usually 85 per cent. at least
of the proteid is absorbed. The diet in the present case consisted largely of
rice and dhall. We shall have more to say with regard to fæcal nitrogen when
we discuss the second series of experiments.
No. 2 of the above table is a particularly , thin man, poor in muscular
development and with practically no fat.
In his case the total intake of nitrogen during the four days was 42.24
grammes, the quantity of this that underwent metabolism being 33.69 grammes.
This means for a body-weight of 50.50 kilos. the metabolism of 0.166 grm. of
nitrogen, or putting it in terms of proteid, the metabolism of 10.37 grammes of
proteid per kilo. of body-weight.
This is a very much higher amount than was the case either in No. I or in
the series of two hundred students and servants analysed above, and it is very
much higher than the quantity considered by Chittenden sufficient to cover all
the proteid needs of the body.
We may draw attention to the fact that although No. 2 assimilated no less
than 6.79 grammes of nitrogen or 42.43 grammes of proteid more than No.
during the four days, yet the nitrogen balance shows that No. I retained actually
more of his proteid than No. 2—the former had a plus balance of 0.80 grm.
nitrogen, while the latter only shows 0.51 grm. nitrogen. This is a very g od
illustration of the first great law of metabolism that, within certain limits—the
limits of nitrogenous equilibrium—the body lives up to its income of nitrogen; the
law may be formulated thus : "Consumption of proteid is largely determined by
supply" (Stewart).
Again, we find a large amount of nitrogen in the fæces, in this instance 23.86
38
per cent. of the total proteid intake re-appeared in the stools, never having been
assimilated and therefore can only be looked on as so much waste. The diet of
No. 2 also largely consisted of rice and dhall.
The second set of investigations was carried out on prisoners. In order to
facilitate the work and to obtain some idea of the constitution and nature of the
different scales of diet laid down for prisoners a table was prepared showing the
quantities of the several proximate principles of the diets in grammes.
This is reproduced in Table XII .
As will be at once evident, these diet scales are exceedingly liberal com-
pared with those we have discussed so far.
The proteid element in some instances almost reaches Voit's standard and
is far superior in quantity to the proteid element in the average diet of the great
majority of the population of the province.
Table XII.
Diet No.
Proximate Principles.
Rice.
Wheat
Flour.
M a i z e .
Suttoo.
Molasses.
Dhall. Vegetables, Mustard Oil. Value of diet in
grammes.
I
Proteid
. . . . . .
46. 39
. . .
. . . ...
. . .
33. 79
3 . 4 8
. . .
8 4 . 6 6
Carbohydrate
. . . . .
613.00
. . .
...
...
. . .
67. 46
9.06
...
7 1 9 . 5 2
Fat
. . . . . . .
1 . 1 0
. . .
. . .
. . .
. . .
5. 44
1.58
17.35
2 4 . 4 7
II
Proteid . . . . . . .
39.85
1 0 . 8 6
. . .
. . .
. . .
33. 79
3 . 4 8
. . .
87.98
Carbohydrate
. . . . .
519.54
63.40
. . .
. . . ...
97. 46
9 . 0 6
...
6 8 9 . 4 6
Fat . . . . . . .
.93
2. 74
. . .
. . . . . .
5. 44
1.58
17.35
2 7 . 0 4
III
Proteid . . . . . . .
39.85
. . .
. . .
21.65
...
33. 69
3 . 4 8
. . .
9 8 . 7 7
Carbohydrate
. . . . .
519.54
...
. . .
48.77
19. 75
97. 46
9 . 0 6
. . . 6 9 4 . 5 8
Fat . . . . . . .
.93
...
...
1.55
. . .
5.44
1 . 5 8
17.35
2 5 . 8 5
IV
Proteid . . . . . . .
28. 98
...
35. 90
...
...
33.79
3 . 4 8
...
102.15
.
Carbohydrate
. . . . .
377.84
...
232. 70
...
. . .
97. 46
9.06
...
7 1 7 . 0 9
Fat
. . . . . . .
2.67
. . .
17. 00
. . .
...
5 . 4 4
1 . 5 8
17.35
4 3 . 0 4
V
Proteid . . . . . . .
