NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
List of numbers of Scientific Memoirs by Officers of the Medical and Sanitary
Departments of the Government of India (New Series) published previous
to the present issue.
No. 1. Standardisation of Calmette's anti-venomous serum with pure cobra venom: the
deterioration of this serum through keeping in India, by Captain G. Lamb,
I.M.S., and Wm. Hanna, Esq., M.B. Price As. 3 or 4d.
No. 2. Malaria in India, by Captain S. P. James, I.M.S. Price Re. 1-8 or 2s . 3 d.
No. 3. Some observations on the poison of Russell's Viper (Daboia Russellii), by Captain
G. Lamb, I.M.S., and Wm. Hanna, Esq., M.B. Price As. 5 or 6 d.
No. 4. On the action of the venoms of the Cobra and of the Daboia on the red blood
corpuscles and on the blood plasma, by Captain G. Lamb, Price
As. 8 or 9d.
No. 5. Specificity of anti-venomous sera, by Captain G. Lamb, I.M.S. Price As. 3
or 4 d.
No. 6. First report on the anti-malarial operations in Mian Mir, 1901-03, by Captain
S. P. James, I.M.S. Price As. 12 or 1s. 2d.
No. 7. Some observations on the poison of the Banded Krait (Bungarus Fasciatus), by
Captain G. Lamb, I.M.S. Price As. 8 or 9 d.
No. 8. A preliminary report on a parasite found in patients suffering from enlargement
of the spleen in India, by Lieutenant S. R. Christophers, I.M.S. Price Re. 1-8
or 2s . 3 d.
No. 9. Second report of the anti-malarial operations at Mian
1901-03, by Lieu-
tenant S. R. Christophers, I.M.S. Price As. 10 or 1s.
No. 10. Specificity of anti-venomous sera (second communication), by Captain G. Lamb,
I.M.S. Price As. 8 or 9 d.
No. 11. On a parasite found in persons suffering from enlargement of the spleen in
India-Second Report, by Lieutenant S. R. Christophers, I.M.S. Price
Rs. 2 or 3s.
No. 12. On the Morphology, Teratology, and Diclinism of the flowers of Cannabis, by
Major D. Prain, I.M.S. Price As. 14 or 1s. 4d.
No. 13. Oriental or Delhi Sore, by Captain S. P. James, I.M.S. Price As. 10 or 1S.
No. 14. On a parasite found in the white corpuscles of the blood of dogs, by Captain
S. P. James, I.M.S. Price As. 10 or 1s.
No. 15. On a parasite found in persons suffering from enlargement of the spleen in
India-Third Report, by Lieutenant S. R. Christophers, I.M.S.
Price
As. 10 or 1s.
No. 16. The specificity of anti-venomous sera with special reference to a serum prepared
with the venom of the Daboia Russellii, by Captain G. Lamb, I.M.S. Price
As. 6 or 7d.
No. 17. Snake-venoms in relation to Hæmolysis, by Captain G. Lamb, I.M.S. Price As. 6.
or 7 d.
No. 18. Hæmogregarina Gerbilli, by Lieutenant S. R. Christophers, M.B., I.M.S. Price
As. 10 or 1s.
No. 19. On Kala Azar, Malaria and Malarial Cachexia, by Captain S. P. James. M.B.,
I.M.S. Price Re. 1-4 or 1s. 11d.
No. 20. Serum-Therapy of Plague in India; reports by Mr. W. M. Haffkine, C.I.E., and
various officers of the Plague Research Laboratory, Bombay, by Lieutenant-
Colonel W. B. Bannerman, M.D., B.Sc., F.R.S.E., Price As. 14 or-
1s. 4d.
2
No. 21. On the Standardisation of Anti-Typhoid Vaccine, by Captain George Lamb,
M.D., I.M.S. (Director, Pasteur Institute of India), and Captain W. B. C.
Forster, M.B., D.P.H., I.M.S. Price As. 6 or 7 d.
No. 22. Mediterranean Fever in India: Isolation of the Micrococcus Melitensis, by Captain
George Lamb, M.D., I.M.S., and Assistant Surgeon M. Kesava Pai, M.B.,
C.M. (Madras). Price As. 10 or 1s.
No. 23. The Anatomy and Histology of Ticks, by Captain S. R. Christophers, M.B.,
I.M.S. Price Rs. 3 or 4s. 6 d.
No. 24. On a parasite found in the white corpuscles of the blood of Palm Squirrels, by
Captain W. S. Patton, M.B., I.M,S. Price As. 12 or 1s. 2 d.