28.98
32.60
...
. . .
...
33.69
3 . 4 8
...
9 8 . 8 5
.
Carbohydrate
. .
. .
377.84
190. 22
...
...
. . .
97. 46
9 . 0 6
. . . 6 7 4 . 5 8
Fat . . . . . . .
2. 67
8.22
...
. . . ...
5. 44
1.58
17 35
3 4 . 2 6
VI Proteid . . . . . .
21. 74
42.47
...
...
. . .
33.79
3 . 4 8
. . . 101.48
Carbohydrate
. . . .
283.38
253.53
. . .
...
. . .
97. 46
9.06
...
6 4 3 . 4 3
Fat . . . . . . .
2. 21
10.96
...
. . .
. . .
5. 44
1 . 5 8
17.35
3 6 . 5 4
VII
Proteid . . . . .
21. 74
32.60o
...
21.65
. . .
33. 79
3 . 4 8
...
1 1 3 . 2 6
Carbohydrate
. . . .
283.38
190. 22
. . .
48.77
19. 75
97. 46
9.06
. . . 648.62
Fat
. . . . . .
2.21
8.22
...
1.55
. . .
5.44
1.58
17.35
3 5 . 3 5
VIII
Proteid . . . . . . .
21.74 ... ....
21.65
. . .
33. 79
3 . 4 8
. . . 1 1 6 . 3 6
Carbohydrate
. . . . . 283.38
...
. . .
48.77
19. 75
97. 46
9.06
...
688.15
Fat . . . . . .
2.21
...
...
1 . 5 5 ...
5. 44
1 . 5 8
7.35
44.13
Average fuel value of above diets—3,380 Calories.
39
40
[A.—Gramineœ.—(1) Oryza Sativa, Linn., RICE.
Hab.—Throughout India, wild and cultivated.
Use.—Rice is the staple-food of the inhabitants of Bengal, many parts of
Madras, Burma and the Western Coast of India, but not of the Central or North-
ern parts of the country, where wheat and millet are largely used.
(2) Zea Mays, Linn., MAIZE.
Vernacular.—Makkai, Bhuta, Janar.
Uses.—Used as a food for man and beast.
(3) Triticum Sativum, Lam., WHEAT.
Hab. —The Euphrates region. Cultivated in North-West India, the Central
Provinces, and Bombay.
Uses.—It is one of the most important of the cereals and largely used for food.
B.—Leguminoœ.—(I) Cicer Arietinum, Linn., COMMON CHICKPEA.
V rnacular.—Chana, But.
Uses.—This pulse is the Cicer of the Romans. In India the seeds form
one of the favourite pulses being eaten raw or cooked in a variety of ways.
The flour is also much used as a cosmetic and in cookery.
(2) Erbum Lens, Linn., MASURA DHALL.
(3) Cajanus Indicus. ARAR DHALL.
(4) Phaseolus Mungo, Linn., MUNG DHALL.
These are the common forms made use of in Bengal. As is wellknown,
another variety—(5) Lathyrus Sativus,—made use of as an article of diet, is
capable of producing toxic symptoms. The condition is known as lathyrismus
and at one time affected nearly four per cent. of the population of one district in
Bengal.
ATTA is the flour obtained from grinding wheat.
SUTTOO is fried chana or chickpea ground to flour.]
These diets, however, are all entirely of a vegetable nature and practically
all the nitrogenous element is derived from rice and dhall. With an ordinary
vegetable diet we expect an average of about 85 per cent. of the proteid to be
absorbed, but, as will be apparent from our observations on prisoners and others,
a much lower percentage is absorbed from diets of the above type. For the
present we are unable to state dogmatically what the cause of this large amount
of unabsorbed nitrogenous material in the fæces is, but from the few observ-
ations made we consider it mainly to be ascribed to the dhall and more parti-
cularly to dhall of a certain type. The whole question of the large nitrogenous
residue characteristic of Bengalis is an important one and requires careful
investigation. A splendid opportunity for the growth of micro-oganisms with its
attendant intestinal putrefaction and toxæmia is provided, predisposing to
numerous Pathological conditions such, for instance, as septic ulceration of the
41
gums, intestinal catarrh and diarrhœa, dysentery and anæmi.. These are all
exceedingly common disorders met with in the outpatient department of a
general hospital.