No. 25. On the importance of Larval characters in the classification of mosquitoes, by
Captain S. R. Christophers, I.M.S. Price As. 8 or 9 d.
No. 26. Leucocytozoon Canis, by Captain S. R. Christophers, M.B., I.M.S. Price
As. 12 or 1s. 2 d.
No. 27. Preliminary Report on the Development of the Leishman-Donovan Body in the
Bed Bug, by Captain W. S. Patten, M.B., I.M.S. Price As. 8 or 9 d.
No. 28. The sexual cycle of Leucocytozoon Canis in the tick, by Captain S. R. Chris-
tophers, M.B., I.M.S. Price As. 12 or 1s. 2 d.
No. 29. Piroplasma Canis and its cycle in the tick, by Captain S. R. Christophers, M.B.,
I.M.S. Price Rs. 2 or 3 s.
No. 30. The Theory and practice of Anti-Rabic immunisation, by Captain W F. Harvey,
M.B., I.M.S., and Captain Anderson McKendrick, M.B,, I.M.S. Price
As. 12 or 1s. 2 d.
No. 31. The development of the Leishman-Donovan parasite in cimex rotundatus—Second
Report, by Captain W. S. Patton, M.B., I.M.S. Price Re, 1 or 1s. 6d.
No. 32. An enquiry on Enteric Fever in India carried out at the Central Research Institute,
Kasauli, under the direction of Lieutenant-Colonel D. Semple, M. D., and Captain
E. D. W. Greig, M.D. Price Re. 1-2 or 1s. 9 d.
No. 33. The Production of Alkali in Liquid Media by the Bacillus Pestis, by Lieutenant-
Colonel W. B. Bannerman, M.D., B.Sc., I.M.S. Price As. 5 or 6 d.
Published by and on sale at the Office of the Superintendent of Government Printing, India, Calcutta,
Copies are also available from all Agents for the sale of Government publications.
STANDARDS OF THE CONSTITUENTS OF THE URINE AND
BLOOD– AND THE BEARING OF THE METABOLISM OF BENGALIS
ON THE PROBLEMS OF NUTRITION.
T HE work recorded in this paper was begun in July 1906 and has been
carried on in the Physiological Laboratories of the Medical College,
Calcutta.(1) Chittenden's investigations and writings have tended to upset the
old-established views on standard dietaries and on the quantities of the different
proximate principles necessary for the maintenance of health and vigour, and
have, at the same time, placed the metabolism of the most important of
the food-stuffs—proteids—on an absolutely different footing. His brilliant re-
searches on the problems of nutrition have stimulated students of physiology
all the world over and were indeed the exciting cause of the present investigations.
The Bengali is, in a very great degree, a vegetarian, living mainly on rice
and dhall (pulse) ; it was therefore very probable that the diet of the Bengali
would be found deficient in proteid compared with ordinary standard diets, and
would approach fairly closely to the type considered amply sufficient by Chit-
tenden. This opinion was early forced on us by the results obtained from a
study of the urine of the Bengali, which was undertaken as a matter of urgent
clinical importance in order to get reliable standards of the excretion of the
different constituents.
It was very soon evident that the ordinary standards of excretion of the
urinary constituents for Europeans, as stated in physiological text-books, could not
be accepted for natives of Bengal and that therefore any deductions of a clinical or
practical nature based on a comparison with those standards must be misleading.
The first part of this paper will deal with standards of the different consti-
tuents found in the urine of Bengalis. These have been obtained from a large
series of observations on several different classes of the native population. The
present publication will take into account only the more important constituents
—those, namely, of clinical rather than of scienti c importance ; the other more
( 1 ) — I n t h e a c t u a l e x p e r i m e n t a l a n d a n a l y t i c a l i n v e s t i g a t i o n s t h e w h o l e s t a f f o f t h e p h y s i o l o g i c a l
d e p a r t m e n t w a s a c t i v e l y e n g a g e d f o r o v e r a y e a r , a n d i t i s d u e t o t h e v e r y a b l e , l o y a l a n d w i l l i n g h e l p o f m y
assistants that the publication of these researches is rendered possible. I desire at once to acknowledge
my indebtedness to my fellow-workers and to secure for them a full share in whatever credit the facts and
figures herein recorded may be considered worthy of. The names of those who assisted are :—
Assistant Surgeon S. C. Banerji, L.M.S., Assistant Professor of Physiology.
" " L. M. Ghos ha l , L. M. S. , Demonstrators, Physiological Department,
and
Medical College, Calcutta.
" " M. M. Dutta. L..M.S..
2
minute details will be dealt with subsequently, the work on them not being at
present complete.