Large quantities of rice have to be given in order to obtain the necessary
amount of proteid ; this leads to an excessive intake of carbohydrate.
Compared with Voit's diet containing 500 grammes or Ranke's containing 240
grammes of carbohydrate, the food provided for prisoners shows a great
abundance of the carbohydrate element. On the other hand the fat element
is deficient ; the deficiency, however, is more than made up by the liberal
carbohydrate allowance.
The excess of carbohydrate over ordinary bodily requirements may be
made use of as a proteid-sparer, but in order to spare even a small quantity of
proteid a large amount of carbohydrate is required. Further, so long as suffi-
cient proteid is being assimilated to maintain nitrogenous equilibrium it is
quite unnecessary to add a large amount of carbohydrates to a diet in order to
spare the proteid material.
We may conclude from an examination of the above types of diet that,
simply as a means of providing fuel for the system, there is a very heavy
wastage, while the constant fermentation and putrefaction made possible by
the copious nitrogenous residue in the alimentary canal must form a source of
chronic irritation to the mucous membrane of the bowel, predisposing to
intestinal catarrh, diarrhœa, etc. At the same time the products of the putre-
factive micro-organisms on absorption lower the general vitality, causing anæmia,
toxæmia, and many other symptoms of ill-health. We are very much inclined
to believe that the diet of the Bengali, prisoner or other, bears a close relation-
ship to the exceeding prevalence of intestinal troubles among the population
of this province.
In carrying out the investigations on prisoners, four healthy men of above
the average weight who had been sentenced to hard labour were selected from
a number of volunteers. Arrangements were made by the Superintendent of
the Jail—Major Mulvany, I.M.S.—for obtaining an accurate record of the total
intake of food and for collection of the excreta, both urine and fæces. The
diet for these four prisoners was prepared separately, each ingredient having
previously been weighed, the quantity of each separate item of the food that
remained uneaten was weighed and its value in nitrogen deducted from the
total nitrogenous value of that day's diet.
Similarly, with regard to the excreta ; special arrangements were made for
these prisoners, the urine and fæces were collected separately, their quantity
measured and weighed and sent for examination.
The enquiry began on the 13th February 1907 and was completed on the G
42
25th March 1907. Daily analyses (Sundays excepted) were carried out on
35 days for each prisoner.
The points noted were :—Caste, age, weight, amount of nitrogen in food,
quantity of urine excreted, specific gravity of urine, urea in terms of nitrogen,
nitrogen in fæces, freezing-point of atrine, the total chlorides of urine and work
done.
The nitrogen of the urine was not specially estimated, as it was considered
that with a knowledge of the total nitrogen intake and the output of fæcal
nitrogen we obtained by subtracting the latter from the former an absolute
measure of the amount of proteid absorbed and assimilated from the food.
However, as a check on this, besides the ordinary Kjeldahl's control, we made
an estimation of the nitrogen execreted in the form of urea each day.
As there is nothing to be gained by giving a complete list of each day's
analyses we reproduce in tabular form the observations made on six consecutive
days at the beginning and end of the period of examination. These 48
analyses are quite sufficient to show everything of importance that is to be
learned with regard to the metabolism of these four prisoners. Table XIII
gives the information referred to.
We have already discussed to some extent the scales of diet laid down for
prisoners. They show, compared with the usual standards, a slight deficiency
in proteid, an excessive carbohydrate element and a low fat intake.
Further, beside the salt present in the different materials composing the
diet, there was added during cooking up to, in most instances, an ounce of
sodium chloride. These men had, therefore, no option with regard to the
amount of salt they consumed. We may take it that the quantity of salt
present in the daily diet was not less than from 3o to 32 grammes.
So far as we are specially concerned the nitrogen and salt of the diet are
the most interesting subjects. The carbohydrate and fat elements may be
accepted as being amply sufficient to meet all demands for heat and energy-
production.
Let us now examine the table in more detail. The nitrogen intake varies
round a standard of 14.40 grammes per day. From analyses of the actual
ingredients of the food for these men we found the nitrogenous intake was made
up in the following way:—
From rice was derived 47.39 grammes of proteid.
„ masur dhall „
19.78
,,
„
„
„
arar
„
,,
16.. 8 9
„
„
,
„ „
vegetables ,,
3'48
,,
,,
,,
„
fish
,.
2.48 or 2.. 6 9 g r a m m e s
„
This totals up to an intake of 90.02 or 90.71 grammes of proteid daily ;
o r expressed in teams of nitrogenls 14.40 or 114.51 grammes as the case may be.
Table XIII.
Day.
No. Caste. Age. Weight.
Amount of
nitrogen
1n food.
Urine
i n
C. Cs.
Specific
Gravity.
Urea
in
nitrogen.
Nitrogen
i n
faces.
Freezing-
point—°C. Chlorides.
Work.
REMARKS.
1 4229 A M
31
123½
14.40
1 8 0 2
1012
7.98
3.79
1 . 4 2 28.48 Hard Labour :
2
,,
, ,
124
14.40
2413
1015
9.57
3.95
1 . 3 3 37.64
expressing
1/8 oz. Nacl.
3
,
, ,
123
14.40
1675
1013
7.42
3.02
1.30
22.91
10 seers of
4
, ,
, ,
1 2 2 ½
14.40
2839
1 0 1 0
9.46
2.83
1 . 1 3 38.04
mustard-o1l
extra.
5
, ,
, ,
124
14.40
1958
1 0 1 6
8.77
4.83
1.42
32.51
da1ly.
, ,
6
, ,
, ,
124½
14.40
2058
1014
8.16
3.97
1.37
32.92
, ,
1 7183 A H
22
135½
14.20
3670
1 0 0 8
1 1 . 1 3
6.51
. 8 433.39
, ,
1/8 oz. Nacl.
2
, ,
, ,
136
14.20
3100
1007
8.67
2.30
. 7 120.77
2
, ,
, ,
135
13.46
3570
1005
9.16
2.77
. 6 219 63
extra.
4
, , ,
, ,
134½
1 4 . 6 1
3280
1 0 0 6
8.41
3.71
. 7 7
27.88
5
, ,
, ,
135
14.40
3305
1006
8.86
3.62
. 8 531.73
, ,
6
, ,
, ,
136½
14.40
3420
1010
9.90
6.66
1.18
46.17
, ,
1 9614 A M
28
128
14.60
1802
1018
7.77
4.98
1.75
35.85
, ,
1/8 oz. Nacl.
2
, ,
, ,
128
14.40
2810
1010
11.80
2.39
. 9 632.87
3
, ,
, ,
128½
14.60
1830
1 0 1 8
9.39
3.31
1.81
37.33
extra.
4
, ,
, ,
128
14.40
1916
1020
10.32
3.31
2.03
35.44
5
, ,
, ,
129
14.40
1690
1018
10.25
2.12
1 . 8 3 36.67
each day.
6
,,
, ,
128
14.40
2839
1 0 1 1
10.26
4.35
1.35
35.48
1 6110 B H
35
120
14.40
2058
1014
7.92
4.97
1.37
27.78
, ,
1/8 oz. Nacl.
2
, ,
, ,
119½
14.40
3037
1007
7.36
. Nil
. 9 229.45
extra.
3
, ,
, ,
120
14.60
2370
1 0 1 1
9.95
6.83
1.12
29.86
4
, ,
, ,
118
14 40
2583
1 0 1 1
10.24
4.26
1.23
30.47
, ,
5
, ,
, ,
118
14.40
2867
1015
11.37
1.23
1 . 4 8 48.73
, ,
6
, ,
, ,
119
14.40
3094
1010
10.46
4.06
1.13
35.58
Weight is given in grammes throughout. The prisoners'. weight in lbs. Nitrogen of food and fæces was estimated by Kjeldahl.s method. The average amount of salt in the
diet was 30 grammes (circa).
Table XIII—continued.