,
Further, as no consideration of the urine in itself could be looked on as a
statement of the whole case, without, at the same time, a review of the condition
of the blood from which the urine is derived, it will be necessary to make some
attempt to examine the modifications met with in the constituents of the blood
in natives of Bengal.
The modifications of the blood and urine found during these investigations
naturally led to the question of the causation of the changes ; a series of inves-
tigations, therefore, was carried out—in which the intake and output were care-
fully estimated—to gain some insight into the metabolism of the Bengali. The
second part of the paper will be devoted to an analysis of the results obtained
from these observations and to other evidence on the sufficiency, or otherwise, of
certain diet standards.
Part I.—The Urine and Blood of the Bengali.
A. THE URINE.
In carrying out this investigation the procedure throughout was as fol-
lows :—The urine passed in each twenty-four hours was collected for four or five
consecutive days. The subjects of the experiments were students attending the
physiological department and servants of the college of different castes and,
therefore, living on more or less different classes of food-stuffs. The students
and qualified assistants were first examined, and our thanks are due to them for
the loyal way in which in every instance they carried out the collection of the
urine and for the interest they took in the investigation.
These two classes, assistants and students, belong to the higher castes and
are fairly well-to-do, so that they have a free choice so far as quantity of food is
concerned, certain meats—more particularly beef—being forbidden by their
religion. Fish, mutton, goat and other forms of flesh-meat, however, are
permitted.
The examination of these two groups being completed, the servants of the
college were next examined. They include durwans or gate-keepers—usually
belonging to higher castes ; bearers of inferior castes ; and lastly domes and
mehtars belonging to the lowest castes.
The importance of the study of the urine of the domes is seen in the table of
analysis—Table I—these men being of low caste eat anything they can get and
are particularly fond of flesh. They purchase the cheaper, almost unsaleable,
portions of animals at the slaughter-house and make use of them as food.
By examining the urine of each person daily for four or five consecutive
days more accurate results were obtained than if the urine passed during one
3
day only had been examined, The results shown in Table I are the averages of
the figures obtained by the daily analyses.
The different points noted are:— Caste—all were Hindus. Age —all were of
adult age. Weight —average weight over a large series is given. Quantity of
Urine—in cubic centimetres. Specific Gravity. Urea—quantity excreted in
grammes. Total Nitrogen —in grammes. Freezing-point of Urine. Chlorides
—in grammes.
Table I.
AVERAGE DAILY EXCRETION OF THE CONSTITUENTS OF THE URINE
OF BENGALIS.
Each observation is the average of the results obtained by daily analyses on
four or five consecutive days.
STUDENTS.
No.
Number of
analyses.
Quantity
of urine i n c . c .
Sp. Gr.
Urea.
grms.
Total
Nitrogen
grms.
Freezing-
point
(Centi-
grade).
Chlorides
grms.
1
.
.
.
.
5
1217
1016
14.33
6.63
—1.56
15.54
2
.
.
. .
5
700
1019
12.88
5.50
—1.54
6.72
3
.
.
.
.
5
1249
1015
14.22
6.85
—140°12.05
4
.
.
. .
4
980
1015
13.51
6.55
—1.16°7.80
5
.
.
.
.
4
1066
1011
11.85
5.23
—1.18°9.26
6
.
.
. .
5
1480
1016
13.51
6.62
—.91°9.86
7
.
.
. .
5
982
1022
12.45
6.06
—1.37°11.14
8
.
.
.
.
4
926
1 0 1 1
14.87
7.20
—2.31°18.04
9
.
.
.
.
4
1855
1 0 1 8
15.88
7.77
—1.06°6.52
10
.
.
.
.
4
805
1017
9.80
4.50
—1.52°1 0.59
1 1
.
.
. .
4
1319
1011
14.60
6.42
—1.45°16.45
12
.
.
. .
5
1461
1 0 1 1
10.83
5.55
—1.11°1 0.11
13
.
.
. .
4
895
1017
7.56
3.87
—1.51º
12.04
14
.
.
.
.
5
1312
1010
10.51
4.50
—1.14°9 .15
15
.
.
.
.
4
860
1022
13.37
6.21
—2.30°1 5.42
1 6
.
.
. .
4
1364
1012
13.08
5.90
—1.35°12.09
17
.
.
.
.
4
4227
1012
12.37
5.54
—1.18°12.23
1 8
.
.
. .
5
1227
1011
10.87
4.91
—.89°8 .48
19
.
. .
.
4
667
1021
11.06
5.21
—1.91º
9.30
B 2
4
STUDENTS- continued.