Day. No. Caste. Age. Weight.
Amount of
nitrogen
in food.
Urine
in
C. Cs.
Special
Gravity.
Urea
in
nitrogen.
Nitrogen
in
fæces.
Freezing-
point —ºC. Chlorides.
Work.
REMARKS.
1 4229 A M 31
1 2 1 ½
14.40
1973
1013
9.28
3.69
1.40
28.08 Hard Labour.
2 ,,
, ,
1 2 3 ½
14.61
1987
1013
9.57
4.25
1 . 2 7
28 84
3
, ,
, ,
123½-
1 4 . 4 0
1930
1014
9.02
3. 42
1 . 3 1
2 9 . 3 0
4
,,
, ,
1 2 2 ½
14.26
1987
1011
11.46
2.68
1 . 3 2
2 5 . 8 4
5
, ,
, ,
124
14.40
1873
1013
8.77
4. 01
1 . 3 7
29.51
6
, ,
, ,
1 2 4 ½
14.60
1930
1010
10.76
3.27
1.10
22.92
1 7183 A H
22
1 3 4 ½
14.11
3208
1013
8.34
3.31
1.26
51.00
, ,
1 / 8 o z N a c l e x t r a
each
day.
2
,,
, ,
1 3 5 ½
1 4 . 6 1
3577
1009
1 0 . 2 6
3.46
.91
3 3 . 2 6
3
,,
, ,
134
14.40
2503
1013
10.24
2.58
1 . 0 4
28 92
4
,,
, ,
1 3 5 ½
14.40
3875
1007
10.30
1.81
.87
36.03
5
, ,
, ,
136
14.61
3350
1009
11.05
2.23
.95
3 8 . 0 9
6
, ,
, ,
135
13.46
3062
1 0 0 8
9.34
4. 20
1.08
36.25
1 8614 A M 28
131
1 4 . 4 0
2190
1 0 0 8
9.65
4. 63
1.07
39.87
,,
, ,
2
, ,
, ,
1 3 0 ½
14.61
2660
1012
6.82
2.58
1.23
43.35
3
, ,
, ,
130
14.40
2360
1 0 1 1
6.85
3.49
1.20
31.86
4
,,
,,
130.
13 60
3080
1013
1 0 . 0 4
4.91
1.28
48.36
5
,,
, ,
130
14.80
2590
1010
12.08
4.23
1.09
27.71
6
, ,
, ,
129
14.40
2040
1012
1 0 . 6 1
4. 83
1.28
23.86
1 6110 B H 35
118
1 4 . 4 0
1731
1 0 1 0
8.88
7.86
1 . 0 8
15.92
, ,
, ,
2
, ,
, ,
117
14.31
2455
1013
1 1 . 0 1
2.71
1.32
31.66
3
, ,
, ,
1 1 6 ½
14.61
1864
1 0 1 0
10.41
1.92
1.38
22.32
4
,,
, ,
1 1 6 ½
14.40
2441
1014
9.52
3.41
1.32
3 4 . 4 1
5
, ,
, ,
1 1 6 ½
14.40
2001
1014
9. 05
4.50
1.34
27.80
6
,,
, ,
118
14.04
1802
1014
8.19
2.83
1.35
27.22
45
Practically speaking the diet is vegetable in character, only 2.48 or at most
2 .69 grammes proteid coming from flesh in the form of fish. More than half
the proteid is provided in the form of rice and the great majority of the remain-
der in the form of dhall.
It will be evident from the results we obtained in the case of students,
servants and assistants that this amount of proteid is quite sufficient to maintain
the body in a condition of nitrogenous equilibrium. Whether maintenance of nitro-
genous equilibrium on a low proteid intake and maintenance of the body in an ideal
condition of health and vigour are identical as Chittenden's statements would tend
to lead us to believe, is an open question and one on which we have been able to
bring a certain amount of evidence to bear. From a quantitative proteid intake
standpoint the diet may be said to have little interest ; but it is very different
when we come to examine its real value, i.e., the amount of proteid absorbable
and of actual service in the system. In order to show the principal points of
importance in connection with the fate of the nitrogen of the food we have
drawn up Table XIV. This table covers the same period as Table XIII and is
derived from it.
Table XIV.
Individual.
Total
nitrogen
intake
in grms.
Total
fæcal
nitrogen
in grms.
Total
nitrogen
assimilated
in grms.
Per cent. of
nitrogen
unabsorbed
from food.
Per cent. of
nitrogen
absorbed
from food.
Nitrogen
excreted as
urea in
grms.
Per cent. of
nitrogen of
food excreted
as urea.
Per cent. of
nitrogen of
urine excre.
ted as urea*.
...
. . .
. . .
. . .
4229 A
.
172.07
43.64
128.43
25.36
74.64
108.22
62.88
84.26
7183 A
.
170.86
42.16
128.70
24.67
75.33
115.66
67.69
89.86
9614 A
.
173.01
46.13
126.88
26.72
73.28
115.84
66.95
91.29
6110 A
.
172.76
44.58
128.18
25.86
74.14
114.36
66.19
89.21
[* The percentages of the nitrogen of the urine excreted as urea are slightly too high ; no notice is taken of the nitrogen
that is assimilated and eliminated in the sweat, epithel i al scales, etc. The total amount of this is, however, very trifling
and may be neglected.]
It may be taken that these four men were in a condition of nitrogenous
equilibrium and that the amount of proteid absorbed was sufficient to meet all
nitrogenous requirements ; as evidence of this we have the fact that they were
able to carry on the work provided—"hard labour"—without distress or any loss
of body-weight.
The average intake of nitrogen works out at 14.34 grammes per day, of which
10.67 grammes were absorbed. The weight of these men on the average was
46
57 kilos so that 10.69/57=0.185 gramme, that is, each man had the metabolism of
0.185 gramme of nitrogen per kilo of body-weight daily. Compared with Chit
-tenden's statement of the quantity he considers necessary, or our own figures
obtained from a study of Bengali students and others, this is a very liberal allow-
ance. On the other hand, when we examine the columns in Table XIV showing
the percentage of the absorbable to the non-absorbable, it is evident that the
diet is an inferior one. Over the series of analyses recorded no less than 25.52
per cent. of the proteid of the food passes out unchanged. This result is in
marked contrast to what Chittenden obtained in different experiments on
students, scientific men and soldiers ; in all his records the fæcal nitrogen
was exceedingly small in amount. To this he attaches the greatest importance
and, in fact, makes it one of the principal arguments in favour of strict modera
tion of proteid intake, contending that with a small nitrogenous residue the
opportunity afforded for intestinal putrefaction and fæcal intoxication is kept
at a minimum. If this view is sound and worthy of credence, and we believe it
to be so, what can be said about the diets presented and discussed above ? They
are one and all bad in every respect, and particularly bad in that the large waste
in the alimentary canal allows excessive micro-organismal development and for-
mation of toxic compounds. As we already have had occasion to point out, this
must assuredly be a factor in the prevalence of intestinal disorders and in the
causation of certain diseases. So much is this the case that an experienced Jail
officer states that it is one of the rarest of novelties to discover a prisoner who
passes a solid stool.
From an economical standpoint alone the large waste in food material
is worthy of consideration and investigation. What part of the diet is princi-
pally to blame ? We have made some investigations and collected evidence
that would appear to inculpate the dhall ; they are not sufficient, however,
to base a definite opinion on. It is well known that, even among those
accustomed to dhall and of course much more so with Europeans, if a small
amount of dhall more than usual be partaken of, diarrhœa and intestinal troubles
are apt to ensue. Further, in connection with the fluid condition of the stool
characteristic of the dhall-eating Bengali we can state from personal experience
that its fluidity is not due to rice,—the Chinese and Japanese are great rice-eating
people, yet their stools are not watery but well-formed. Dysentery may be said to
be comparatively rare in the provinces of India where the diet of the population
does not mainly consist of rice and dhall, whereas in Bengal, both in the Jails
and elsewhere, dysentery is very prevalent.
An enquiry into this matter is urgently necessary and might materially
assist in eradicating some of the most serious and fatal afflictions from the province
of Bengal.