No.
Number of
analyses.
Quantity
of urine
in c.c.
Sp. Gr.
Urea grms.
Total
Nitrogen
grms.
Freezing-
point
(Centi-
grade).
Chlorides
grms.
20 .
.
. .
4
1115
1015
11.30
5.31 -1.48°1 1.97
21 .
.
5
985
1016
13.04
6.32 -1.46°11.65
22 . . . .
5
1634
1014
18.17
9.04
-1.55°19.39
23 .
.
.
.
5
1256
1012
11.93
5.27
-1.28°15.64
24 .
. . .
4
1415
1015
16.42
7.65
-1.38°1 4.50
25 .
.
.
.
5
948
1024
15.67
7.24
-2.400
18.17
26
. . . .
4
720
1015
7.79
3.40
-1.37°6 .65
27 .
.
.
.
4
1447
1012
15.92
7.35
-1.35°1 5.09
28
. . . .
4
1230
1017
14.91
6.85
-1.52°10.66
DURWANS.
29
. . . .
5
1650
1 0 1 1
19.68
9.30
-1.23°12.42
30
5
1492
1007
11.22
5.14
-.96°8 .53
31
. . .
5
1742
1006
9.87
4.21
-.71°5.98
32
5
670
1024
15.31
7.11
-2.45º
9.92
33
. . . .
5
732
1019
13.25
5.94
-1.86°8.06
34 .
. . .
6
650
1 0 1 1
5.56
2.61
-1.11°4 .88
35
. . . .
5
830
1023
15.91
7.60
-2.24°12.16
B E A R E R S .
36
. . . .
4
1131
1006
6.99
3.22
-.70°6 .47
37
. . .
4
1408
1008
7.58
3.47
-.89°1 0.91
DOMES AND MEHTARS.
38
. . .
4
884
1 0 1 8
14.95
7.06 -1.48°7.80
39
. . .
4
1 1 2 0
1012
17.75
8.12
-1.20°8.95
40
5
1002
1009
7.58
3.52 -1.05°4 .35
41
4
2216
1008
28.98
14.02
-1.16º
11.24
42
5
1080
1006
7.59
3.44 -.75°4.81
43 . . .
5
1877
1006
14.77
7.22
-.68°4 .95
44 . . .
5
1552
1006
10.05
4.58
-.9º
7.85
We have now over two hundred analyses of the urine of students and others,
all of whom had a free choice of food ; it will be our first duty to attempt to lay
down, as accurately as possible from the number of observations at our disposal,
standards for at least the more important constituents and to compare them with
the standards generally accepted for Europeans in a colder climate. For this
purpose it will be sufficient to strike an average for the total number of analyses
without taking any note of the particular caste of the subject from whom the urine
was obtained.
1. Quantity of urine excreted in the twenty-four hours. —As our investiga-
tions extended over a period covering both the hot and cold weather in Calcutta,
the modification in the quantity of urine passed due to loss of fluids from the
lungs and in sweat may be, to a large extent, neglected in the average amount
obtained from the series.
It will be evident from the above figures that the quantity passed varies
within very wide limits. In the average for each separate individual these limits
were between 650 c.c. and 2216 c.c. and when we examine the daily quantities
even wider limits are found—the lowest amount passed on one day being 330 c.c.,
and the largest quantity 2790 c.c. Variations more or less similar to these are
observed in all countries and depending, as they do, on a large variety of circum-
stances are not of much importance—wide variations in the quantity of urine
passed being quite compatible with health.
The average quantity found over the whole series of two hundred observations
is 1177 c.c. This approximates very closely to that recorded for American
students (1) in the winter, viz,, 1166 c.c., but, as would be expected, is below
the average amount voided by an adult male European, viz. , 1200—1500 c. c.
per day.
We may therefore fix our average for the quantity of urine passed in the
24 hours by Bengalis at from 1000—1300 c.c.
2. The Specific Gravity.—In Europeans the average specific gravity of
normal urine is 1020 with variations in health of from 1015—1025, and, unless
under exceptional circumstances such as after the imbibition of large quantities
of fluids, it rarely falls below this; in certain cases where fluids are withheld for
some time the specific gravity may rise to 1035 or more.
When we compare these standards with the results shown in the above table
it will at once be seen that there is a very marked difference. The limits of
variation found in the urine of the Bengali are very much wider than is the case
for the European ; as a rule, the specific gravity is on a lower scale.
On examining the average specific gravity—table I—of the urine of the
individual cases we find it ranges between 1006 in domes and 1024 in the case
(I) Manual ofPhysiology—Stewart.
6
of one student and one durwan. These limits practically cover the variations seen
in the daily analyses also.
The average specific gravity over the whole series works out to about 1013,
being slightly higher than this for the students alone, viz. , 1015.
We therefore find that, although a much larger proportion of the fluids got
rid of from the body goes by the skin in tropical climates than in Europe, still
the excretion of the total solids as measured by the specific gravity—also by
the lowering of the freezing-point as will appear later—is less in quantity in
Bengalis than in Europeans. This is exactly the opposite of what would be
expected.
Rubner and his pupils have provided very accurate information upon the
relation of climate and the evaporation of water from the lungs and skin (Von
Noorden, Volume 1, page 395). " It is least in temperate climates, it is greater
at low temperatures, and is much increased at high temperatures. The next
most important point is the relative humidity of the atmosphere. Air very
nearly saturated with moisture can take up only a little more water-vapour,
hence the body loses less water in damp than in dry air ". Generally speaking the
quantity of urine varies inversely with the amount of perspiration. The surplus
left by the skin is excreted by the kidneys.
With regard to the amount of urine passed by the Bengali and its low
specific gravity—the small quantity stands close relationship to the small
amount of total solids it contains and to the almost wholly vegetable character
of the food—poor in nitrogen—upon which they live.
In the second part of this paper we shall return to this point, when the
results of investigations on urine containing a much higher percentage of solids
will be given.
3. Urea .—By far the greatest proportion of the nitrogen of metabolism is
excreted by the kidneys in the form of urea. Von Noorden gives the percent-
age as being from 84—87 ; with animal diet the relative value is higher than
with a mixed or a purely vegetable diet. " Not only the nitrogen of proteid is
excreted in the form of urea, but the proteid decomposition products, glycocoll,
leucin, and tyrosin, also give rise to an increase in urea corresponding to their
contained nitrogen. This is also the case with asparaginic acid and ammonium
salts. The nitrogen of nucleinic acid is also in part at least excreted as ure(1) ".
The urea derived from all these different sources that is excreted by
Europeans is generally accepted to be about 30—35 grammes per day or equal
to about a 2 per cent. solution. It is the most important of the nitrogenous
excretions of the body, being the chief end-product of the physiological oxida-
tion of the proteids of the food.
(1) Von Noorder.—The Physiology of Metabolism, 1907.
7
Since, however, some of the nitrogen of proteids is eliminated in forms other
than urea—as uric acid, xanthin, creatinin, etc.—even an exact determination.
of the urea is insufficient to provide an accurate measure of proteid katabolism.
We shall, therefore, for the present rest content with fixing the standard of
urea from the analyses shown in Table I and discuss the significance of the
results under the heading of the tota nitrogen.
The smallest amounts of urea excreted occurred in the cases of one durwan
.and of two domes; these were 5.56 grammes and 7.58 and 7.59 grammes
respectively for an average of five consecutive days' analyses. The maximum
quantities for similar periods were 19.68 in a durwan and 18.17 grammes in
(the average of) a student.
The average excretion of urea on the whole series of 200 observations
works out to—students 12.95 grammes ; durwans 12.97, and for domes and
mehtars 12.91 grammes in the 24 hours. (In the case of the last class the
averages hide the real facts ; their output of urea varied very much from day to
day depending on their success or otherwise in obtaining a plentiful supply of
cheap proteid food.)
A comparison of these standards of urea elimination with those for
Europeans shows a very marked difference—the amount of urea excreted by
the Bengali being less than half that usually accepted as the normal excretion
of the European.
This important observation at once opened up the question of the bearing of the
metabolism of the Bengali on recent researches(1) on the problems of nutrition.(2)
Here we had ready-made the very conditions Chittenden had to plan and arrange
in order to carry out his brilliant series of investigations ; and that, too, in a whole
community of millions of people accustomed to these conditions from early life.
From a clinical point of view also, a knowledge of this low standard of urea
excretion is a matter of practical importance in conditions requiring quanti-
tative analyses of the urine.
4. The total Nitrogen. (Kjeldhal's method of estimation was adopted in
every instance.)
In all problems concerning proteid metabolism in the body both as regards
its character and extent the quantitative study of the nitrogenous excretion is of
paramount importance.
By the determination of the total nitrogen excreted in the urine we have a
measure of the total nitrogenous katabolism without regard to the specific
forms in which the waste products are eliminated. The nitrogen excreted in the
(1) Chittenden—Physiological Economy in Nutrition, 1905.
The Nutr tion of Man, 1907.
(2) Leathes—Problems in Animal Metabolism, 1906.